Telemedicine, Telemedicine in Nursing, Telesurgery, telenursing, Medical Informatics, Role of Nurse in Telemedicine,

1. WELCOME

2. I.INTRODUCTION

3. TELEMEDICINE
II.DEFINITION
Telemedicine is defined as the use of
telecommunications to deliver health care expert sharing of
medical knowledge with persons at distant locations.
(Computer for Doctors.)
Telemedicine has been defined is general terms
to be medicine practiced at a distance and as such it
encompasses both diagnosis and treatment, as well as
medical education.
(Genomics Journal seek)

4. Medical data such as:-
High resolution Photography
Radiological Images
Sound and patient records.
Electronic signals via the internet
Intranet
Personal Computers (PLS)
Telephone lines.

5. III HISTORY OF TELEMEDICINE:-
University of Nebraska did first documented use of visual
telecommunication in health care in 1959.
Under first international telemedicine program in
December 1986, the site of a massive earth quake in
Armenia was linked to medical centers in united states for
telemedicine Consultations.
The program was extended to Russia to provide
telemedicine consultation to burn victims after a terrible
train accident.
First internet based telemedicine trial was conducted in
April 1955 when a Chinese student zee ling who was
studying in Beijing university fell sick and her condition
could not be diagnosed in china.
Some of her friends. Put all her records in internet. She
was diagnosed to have thallium poisoning through internet
and she was prescribed treatment through internet.

6. 1 Telegraphy and telephony 1920s
2 Wireless/radio 1950s
3 TV 1960s
4 Computers and internet 1990/2000
HISTORY OF TELEMEDICINE

7. IV. TELEMEDICINE APPLICATIONS:-
Emergency Healthcare
Video consulting
Telepathology
Telecardiology
Teledermatology
Teleophthamology
Teleoncology
Telepsychiatry
Teledentistry
Distance hearing
Medical education and the transfer of medical data.
Medical care delivery, diagnosis, Consultation and
treatment at a distance.
Nursing homes or retirement centers
Home monitoring for patients.
Health care in the aftermath of disasters.

8. International Journal of telemedicine and application
publishes two types of issues
 Regular issues and
 Special issues
 Regular Issues :-
 Regular issues publish collections of papers with out
special solicitation.
 Regular papers can be submitted at any time.
 Special Issues:-
 Special issue papers can be submitted only based on
planned schedules and submission guidelines of the
Call for papers.
 Proposals for special issues can be Submitted directly
to the editor-in-chief.

9. SCOPE OF TELEMEDICINE
Telemedicine, not only provides consultation but
Also education, monitoring and more. Telemedicine falls in
four categories
Tele consultation
Tele education
Tele monitoring
Tele Surgery

10. I.TELE CONSULTATION
A Doctor or a paramedic or even a patient himself in
remote area can have a consultation with a specialist.
II. TELE EDUCATION
The use of Telemedicine technologies makes it
muchbetter Doctors can attend clinical meetings at remote
places and also participate and present cases in them. Some
projects such as Health Net Project of Africa uses both
internet and satellite communications for doctors in remote
area.
Tele Consultation, video conferencing on surgery,
online clinical audit and continuing medical education are
just some of the education applications of tele education.

11. (iii) TELE MONITORING
Monitoring is the remote monitoring of patient
data.
The patient’s status can be monitored.
These can be transmitted using telephone lines or
through wireless with the use of appropriate
devices that can transmit these data over phone.
These devices are commercially available and can
be attached to any telephone line.

12. (iv) TELE SURGERY
It actually means tele presence surgery where robotic
arms carry put the surgeons instructions.
It ensures tremor – free surgery. Tele surgery, where a
surgeon directs surgery in a remote place is still to
come.
(v) BENEFITS OF TELE MEDICINE
Resource utilization
Early intervention
Avoids unnecessary transportation
Community based care
Medical education and Research
Cost saving
Improved patient Documentation
Increased Range of care and education.

13. (A)RESOURCE UTILIZATION
First benefit of telemedicine is proper utilization of resources.
In India doctor population ration is 1:15000 in comparison to
1:500 in developed nations, and these doctors are not
distributed equally.
80% Indian population lives in rural and semi urban areas.
Telemedicine can help in cost effective utilization of meager
resources and of the same time can decrease patient work
load on few referral centers.
(B)EARLY INTERVENTION
One of the most effective means of providing medical
intervention is by early detection and treatment.
(C) AVOIDS UECESSARY TRANSPORTATION
Unnecessary referral and patient transport can be definitely
avoided.
(D) COMMUNITY BASED CARE
Community based care is another big advantage of telemedicine.
People like to receive high quality care in thesis local
community.
This reduces travel time and related stresses associate with many
referrals.

14. (E) MEDICAL EDUCATION AND RESEARCH
Telemedicine is also useful in medical education.
When medical students are posted in rural area they
can be linked to medical college for grand sounds and
they can also do case presentation to teachers in
medical colleges.
In India Indira Gandhi National open university (IG NOU)
Carries out regular monthly sessions of teaching of its
diploma in Maternal and child health Students.
Physicians living in different parts of the world also use
telemedicine in collaborative research, they can also
share data or can discuss current share data or can
discuss current trends.

15. (F) COST SAVING
Technology is becoming increasingly cheaper and the
cost of telemedicine has gone down considerable.
It has been worked out that tele medicine has resulted
in considerable savings more So in tele radiology and in
home care of clinically ill patient.
In India use of telemedications is expected to reduce
the cost considerably with the investment of around
200,000 for telemedicine in a primary health center.
(G)IMPROVED PATIENT DOCUMENTATION
Use of telemedicine ensures that patient data is stored
electronically and digitally.
Previous medical history of patients, X-rays, test,
results and notes are transmitted using standard
protocols.
This ensures better documentation, which is more
accurate and complete.

16. (F) INCREASED RANGE OF CARE AND EDUCATION:-
When health care institutions implement telemedicine
technologies they create a system by which they can
service and needs of the local, regional, national and
international Communities.
(G) WHICH DATA CAN BE TRANSFERRED:-
Basically four types of data are used in telemedicine.
Text-for patient notes, generally having a file of less
than 10 kb.
Audio-electronic Stethoscope, with file size of around
10kb.
Still image x-rays which are still images having a size of
around 1 MB.
Video movie – ultra sound / patient visualization – movie
images have a size of 10 MB or more. The patient can
be seen by a doctor at a remote place using cameras.

17. (H) TELEMEDICINE CONCEPTS
FRAME RATE AND BANDWIDTH
 A Video image has a rate of motion knows as the
frame rate.
 This standard video like the one seen of the television
has a frame rate of 30 frames per second.
 This 30 frames per second rate is required so human
eyes does not perceive any gaps in information.
 In video conferencing there is limitation or restriction on
the amount of information that can be transmitted
through digital lines.
This limitation on amount of information that can be
transmitted is known as bandwidth.
HOW THIS DATA CAN BE TRANSFERRED
 This digital data can be transferred via ordinary
telephone lines (PSTN or Publics service telephone
network)

18. SYSTEM DATA SPEED ADVANTAGES
&DISADVANTAGES
PSTN (Public service telephone
network)
ISDN (Integrated Service
Digital Network) ISDN
Satellite
Wireless
Microwave
Leased lines
ATM (Asynchronous transfer mode)
ADSL (Asynchrono digital subscribes
line)
56 KBps
128 KBps
2 MBps
2 MBPS
<2MBps
<20 MB ps
64KBps-
50MBps
155MBps.
Economical, ubiquitous slow, not
suitable for high resolution.
Cheap, flexible
Fast high quality, expensive,
patchy availability.
High quality, remote access
expensive.
Convenience, free movement, new
technology, limited standards
Good quality, inexpensive to run
line of sight only.
Short distances Reliable.
Highbandwidth, expensive, may
be superseded.
MODALITIES OF DATA TRANSMISSION IN
TELE MEDICINE

19. (J) TELEMEDICINE TECHNOLOGIES
(A) Store and forward technology
(B) Real time telemedicine
(C) Video conferencing
STORE AND FORWARD TECHNOLOGY
In store and forward technology an event is captured as
Single image and stored. Then this single image or series of
images along with voice, text and data are forwarded to a
specialist through e-mail or modem. This store and forward
technology is commonly used in radiology, pathology, and
dermatology. Most common use of store and forward
technology.

20. B. REAL TIME TELEMEDICINE
The telemedicine transaction in process as soon as it
is received. That is, a direct link is established between the
remote patient and the health expert.
This is of great value in emergencies where store and
forward will have little applicability. This requires real time
equipment and telecommunication facility for transmission
of text, images, audio and video images video conferencing
is the technology, which is used mostly for Real-time
telemedicine.
C. VIDEO CONFERENCING
Here there are two locations on one side is patient and
local health provides and on other side is specialist. These
two sides are linked by putting video conferencing
instruments at both locations so a real time consultation take
place between specialist and patient and local health
provides.

21. (K) TELEMEDICINE DEVICES
(A) Video conferencing system
(i) Roll about systems
(ii) Set top system
(iii)Desk top system
(B) Peripheral Devices
(i) Medicals Peripherals
(ii) Non medical peripherals
(A)video Conferencing System
There are various types of video conferencing systems.

22. (i)ROLL ABOUT SYSTEMS
There are self contained mobile units comprising of a
monitor, camera and associated hardware and can go to any
site where it is required.
(ii)SET TOP SYSTEM
There are compact systems that sit on top of
conventional computers and provide the telemedicine
service.
(iii)DESK TOP SYSTEMS
The standard PC is modified using PC cards. This is
the most economical and also provides the latest resolution
Through with currently available graphic and audio cards
even the ordinary PC can be converted to most powerful
Telemedicine device with just the addition of a high-
resolution camera and ISDN access.

23. THE EQUIPMENT REQUIRED FOR VIDEO CONFERENCING
INCLUDES THE FOLLOWING
Digital camera having the zoom and micro
facility to access any part of patient and also the facility of
video recording.
This needs to connected to the computer for
processing the image processing software which can
compress the image and aid in its onward transmission.
PHRIPHERAL DEVICES
These are those pieces of equipment or
hardware that allow for the imaging of events or the
collection of data.
These peripheral devices are divided into to categories.
•Medical Peripherals
•Non medical Peripherals

24. MEDICAL PERIPHERALS
Medical peripherals can be used only for medical
purposes. They either collect medical images such as
those captured by an otoscope (for the ears) Ophthalmo scope
(For the eyes) derma scope (for the sain) or any other wind of
Medical imaging device. Other devices may amplify bodily
sounds.
The most common device is electronioc stethoscope by
which specialist can listen to heart, lung and bowel sounds
while conducting a telemedicine examination over a video
conference system.
Then there are medical peripherals used to collect
Biometric data of patient like pulse, BP etc.,
Images from damaging devices like echocardiogram,
ultra sound, microscope and surgical devices laparoscope,
endoscope etc., also can be transmitted using telemedic x-rays
need to be digitized. Hence the need for digital x-ray
processing machines.

25. 2.NON MEDICAL PERIPHERALS
Many devices and instruments are used in conjunction
with video conferencing to assist in communication of
information and ideas.
Many institutions use inexpensive, commercially
available video cameras as an essential part of their
telemedicine network. Another non-medical Peripheral
is the video tape recorder.
A video can be made of specific patient or procedure
that would not be available at the time a consultation is
scheduled. Scanners to scan x-Rays are also another
such devices.
A video presentation stand, similar in design to an
overhead projector, can be used to collect an image of
document or other object and send it across the video
connection.

26. (XI) LIMITATIONS TO SPREAD OF TELEMEDICINE
(i)Poor patient – Doctor Relationships
(ii)Patient Acceptance
(iii)Fear of Technolog
(iv)Low Rates of utilization
(v)Infrastructure.
(i) POOR PATIENT- DOCTOR RELATIONSHIPS
This is most likely when paramedical staff or patients
Directly use telemedicine to get consultation and there is no
Direct contact. But this can be correctly by making the
Interaction real time and with adequate follow-up with the
Consulting doctor using email telephone etc.,
(ii)PATIENT ACCEPTANCE
Patient acceptance can be improved by
adequately educating the patients and other users about
the aims and benefits of the new technology.

27. (iii)FEAR OF TECHNOLOGY
The technology is new and there will be
apprehensions. Hence, all persons using this will need
to be with the persons operating fill. They are
adequately confident in using the machines.
(iv)LOW RATES OF UTILIZATION
Initially there may be a low rate of utilization and if run
commercially may not be viable. But, with Increasing Use
as with anything new, the user base will pick-up.
(V)INFRASTRUCTURE
Very costly equipment needs to be put in place for
starting telemedicine. That too in places where basic
medical facilities do not exist. This will be the picture in
developing countries. T his is a big hurdle that needs to
be crossed. National policy and government support for
use of telemedicine will need to be formulated. In India
this has not been put in place. Such policies exist in USA,
UK, Malaysia and Australia.

28. (XII) ETHICAL ISSUES IN TELEMEDICINE
The most important ethical issues are:-
The doctor-patient relationship. The
confidentiality of patient Data. The standard of care, the
liability of the physician and physician accreditation.
(XIII)INDIAN SCENARIO OF TELEMEDICINE
Now with the availability of internet connection
in most cities of India interest in telemedicine is increasing
day by day but still major drawback in India is that
communication network is not suitable for most
telemedicine applications.
ISDN lines are not available in most of the
places in India, which is basic requirement for video
conferencing.

29. BARRIERS TO TELEMEDICINE
There are still several barriers to the practice of
telemedicine.
Many countries will not allow but of country
physicians to practice under licensed in the country.
Many rural areas still do not have cable wiring or other
kinds of high band width telecommunication access
required for more sophisticated uses.
Many countries are creating networks which link
education, government, business and health care.