Pawan..Telemedicine and E-health
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Transcript of Pawan..Telemedicine and E-health
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TELEMEDICINE AND E-HEALTH
Enabling Specialty Healthcare to the
Rural and Remote Population of India
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Use of information and communication technologies:
i) To provide specialized health care consultation to patients in
remote locations,
ii) To facilitate video-conferencing among health care experts for
better treatment & care,
iii) To provide opportunities for continuing education of healthcare personnel.
Objectives of Telemedicine
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Relevance of Telemedicine
Inadequate infrastructure in rural/district hospitals
Large number of indoor/outdoor patients requiring referral for
specialized care
Low-availability of Health Experts in district/remote hospitals
Dearth of adequate opportunities for training or continuing
Medical Education for Doctors in Rural/Remote Health facilities.
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Telemedicine : The Model
Patient under treatment
Physician treating the patient
A remote telemedicine console having
audio visual and data conferencing
facilitiesNodal Hospital
Referral Hospital
An expert / specialised doctor
A central telemedicine server having
audio visual and data conferencing
facility
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NEED OF TELEMEDICINE
Indiasbooming population,currently 1.1 billion and
growing at 2% annual rate.
infrastructure: woefully
inadequate to meet theincreasing healthcare
Demands.
Although nearly 75% of
Indians live in rural villages.Most of the 620 million
rural Indians lack access to
basic health care facilities
it impossible to retaindoctors in villages .
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Can Telemedicine Bridge the Divide?
Telemedicine may turn out to be the cheapest, as well as the
fastest, way to bridge the ruralurban health divide. Taking
into account India's huge strides in the field of information and
communication technology, telemedicine could help to bring
specialized healthcare to the remotest corners of the country
The efficacy of telemedicine has already been shown through
the network established by the Indian Space Research
Organization (ISRO), which has connected 22 super-specialtyhospitals with 78 rural and remote hospitals across the country
through its geo-stationary satellites
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Technology of Telemedicine
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Technology of Telemedicine
Telemedicine is a confluence of Communication Technology,Information Technology, Biomedical Engineering and MedicalScience.
The Telemedicine system consists of customised hardware and
software at both the Patient and Specialist doctor ends with some ofthe Diagnostic Equipments like ECG, X-ray and pathologyMicroscope/Camera provided at the patient end.
They are connected through a Very Small Aperture Terminal
(VSAT) system and controlled by the Network Hub Station
Through a Telemedicine system consisting of simple computer withcommunication systems, the medical images and other information
pertaining to the patients can be sent to the specialist doctors
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Technology of Telemedicine
Either in advance or on a real time basis through the satellite
link in the form of Digital Data Packets.
These packets are received at the specialist centre, the images
and other information is reconstructed.
so that the specialist doctor can study the data and suggest the
appropriate treatment during a Video Conference with the
patient end.
In this way, the systematic application of Information and
Communication Technologies to the practice of healthcare
rapidly expands the outreach of the healthcare system
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Sequence of Tele-consultation (I)
PATIENT IN
Patient visits OPD
Local Doctor checks up
Patient receives treatment
and is not referred to
telemedicine system
Patient referred to the Telemedicine system (some
special investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator enters patient record, data and images of
test results, appointment date is fixed for online
telemedicine session
OUT
OUT
Offline Data
transfer
from Nodal
Centre
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Patient 1
Patient 2
Patient 3
Patient 4.
.
.
Online video conference & tele-
consultation for patients between
local doctors at the nodal hospital and
specialist doctors at the referralhospital
Patient queue
IN OUT
Sequence of Tele-consultation (II)
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Telemedicine Technology Evolution in
India
Point to point
Point to multipoint
Multipoint to multipoint
Tele-education
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Telemedicine Technology Evolution
Point to Point System - One patient end connect to One
Specialist Doctor within the hospital.
Point to Multi Point System - One patient end at a time
connect to any of the specialist Doctors end within the
hospital.
Multi Point to Multi Point System - Several patients end
simultaneously connect to different Doctors end at different
hospitals at different geographical locations
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Major areas of Telemedicine Technology
Adopted
Tele-consultation, Tele-diagnosis, Tele-treatment-The patient
with the local doctor consults the specialist, obtains the line of
treatment.
Tele-education, Tele-training- For Continuing Medical
Education, Training for doctors & paramedics from a higher
level Hospital/Institution.
Tele-monitoring- Regular monitoring for intensive care &
emergency care.
Tele-support- Support during disaster management.
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Different types of services
Telecardiology
Teleradiology
Telepathology
Telepsychiatry
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Telecardiology
Electrocardiography (ECG or EKG) is the recording of the
electrical activity of the heart.
ECG or electrocardiograph can be transmitted using telephone
and wireless.
This system enabled wireless transmission of ECG from the
moving ICU van or the patients home to the central station in
ICU of the department of Medicine.
The ECG output was connected to the telephone input using a
modulator which converted ECG into high frequency sound.
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ECG CIRCUIT
Instrumentation
Amplifier
1. Get differential signal
2. High input impedance3. High CMRR
A further stage in this
is to use band pass
filter
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TELERADIOLOGY
Teleradiology is the ability to send radiographic images (x-rays) from one location to another.
For this process to be implemented, three essential componentsare required, an image sending station, a transmission network,
and a receiving / image review station. The most typical implementation are two computers connected
via Internet.
The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared forclinical purposes.
Sometimes the receiving computer will have a printer so thatimages can be printed for convenience.
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Telepathology
Tele-pathology is the practice of pathology at a distance i.e. the
electronic transmission of pathological images using
information and communication technology
The minimum equipment required for tele-pathology purposes
are:
1. A light microscope.
2. A high resolution camera either digital or analog with a
frame grabber card.
3. PC work station.
4. Access to telecommunication network, either by modem or
digitized data transfer card.
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TYPES OF TELEMEDICINE
Real time
(Synchronous)
Store-and-Forward(Asynchronous)
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Real time Telemedicine
Real time telemedicine could be as simple as a telephone callor as complex as robotic surgery.
It requires the presence of both parties at the same time and a
communications link between them.
The advantage of real- time telemedicine is that decisions may
be made immediately at the time of the session
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Store-and-forward Telemedicine
Involves acquiring medical data and then transmitting at a
convenient time for assessment offline.
Digital image may be send via email direct to the specialist,
e.g. Teleradiology.
It does not require the presence of both parties at the same
time.
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Telemedicine Infrastructure
Hardware
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Skype
Skype is free video-call software which can be downloaded
and installed on a computer.
Skype has over 600 million users world-wide.
To use Skype, it is necessary for each party conducting video
communication to have downloaded the software and to have
created a Skype account.
Skype sound and imagery quality will be very high on a good
connection using good equipment.
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Getting the best quality service
Make sure your internet speed is as high as possible (minimum 512Kbps - 1 Mbps upload speed). If possible install a separate
broadband connection preferably ADSL2.
Avoid Skype for long consultations: there is a significant risk ofSkype dropping out at least once over an hour or more
If there is a loss of transmission and you donthave an alternativesoftware program ready, use the telephone to maintain the audio linkuntil the video link is resumed.
If it is likely that video calls will be used regularly for critical orurgent clinical consultations it is advisable not to rely on Skype.Instead use more reliable video conferencing software for yourTelehealth work. A list is available on the
ACRRM Technology Directory.
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Security Risks of Video Sessions
Skype is encrypted during transmission; the risk of a
transmission being intercepted is low if there is a direct
connection between the two users
Skypes file-transfer function does not integrate with any
antivirus products, although Skype claims to have tested its
product against antivirus Shieldproducts.
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Application of Telemedicine
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Benefits of Telemedicine (I)
Benefits to Patients:
Access to specialized health care services to under-served rural,
semi-urban and remote areas,
Access to expertise of Medical Specialists to a larger population
without physical referral,
Reduced visits to specialty hospitals for long term follow-up care
for the aged and terminally ill patients.
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Benefits to Physicians:
Improved diagnosis and better treatment management
Access to computerized, comprehensive data (text, voice,
images etc.) of patients offline as well as real time
Quick and timely follow-up of patients discharged after
palliative care
Continuing education or training through video
conferencing periodically
Benefits of Telemedicine (II)
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Advantages
Reduce travelling.
Saves time for the patient.
Can get specialist advice when not available locally.
Results of tests and images readily.
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Disadvantages
Lack of telecommunication access in rural areas.
Not so effective when compared to personal discussion
between a doctor and a patient. Cost is very high.
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References
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