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C an a case of the flu be diagnosed over Skype? Is it possible to learn the re-sults of your computed tomography

scan after midnight? Can a young mother receive care where a trained pediatrician can’t visit? The answer to all of these ques-tions is yes. With the latest revolution in information technology and the availability of advanced computer systems worldwide, telemedicine has made all of this possible.

In the past few decades, hospitals have become smarter, safer, and more sophisti-cated, which has accentuated health care costs and generated a rural-urban health care divide. Telemedicine has stepped in as an instrument to bridge the gaps and pro-vides the ability to exchange medical in-formation, such as patient health records, using telecommunication technology, including video calls, smartphones, and wireless tools [1]. The use of telemedicine offers huge potential in disease diagno-sis, consultation, monitoring, treatment,

education, and management; thus, it makes the emergent intelligent health care infrastructure universal and more ac-cessible to the common masses (Figure 1).

As most economies steer in the direc-tion of unsustainable health care costs, telemedicine offers significant promise as an efficient health care delivery and management tool. Limited access to ad-equate medical care, especially in remote settings, the growing pressure of aging patient populations, increasing life ex-pectancies, the increasing prevalence of chronic conditions, and the shortage of medical professionals continue to burden health care systems worldwide.

There is growing evidence to support the cost-effectiveness of implementing telehealth technologies. For example, a research article published by the Center for Information Technology Leadership in November 2007 observed that the savings

Making Health Care Universally Accessible The emergence of telemedicine as a core necessity

Niharika Midha and Subhamoy Mandal

Digital Object Identifier 10.1109/MPUL.2014.2355316

Date of publication: 14 November 2014

FIGURE 1 A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have been relentless and still continue today. The years after 1976 are the period of maturation and rapid growth of telehealth technologies.

First Exposition onTelehealth Care

1924Photophone

1880

TransatlanticWireless

Transmission1901

ElectricTelegraph

1844

1840 1900 1940

Digital (Binary)Transmission

1949

Telephone1875

Television1884

(First Patent)

First ECGTransmission

1906

The Internet

ISRO (India)Telemedicine Project

2001

First InternetTransmission

1969

TCP/IPGoes Global

1989

1980

2000196019201880

Telerobotic RemoteSurgery Service

2003

NASA (U.S.) ATS-6Satellite

1974

6 ieee pulse ▼ NOVEMBER/DECEMBER 2014

generated by eliminating the transfer of patients between emergency departments could fund the installation of hybrid tele-health technologies across all emergency departments in the United States. The au-thors reported that 2.2 million patients are transported each year between emer-gency departments at a cost of US$1.39 billion and that telehealth technologies can avoid 850,000 transports at a cost savings of US$537 million annually [2]. Recent re-ports from HealthCursor Consulting Group observe that remote health care and E-health can give hospitals an easy return on investment with a lucra-tive profit margin in a short period of time. Health care operators such as Apollo and Fortis in India are lured by the pan-India reach, and lower operating costs have escalated their entry into the vast untapped domain of telemedicine.

Moreover, newer and smarter health devices have provided an impetus to the industry’s growth. Heart and blood pres-sure monitors can now wirelessly trans-mit the patient’s data to mobile phones or to a central online database accessed by telemedicine centers [3]. This has encour-aged more academic research on point-of-care devices [4], and more companies are coming out with devices with mobile health care capabilities [5].

The consumer demand (see “Indus-try Outlook”) for high-quality health

care has also played a fundamental role in the overall acceptance, as well as in-tegration, of these technologies. In ad-dition, patient satisfaction has gained vital importance in this expanding era of personalized medicine. Some studies suggest that telemedicine has been able to achieve high levels of patient satisfac-tion as it allows for easy and rapid ac-cess to health care. A study by Gustke et al. concluded that 98.3% of patients (n = 495) were satisfied with interactive

telemedicine clinical con-sultations [6].

According to Global-Data’s estimates, the tele-health and telemedicine market will increase at a compound annual growth rate of 14% to be worth an estimated US$32.5 bil-lion by 2018. Telehealth pilot programs and regu-latory and standardiza-tion initiatives to attract

investment by private organizations have been adopted by governments in several regions of the world. One sector where telemedicine has been accepted rapidly is disease diagnosis. For example, teleradiol-ogy has witnessed considerable growth in recent years.

Teleradiology encompasses medical im-aging information systems that improve the ease of capturing, storing, and exchang-ing medical images between providers, including remotely located medical prac-titioners and patients, through integrated

electronic health records. Picture archiving and management systems equipped with clinical decision support systems enable the efficient management of remote di-agnosis and faster clinical management. Teleradiology is gradually being adopted throughout the world to meet the growing gap between the demand for and supply of trained radiologists. Furthermore, it has also opened avenues for making specialists available around the clock. For example, if an emergency occurs at a time when Eu-ropean radiologists are not available, their counterparts in Asia can evaluate the pa-tient to provide immediate assistance.

However, as with most new technolo-gies, data security and privacy concerns have been raised and are key impedi-ments to the adoption of telehealth so-lutions and services. Inadequate data security and transmission could lead to inaccurate diagnosis and erroneous prog-nosis. These issues negatively impact the overall utilization of telemedicine. In ad-dition, the penetration of telemedicine solutions and services in the emerging markets is currently limited by the sparse availability of broadband technologies. As most of these developing countries have a significantly larger rural population, the low penetration levels and the asso-ciated higher up-front costs substantially limit the deployment of telehealth mod-els. Thus, we can conservatively opine that, while the information technology-enabled approach to health care can

industry Outlook Modern computing, communications, medical devices, and health informatics technologies, when integrated in a holistic manner to create telemedicine and e-health services with skill development and business model, have the potential to solve the health care delivery problems that the large population of the world faces. Today, teleradiology can be considered as an established telemedicine model where technology, cost, quality, convenience, and information safety aspects have been addressed. Simultaneously, there is a range of areas where telemedicine practices are being newly applied. Some of these areas include, but are not limited to, ophthalmology, surgery, dentistry, dermatology, pathology, and public health. The success of public–private partnership programs offering telescreening services to rural and semiurban premature infants, viz., Karnataka Internet Assisted Diagnosis of Retinopathy of Pre-maturity (KIDROP) in India, stands testimony to the emergent trend. In this government-funded program, the health care industry provides medical

expertise and helps in skills development, whereas technology companies provide the customized communications, storage, and computing services along with innovative features that improve diagnostic value of the information being communicated [7].

Another novel application of the telemedicine solutions has been found in continuing medical education (CME). CME that is vital for professional development is also a mandatory requirement for extending license practice in many countries. CME helps those in the medical field to maintain competency and learn about new and developing areas of their field. Currently, a significant portion of CME activities takes place as live events such as conferences, publications, and e-learning or online CME, which is a convenient, cost-effective alternative with the potential to reach a wider audience, and is expected to seize the majority market share in the near future [8].

(Input from: Hrushikesh Garud, Texas Instruments, India.)

Teleradiology is gradually being

adopted throughout the world to meet the growing gap between

the demand for and supply of trained

radiologists.

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NOVEMBER/DECEMBER 2014 ▼ ieee pulse 47

The closer our relationships, the more we favor those individuals; the farther apart we are, the more we recognize the differ-ences. We treat diversities as excuses to direct our positive attitudes elsewhere, especially if we consider dissimilar indi-viduals as competing for limited finan-cial, physical, or emotional resources.

One troubling form of discrimination is racism. Racism exists in many forms and many places; it is especially noted whenever different races come in close contact with each other. Fortunately, I have observed over the course of my lifetime that racism in the United States has diminished somewhat, although no one dares to say that racism is even close to being eradicated in our country. Hav-ing lived through the time of the civil rights marches 50 years ago, listened to and taken to heart the words of Martin Luther King, Jr., and admired the cour-age and resolution of Rosa Parks, I am very happy with this trend. And it seems that the acceptance of other races is being led by the younger generations, who seem to be much more tolerant than their parents.

Discrimination may be a natural con-sequence of our genomes, but discrimina-tion does not have to turn into racism. To keep that from happening, we should become more familiar with the other people so that the differences become less important compared to the similari-ties we discover. If we no longer consider relationships as competitive, then we can act in a more generous and tolerant way. Engineering success, which should be based on merit and cooperation, can become a model of the way that we wish society in general to behave. In this case, we can exercise another deeply ingrained biological attribute—that of fairness and altruism—also embedded in our genomes [2], [11]. That should make it easier to move beyond the extremes of discrimina-tion originating with our genes.

References[1] J. Ackerman, “Dragonflies strange love,”

Nat. Geogr., vol. 209, no. 4, pp. 105–119,

Apr. 2006.

[2] S. F. Brosnan and F. B. DeWaal, “Mon-

keys reject unequal pay,” Nature, vol. 425,

no. 6955, pp. 297–299, Sept. 2003.

[3] R. Dawkins, The Selfish Gene, 2nd ed. Cam-

bridge, U.K.: Oxford Univ. Press, 1989.

[4] B. W. Domingue, J. Fletcher, D. Conley,

and J. D. Boardman, “Genetic and edu-

cational assortive mating among U.S.

adults,” PNAS, vol. 111, no. 22, pp. 7996–

8000, 2014.

[5] B. Ganetsky, “Tracking down a cheat-

ing gene,” Amer. Sci., vol. 88, no. 2, pp.

128–135, Mar.–Apr. 2000.

[6] W. D. Hamilton, “The genetical evolu-

tion of behaviour,” J. Theor. Biol., vol. 7,

no. 1, pp. 1–16, July 1964.

[7] W. D. Hamilton, “The genetical evo-

lution of behaviour II,” J. Theor. Biol.,

vol. 7, no. 1, pp. 17–52, July 1964.

[8] A. T. Johnson, Biology for Engineers.

Boca Raton, FL: CRC Press, 2011.

[9] A. T. Johnson, “The fallacy of genetic

selection,” IEEE Pulse, vol. 5, no. 2,

p. 66, Mar.–Apr. 2014.

[10] J. Purdy, “Love is the answer,” UGA Res.

Mag., vol. 34, no. 1, pp. 32–43, summer

2005.

[11] F. Range, L. Horn, Z. Viranyi, and L. Hu-

ber, “The absence of reward induces in-

equity aversion in dogs,” PNAS, vol. 106,

no. 2, pp. 340–345, Jan. 2009.

virtually extend the services of the tertiary hospital to urban homes and remote rural health care centers, there is a sea of chal-lenges—both technical and human factor related—that needs to be surmounted before we develop a truly intelligent sys-tem that connects the teeming millions across geographical boundaries.

Niharika Midha received her M.Sc. degree in biomedical engineering with a focus on medical physics from Imperial College London. She is a medical devices analyst based in GlobalData’s Singapore office. Before joining GlobalData, she was a health care journalist for BioPharm Insight, which is part of the Financial Times Group, and a research assistant at Imperial College London. Subhamoy Mandal is cur-rently a DAAD Ph.D. scholar with the Institute of Biological and Medical Imaging at the Tech-nical University of München and Helmholtz Zentrum München. He was the recipient of the IEEE Education Society Student Leadership Award in 2013 and the IEEE Computer Society Richard E. Merwin Scholarship in 2014.

References[1] National Leadership and Innovation

Agency for Healthcare. (2014, Aug. 14).

FAQs. Telemedicine/telehealth. [Online].

Available: http://www.wales.nhs.uk/

technologymls

[2] P. Eric, C. Cusack, J. Hook, A. Vincent, D.

C. Kaelber, D. W. Bates, and B. Middleton,

“The value of provider-to-provider tele-

health,” Telemed. e-Health, vol. 14, no. 5,

pp. 446–453, 2008.

[3] D. Lalmalsawma. (2014, June 4). Tele-

medicine in India might be just what the

doctor ordered. India Insights. [Online].

Available: http://blogs.reuters.com/india/

2014/06/04/telemedicine-in-india-might-

be-just-what-the-doctor-ordered/

[4] S. Mandal, K. Basak, K. M. Mandana, A. K.

Ray, J. Chatterjee, and M. Mahadevappa,

“Development of cardiac prescreening device

for rural population using ultralow-power

embedded system,” IEEE Trans. Biomed. Eng.,

vol. 58, no. 3, pp. 745–749, Mar. 2011.

[5] H. Garud, A. K. Ray, S. Mandal, D. Sheet,

M. Mahadevappa, and J. Chatterjee,

“Volume visualization approach for

depth-of-field extension in digital pathol-

ogy,” in Proc. 2011 4th Int. Congr. Image and

Signal Processing (CISP), Oct. 15–17, 2011,

vol. 1, pp. 335–339.

[6] S. S. Gustke, D. C. Balch, V. L. West, and

L. O. Rogers. “Patient satisfaction with

telemedicine,” Telemed. J., vol. 6, no. 1 pp.

5–13, 2000.

[7] A. Vinekar, C. Gilbert, M. Dogra, M. Ku-

rian, G. Shainesh, B.Shetty, et al., “The

KIDROP model of combining strategies

for providing retinopathy of prematurity

screening in underserved areas in India

using wide-field imaging, tele-medicine,

non-physician graders and smart phone

reporting,” Indian J. Ophthalmol., vol. 62,

pp. 41–49, 2014.

[8] J. M. Harris, B. M. Sklar, R. W. Amend,

and C. Novalis-Marine, “The growth,

characteristics, and future of online

CME,” J. Contin. Educ. Health Prof., vol. 30,

pp. 3–10, 2010.

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