This document discusses telemedicine, including its history, types, technologies used, and applications in clinical research. It began with definitions of telemedicine and telehealth. Historically, NASA and the National Library of Medicine played important roles in early telemedicine development to provide health care to remote areas. Common telemedicine types are store-and-forward, remote monitoring, and interactive videoconferencing. Emerging technologies discussed that are useful for clinical research include robotic process automation, artificial intelligence, augmented/virtual reality, the internet of things, nanotechnology, and 3D printing. The document also reviews current telemedicine efforts and utilities in India as well as ongoing challenges.

1. Telemedicine in clinical research
Iswarya t
BDS INTERN
iswaryathemadath@gmail.com

2. contents
1. Definition
2. History
3. Infrastructure
4. Types
5. Telecommunication technologies
6. Common technologies in use
7. Telemedicine in India
8. Current efforts
9. Utility
10. Challenges

3. Telemedicine:
The delivery of health care services, where distance is a critical factor,
by all health care 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 continuing education of health care providers , all in
the interests of advancing the health of individuals and their
communities.
Telehealth:
It is the use of electronic information and telecommunication
technologies to support long distance clinical health care , patient and
professional health related education and training , public health and
health administration.

4. HISTORY:
- The national aeronotics and space administration played an important part important
part in the early development of telemedicine.
- Its goals were to provide health care to astronauts and space .
- In 1971,26 sites in Alaska were chosen by the national library of medicines lister hill
National centre for biomedical communication to see if reliable communication would
improve village health care.
- It used ATS –1 ,the first in NASA’s series of applied technology satellites launched in
1966.

5. Telemedicine consultation centre(TCC):
It is the site where the patient is present.
In a TCC , equipment for scanning / converting , transformation and
communicating the patients medical information can be available .
Telemedicine speciality centre (TSC):
It is a site where the specialist is present .
He can interact with the patient present in the remote site and
view his reports and monitor his progress.
Telemedicine system:
It consists of an interface between hardware , software and a communication
channel to eventually bridge two geographical locations to exchange
information and enable teleconsultancy between two locations.

7. TYPES :
Store and forward:
involves acquiring medical data and then transmitting this data to a
doctor or a medical specialist at a convenient time for assessment.
Remote monitoring:
Also known as self monitoring or testing , enables medical
professionals to monitor a patient remotely using various
technological devices.
Interactive telemedicine:
Provides real time interaction between patient and provider , to
include phone conversation and online communication .

8. TELECOMMUNICATION TECHNOLOGIES:
Integrated services digital network:
ISDN is a dial up digital connection to the telecommunication
carrier.
It is a circuit switched telephone network system that transmits
both data and voice over a digital line.
An ISDN line can carry information at nearly five times the
fastest rate achievable using analog modems over POTS.
Today , ISDN has been replaced by broadband internet access
connections like DSL, WAN, and cable modems.
Plain old telephone service:
It is basically an analog voice transmission phone system
implemented over copper twisted pair wires.
POTS transmits data at a rate of up to 56 kilobits per second
and is the most widely available telecommunication technology
in the world.
POTS can be suitable for audio conferencing , store and forward
communication, internet and low bandwidth video conferencing.

9. CURRENT TECHNOLOGIES IN USE:
1. Robotic process automation
2. Artificial intelligence
3. Augmented and virtual reality
4. Iot
5. Nanotechnology
6. 3D printing

10. Robotic process automation:
- Clinical trials requires extensive data handling work.
- Automation provides a solution by cutting costs, speeding up research , reducing errors.
- RPA is a digital tool that operates computer systems through their user interfaces: spreadsheets,
legacy platforms, cloud based apps, web portals.
- These mirrors the human control of digital applications thus called bots.
- RPA IN CLINICALTRIALS:
- 1. patient recruitment
- 2. participant onboarding
- 3. test data collection and organization
- 4. follow up visits with patient participants
- 5. streamlining data analysis

11. ARTIFICIALINTELLIGENCE
Artificial intelligence : how systems emulate the human mind to make decisions and learn.
Artificial intelligence robotics :robots controlled by AI programmes.
AI reduces clinical trial cycle times while improving the costs of productivity and outcomes of clinical development.
AI algorithms combined with an effective digital infrastructure , could enable the continuous stream of CT data to be
cleaned, aggregated , coded, stored , and managed.
In addition , improved electronics data capture(EDC) reduces the impact of human error in data collection and facilitate
seamless integration with other databases.

12. AUGMENTED REALITY:
It is an interactive experience of a real world environment wherethe objects
that reside in the real world are enhanced by computer generated
perceptual information sometimes across multiple sensory modalities.
VIRTUAL REALITY:
It is a simulated 3D environment that enables users to explore and interact
with a virtual surroundingin a way that approximates reality as it is
perceived through users senses

13. APPLICATIONS:
1.Drug discovery:
VR allows chemists to move beyond the screen and step into
human scale 3D models of small molecules.
The ability to view a shape from an unlimited number of
angles can be particularly useful in understanding why it does
not bind with a target.
2. Patient adherence:
VR can be used to combat non adherence by clinical trial
subjects by providing complex medical information in highly
memorable , intuitive ways.
Eg. HIV patients were significantly more adherent after
viewing a 7 minute interactive VR experience explaining how
antiretroviral therapy improved immune cells ability to
respond to viral progeny.
3.To understand the pathologies:
Creating 3D representation of complex data sets that can
then be observed in detail.
Scientists could later use this projection to observe the organ
in detail.

14. IoT INTERNET OF THINGS :
Describes system of interrelated computing devices , mechanical or digital machines ,objects
with sensors , processing ability , software , and other technologies that connect and exchange
data with other devices and systems over the internet or other communication networks.
APPLICATIONS:
1.Remote patient monitoring
2.Glucose monitoring
3.Smart inhalers
4.Ingestible sensors
5.Connected contact lenses
6. Depression and mood monitoring

15. Remote patient monitoring: It can automatically collect health metrics like heart rate , blood pressure,
temperature and more from patients who are not physically present in a health care facility.
The device then forwards the data to a software application where healthcare professionals can view it.
A smart inhaler : is an inhaler that integrates connectivity with a mobile app,
Bluetooth , for instance.
These devices are built with sensor technology that helps record data about the
time and date of use, and the location of the patient at each use.

16. Ingestible electronic systems: that are capable of embedded sensing, particularly within the GIT and its accessory organs,
have the potential to screen for diseases that are difficult if not possible to detect at an early stage using other means.
1. Reduce labour and facility cost
2. Promote research for discovering bio marker targets for associated pathologies.
3. Provide a foundation for epithelialy targeted therapeutic interventions.
Connected contact lenses: can act as medical devices, health
trackers or gauges, and audio and video recorders.
It can transmit the data by interscatter communication

17. NANOTECHNOLOGY:
It refers to the branch of science and engineering devoted to designing, producing , and using
structures, devices , and systems by manipulating atoms and molecules at nanoscale.
Enables researchers to investigate and monitor cellular and molecular function and to alter
systems that are deregulated in disease.
APPLICATIONS
1. In drugs and medicines – eg. Gold nanoshells
2. In surgery – a. minute surgical instruments and robots
b. nanocameras
3. Medical robotics
4. Drug delivery
5. Photodynamic therapy

18. In drugs and medicines: Nanotechnology can deliver drugs into specific parts of human body, thereby making them more
effective and less harmful to the other parts of the body.
Gold nanoshells are useful to fight cancer because of their ability to absorb radiation at certain wavelengths . Once the
nanoshells enter tumour cells and radiation is applied they absorb energy and heat up enough to kill the cancer cells.

19. 3D PRINTING :
The action or process of making a physical object from a 3D digital model , typically by laying
down many thin layers of a material in succession.
APPLICATIONS:
1. Bioprinting
2. Personalised / precision medicine
3. Streamlined and more efficient R and D process
4. Diagnosis and medical training
5. Aging population and rise of chronic disease
6. Removing the need for animal testing

20. Bio printing :
Bioprinters uses computer guided pipette to layer living cells referredto as bio ink on top of another to create artificial living
tissues in a laboratory.
These tissue constructs or organoids can be used for medical research as they mimic organs on a miniature scale.
Personalised / precison medicine:
provides developmentof medicine at both pharmacy and industrial scale .
Can print pills with complex structures to control the release rate, accurate the dosage , precisely control the distribution to
cells

21. streamlined and efficient R and D processes:
researchers can fully print functional organs made of human cells to test a drugs efficacy prior to using in
vivo animals or human tests.
expedites the entire R and D process
Diagnosis and medical training:
3D printing gives insights into pathological changes as well as a visualisation of patient specific
organ anatomy.
Removing need for animal testing :
Animals are bred for testing and euthanised once the experiment has concluded.
3D bioprinting offers potential to create functional, living, 3D tissues resulting in more predictive
results for drug candidates.

22. TELEMEDICINE IN INDIA:
- At present in India total primary medical care in rural areas is not available.
- Secondary and tertiary medical care is not uniformly available even in suburban
and urban areas.
- In contrast to bleak scenario in healthcare, computer literacy is developing
quickly in India.
- It is far easier to set up an excellent telecommunication infrastructure than to
place a health specialist at several locations
- WHO recommends a doctor population ratio of 1: 1000 while the current doctor
population ratio in India is only 0.62:1000.
- This deficit is partly being made up by the active telemedicine services .
- On march 25 2020 the government of India granted permission to the practise of
telemedicine in India by any registered medical practitioner by issuing certain
guidelines to follow.
- These developments were mainly because of COVID – 19 scenarios.

23. CURRENT EFFORTS:
In India telemedicine programmes are actively supported by:
1. Department of information technology
2. Indian space research organisation
3. NEC telemedicine program for north eastern states
4. Apollo hospitals
5. Asia heart foundation
6. State government

24. Utility of telemedicine :
1. Easy access to remote areas .
2. Reduce the time and cost of patient transportation .
3. Monitoring home care and ambulatory monitoring
4. Mitigate uneven distribution and improve physician shortage .
5. Provide alternative avenues to seek highly specialized care .
6. Improves patient management and adherence to it ( follow up
appointments )
7. Tool for public awareness and disaster management

25. Challenges :
1. Perspective of medical practitioners
2. Patients fear and unfamiliarity
3. Financial unavailability
4. Literacy rate and diversity in languages
5. Lack of basic amenities
6. Technical constraints
7. Government support
8. Low band width
9. Satellite transmission is pricey
10. Quality aspect

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