Telemedicine

(simplified)
Dr RK Pathni AIIMS

15 April 2012

Dept. of Hospital Administration, AIIMS

15 April 2012

Dept. of Hospital Administration, AIIMS

What is Telemedicine?

The delivery of healthcare services, where distance is a critical

factor, by all healthcare professionals using information and

communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.
WHO(2002)

15 April 2012

Dept. of Hospital Administration, AIIMS

What is Telemedicine?

Patient and doctor are located in different places Patients can be examined, treated and monitored

Patients data (text, voice, images or even video) can be sent from a remote location and medical advice offered from a speciality Centre.

15 April 2012

Dept. of Hospital Administration, AIIMS

Calling Names

Virtual Outreach Hospitals Without Walls Reaching The Unreached Bridging the Urban-Rural divide

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine

Emergency Medical Care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility and

provision of adequate care at the facility.

WHO (2002)

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine

Emergency Medical Care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility and

provision of adequate care at the facility.

WHO (2002)

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine

Golden Hour

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine

Telemedicine ensures delivery of

right medical advice

at the right place at the right time

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine

Non availability of facilities locally
Non availability of appropriate skills / technology locally Travel

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for Telemedicine In India

Huge population (above 1 billion) with inequitable distribution of resources 70% of Indias population lives in rural areas whereas 75% of qualified consultants practice in urban centres Vast land area with difficult / inaccessible terrain Seasonal isolation of some tracts of land e.g. due to floods, snow, etc

15 April 2012

Dept. of Hospital Administration, AIIMS

AIIMS : IN-PATIENTS (2004-05)

From Delhi From outside

15 April 2012

Dept. of Hospital Administration, AIIMS

Advantages of TM
Makes expertise available - anywhere
Early institution of appropriate treatment

need for transfers

Effective utilization of transports Saves costs to patient , provider, system

15 April 2012

Dept. of Hospital Administration, AIIMS

TYPES
On the Basis of Time frame

Store & forward

Real-time

15 April 2012

Dept. of Hospital Administration, AIIMS

Applications

Tm can be utilized in all Clinical applications medical, surgical, diagnostic Emergency care Military medicine Disaster management Homecare, Rehabilitation

TELE-EDUCATION

15 April 2012

Dept. of Hospital Administration, AIIMS

Types
Tele-Radiology

Tele-Cardiology
Tele-Pathology Tele-Ophthalmology

Tele-Dermatology
Tele-Psychiatry Tele-Surgery Tele..Anything

15 April 2012

Dept. of Hospital Administration, AIIMS

Features of Telemedicine

Teleconsultation Telediagnosis Teletreatment Telemonitoring Telepresence

15 April 2012

Dept. of Hospital Administration, AIIMS

Entities involved in Telemedicine

Telemedicine Platform. Telemedicine Software. Clinical Devices.

Communication Media.

15 April 2012

Dept. of Hospital Administration, AIIMS

15 April 2012

Dept. of Hospital Administration, AIIMS

Telemedicine Platform

Desktop PC Laptop Palmtop / PDA (System in a Suitcase)

Clinical Devices Videoconferencing Equipment

15 April 2012

Dept. of Hospital Administration, AIIMS

Clinical Devices
Digital ECG Electronic Stethoscope High Resolution Camera Tele-pathology Microscope Trinocular Tube X-Ray Digitizer

FHR, PFT, etc

Digital Camera
Dept. of Hospital Administration, AIIMS

15 April 2012

Contd.

Telemedicine Software

Acquisition, Storage and display, and

Transmission of patient related information

15 April 2012

Dept. of Hospital Administration, AIIMS

Application Software Architecture Acquires images and data from the medical equipment User Interface Image Acquisition System Backplane Patient Records Secure, transfers data, allocates bandwidth Communications Protocols

interacts with the system

stores and retrieves patient data

unites the Service Areas Processing performs specialized image manipulation

15 April 2012

Dept. of Hospital Administration, AIIMS

Telemedicine Software

Capturing of images / document from scanner.

Capturing of video / other data from the output of

the medical eqpmt. and conversion to DICOM.

Conversion of DICOM to Non-DICOM format

15 April 2012

Dept. of Hospital Administration, AIIMS

Media of Connectivity
Terrestrial Connectivity

PSTN / POTS ISDN VSAT LAN / WAN

Mobile Connectivity

GSM (Global System of Mobile Communication) GPRS (General Packet Radio Services) 3G Cell phone with serial / USB Interface to connect PC CDMA
Dept. of Hospital Administration, AIIMS

15 April 2012

Transmitted Data
Text History, examination, blood reports etc .

Audio (MP3 format ) (heart sounds, murmurs, voice, etc )

Still images (JPEG, TIF, GIF Format) ECG, X-Rays, Ultrasound, CT scan, MRI etc. Video (MPEG2 Format) Operative procedures, Echocardiograms, Angiograms , Teleconsultation

15 April 2012

Dept. of Hospital Administration, AIIMS

Need for speed Latency or delay factor 1 Seconds (VSAT Link )

15 April 2012

Dept. of Hospital Administration, AIIMS

Objectives of TM
Enable the medical experts to take control of a remote medical emergency when required The telemedicine system and sub-system especially at the remote location should be designed for use by non-medical but trained personnel

The remote telemedicine system should be designed for easy portability

The telemedicine solution should be cost effective requiring minimal training, installation and maintenance The telemedicine equipment used should use a optimum bandwidth for data communication

15 April 2012

Dept. of Hospital Administration, AIIMS

A Model for TM
TeleMedicine Specialty Center

TM Consulting Centre

Remote Site

15 April 2012

Dept. of Hospital Administration, AIIMS

15 April 2012

Dept. of Hospital Administration, AIIMS

Mobile TMU

15 April 2012

Dept. of Hospital Administration, AIIMS

Mobile TM Unit

Diagnostic Devices
Communication Media

15 April 2012

Dept. of Hospital Administration, AIIMS

Contd.

System Required at Base Unit

The base unit consist of

Computer with telecommunication facility. Multimedia Software for displaying biosignals and view Digital images.

15 April 2012

Dept. of Hospital Administration, AIIMS

Contd.

15 April 2012

Dept. of Hospital Administration, AIIMS

Tele Consulting Center

15 April 2012

Dept. of Hospital Administration, AIIMS

Usage Scenario

The patient is examined and the data is embedded in an encrypted message and sent to the referring site's server

The specialist opinion

Diagnosis is sent back and if required video conferencing is used

15 April 2012

Dept. of Hospital Administration, AIIMS

Problems
Reliability of connectivity Need for speed- (Bandwidth) Legal issues, Licensing Data Security, Patient confidentiality Learning Curve Resistance to change Standards
15 April 2012 Dept. of Hospital Administration, AIIMS

Reality ?
Technical demonstrations of the future Tele-presence surgery / Tele - Robotic Surgery 1992 experimental demonstrations 1997 Lapcholecystectomy 1998 - Beating heart surgeries

Tele Hypnosis

15 April 2012

Dept. of Hospital Administration, AIIMS

CONCLUSION
TM is for real and real-time TM interventions are practical
Potential to reduce costs and save lives

15 April 2012

Dept. of Hospital Administration, AIIMS

Telemedicine is a concept, a tool. Its use is limited only by

your

imagination.

15 April 2012

Dept. of Hospital Administration, AIIMS

15 April 2012

Dept. of Hospital Administration, AIIMS