Telemedicine Overview

Historical Perspectives

• Efforts to communicate beyond hearing range have been part of human civilization, including smoke signals, drums, and pigeon carriers.
• Inequality in healthcare availability between higher and lower classes has existed throughout history, with the highest quality care restricted to kings and nobles.
• The use of communication technology to convey health-related information at a distance dates back to Roman times, with examples including "leper bells" and quarantine flags on ships.
• In 1876, Alexander Graham Bell used the telephone to request medical assistance after spilling acid on his hand.
• In 1879, the first description of telephone use for clinical diagnosis was published in a medical journal.
• The concept of telemedicine evolved in 1905, with a Dutch physiologist using the telephone to transmit and monitor cardiac sounds and rhythms.

Development of Telemedicine

• Phases of telemedicine development:
  • Telegraphy and telephony (1840s-1920s)
  • Radio (1920s onwards)
  • Television/space technologies (1950s onwards)
  • Digital technologies (1990s onwards)

Definitions of Telemedicine

• Telemedicine is the provision of clinical care remotely, using clinical processes such as teleconsultation, telediagnosis, etc.
• The prefix "tel" comes from the Greek word for "far" or "at a distance", signifying medicine delivered at a distance.
• Alternative definitions of telemedicine include:
  • The transfer of electronic medical data from one location to another
  • The use of telecommunications to provide medical information and services

Types of Telemedicine

• By device/communication mode:
  • Real-time or synchronous (e.g. video conferencing)
  • Store and forward (S&F) or asynchronous (e.g. recording and transferring information)
  • Telemonitoring or remote monitoring (e.g. medical devices transmitting data to clinicians)
• By partners and direction of information flow:
  • Between patient and provider (e.g. phone calls, emails, messaging services)
  • Between providers of different levels (e.g. primary care to specialist)
  • Between providers of the same level (e.g. tele-education, online CMEs)
  • Home healthcare (e.g. ICT-based monitoring with or without medical personnel)
• By specialty:
  • Telepsychiatry
  • Teleradiology
  • Teledermatology
  • Teleoncology
  • Telecardiology

Rationale for Telemedicine

• Providing access to healthcare in rural areas
• Medical emergencies
• Cost savings (e.g. travel costs, medical equipment)
• Key motivations for telemedicine deployments:
  • Providing access to healthcare in rural areas
  • Medical emergencies
  • Cost reduction

Drivers of Telemedicine

• Technological drivers:
  • Computing and information technology
  • Network and telecommunications infrastructure
  • Technology-led society
• Non-technological drivers:
  • Extension of access to healthcare services
  • Healthcare provision for travelers
  • Military applications
  • Home telecare
  • Cost reduction
  • Market development
  • Health policy and strategy

Scope and Types of Telemedicine

• Teleconsultation:
  • Consultations and diagnoses
  • Emergency consultations
• Tele-education:
  • Medical/health education and training
• Telemonitoring:
  • Remote monitoring
  • Follow-up care
• Telesurgery
• Teletherapy/mental health services:
  • Telemedicine has proven particularly valuable in providing mental health services
  • Allows individuals to access mental healthcare from the comfort and privacy of their own homes### Types of Tele-education
• Clinical education via teleconsultation
• Clinical education via the Internet
• Academic study via the Internet
• Public education via the Internet

Telemonitoring

• Use of telecommunications link to gather patient data
• Acquisition process can be manual or automated
• Data can be submitted in real-time or store-and-forward mode
• Connected devices allow for collection and analysis of patient data
• Examples of data collected include vital signs, glucose levels, and medication adherence

Telesurgery

• Two approaches: telementoring and telepresence surgery
• Telementoring: assistance given to surgeons via video and audio connection
• Telepresence surgery: guides robotic arms to carry out remote surgical procedures
• Allows for complex micro surgeries through the use of robotic arms

Benefits of Telemedicine

• Better access to healthcare
• Access to better healthcare
• Improved communication between caregivers
• Easier and better continuing education
• Better access to information
• Better resource utilization
• Reduced costs

Limitations of Telemedicine

• Poor patient-caregiver relationships
• Poor relationships between healthcare professionals
• Impersonal technology
• Organizational disruption
• Additional training needs
• Difficult protocol development
• Uncertain quality of health information
• Low rates of utilization

Patient Perceptions

• Concerns over privacy and confidentiality
• Fear of technology not displaying medical condition clearly
• Fear of doctors blaming technology for mistakes
• Concerns decrease after repeated experience of telemedicine

Caregivers and Procedures

• Need for process guideline to allay patient concerns
• Guideline includes stages such as explaining purpose, establishing remote link, and reviewing patient's condition

Organizational Disruption

• Fear of increased workload
• Fear of market-driven rather than user-driven approach
• Fear of technological obsolescence
• Lack of skills and need to acquire them
• Lack of agreed standards

Barriers to Progress

• Technical: telecommunications infrastructure and standards
• Economic: cost effectiveness
• Organizational and behavioral: national policy and strategy, ethical and legal aspects