Telemedicine

Telemedicine is the delivery of healthcare services, where distance is a critical factor, using information and communication technologies for the exchange of medical information for the diagnosis, treatment, and prevention of disease and injury. Telemedicine utilizes videoconferencing, telephone consultations, electronic communications, as well as other associated technologies to enhance information sharing and improve patient care. The World Health Organization (WHO) has recognized the role of ‘health telematics’ in improving access to medical and health care, health education, global health promotion, training of health personnel and the management of emergency situations.

The Promise of Telemedicine with Respect to Global Health

Telemedicine has become increasingly popular in both industrialized and developing countries. With rapidly rising healthcare costs in the developed world (perhaps most notably in the US), telemedicine offers a variety of potentially cost-efficient solutions to provide services, monitor patients, and deliver treatment. The potential impact of telemedicine, however, is even more significant when considered at a global health level. It has the potential to improve health care by removing time and distance barriers, providing medical education and medical care, and optimizing the use of the limited health services available in under-served communities. Around the world, millions of people in rural (and often urban) areas lack access to medical specialists, such as a radiologist to read an ultrasound or a cardiologist to evaluate a patient with rheumatic heart disease. With the rapid expansion of cellular networks and substantial advancements in smartphone technologies, it is now possible - and affordable - to transmit patient data digitally from remote areas to specialists in urban areas, receive real-time feedback, and capture that consultation in a database. This enables healthcare workers in these areas to break down distance barriers to treatment and provides unprecedented opportunities for underserved populations to receive better healthcare. ^[1]

What Telemedicine Can Do

The main types of services currently being delivered through telemedicine include the following:

• Specialist referrals. Typically, this involves specialists assisting general practitioners in diagnosing a patient. The patient may be “examined” by the specialist over a live online interaction or through the transmission of video, still images, and/or other test results.
• Patient consultations. Telecommunications are used by a patient to provide medical data to his or her doctor, which are in turn used to determine a diagnosis and/or design a treatment plan.
• Remote monitoring of patients. Devices are installed to collect and transmit health-related data from the patient to his or her doctor or hospital.
• Electronic Health Records. Information about patients is held electronically which facilitates the manipulation, sharing, and access of files and data.
• Medical education. Provides access to practitioners to educational resources and often allows them to receive continuing education credits.
• Consumer information. The Internet serves as a resource for patients to access health information and offers a way to communicate with on-line communities about health-related topics. ^[2]

Why Telemedicine is Being Used

Telemedicine can help overcome the health challenges faced in a variety of settings and situations, the major ones being:

• Rural areas. One of the major difficulties in rural health is ensuring that the appropriate medical expertise is available where it is needed when it is needed. It allows patients access to adequate care without the need to travel. Rural healthcare facilities are generally unable to attract, afford and/or retain specialists. Telemedicine offers access to medical expertise without requiring the physical presence of the doctor. It also reduces the isolation of physicians that do operate in rural areas.
• Developing countries. In developing countries, telemedicine can increase access as it allows the centralization of medical resources. Delivery no longer requires expensive infrastructure but can rather be delivered through inexpensive clinics that are communicated to a centralized facility.
• Mobile Health. Telemedicine allows mobile health units access to specialist expertise regardless of their location and the location of the specialist.
• Disaster Relief. Telemedicine allows medical personel to assist a larger number of patients quickly, effectively and with access to centralized expertise and resources.

Some Key Players and Organizations

Driven by aging population, increased medical requirements in remote locations and technology advancements, the world market for telemedicine is projected to exceed $18 billion by the year 2015. Application of telemedicine is expanding virtually across all the medical areas. Telemedicine currently finds application in a majority of medical domains including radiology, cardiology, dermatology, psychiatry, dentistry, pediatrics and pathology, among others.

Some of the key participants in the global telemedicine market include Aerotel Medical Systems Limited, AMD Telemedicine, Apollo PACS Inc., CARD GUARD® Group, CardioNet Inc., Cerner Corporation, Cybernet Systems Corporation, GE Healthcare Ltd., Honeywell HomMed LLC, Invivo Corp., Johns Hopkins Medicine, Mennen Medical Corp., NightHawk Radiology Services LLC, Philips Healthcare, SHL TeleMedicine Ltd., Siemens Healthcare, Polycom, TANDBERG, TeleVital Inc., Templeton Readings LLC, United Therapeutics Corporation, Welch Allyn Protocol, Inc. and WorldCare International Inc., among others.

Examples of Projects in Developing Countries

Roshan (Pakistan)

Roshan, a telecom operator in Afghanistan, is expanding its first-of-its-kind telemedicine solution in Afghanistan beyond Kabul to include provincial hospitals. Bamyan Provincial Hospital will be the first provincial medical facility linked to the innovative telemedicine project, which uses broadband technology, wireless video conferencing and digital image transfer, to provide hospitals in Afghanistan with real-time access to specialist health care diagnosis, treatment and training expertise from abroad.

Roshan has teamed with Cisco, the Government of Afghanistan, The Aga Khan University Hospital, Karachi (AKUH), French Medical Institute for Children (FMIC), Aga Khan Health Services (AKHS), Bamyan Provincial Hospital (BPH) and other technology suppliers to undertake the project. Launched in 2007, the project already links FMIC in Kabul, Afghanistan to AKUH in Karachi, Pakistan, enabling access to a broad array of radiology expertise provided by AKUH.

Telemedicine involves the use of broadband technology that provides real-time high speed access for the transfer of medical imaging, video, data and voice. Applications include the ability to send real-time X-ray, ultrasound and CAT Scans - Computerized Axial Tomography - for evaluation. The technology also enables e-learning and learning through video conferencing. The initial service provided is teleradiology, the electronic transmission of radiological patient images. There are currently an average of 40 teleradiology cases evaluated monthly between FMIC and AKUH and ongoing training provided to medical professionals to build capacity. Telemedicine capabilities will gradually be expanded to other rural regions of Afghanistan, to include the use of smart-phone and PDAs, and to address different services and procedures including evaluation of tissue samples and the on-line performance of medical and surgical procedures. ^[3]

Floating Mobile Clinics (Ecuador)

The concept of boats traveling along rivers in South America to provide medical services to local communities is becoming a reality as boats in the Amazonian region are currently being configured as mobile floating clinics on the Rio Aquarico, Rio Napo and Rio Morona; major tributaries in Ecuador connecting to the Amazon. These boats will have Telehealth links connected to medical experts in Ecuador and anywhere in the world through wireless telecommunication connections, providing exciting opportunities for cultural exchange and knowledge sharing, as well as opportunities for international faculty and student interaction in a variety of disciplines. Formal agreements for these projects have been established between Universidad Tecnologica Equinoccial in Quito other universities, Ministry of Public Health Ecuador, University of New Mexico School of Medicine and the Iberoamerican Science, Technology, and Education Consortium (ISTEC). The Ecuadorian Air Force is donating broad-band satellite connectivity throughout the country, as well as links to international networks. This telehealth network is already establishing links between universities in Ecuador and remote communities in the Ecuadorian jungle, Andes and the Galapagos. ^[4]

HealthNet (Nepal)

HealthNet Nepal is a non-governmental organization (NGO) that serves the Nepalese health community by providing affordable Internet service, access to health information, and technical support for several regional information-sharing initiatives. HealthNet Nepal is housed at the Health Learning Materials Centre (HLMC) of the Institute of Medicine at Tribhuvan University (IOM), and affiliated with the Institutes of Medicine and Engineering. The users of HealthNet Nepal are health workers from several prominent health and medical facilities, university departments, and non-governmental organizations. HealthNet Nepal was established in partnership with SATELLIFE, a non-governmental organization based in Watertown, Massachusetts whose mission is to combat isolation and information poverty among health professionals throughout the developing world.

HealthNet Nepal is responsible for introducing many health organizations throughout Nepal to the power of information and communication technology, particularly electronic mail, as a low cost communication medium and a tool for accessing information from various sources such as MEDLINE, discussion groups, and news groups. ^[5]

The 10 critical steps for a successful telemedicine program ^[6]

• Establish a vision and stay focused
• Build a long term financial plan
• Create a convenient and effective work environment
• Mainstream telemedicine into the standard care process
• Plan and assure effective training
• Have a full time coordinator(s) and an Effective leader and cheerleader
• A project plan = manageable milestones = reasonable expectations
• Decide whether horizontal vs. vertical implementation is ideal in your context
• Develop a strong marketing campaign
• Publish your results and lessons

Challenges and drawbacks

Although telemedicine offers a wide range of potential benefits, there are also several challenges and drawbacks to its implementation. The main ones include:

• High cost, lack of evidence with respect to return on investment, and refusal of reimbursement by third party payers
• Breakdown in the relationship between the health professional and the patient as well as between health professionals
• Concerns about security and privacy
• Issues concerning the quality of the information
• Lack of common standards and classification

References

1. ↑ “Telemedicine Defined”. American Telemedicine Association online. www.americantelemed.org. April 2010.
2. ↑ “Telemedicine Applications”. AMD Global Telemedicine online. www.amdtelemedicine.com/telemedicine-resources/telemedicine-applications.html. April 2010.
3. ↑ “Roshan is expanding Afghanistan's first telemedicine project to Bamyan region”. Virtual Medical Worlds Monthly. www.hoise.com/vmw/09/articles/vmw/LV-VM-07-09-4.html. 1 June 2009.
4. ↑ “International Telehealth - Promoting the Sharing of Knowledge, Understanding, Respect, Skills and Expertise”. University of New Mexico, School of Medicine. hsc.unm.edu/som/telehealth/international.shtml. April 2010.
5. ↑ Healthnet Nepal online. www.healthnet.org.np. April 2010
6. ↑ Vanderwerf, Mark . 2001. AMD Global Telemedicine.

7. Koncept Analytics Publishes New Report Analysis of Telemedicine Market”. Newswire online. www.newswiretoday.com/news/64621. 8 February 2010.