Telemedicine involves using technology to provide medical services from a distance. It includes teleconsultations, teleeducation, mobile medical services, remote patient monitoring, and telesurgery. Screening in various medical fields helps detect diseases early through simple and standardized tests. This allows for preventive measures that can improve health outcomes. Information systems also support doctors by providing medical information and decision support. They help increase the quality of diagnosis and treatment.

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Theme № 3. The basics of information support of the hospital and family doctor
ambulatory.
1. What is telemedicine? Directions of telemedicine.
Definition. Main documents.
-According to WHO (World Health Organization) telemedicine ("remote health care"
comes from Greek "tele" - over a distance, distant) is a method of providing medical
service in the remote areas where distance is a critical factor. Healthcare services are
provided by all the representatives of the medical profession by means of information and
communication technologies of disease treatment and prevention.
Telemedicine areas:
 Telemedical consultation is the exchange of medical information via electronic
communication. The consultations can be of two types: real time consultation and
store-and-forward consultation. Store and forward type is a cheap and simple way of
transmitting medical data via e-mail. Real time (on-line) consultation requires a
communication link and special video-conferencing equipment. Pre-arranged and
urgent video consultations is direct communication between consulting physician and
attending physician sometimes involving the presence of the patient. The
videoconferencing session can take place between two parties and in the multipoint
mode, which means that the most hard cases can be discussed by the concilium from
different medical centers.
 Teleeducation. The delivery of the telemedical lectures, video seminars and
conferences.
 Mobile telemedical sets for working on accident sites.
 Telemedical systems for case monitoring are used for monitoring the patients
who suffer from chronic diseases.
 Telesurgery, distant examination are long-term trends.
2. Practical results of the telemedicine introduction into medical practice.
 Quality improvement of the stationary and outpatient medical care for patients who
are located in any part of the region.
 Consultation assistance for medical workers working at central regional hospitals and
family outpatient clinics situated at any distance from the
 Decrease of the temporary disability time and the number of cases of disabilities
because of the timely accident service aid.
 Reduction in the number of unreasonable hospitalizations and visits to the physician.
 Reduction in the number of the cardiological emergency calls that are 30% of the total
number of calls.
 Reduction in value of qualified medical treatment due to decrease in interurban
travels.

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3. Information support of a family doctor.
The main aim of medical information systems of the basic level is informational
support of a doctor's work. They allow to increase the quality of preventive and
diagnostic work.
There are several types of these systems:
1) Inquiry and communication systems are intended to search and
provide medical information on the user's demand.
2) Consultation and diagnostic systems are used for the diagnosis of the
pathosis including prognosis and recommendations on the ways of
treatment for general diseases.
3) Instrumental and computer systems are used for informational support
and/or automatization of the diagnostic and treatment process at the time
of the direct contact with the patient's body.
4) Automated working places of specialists with the aim of
automatization of the whole technological process for the particular
doctor specialty that provide informational support when making
diagnostic and tactical medical decisions.
4. Control systems of treatment process.
Control systems include automated systems of intensive care, biological
feedback, prosthesis and artificial organs created on the basis of the
microprocessor technology. Precise proportion of the quantity of work and
steady retention of their set value in conditions of the physiological
characteristics variability of the patient's body are of crucial importance when
talking about control systems.
5. Computer-aided systems of medical examination service and their types.
There are three groups:
 computer-aided planning and accounting system of the population medical
examination of an administrative territory;
 computer-aided system of medical examination of the organized groups of
population with wide use of medical equipment connected to a computer that
provides medical reports;
 computer-aided system of complex medical examination of population that uses
the results of standard instrumental examinations and anamnestic interviews
and detection of sickness profile that are based on use of microcomputers and
other types of computers.
6. Computer-aided systems of medical examination service and their aims.
The main aims of these systems are:

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 Data processing automatization of laboratory tests, electrocardiographic
examinations, biochemical, anthropomorphic, photofluorographic and
anamnestic studies;
 presentation of information about each patient based on medical
examination by different physicians;
 making the final diagnosis based on the results of medical and computer-
assisted diagnosis;
 planning, accounting and control of population medical examinations,
detection of their professional suitability, curative measures' planning and
statistical reporting.
7. Medical rehabilitation (MR) computer-aided systems and their requirements.
Computer-aided systems of medical rehabilitation are:
 software that allows to use earlier developed rehabilitation and expert diagnosis
of CAD (coronary artery disease), hypertension, COPD (chronic obstructive
pulmonary disease), diabetes mellitus and others nosology;
 results prediction made by MR;
 choice of medical rehabilitation protocol, evaluation of effectiveness made by
MR.
Requirements are:
1) arrangements must be made at the acuity period or at the early recovery period;
2) strict continuity and succession of rehabilitation measures;
3) complex character of rehabilitation measures with participation of different
specialists and application of different methods of stimulation;
4) constant control of the effectiveness of the measures taken;
5) application at the stage of patients medical examination.
8. Screening (S.) in family medicine. The common principles.
Screening is a process of identifying apparently healthy people who may be at
increased risk of a disease or condition with the aim of reducing risk of an
adverse outcome, or with the aim of giving information about risk. S. is done
by the application of tests, examinations, or other procedures which can be
applied rapidly.
 S. is used with the aim of early disease diagnostics or disease predisposition in
order to control and prevent it timely. The screening results are also used for studying
prevalence of the disease studied, risk factors of its development and their meaning.
Screening allows to define proportion of some particular forms of the coronary heart
disease at population and prevalence of such risk factors as hypertension,
hypercholesterinemia, smoking and alcohol abuse. By estimating some risk factors

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and their combination special tables are created to characterize the degree of risk of
new cases occurrence.
 The main conditions for screening are the presence of qualified personnel and
standard approach to the detection of the signs and evaluation of the results
obtained. The methods applied must be simple, reliable and reproducible. It is
necessary for these methods to be of high sensitivity and specificity.
 The importance of the test is estimated by its sensitivity and specificity. The
sensitivity of the method is the probability that the study result will be positive if the
disease is present. The specificity is the probability that he result will be negative if
the disease isn't present.
 The role of S. is especially important when talking about mass detection when
having standard medical examinations. These are mass preventing gynecological
examination, fluorography and mammography. S. becomes popular with cardiology,
oncology, pharmacology and medical genetics.
 The necessity of mass examination according to standard criteria has made it
possible for automated and semiautomatic screening methods to appear. These are
automated and semiautomatic machines for polling, measurements and analysis of the
factors studied, data processing of the population opinion polls.
 When carrying out screening we should take into account its economical
justifiability. For example when there is a sharp disease decrease mass
population examination can be economically unjustified.
9. Screening in medical genetics
Screening in medical genetics is one of the methods of early detection of genetically
caused metabolism problem.
Public health services of many countries use screening methods for newborn
infant to detect phenylketonuria, hypothyroidism, antitrypsin deficiency,
mucoviscidosis and galactosemia.
If the disease is detected specific treatment can help, avoiding early disability
development and even fatal cases. Phenylketonuria is one of the few disorders
leading to a genetically transmitted metabolic abnormality. If the defect is detected
very early in life mental retardation can be prevented or favourably modifred through a
special diet low in phenylalanine.
For populations with frequent detection of hereditary defects of metabolism
prospective screening is applied, thus making it possible to detect parents who might
produce galactosaemic children. The detection is possible by making prenatal
diagnostics. An example of such application method can be the examination of Afro-
Americans, Puerto Ricans, and Italians for hemoglobinopathy.
There are programs of selective screening for detection of hereditary defects of
metabolism in patients with high risk of these defects accumulation. For example,
programs of selective screening for child care clinics that are aimed to detect hereditary
defects of aminoacid, carbohydrate, lipidic, purine, pyrimidine and other types of
metabolism. Another field of selective screening application can be programs for

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mentally retarded, ophthalmologic and hematologic patients. The selective screening
doesn't bring direct benefit to patients, but contributes to further prevention of
hereditary defects by means of genetic consultation for hereditary tainted parents. With
the help of these programs the range of inborn defects of metabolism common among the
population is detected.
10. Screening in cardiology.
 Screening in cardiology allows to detect ischaemic heart disease and arterial
hypertension and the risk factors of their development.
 Screening examination is held by the personnel qualified to measure arterial
tension, height and weight. They also fill in standard questionnaires (questions are
aimed to detect exertional angina, bad habits - smoking and alcohol abuse).
 Thorough standardization of biochemical measurements (for fats, blood sugar etc)
is also held.
 Depending on the aims the examination is a single-step or a stepped procedure.
Repeated examinations allow to estimate the reliability of the measurements studied
i.e. the level of arterial tension and to specify the diagnosis and also to define the
course of risk factors, case rate and death rate, to work out the system of preventive
measurements realized by public health authorities.

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mentally retarded, ophthalmologic and hematologic patients. The selective screening
doesn't bring direct benefit to patients, but contributes to further prevention of
hereditary defects by means of genetic consultation for hereditary tainted parents. With
the help of these programs the range of inborn defects of metabolism common among the
population is detected.
10. Screening in cardiology.
 Screening in cardiology allows to detect ischaemic heart disease and arterial
hypertension and the risk factors of their development.
 Screening examination is held by the personnel qualified to measure arterial
tension, height and weight. They also fill in standard questionnaires (questions are
aimed to detect exertional angina, bad habits - smoking and alcohol abuse).
 Thorough standardization of biochemical measurements (for fats, blood sugar etc)
is also held.
 Depending on the aims the examination is a single-step or a stepped procedure.
Repeated examinations allow to estimate the reliability of the measurements studied
i.e. the level of arterial tension and to specify the diagnosis and also to define the
course of risk factors, case rate and death rate, to work out the system of preventive
measurements realized by public health authorities.