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.