Telemedicine is a rapidly evolving field that employs electronic communication for clinical care delivery, including consultations and examinations. It encompasses various modalities like interactive and store-and-forward telemedicine, and has applications in remote monitoring and specialty consultations, particularly beneficial for isolated populations. Despite its advantages, such as improved access and cost-effectiveness, challenges include potential system abuse, diminished patient-doctor relationships, and the need for expensive equipment.

1. TELEMEDICINETELEMEDICINE

2.  Rapidly developing application of clinical medicine.Rapidly developing application of clinical medicine.
 TeleTele == ‘far’‘far’ (Greek) and(Greek) and MederiMederi == ‘to heal’‘to heal’ (Latin).(Latin).
 The use ofThe use of communications and ITcommunications and IT for thefor the delivery of clinical caredelivery of clinical care..
phone / internetphone / internet
 Medical info consulting, remote medicalMedical info consulting, remote medical
procedures / examinations.procedures / examinations.
 SimpleSimple (2 health professionals discussing a case over telephone);(2 health professionals discussing a case over telephone);
ComplexComplex (real-time consultation b/n medical specialists in(real-time consultation b/n medical specialists in differentdifferent
countriescountries viavia satellite technology & videoconferencing equipmentsatellite technology & videoconferencing equipment).).
 Also calledAlso called In absentiaIn absentia carecare
• Care at a distance;Care at a distance;
• old practice often conductedold practice often conducted via postvia post..
• in absentia health care hasin absentia health care has evolved into modern telemedicineevolved into modern telemedicine..

3. ‘‘Use ofUse of medical informationmedical information exchangedexchanged
fromfrom one site to anotherone site to another ,, viavia electronicelectronic
communicationcommunication for thefor the health andhealth and
educationeducation of theof the patientpatient and/and/oror healthhealth
care providercare provider , and, and for the purposefor the purpose ofof
improving patient careimproving patient care .’.’

4.  Telemedicine
• Provision ofProvision of clinical services onlyclinical services only..
• Focuses onFocuses on curative aspectscurative aspects..
 Telehealth
• Refers toRefers to clinical and non-clinical servicesclinical and non-clinical services (medical education,(medical education,
administration, and research).administration, and research).
• Expansion of telemedicineExpansion of telemedicine..
• Focuses onFocuses on preventive, promotive and curative aspectspreventive, promotive and curative aspects..
 e-health – Umbrella term (includes telehealth, electronic– Umbrella term (includes telehealth, electronic
medical records, and other components of health IT);medical records, and other components of health IT);
particularly in the UK and Europe.particularly in the UK and Europe.

5.  11stst
interactive Telemedicine systeminteractive Telemedicine system
• OperatedOperated over standard telephone linesover standard telephone lines;;
• For remotely diagnosing and treating patients requiringFor remotely diagnosing and treating patients requiring cardiaccardiac
resuscitationresuscitation (defibrillation);(defibrillation);
• Was developed and marketed byWas developed and marketed by MedPhone CorporationMedPhone Corporation inin 19891989
under the leadership of S. Eric Wachtel.under the leadership of S. Eric Wachtel.
HOW DID TELEMEDICINE DEVELOP SOHOW DID TELEMEDICINE DEVELOP SO
RAPIDLY?????RAPIDLY?????
 1990s – development of medical devices suited to capturing images1990s – development of medical devices suited to capturing images
and other dataand other data inin electronic formelectronic form..
 Development ofDevelopment of high speed communication systemshigh speed communication systems around thearound the
world.world.
CLASSIFICATIONCLASSIFICATION
→→ Store-and-forwardStore-and-forward
→→ Remote monitoringRemote monitoring

6. Store-and-forwardStore-and-forward
 AA properly structured Medical Recordproperly structured Medical Record ((electronicelectronic
formform) is a key component of this transfer.) is a key component of this transfer.
 NO actual physical examination and history takingNO actual physical examination and history taking..
 Clinician relies on aClinician relies on a history report and AV infohistory report and AV info forfor
the physical examination.the physical examination.
MEDICAL DATA
(medical images,
biosignals)
Doctor / Medical specialist
(for offline assessment)

7. Remote monitoringRemote monitoring
 self-monitoring/testingself-monitoring/testing;;
 Enables medical professionals toEnables medical professionals to monitor a patientmonitor a patient
remotelyremotely using varioususing various technological devices.technological devices.
 Primarily used for managingPrimarily used for managing chronic diseases orchronic diseases or
specific conditionsspecific conditions (like heart disease, DM or BA).(like heart disease, DM or BA).
 Can provideCan provide comparable health outcomescomparable health outcomes toto
traditional in-person patient encounters.traditional in-person patient encounters.
 Greater patients satisfaction; cost-effective.Greater patients satisfaction; cost-effective.

8. Interactive telemedicine servicesInteractive telemedicine services
 provideprovide real-time interactionsreal-time interactions between the patientbetween the patient
and providerand provider (includes phone conversations, online(includes phone conversations, online
communication and home visits).communication and home visits).
 History review, P/E, psychiatric evaluations andHistory review, P/E, psychiatric evaluations and
ophthalmology assessmentsophthalmology assessments can be conductedcan be conducted
comparablycomparably to those done in traditional face-to-faceto those done in traditional face-to-face
visits.visits.
 ‘‘Clinician-interactive’ telemedicine servicesClinician-interactive’ telemedicine services may be lessmay be less
costly than in-person clinical visits.costly than in-person clinical visits.

9.  Medical consultationMedical consultation
• specialist reviewsspecialist reviews still images and video-clipsstill images and video-clips (low(low
bandwidth is sufficient).bandwidth is sufficient).
• Real time telephone voice interaction + images +Real time telephone voice interaction + images +
video-clipsvideo-clips (greater bandwidth required).(greater bandwidth required).
• Real-time interactive videoReal-time interactive video is applicable to reviewingis applicable to reviewing
cardiology videos (cardiac catheterizations or ECGs);cardiology videos (cardiac catheterizations or ECGs);
highest bandwidth is required.highest bandwidth is required.
F.Y.I.F.Y.I.
 Bandwidth is used forBandwidth is used for data transmissiondata transmission, and is, and is directlydirectly
related to costrelated to cost..
 Digital data (transferred through ordinary telephoneDigital data (transferred through ordinary telephone
line);line);
 Telemedicine (better bandwidth needed).Telemedicine (better bandwidth needed).

10. TELEMEDICINE INTERACTIONSTELEMEDICINE INTERACTIONS
 SimplestSimplest ::
• optical disk system at hospital transmits images, text andoptical disk system at hospital transmits images, text and
other data to a physician’s home. (physician requires littleother data to a physician’s home. (physician requires little
bandwidth and specialized equipment).bandwidth and specialized equipment).
 LecturesLectures ::
 medical student education course given from hospitalmedical student education course given from hospital
location to students in another region.location to students in another region.
 One-way videoOne-way video [students can only view the lecture].[students can only view the lecture].
2-way video2-way video [students can also take part].[students can also take part].
 Instructor can transmit sound , video, text and images toInstructor can transmit sound , video, text and images to
multiple classrooms.multiple classrooms.
 Minimum bandwidth required (moderate to high).Minimum bandwidth required (moderate to high).

11. Modalities of data transmission in telemedicineModalities of data transmission in telemedicine
SystemSystem Data speedData speed Adv./ Disadv.Adv./ Disadv.
Public telephone networkPublic telephone network
ISDN (Integrated service digitalISDN (Integrated service digital
network)network)
ISDNISDN
SatelliteSatellite
WirelessWireless
MicrowaveMicrowave
Leased linesLeased lines
ATM (asynchronous transferATM (asynchronous transfer
mode) ormode) or
ADSL (asynchronous digitalADSL (asynchronous digital
56 Kb/s56 Kb/s
128 Kb/s128 Kb/s
2 Mb/s2 Mb/s
2 Mb/s2 Mb/s
< 2 Mb/s< 2 Mb/s
< 20 Mb/s< 20 Mb/s
64 Kb/s64 Kb/s
155 Mb/s155 Mb/s
Economical, easily available, slow.Economical, easily available, slow.
Cheap, flexible, slow.Cheap, flexible, slow.
Fast, high quality, expansive, patchyFast, high quality, expansive, patchy
availability.availability.
High quality, remote access,High quality, remote access,
expensive.expensive.
Convenient, free movement, newConvenient, free movement, new
technology.technology.
Good quality, inexpensive, to runGood quality, inexpensive, to run
line of sight only.line of sight only.
ReliableReliable
High bandwidth, expensive.High bandwidth, expensive.

12. BENEFITS & USESBENEFITS & USES
 Most beneficial for populations living inMost beneficial for populations living in isolated communities andisolated communities and
remote regions.remote regions.
 Currently being appliedCurrently being applied in virtually all medical domainsin virtually all medical domains..
[Teleradiology, telecardiology, etc].[Teleradiology, telecardiology, etc].
 Useful as a communication tool b/n aUseful as a communication tool b/n a general practitioner and ageneral practitioner and a
specialistspecialist available at a remote location.available at a remote location.
 Monitoring a patient at homeMonitoring a patient at home (using devices like B.P. monitors) and(using devices like B.P. monitors) and
transferring the information to a caregivertransferring the information to a caregiver is a fast growing emergingis a fast growing emerging
service.service.
 Primary Remote Diagnostic VisitsPrimary Remote Diagnostic Visits
• In developing countries;In developing countries;
• A doctor uses devices to remotely examine and treat a patient.A doctor uses devices to remotely examine and treat a patient.
• holds big promises to solving major health care delivery problems.holds big promises to solving major health care delivery problems.

13. TELECARDIOLOGYTELECARDIOLOGY
 ECG is transmitted via telephone and wireless.ECG is transmitted via telephone and wireless.
 Barr (1958)Barr (1958) – transmitted ECG tracings to about 40,000 feet.– transmitted ECG tracings to about 40,000 feet.
 Teletransmission of ECG using indigenous methodsTeletransmission of ECG using indigenous methods
• Dr. Ajai Shanker et al (GR Medical college; Gwalior 1975 –Dr. Ajai Shanker et al (GR Medical college; Gwalior 1975 –
first time in India.first time in India.
 It enabledIt enabled wireless transmission of ECG from the moving ICU van orwireless transmission of ECG from the moving ICU van or
the patients home to the central station in ICU of the department ofthe patients home to the central station in ICU of the department of
Medicine.Medicine.
 Transmission was doneTransmission was done through telephone linesthrough telephone lines usingusing frequencyfrequency
modulationmodulation (using a(using a modulator whichmodulator which converted ECG into highconverted ECG into high
frequency soundfrequency sound)) which alsowhich also eliminated noise.eliminated noise.
 ECG outputECG output waswas connected to the telephone inputconnected to the telephone input (which contained a(which contained a
DemodulatorDemodulator ).).
 DemodulatorDemodulator reconverted the sound waves into ECG with goodreconverted the sound waves into ECG with good
accuracy.accuracy.
 ECG was converted to sound waves with a frequency varying fromECG was converted to sound waves with a frequency varying from 500500
Hz to 2500 HzHz to 2500 Hz (500 Hz at baseline).(500 Hz at baseline).

14. TELERADIOLOGYTELERADIOLOGY
 Ability to sendAbility to send radiographic images (x-rays) from one location toradiographic images (x-rays) from one location to
another.another.
 3 essential components3 essential components ::
Image sending stationImage sending station
Transmission networkTransmission network
ReceivingReceiving // image review stationimage review station
 Most typicalMost typical :: 2 computers are connected via Internet2 computers are connected via Internet..
 Computer at receiving end requiresComputer at receiving end requires high-quality display screen and ahigh-quality display screen and a
printerprinter..
 ProcessProcess ::
• begins at the image sending station (radiographic image and modembegins at the image sending station (radiographic image and modem
or other connection required).or other connection required).
• scanned imagescanned image is sent (via the network connection) to the receivingis sent (via the network connection) to the receiving
computer.computer.

15. ON TO THE NEXTON TO THE NEXT
LECTURE !!!LECTURE !!!

16. TELEMEDICINE – IITELEMEDICINE – II

17. 1.1. Real time telemedicine (synchronous)Real time telemedicine (synchronous)
 Requires …Requires …
• thethe presence of both partiespresence of both parties at the same timeat the same time
• communications link b/n themcommunications link b/n them (that allows a(that allows a real-time interactionreal-time interaction toto
take place).take place).
• Video-conferencing equipmentVideo-conferencing equipment (aids in interactive examinations like(aids in interactive examinations like
tele-otoscope, tele-stethoscope).tele-otoscope, tele-stethoscope).
• Peripheral devicesPeripheral devices (can be attached to computers).(can be attached to computers).
TelenursingTelenursing
 EquipmentsEquipments:: low resolution videophone, electronic stethoscopelow resolution videophone, electronic stethoscope andand
digital BP monitordigital BP monitor

18. 2.2. Store-and-forward telemedicine (asynchronous)Store-and-forward telemedicine (asynchronous)
 AcquiringAcquiring medical datamedical data (eg: medical images).(eg: medical images).
 Transmitting this data to a doctor or medical specialist at a convenient timeTransmitting this data to a doctor or medical specialist at a convenient time
for assessmentfor assessment..
 AA properly structured Medical Record ( electronic form)properly structured Medical Record ( electronic form) is vital.is vital.
Electronic referralsElectronic referrals
 Referrals dealt by electronic messages (Referrals dealt by electronic messages (e-mailse-mails).).
 Much cheaperMuch cheaper method than the conventional method.method than the conventional method.
 A study has shown that the direct costs of a visit to an outpatient clinic inA study has shown that the direct costs of a visit to an outpatient clinic in
internal medicine wereinternal medicine were seven times greaterseven times greater per patient than those of anper patient than those of an
electronic consultation.electronic consultation.

19. TeleconsultationTeleconsultation
 A general practitionerA general practitioner retains a patient in primary careretains a patient in primary care andand
manages the problem bymanages the problem by teleconsulting a specialistteleconsulting a specialist..
 UsefulUseful when a conventional referral to a hospital/tertiary centrewhen a conventional referral to a hospital/tertiary centre
involves much travel on the part of the patient or doctorsinvolves much travel on the part of the patient or doctors
concernedconcerned..
 Enable patients as well as doctorsEnable patients as well as doctors in rural areasin rural areas to getto get adviceadvice
from specialists (often in urban areas).from specialists (often in urban areas).
 The computer allows real time videoconferencing.The computer allows real time videoconferencing.

20. ADVANTAGESADVANTAGES
1.1. For the consumerFor the consumer
 ImprovedImproved access to healthcareaccess to healthcare andand reduced number of unnecessary visitsreduced number of unnecessary visits toto
physician's offices.physician's offices.
 Enhanced delivery & quality of home careEnhanced delivery & quality of home care..
 ProvidesProvides patient educationpatient education on early symptoms management.on early symptoms management.
 Provides potential forProvides potential for early interventionearly intervention..
2.2. For the Health Care providersFor the Health Care providers
 Reduced number of visits.Reduced number of visits.
 Avoids unnecessary costly visitsAvoids unnecessary costly visits by specialists.by specialists.
 Provides aProvides a potential for early intervention.potential for early intervention.
 Prevention of repeat hospitalizationPrevention of repeat hospitalization..

21. Other benefits
Improved patient documentation
Use of telemedicine ensures that patient data is stored electronically.
Medical history of patients, X-rays, test results can be transmitted using
standard protocol. Ensures better documentation –more accurate and
complete.
Increased range of care & education
Implementation of telemedicine creates a system that can service the
needs of local, regional, national and international communities. These
provides access to new patient population, research and collaboration.

22. DISADVANTAGESDISADVANTAGES
 Unrestricted use may lead toUnrestricted use may lead to abuse of the systemabuse of the system where personswhere persons
without the proper qualifications or training may offerwithout the proper qualifications or training may offer unsolicitedunsolicited
opinionopinion (can be harmful to patients and possibly lead to increased(can be harmful to patients and possibly lead to increased
costs).costs).
 Poor patient-doctor relationshipsPoor patient-doctor relationships . No direct contact between. No direct contact between
doctor and patient. Interaction can be improved by real-timedoctor and patient. Interaction can be improved by real-time
interaction.interaction.
 Cultural and other barriersCultural and other barriers which may lead towhich may lead to misunderstandingsmisunderstandings
between the patient and the physician.between the patient and the physician.
 Lack of local expertsLack of local experts involvement.involvement.
 Need forNeed for expensive equipmentsexpensive equipments ..
 The information on the virtual world has some risks of being ‘The information on the virtual world has some risks of being ‘stolenstolen
easily’easily’..

23. TelehealthTelehealth
inin
MalaysiaMalaysia

24. THE NEED FOR A TRANSFORMATION….THE NEED FOR A TRANSFORMATION….
 A changing pattern of diseases fromA changing pattern of diseases from infectiousinfectious
diseases to lifestyle diseases.diseases to lifestyle diseases.
 Rural to urban migrationRural to urban migration
 Increased life expectancyIncreased life expectancy
 Increased expectations of consumersIncreased expectations of consumers
 Rising healthcare costsRising healthcare costs..

25. Telehealth Flagship ApplicationTelehealth Flagship Application
Consists of four sub-applicationsConsists of four sub-applications::
 Lifetime Health Plan (Lifetime Health Plan (LHPLHP))
 Mass customised and personalisedMass customised and personalised
health information and educationhealth information and education
((MCPHIEMCPHIE))
 Continuing medical education (Continuing medical education (CMECME))
 Teleconsultation (Teleconsultation (TCTC))

26. Integrated TelehealthIntegrated Telehealth
 An individual requiring health services could log into theAn individual requiring health services could log into the
consumer health (consumer health (MCPHIEMCPHIE) portal & find) portal & find information oninformation on
maintenance of health, prevention of diseases &maintenance of health, prevention of diseases &
diagnosis & treatment of symptoms or diseases.diagnosis & treatment of symptoms or diseases.
 AA directory of health care facilitiesdirectory of health care facilities permitspermits selection of aselection of a
suitable facility for caresuitable facility for care and the requesting of anand the requesting of an
appointment.appointment.

27. Integrated Telehealth (contd.)Integrated Telehealth (contd.)
 The MCPHIE portal also providesThe MCPHIE portal also provides health risk assessmentshealth risk assessments
which are eitherwhich are either life stage-basedlife stage-based oror condition-specificcondition-specific..
Completing the relevant life stage-based health riskCompleting the relevant life stage-based health risk
assessment would generate aassessment would generate a customised Lifetime Healthcustomised Lifetime Health
PlanPlan. At periodic health visits to a doctor, this health plan. At periodic health visits to a doctor, this health plan
would be personalised and validated.would be personalised and validated.
 The MCPHIE portal is therefore theThe MCPHIE portal is therefore the consumer’s access toconsumer’s access to
his/her own Lifetime Health Planhis/her own Lifetime Health Plan..
 Alerts, reminders and customised health informationAlerts, reminders and customised health information can becan be
channeled to the individual through this portal.channeled to the individual through this portal.

28. ELEMENTS OF MCPHIEELEMENTS OF MCPHIE
Mass Customised Personalised Health Information EducationMass Customised Personalised Health Information Education
Virtual Community
Tools/Facilities
Virtual
Resources
Directory of
Products/Services
& Facilities
Quizzes
Risk Assessment
Special Interest
Generate profiles
Health Related
- general
awareness
Detailed disease
description
- modularized to
enable relevant
part/s to be
extracted based
on
individual risk
assessment
outcome
(personalised)
• Chat
• Discussion List
• Electronic newsletter

29. Integrated Telehealth (contd.)Integrated Telehealth (contd.)
 An individual with a need for health services could presentAn individual with a need for health services could present
himself at a health facility (himself at a health facility (primary health centre/hospitalprimary health centre/hospital))
where the episode of care would be documented using anwhere the episode of care would be documented using an
electronic clinical support systemelectronic clinical support system (minimal or comprehensive(minimal or comprehensive
depending on the facility) and stored in the facility’sdepending on the facility) and stored in the facility’s ElectronicElectronic
Medical Record system.Medical Record system.

30.  A summary of the episode would be stored in anA summary of the episode would be stored in an electronicelectronic
Lifetime Health RecordLifetime Health Record which can bewhich can be retrievedretrieved during aduring a
future health visit atfuture health visit at the samethe same or aor a different health facilitydifferent health facility..
Based on the findings of the health visit, the doctor wouldBased on the findings of the health visit, the doctor would
modify the Lifetime Health Planmodify the Lifetime Health Plan or create one where noneor create one where none
exists.exists.
Integrated Telehealth (contd.)Integrated Telehealth (contd.)

31. Integrated Telehealth (contd.)Integrated Telehealth (contd.)
 If the healthcare provider is in need of information at the pointIf the healthcare provider is in need of information at the point
of care he could log into theof care he could log into the Continuing Medical EducationContinuing Medical Education
(CME) portal(CME) portal and have access to over 50and have access to over 50 CPGsCPGs from thefrom the
Academy of Medicine Malaysia,Academy of Medicine Malaysia, 58 full text journals58 full text journals andand 3636
textbookstextbooks,, MedlineMedline and theand the Cochrane Database.Cochrane Database.
 Every registered healthcare provider can recordEvery registered healthcare provider can record his/herhis/her
continuing professional development activities in a CPD diarycontinuing professional development activities in a CPD diary,,
andand access postbasic and postgraduate courses online withoutaccess postbasic and postgraduate courses online without
leaving hisleaving his // her place of work.her place of work.
 This is important inThis is important in retaining much needed doctors and nursesretaining much needed doctors and nurses
in the more distant parts of the countryin the more distant parts of the country who would have towho would have to
otherwise leave for medical faculties and other training centresotherwise leave for medical faculties and other training centres
in the larger citiesin the larger cities for longer periods of timefor longer periods of time..

32. Institutions of Higher Learning and Teaching Hospitals
GP Clinics
Health Clinics
Health Professional
Homes
CME Service
Centre
CONTENT
•Electronic textbooks, journals
•CME video on demand
•Clinical practice guidelines
•Structured education programs
(postgraduate, postbasic)
•Discussion groups
•Knowledge databases
•Research support
Objective: To utilize multimedia and telecommunication to
integrate and deliver continuing education, to ensure a high
standard of healthcare
Continuing Medical Education

33. Behind the screen…….Behind the screen…….
What is needed?What is needed?
 General & professional standardsGeneral & professional standards
 Data protection & utilizationData protection & utilization
 LegislationLegislation
 HR developmentHR development
 Ethical considerationsEthical considerations
 FinanceFinance
 ResearchResearch
 Monitoring & evaluationMonitoring & evaluation
 Structure & organizationStructure & organization

34. General standardsGeneral standards
 All aspects of telehealth including use of equipment,All aspects of telehealth including use of equipment,
telecommunication technology, qualifications andtelecommunication technology, qualifications and
training of personnel, work processes & managementtraining of personnel, work processes & management
of dataof data must meet the accepted standards ofmust meet the accepted standards of
regulatory or professional bodies.regulatory or professional bodies.
 The provision of healthcare must beThe provision of healthcare must be oriented towardsoriented towards
quality to ensure optimal outcome.quality to ensure optimal outcome.

35. Professional standardsProfessional standards
 All healthcare professionals involved in providingAll healthcare professionals involved in providing
telehealth services must …telehealth services must …
• have thehave the proper qualificationsproper qualifications..
• bebe registered with the appropriate authorities.registered with the appropriate authorities.
• bebe credentialed by their respective professional bodiescredentialed by their respective professional bodies..
 The level of care should be as provided by theThe level of care should be as provided by the appropriateappropriate
practice guidelinespractice guidelines, which should, where possible, be, which should, where possible, be
based on evidence.based on evidence.

36. Data protection and utilizationData protection and utilization
1.1. Ownership, custody and controlOwnership, custody and control
 ByBy Government of MalaysiaGovernment of Malaysia (rather than privately held by(rather than privately held by
commercial entities).commercial entities).
 Presently, ownership, custody and control of data rest with thePresently, ownership, custody and control of data rest with the
body from whom the data originatesbody from whom the data originates, or who collects and stores, or who collects and stores
the data.the data.
 For theFor the Lifetime Health Record (LHR)Lifetime Health Record (LHR) to be functional, theto be functional, the
various care providers must be able to bothvarious care providers must be able to both read from as wellread from as well
as write to the LHRas write to the LHR. The formulation of the LHR dataset should. The formulation of the LHR dataset should
include input from all health sectorsinclude input from all health sectors and should form a commonand should form a common
minimum core dataset.minimum core dataset.

37. Data protection and utilizationData protection and utilization
2.2. Confidentiality and privacyConfidentiality and privacy
 TheThe confidentiality and privacy of the individual’s recordconfidentiality and privacy of the individual’s record shouldshould
be ensured at all time.be ensured at all time.
 A system should be developed to ensure the security of dataA system should be developed to ensure the security of data
againstagainst data loss, tampering and unauthorised accessdata loss, tampering and unauthorised access..
 The individual’s health record contains much information, whichThe individual’s health record contains much information, which
the individual considers to bethe individual considers to be sensitivesensitive and not to be revealedand not to be revealed
to others and must therefore be kept confidential.to others and must therefore be kept confidential.
 TheThe rules and procedures regarding usagerules and procedures regarding usage of this informationof this information
must also take into consideration the safeguarding of themust also take into consideration the safeguarding of the
individual’s right on confidentiality and privacy.individual’s right on confidentiality and privacy.

38. Data protection and utilizationData protection and utilization
3.3. Accuracy and reliabilityAccuracy and reliability
 All data and information collected stored and transmitted mustAll data and information collected stored and transmitted must
bebe accurate, complete, reliable and validaccurate, complete, reliable and valid. (For data to be useful,. (For data to be useful,
the user must be assured that the data is accurate, complete,the user must be assured that the data is accurate, complete,
reliable and valid).reliable and valid).
 Otherwise, the usefulness of the data is limited and the data willOtherwise, the usefulness of the data is limited and the data will
not be utilized for the purpose for which it was first collectednot be utilized for the purpose for which it was first collected
and stored.and stored.
 A common dataset will be established thatA common dataset will be established that complies withcomplies with
national and international standards.national and international standards.
 A common protocol (technical specification) for the collection,A common protocol (technical specification) for the collection,
storage and transmission of data will be established and actionstorage and transmission of data will be established and action
taken to ensure that implementation of any information systemstaken to ensure that implementation of any information systems
complies with such standards.complies with such standards.

39. LEGISLATIONLEGISLATION
 There shall be adequate legal provision to ensureThere shall be adequate legal provision to ensure
operationalisation of all theoperationalisation of all the Telehealth ApplicationsTelehealth Applications..
 In order to control the quality of care as well as to ensure thatIn order to control the quality of care as well as to ensure that
only qualified health professional undertake/deliver telehealthonly qualified health professional undertake/deliver telehealth
assisted healthcareassisted healthcare, appropriate existing and future acts and, appropriate existing and future acts and
regulations (including licensing) need to be constructed.regulations (including licensing) need to be constructed.
 Threats and security issuesThreats and security issues related to outcome of data miningrelated to outcome of data mining
from group data services need to be addressed.from group data services need to be addressed.
 Existing laws and regulations regarding ownership,Existing laws and regulations regarding ownership,
confidentiality, privacy and usage of data will govern all policiesconfidentiality, privacy and usage of data will govern all policies
and procedures of telehealth programmes.and procedures of telehealth programmes.

40. THE ENDTHE END