Telemedicine has changed healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

Telemedicine is delivering healthcare services to the remotest locations with the use of information and communication technologies. It is exchanging medical information amongst physicians and patients in remote locations with the help of technologies like Local Area Networks, ISDN (Integrated Services Digital Network) and VSAT (Very Small Aperture Terminal), Virtual Private Networks.

Telemedicine has changed healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

Telemedicine works over two types of technology concepts

• Real time/two-way interactive technology also called synchronous telemedicine, where an interactive consultation between doctor and patient takes place in real-time using video conferencing equipment. However, other peripheral devices (like electronic stethoscope or tele-otoscope) can also be attached to the entire setup to aid the interactive patient examination. This method has been successfully used in internal medicine, psychiatry, cardiology, pediatrics, obstetrics and gynecology, and neurology, to name a few.
• Store and forward technology also called asynchronous telemedicine, typically involves transfer of medical data (like x-ray images, ECG signals etc.) to a doctor at a different location for diagnosis or consultation offline. This method is commonly used in radiology, pathology and dermatology.

Telemedicine has two business perspectives

• Social perspective – to extend health services in rural and remote areas.
• Commercial perspective to use as a marketing outpost especially for private sector healthcare providers

Trends

Currently, telemedicine is being used for various reasons such as e-consultation for Cardiology, Gynecology, Pediatrics, and other vital parameters, remote monitoring of critically ill patients in homecare or hospital set-ups and e-Education in medical sciences.

Technological Advancements/ trends

The key focus of advanced technologies in telemedicine is to create an easy user interface for the patients at the point-of-care. With the introduction of advanced monitoring devices in the market patient monitoring at a remote location is getting easier at both the physicians’ and patients’ end.

Healthcare providers are setting up wireless networks to enable physicians and nurses to share and access critical patient information over the network without being present at the actual point-of-care, helping in faster information flow leading to quick decision-making and improved patient care.

Telemedicine in India

• Telemedicine started in India in the year 2000 with Apollo’s Aragonda project in Andhra Pradesh.
• There are around 400 telemedicine centers across India and approximately 50 specialty hospitals are linked to these. Apart from this there are around 100 tele-ECG centers supported by various specialty hospitals.
• An estimated 0.15 million patients have been provided online consultation by various Government and private telemedicine centers.
• Around 4000 patients have been thrombolised by telecardiology services.

In the future, telemedicine applications will use ‘unified communications’, which means all disparate communication systems like audio, video, web-access and data would be integrated into one stand-alone monitoring system.

There have been a lot of advancements in patient care in home, hospital and mobile environments as well. For home care services there are home monitoring solutions for patient’s vital parameters. More compact versions of these solutions are the wireless home monitoring devices, which can be used by patients at home, office or while in transit.

There are plenty of new innovative technologies that help fill gaps in the processes  like CPOE (Computerized Physician Order Entry) and e-Prescribing, which makes the process of patient care much easier for physicians and nurses.

A CPOE application substitutes physical medical records with an electronic template where the physicians can issue orders for therapy and procedures electronically, saving time in patient care. These advanced technologies are helping in extending fast and to-the-point healthcare services and also enhancing the productivity and efficiency of healthcare providers.

Growth drivers

The key drivers for Telemedicine projects are:

• Huge rural population – With almost 70 percent of India’s population living in rural areas and 90- 95 percent tertiary health centers located in metros / mini-metros, there is an enormous need for telemedicine projects, to reach out the remotest of areas with healthcare services.
• The Time-lag factor – The time-lag between the occurrence of medical need and delivery of the medical services, makes the requirement of Telemedicine facilities even more imperative.
• Cost Effectiveness With the increasing cost of healthcare services, telemedicine is an effective way for providing cost effective care services by saving on travel and time.
• Technological Innovations new technological innovations are providing easy-to-use devices and applications thus reducing the call-for-expertise to operate and manage these devices.
• Breaking Geographical Boundaries telemedicine set-ups have broken distance barriers and have helped healthcare services to extend outreach to remote locations.
• Knowledge enhancement telemedicine will give opportunity for remote doctors to enhance their clinical knowledge over a period of time by having expert opinion for patients.

Challenges

• Some challenges faced by the telemedicine service providers are:
• Technology integration, that is, successful interfacing of medical equipment and networking
• hardware and software, satellite connections etc.
• Difficulties in achieving the last mile connectivity
• Availability of skilled manpower resources (both medical and non-medical) at remote locations
• Data protection and security issues
• Cost-benefits of the project and of course the adequate patient traffic at the remote centers

Telemedicine and its Uses

Teleconsultation real time consultation with patients in presence of remote doctors for various specialties like pediatrics, gynecology, neurology, cardiology, etc.

• Teleradiology and Telepathology consultation and reports for radiology services and pathology tests conducted at remote locations.
• Telecardiology online consultation, real time ECG transfer
  e-ICU real-time monitoring of remote ICU through multi-parameter monitors
• Tele-Asthma monitoring Pulmonary functions re-motely and providing consultation based on results.
• Tele-Psychiatry providing psychiatric counseling and consultation by experts through video conferencing
• Tele-Dermatology providing diagnosis and consultation based on images of patient’s ailments

• Work done so far
  
  In India, many Government and private hospitals have taken initiatives for implementing telemedicine projects.

  To name a few:

  Indian Space Research Organization pioneer in conceptualizing and implementing telemedicine projects across the country in private and government organizations. ISRO has been providing VSAT connectivity, hardware, software and telemedicine services to various organizations.It has also started setting up Tele-health / Tele-education facilities at Village Resource Centers across India to increase the outreach to more number of rural villages.

  Some major Telemedicine programs are also being run by the following organizations:

  All India Institute of Medical Sciences(New Delhi), Apollo Hospitals (Hyderabad), Aravind Eye Hospital (Madurai), Army Hospitals, Fortis Healthcare (Delhi), KLES Hospital (Belgaum),  L. V. Prasad Eye Institute (Hyderabad), Manipal Health Systems (Bangalore), Max Healthcare (Delhi), Narayana Hrudayalaya (Bangalore), Navy Hospitals, PGI (Chandigarh), Sankara Nethralaya (Chennai), SGPGI (Lucknow), Space Hospitals (Chennai), SRMC (Chennai), Tata Memorial Hospital (Mumbai).

  State Government Telemedicine projects have been implemented by the following states:

  Karnataka, Tamil Nadu, Madhya Pradesh, Chhatisgarh, Rajasthan, Jammu and Kashmir, Pondicherry, Kerala, Gujarat, West Bengal, and the north eastern states, etc. 

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