This document discusses telehealth and telemedicine. It defines telehealth as referring to both clinical and non-clinical services, while telemedicine only refers to clinical services. It then provides an introduction to the growth of telemedicine in India through technological advancements. It discusses the objectives, needs, examples and current state of telemedicine in India, highlighting projects by organizations like ISRO and hospitals to increase access to healthcare in rural areas through telemedicine.

1. Dr. Shweta Gaur
Asst Professor
ICRI, Bangalore Campus

2. TELEHEALTH & TELEMEDICINE
What is the difference between Telehealth and
Telemedicine?
Telehealth can either refer to clinical and/or non-
clinical services.
Telemedicine only refers to the provision of clinical
services.

3. Introduction
The advancement in telecommunication
and satellite communication in the recent
years has experienced many fold
development in India in IT enabled
services, BPOs, Overseas communication,
rural telephony, and also in the field of
medicine.
Telemedicine is the new buzz word
amongst the healthcare administrators
around the world.

4. In the last decade leading hospitals and
healthcare providers in India have used
telemedicine as a medium of
communication between medical fraternity
in seeking opinion for rendering better
patient care services and sharing of
knowledge base to the fellow counterparts.

5. Making healthcare accessible reduces investment in
health thus contributing to overall economic and
social development. India faces various problems in
the provision of medical services and health care,
including
funds,
expertise and
resources.
Telemedicine has the potential to improve both the
quality and the access to health care regardless of the
geography. It enables medical and health care
expertise to be accessed from under served locations.

6. First Wave Second Wave Third Wave
Early 90’s Coming
Timeframe 60’s-70’s
to present decade
Clinical
Emphasis Feasibility Industrialization
Development
Fringe Mainstream
Scope Very limited
populations Care Delivery
Nature Video links + Instrumentation + Informatics
Telemedicine is still young and evolving. Maturing it fully will require vision
and deliberate attention to the technical foundations on which it rests.

7. TELEMEDICINE???
Tele-medicine system consists of customized
medical software integrated with computer
hardware, along with diagnostic instruments
connected to the VSAT (Very Small Aperture
Terminal) at each location.
Generally, the medical record/history of the
patient is sent to the Specialist Doctors, who will
in-turn study and provide diagnosis and treatment
during video-conference with the patient's end.

8. Assessment
Plan
Control
Stimuli
Clinical
Status
Observables Device
Clinical
Data Aide
Patient Doctor
Teleconsultation
Traditional
Assessment
Encounter
Order Plan
Control Status
Stimuli
Patient Doctor
Observables
Station Clinical Station Clinical
Data Data
Automated Patient
Doctor
Assessment Plan
Control
Smart
Status Doctor
Patient Assessment Assessment
Stimuli Station
Station
Observables Doctor
Patient

9. What is telemedicine
It consists of three elements:
 Firstly, it uses the information technology to provide
information for medical decision making.
 Secondly, it changes signals which could be
Bioengineering components.
Thirdly, arrange the practice for medicine at distance.

10. Objectives of Telemedicine
To enhance citizens' equality in the availability of
specialised medical services by bringing these services to
remote primary health care centers.
To promote the proficiency of physicians and other health
care personnel by means of teleconsultation and video
conference based training
To reduce the waiting lists in specialised health care, e.g.
for glaucoma and retinopathy screening and follow-up,
and for initial and follow-up visits in surgery.
To save money!

11. NEED FOR TELEMEDICINE
In India only one-third of households are in urban
areas, with remaining two-thirds in rural areas but
majority of healthcare activities and availability of
healthcare facilities are present in urban areas
Non availability of adequate number of resources and
the challenge to overcome can possibly be done by (
a) Making specialist services available in rural / remote
healthcare settings and
(b) Making critical care accessible to rural / remote
areas.

12. NEED FOR TELEMEDICINE
Tele-medicine helps patients in rural and distant areas to
avail timely consultations of Specialist Doctors without
going through the ordeal of travelling long distances.
The facility enables transmission of patient's medical
records including images, besides providing live two-way
audio and video link.
With the help of these, a Specialist Doctor can advise a
Doctor or a paramedic at the patient's end on the course of
treatment to be followed. He can even guide the Doctor
during a surgery.
In the context of rural and distant areas, the Tele-medicine-
based medical care is also highly cost effective.

13. Examples
Some examples of telemedicine
 teleconsultation,
 telemonitoring,
 telediagnosis,
 teletreatment,
 telecare-provision.
 Store and forward

14. Teleconsultation
Connect professionals to share data and obtain expert
opinion. For example video-consultation

15. Video conferencing
Any videoconferencing terminal must have a
few basic components:
 a camera (to capture local video),
 a video display (to display remote video),
 a microphone (to capture local audio),
 and speakers (to play remote audio).
 optionally a docum

17. Telediagnosis
To perform diagnosis remotely
Patient-to-doctor connection (vs.
doctor to doctor connection in
Teleconsultation
Mobile tele-medical unit can
perform specialist care (central
hospital standard) studies in health
care centres usingmobile
telemedical units.
The results can be sent to super
specialty hospital, thus
permitting telediagnosis.

18. TELEMEDICINE IN INDIA
One of the recent applications of space technology
initiated by ISRO is in the field of Tele-medicine to
provide expert medical services to the rural and remote
areas.
Under the Tele-medicine project, Hospitals/health
centers in remote locations are linked via INSAT
satellites with super specialty Hospitals at major
towns/cities, bringing in connectivity between patients
at remote end with the Specialist Doctors for medical
consultations and treatment.
Tele-medicine pilot projects are undertaken by ISRO
with the involvement of selected super specialty
Hospitals located in major cities and smaller health
centers in distant and rural areas.

19. TELEMEDICINE IN INDIA
Indian Space Research Organisation has done pioneering
work by partnering with leading healthcare providers,
various state governments in making healthcare accessible
in the rural and remote parts of the country.
With the advent of communication technology especially
the Satellite Communication (Sat-Com) combined with
Information Technology, enables benefiting from the
advanced medical sciences to reach even the remote and
inaccessible areas.
Indian Space Research Organisation (ISRO) as a part of
application of space technology for Health care and
education, under GRAMSAT (rural satellite) programme,
has initiated number of Telemedicine pilot projects which
are very specific to the needs of development of the society.

20. TELEMEDICINE IN INDIA
Integrated Telemedicine Tele-health Project is the
first-of-its-kind initiative jointly sponsored by Indian
Space Research Organisation (ISRO), Asia Heart
Foundation in Kolkata and Narayana Hrudayalaya in
Bangalore was initiated in 2001.
With the inception of the program, it has been
implemented in the remote areas of north eastern
states of Tripura, Nagaland and in south Indian state
of Karnataka in its tribal belt.

21. TELEMEDICINE IN INDIA
ISRO’s satellite based Telemedicine network, which
started in 2001 on an experimental basis has linked
remote/rural district hospitals with super-speciality
hospitals in major cities via INSAT. While ISRO
provides the software, hardware and communication
equipment as well as satellite bandwidth, the
speciality hospitals provide the infrastructure,
manpower and maintain the system. ISRO’s
telemedicine network has matured into an
operational system and now covers 165 hospitals – 132
remote/rural/district hospitals/health centres
connected to 33 speciality hospitals located in major
cities.

22. TELEMEDICINE IN INDIA
ISRO’s satellite based Telemedicine network, which
started in 2001 on an experimental basis has linked
remote/rural district hospitals with super-speciality
hospitals in major cities via INSAT.
While ISRO provides the software, hardware and
communication equipment as well as satellite
bandwidth, the speciality hospitals provide the
infrastructure, manpower and maintain the system.
ISRO’s telemedicine network has matured into an
operational system and now covers 165 hospitals – 132
remote/rural/district hospitals/health centres
connected to 33 speciality hospitals located in major
cities.

23. TELEMEDICINE IN INDIA
Apart from ISRO’s telemedicine network association, Asia
Heart Foundation and Narayana Hrudayalaya have
initiated telemedicine activities with the help of high speed
telephone connectivity or Integrated Services Digital
Network (ISDN) connectivity to connect remote Intensive
Care Units to provide critical care to cardiac patients
admitted in government district level or sub-divisional
hospitals in the remote areas of West Bengal, Assam, Bihar,
Jharkhand and tribal belts of Karnataka.
AHF & NH have created a network of 4-5 Intensive Care
Units and 20 telemedicine centres providing 24 hour
support in treating the patients and also rendering
outpatient consultation in all available specialties

24. TELEMEDICINE INSTRUMENTS
Telemedicine enables access to specialists for seeking their
opinion in shorter time with accuracy, efficiency and
precision.
Provide expert advice to remote locations
Link medical professionals by utilizing live video from
a microscope through video conferencing software
Offer instant answers to patients or other clinicians
through live video communication
Display real-time motion video over broadband
networks through existing PC or room-based video
Create easy to use, affordable and scalable solution

25. Mobile Video Cart with
Digital Stethescope
The i8570 MVC is specifically
designed for applications where
a compact, mobile system is
required. The i8750 MVC can
be utilized for many clinical
applications, such as remote
consultations, rural health care
and emergency response, as
well as administrative meetings
and continuing medical
education.

26. StethOne™ Chest Piece Set
The StethOne™ Telephonic
Stethoscope transmits and
receives heart sounds through
high speed broadband
connections or through most
videoconferencing systems for
the ultimate in medical video
conferencing. This patient
transmit package includes; one -
dual noise reduction headset,
one - extended frequency
transmit and receive bases and
one - chest piece.

27. Telemedicine carts are essential in today's
hospital environment.
Full solution medical carts with portable video
conferencing systems enable doctors, nurses,
patients, practitioners and other individuals
involved in medicine to communicate directly.
 Portable Medical carts with wheel base and flat
screen monitors make it easy to transport the
medical video conferencing cart.

28. LIMITATIONS OF TELEMEDICINE
Expensive Telemedicine Software and high tech
gadgets like digital cameras, online microscopes,
medical scanners used in transfer and storage of
medical data like X-Rays, CT Scans & MRIs get
eliminated in centres where there is no facility for a
patient to access and undergo such high-tech
examinations in the first place
Trained manpower

29. Assessment
Plan
Control
Stimuli
Clinical
Status
Observables Device
Clinical
Data Aide
Patient Doctor
Teleconsultation
Traditional
Assessment
Encounter
Order Plan
Control Status
Stimuli
Patient Doctor
Observables
Station Clinical Station Clinical
Data Data
Automated Patient
Doctor
Assessment Plan
Control
Smart
Status Doctor
Patient Assessment Assessment
Stimuli Station
Station
Observables Doctor
Patient

30. Conclusion
Telemedicine offers solutions for emergency medical
assistance, long-distance consultation, administration
and logistics, supervision and quality assurance and
education and training for health care professionals
and providers.
Telemedicine needs to be implemented carefully and
managed well. The impact of telemedicine on health
care structures can be significant. In this respect,
telemedicine can be seen as a tool that is being used
to build up new health care horizon. However, there
are

31. Conclusion
Telemedicine needs to be implemented carefully and
managed well.
The impact of telemedicine on health care structures
can be significant. In this respect, telemedicine can be
seen as a tool that is being used to build up new
health care horizon.
However, there are also concerns about liability,
confidentiality and other policy, regulatory issues and
pricing.

32. Conclusion
The medical establishment is not currently equipped to
address this problem
 A partnership between medicine, engineering, law, business,
economics, social sciences, and other disciplines is required
No entity currently owns the problem
 Not primary, secondary healthcare bodies nor any private
concerns
This work could be “birthed” at the local level and then
“raised” at the national
 Workshops / pilot initiatives would help provide insights
needed to engender a national dialog
If successfully cultivated, healthcare delivery science will
necessarily drive industry

33. Conclusion
Need to adopt sound policies and strategic plans
which can guarantee the provision of high quality,
sustained and integrated health care services to the
population.
Such provisions are required to be developed in order
to make healthcare more accessible to the rural and
remote areas with few entrepreneurs to lead.