Telemedicine
• Telemedicine uses computers and
telecommunications lines to deliver
health care at a distance.
• Telemedicine may use store-andforward technology to transmit still
images or interactive videoconferencing
for real-time consultation.
Figure 4.1a
MEDI PORT
Source: Courtesy of C-PORT Solutions.
Figure 4.1b
QUADPORT are “mobile computing platforms enabled with high definition video
conferencing capability . . . . The device allows remote medical specialists to interact with
patients and provide expert counsel, which is especially important for rural clinics and
field hospitals with limited medical staff. Live surgeries can be shared remotely for
purposes of mentoring and better clinical outcomes are enabled via bedside access to
patient data and web-based resources.”
Source: Courtesy of C-PORT Solutions.
Interactive Videoconferencing
• A telemedicine consultation involves a
doctor at one site with the patient at
another site.
Figure 4.2
A telemedical consultation.
Source: Corbis Bridge/Alamy.
Telemedicine Continues to Grow
• By 2010, there were about 200
telehealth networks in place in the U.S.
They linked more than 2,500
institutions.
Telemedicine Continues to Grow
• The Veterans Health Administration has
50 health management programs in 18
integrated networks (2011). It has
found that remote monitoring reduces
the number of bed days by 25% and
the number of admissions by 20%.
Telemedicine Continues to Grow
• Telemedicine has been used in prisons
for years, and the prison population is
growing.
Subspecialties
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Teleradiology
Telepathology
Teledermatology
Teleophthalmology
Telecardiology
Subspecialties
• Teleneurology, including telestroke and
the treatment of epilepsy and
Parkinson's Disease
• Telehome care, using remote
monitoring devices
Telecardiology
• listening to the heart at a distance
• 1960s
 It became possible to transmit heart
sounds accurately and to fax ECGs.
• 1990s
 Echocardiograms could be
telecommunicated.
Telecardiology
• Second opinions via telecardiology are
one of the most common requests in
telemedicine.
 People come into rural emergency
rooms with chest pains, and many ER
doctors want an expert consultation.
Telecardiology
• In 2009, a study in Italy found that
telemedicine could correctly diagnose
heart attacks in elderly people at home.
• The use of telecardiology both
improved diagnosis and delivered
treatment more quickly.
Telecardiology
• A major area of growth for
telecardiology is in the diagnosis of
infant congenital heart disease.
Remote Monitoring Devices
• Make it possible for patients to be
monitored at home from afar.
• New experimental devices embed
sensors in wearable fabric.
Figure 4.3
Data from a digital spirometer can be directly transferred to the electronic health record.
Source: Courtesy of Midmark Diagnostics Group.
Telehome Care
• Involves a link between the patient's
home and a hospital or central office
that collects the data.
• Equipment (which now may be as small
as a smartphone) is used in the
patient's home.
Telehome Care
• In 2010, approximately 31,000 people
used VA telehome care.
• Automated robots are being used to
make house calls.
• Homes can be equipped with sensors
that allow adult children to monitor
their parents' movements.
• CardioCam uses “slight variation in skin
tone” to measure the pulse.
Telehome Care
• The patient can telecommunicate vital
signs to a nurse at a distant location,
and can also speak to the nurse.
• Telehome care has been found to cut
rehospitalizations and ER visits, and to
reduce hospital stays.
Telehome Care
Several factors retard the adoption
of telehome care.
• the attitudes of home health agencies,
• the initial cost of the equipment,
• reimbursement rates,
• and the fact there are few studies
demonstrating that it is cost-effective
Telenursing
• Teletriage
• Telecommunication of health-related
data
• Remote house call
• Monitoring of chronic disease
What Is Telenurse?
• The nurses use diagnostic software and
are linked to databases, hospitals,
primary care providers, and ambulances
• Nurses need to be familiar with
computerized equipment and comfortable
using it
What Is Telenurse?
• change the way nurses work.
• First, the nurses work in call centers, not
clinical settings, and
• second, they do not examine the patient
Smartphones
• New health-related applications for
smartphones are being developed:
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Airstrip OB
Tumor analysis
Fitness and weight control programs
Stress-reduction programs
Medication reminders
Figure 4.4
Set of touch-screen smartphones.
Source: Oleksiy Mark/Shutterstock.com
Tablet Computers
• Are telehealth mobile computing
devices
• Uses
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Taking notes
Accessing records
Accessing medical references
Viewing medical images
Tablet Computers
• Clinical apps
 Medication checker
 Drug databases
• HIPAA compliant
Figure 4.5
A modern tablet computer with application icons ready for mobile connectivity.
Source: iQoncept/Shutterstock.com
Technical, Legal, Insurance, and
Privacy Issues
• An appropriate telecommunications
infrastructure must be in place.
• In addition, several issues need to be
addressed such as:
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Licensing
Medical liability
Insurance
Privacy concerns
Reimbursement
Is Telemedicine Effective?
• There are many studies, but few solid
conclusions:
 Telecardiology is both effective and
efficient.
 There are ongoing studies.
• It has the potential of making highquality health care available to anyone,
regardless of distance to major medical
centers.
What technical, legal issues need to be addressed
for telemedicine to fulfil its promise?
• On the technical side, require high-speed,
broadband media
• On the legal side, issues include licensing,
medical liability, and privacy concerns
RELATED WEB SITES
• The American Telemedicine Association
http://www.atmeda.org
• The National Library of Medicine
http://www.nlm.nih.gov can provide you with
access to a great deal of information, including
bibliographies
• Telemedicine and Telehealth Networks: The
Newsmagazine of Distance
Healthcarehttp://www.telemedmag.com is a
journal covering the field. Online access to past
issues