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Telemedicine

Telemedicine. (simplified). Dr RK Pathni AIIMS. What is Telemedicine?.

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Telemedicine

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  1. Telemedicine (simplified) Dr RK Pathni AIIMS Dept. of Hospital Administration, AIIMS

  2. Dept. of Hospital Administration, AIIMS

  3. 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) Dept. of Hospital Administration, AIIMS

  4. What is Telemedicine? • Patient and doctor are located in different places • Patients can be examined, treated and monitored • Patient’s data (text, voice, images or even video) can be sent from a remote location and medical advice offered from a speciality Centre. Dept. of Hospital Administration, AIIMS

  5. Calling Names • Virtual Outreach • Hospitals Without Walls • Reaching The Unreached • Bridging the Urban-Rural divide Dept. of Hospital Administration, AIIMS

  6. 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) Dept. of Hospital Administration, AIIMS

  7. 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) Dept. of Hospital Administration, AIIMS

  8. Need for Telemedicine Golden Hour Dept. of Hospital Administration, AIIMS

  9. Need for Telemedicine Telemedicine ensures delivery of • right medical advice • at the right place • at the right time Dept. of Hospital Administration, AIIMS

  10. Need for Telemedicine • Non availability of facilities locally • Non availability of appropriate skills / technology locally • Travel Dept. of Hospital Administration, AIIMS

  11. 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 Dept. of Hospital Administration, AIIMS

  12. AIIMS : IN-PATIENTS (2004-05) From Delhi From outside Dept. of Hospital Administration, AIIMS

  13. 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 Dept. of Hospital Administration, AIIMS

  14. TYPES • On the Basis of Time frame – • Store & forward • Real-time Dept. of Hospital Administration, AIIMS

  15. Applications • Tm can be utilized in all Clinical applications - medical, surgical, diagnostic • Emergency care • Military medicine • Disaster management • Homecare, • Rehabilitation • TELE-EDUCATION Dept. of Hospital Administration, AIIMS

  16. Types • Tele-Radiology • Tele-Cardiology • Tele-Pathology • Tele-Ophthalmology • Tele-Dermatology • Tele-Psychiatry • Tele-Surgery • Tele……..Anything Dept. of Hospital Administration, AIIMS

  17. Features of Telemedicine • Teleconsultation • Telediagnosis • Teletreatment • Telemonitoring • Telepresence Dept. of Hospital Administration, AIIMS

  18. Entities involved in Telemedicine • Telemedicine Platform. • Telemedicine Software. • Clinical Devices. • Communication Media. Dept. of Hospital Administration, AIIMS

  19. Dept. of Hospital Administration, AIIMS

  20. Telemedicine Platform • Desktop PC • Laptop • Palmtop / PDA (System in a Suitcase) + • Clinical Devices • Videoconferencing Equipment Dept. of Hospital Administration, AIIMS

  21. 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 Contd.

  22. Telemedicine Software • Acquisition, • Storage and display, and • Transmission of patient related information Dept. of Hospital Administration, AIIMS

  23. Application Software Architecture Acquires images and data from the medical equipment interacts with the system User Interface Image Acquisition System Protocols Backplane stores and retrieves patient data unites the Service Areas Patient Records Processing Communications Secure, transfers data, allocates bandwidth performs specialized image manipulation Dept. of Hospital Administration, AIIMS

  24. 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 . Dept. of Hospital Administration, AIIMS

  25. 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

  26. 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 Dept. of Hospital Administration, AIIMS

  27. Need for speed Latency or delay factor 1 ½ Seconds (VSAT Link ) Dept. of Hospital Administration, AIIMS

  28. 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 Dept. of Hospital Administration, AIIMS

  29. A Model for TM TeleMedicine Specialty Center TM Consulting Centre Remote Site Dept. of Hospital Administration, AIIMS

  30. Dept. of Hospital Administration, AIIMS

  31. Mobile TMU Dept. of Hospital Administration, AIIMS

  32. Mobile TM Unit • Diagnostic Devices • Communication Media Dept. of Hospital Administration, AIIMS Contd.

  33. System Required at Base Unit • The base unit consist of – • Computer with telecommunication facility. • Multimedia Software for displaying biosignals and view Digital images. Dept. of Hospital Administration, AIIMS Contd.

  34. Dept. of Hospital Administration, AIIMS

  35. Tele Consulting Center Dept. of Hospital Administration, AIIMS

  36. Usage Scenario The patient is examined and the data is embedded in an encrypted message and sent to the referring site's server Diagnosis is sent back and if required video conferencing is used The specialist opinion Dept. of Hospital Administration, AIIMS

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

  38. Reality ? Technical demonstrations of the future - • Tele-presence surgery / Tele - Robotic Surgery 1992 experimental demonstrations 1997 – Lapcholecystectomy 1998 - Beating heart surgeries • Tele Hypnosis Dept. of Hospital Administration, AIIMS

  39. CONCLUSION • TM is for real and real-time TM interventions are practical • Potential to reduce costs and save lives Dept. of Hospital Administration, AIIMS

  40. Telemedicine is a concept, a tool. Its use is limited only by your imagination. Dept. of Hospital Administration, AIIMS

  41. Thank You Dept. of Hospital Administration, AIIMS

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