Telemedicine, and check out Telemedicine on Wikipedia, Youtube, Google News, Google Books, and Twitter on Digplanet. Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance. Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. The downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease.[12][13] In the early 1900s, people living in remote areas of Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia. The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. Telemedicine can be broken into three main categories: store-and-forward, remote patient monitoring and (real-time) interactive services. Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices.
Electronic consultations are possible through interactive telemedicine services which provide real-time interactions between patient and provider.[1] Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits.
Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile and Brazil. A recent study identified three major barriers to adoption of telemedicine in emergency and critical care units. Lack of acceptance and reimbursement by government payers and some commercial insurance carriers creating a major financial barrier, which places the investment burden squarely upon the hospital or healthcare system. Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Pharmacy personnel deliver medical prescriptions electronically; remote delivery of pharmaceutical care is an example of telemedicine.
Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist.
Telerehabilitation (or e-rehabilitation[24][25]) is the delivery of rehabilitation services over telecommunication networks and the Internet.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR) [1] supports research and the development of telerehabilitation. Only a few health insurers in the United States, and about half of Medicaid programs,[27] reimburse for telerehabilitation services. Telemedicine can be utilized to improve the efficiency and effectiveness of the delivery of care in a trauma environment. Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries.
Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C.[32] Various specialties are contributing to telemedicine, in varying degrees. One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Ajai Shanker, S. 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. In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology. Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. In April 2012, a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress related conditions called InstantCBT [43] The site supported at launch a variety of video platforms (including Skype, GChat, Yahoo, MSN as well as bespoke) [44] and was aimed at lowering the waiting times for mental health patients. In the United States, the American Telemedicine Association and the Center of Telehealth and eHealth are the most respectable places to go for information about telemedicine. The Health Insurance Portability and Accountability Act (HIPAA), is a United States Federal Law that applies to all modes of electronic information exchange such as video-conferencing mental health services. The SATHI Telemental Health Support project cited above is another example of successful Telemental health support.
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.
Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research.


Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine. Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition.
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is immaterial. Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines, essentially the same as slow scan TV systems. Currently videotelephony is particularly useful to the deaf and speech-impaired who can use them with sign language and also with a video relay service, and well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services.
Health information technology (HIT) provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers. Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.
For developing countries, telemedicine and eHealth can be the only means of healthcare provision in remote areas.
The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan, an Indian Ayurvedic doctor and the Director of Jiva Ayurveda.
The Satellite African eHEalth vaLidation (SAHEL) demonstration project has shown how satellite broadband technology can be used to establish telemedicine in such areas. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another. Some definitions (such as the definition given by the World Health Organization[2]) include all aspects of healthcare including preventive care. For example, a patient suffering from a bacterial infection might be given an antibiotic hypodermic injection in the clinic, and observed for any reaction, before that antibiotic is prescribed in pill form.
A properly structured medical record preferably in electronic form should be a component of this transfer.
This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital.
It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Most types of services fall into two categories: clinical assessment (the patienta€™s functional abilities in his or her environment), and clinical therapy.
As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones and webpages containing rich Internet applications.
Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC.
If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care.
Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians.
Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. Willem Einthoven, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub.
In the United States, Skype, Gchat, Yahoo, and MSN are not permitted to conduct video-conferencing services unless these companies sign a Business Associate Agreement stating that their employees are HIPAA trained.
Therefore, they do not need particular workstations to view the images; a standard Personal Computer (PC) and Digital Subscriber Line (DSL) connection is enough to reach keosys central server. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research.[49][50] Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.


Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system (Chaudhry et al., 2006). Additionally, some patients who feel uncomfortable in a doctors office may do better remotely.
A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech-language pathology, audiology, occupational therapy, and physical therapy.
The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense.[26] Outside the United States, excellent research is conducted in Australia and Europe. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. No particular software is necessary on the PC and the images can be reached from wherever in the world. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement is the selection of microscopic fields-of-view for analysis and diagnosis.
A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems.
Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. This aids in the transition of care for patients from the night shift to the morning shift, but also serves as an educational experience for new residents to the team. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab.[33] See above reference-General health care delivery. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound.
Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi.
Sometimes the receiving computer will have a printer so that images can be printed for convenience.
While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.
Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. A new approach features the team conducting rounds from a conference room using a video-conferencing system.
These 12 remote sites were connected and on average of 1,500 patients being treated per month per hub.
A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.
This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children.
The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patienta€™s bedside.
Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".



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