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

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

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  • 1. WELCOME
  • 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.