Tele-Medicine

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)

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

Need for Telemedicine in India

	Huge population (above 1 billion) with inequitable distribution of resources
	70% of India’s 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

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

Types
On the Basis of Time frame –

	Store & forward
	Real-time

Applications

	TM can be utilized in all Clinical applications - medical, surgical, diagnostic
	Emergency care
	Military medicine
	Disaster management
	Homecare
	Rehabilitation
	TELE-EDUCATION

Types

	Tele-Radiology
	Tele-Cardiology
	Tele-Pathology
	Tele-Ophthalmology
	Tele-Dermatology
	Tele-Psychiatry
	Tele-Surgery
	Tele……..Anything

Features of Telemedicine

	Teleconsultation
	Telediagnosis
	Teletreatment
	Telemonitoring
	Telepresence

Entities involved in Telemedicine

	Telemedicine Platform
	Telemedicine Software
	Clinical Devices.
	Communication Media.

Telemedicine Platform

	Desktop PC
	Laptop
	Palmtop / PDA (System in a Suitcase)+
	Clinical Devices
	Videoconferencing Equipment

Clinical Devices

	Digital ECG
	Electronic Stethoscope
	High Resolution Camera
	Tele-pathology Microscope
	Trinocular Tube
	X-Ray Digitizer
	FHR, PFT, etc
	Digital Camera

Telemedicine Software

	Acquisition,
	Storage and display, and
	Transmission of patient related information

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

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

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

Need for speed

For data transfer 64 kbps onwards is manageable but for video conferencing minimum of 128 kbps is required but optimum speed will be 384 kbps where 25 – 30 frames per second can be achieved.

The would also facilitate to have online view of videos from echo, gastro and other areas can be seen and expert opinion can be given which reduces the burden on patient transfers to the expert locations for diognosis.

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

Mobile TM Unit

	Diagnostic Devices
	Communication Media

System Required at Base Unit
The base unit consist of –

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