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Telemedicine - A Tool For More Equal Distribution Of Health Care In The World

Dr Jayanth G Paraki 
Clinic for Holistic Healing, Bangalore, India

Experts from across the globe gathered at the prestigious and world-renowned Uppsala University, Uppsala, Sweden on June 18th, 2001 to deliberate and discuss on the medical applications of Telemedicine. The central theme of the 6th International Conference on Medical Applications of Telemedicine was on creating value for the patient and Telemedicine as a tool for more equal distribution of health care in the world {www.telemedicine2001.com}

Telemedicine may play a significant role in healthcare worldwide, as providers realize its potential to effectively distribute world-class healthcare to regions near and far without incurring the expense of a physical presence. With telemedicine, healthcare providers can improve the quality of their care by establishing links beyond the country's borders with international centers of excellence. They can also establish links deep within the country to enhance their outreach to remote areas, which currently lack adequate medical facilities.

Telemedicine Defined

Dr Salah Mandil, Director and Advisor, Telematics, WHO said, "Telemedicine is the actual use of audio, video and data communications in the delivery of health care".

The Telemedicine Research Center in Portland, Oregon, broadly defines telemedicine as the transfer of electronic medical data, such as high-resolution images, sounds, live video, and patient records, from one location to another.

Telemedicine Network

Successful implementation of telemedicine relies on a multimedia network 
using telecommunications, information, and multimedia technologies to link the participants. Potential telemedicine participants are:

Telemedicine Participants

bullet Healthcare Consumers - Patients, Relatives, Community
bullet Healthcare Providers - Clinics, Primary Centers, Hospitals, Doctors, Pharmacists, Laboratories, Imaging Centers
bullet Public Institutions - Ministry of Health Universities - Researchers, Teachers, Students
bullet Healthcare Financing - Insurance Companies, Managed Care Organizations

Telemedicine Services

Telemedicine can deliver a range of services including education, consultation, diagnosis, treatment, support, information storage, and governance. Health-related transactions can deliver services directly to users in a fast and cost-effective manner regardless of time and place. 

The transfer of data can use a variety of telecommunication technologies, including ordinary telephone lines, ISDN, fractional to full T-1's, ATM (Asynchronous Transfer Mode) switching equipment, the Internet, intranets, and satellites. Worldwide, telemedicine is used in a growing number of medical specialties, including dermatology, oncology, radiology, surgery, cardiology, psychiatry, and home healthcare.

Services suitable for delivery via telemedicine are summarized below:

bulletLibrary of topic-specific information
bulletInteractive courseware and training
bulletPatient histories
bulletDiagnostics (including radiology, echo cardiology, pathology, ultrasound, high risk pregnancy monitoring, fetal heart monitoring, electro cardiology, stethoscope)
bulletMedical supplies to patient
bulletMedical supplies to institutions
bulletInsurance systems
bulletPayment systems
bulletIndustry advisory councils

Telemedicine Applications

Telemedicine can provide a comprehensive range of high-quality health services and programs. Telemedicine can deliver general or person-specific information on health-related issues, illness, or services aimed at raising individual or community awareness. Healthcare professionals can also access specialty training designed to update knowledge and skills. Consultation, diagnostic, treatment, and rehabilitation services can be delivered to individuals or discussed with other healthcare professionals. Telemedicine can offer cost-effective delivery of healthcare services, support services including pharmaceutical and medical supplies, and insurance and payment arrangements. Issues related to the governance of high-quality healthcare such as policies, laws, enforcement, accreditation, standards, guidelines, financing systems, and advisory services can be handled very effectively within a networked medical community.

Global Telemedicine Scenario

Andrey Manankov, Head of the IT and Telemedicine Department of Arkhangelsk Regional Children Hospital in rural Russia conducted 48 telemedicine consultations in the year 2000.

He says he has learnt many lessons. "Many instrumental investigations not accessible in the districts are now possible. There is maximum possible coverage of medical problems and less need for rural patients to be transported to district hospitals".

Dr Russell D'Souza MBBS, MD (Madras) DPM (Melbourne), MPM (Monash) ABDA 
(USA) Director, Center of Excellence in Remote Psychological Medicine, The University of Sydney, Broken Hill has established a Telepsychiatry Network spanning 43 Regional Sites. Telemedicine is an integral part of Rural Mental Health in Australia and supports rural based psychiatric care. The Aim is to develop the most effective comprehensive psychiatric care located in rural regions and Tele-health is used to improve treatment adherence in psychiatric patients.

In India, Dr Jayanth G Paraki, Director, Clinic for Holistic Healing is spearheading the Telemedicine movement. He says, "India today is at the crossroads in becoming a global leader in IT & Telecommunications. Progressive outlook of the present Government, successful launch of INSAT-3B satellite in March 2000 and allowing use of KU-Band for the first time, harbinger well towards achieving this goal. VSATs are a pivot to the convergence of various technologies, most important of them today, being IT. A National Institute of Telemedicine will serve the interests of our country now and in the future. The key requirement is for decision makers at the Center to invest in the necessary infrastructure and allow medical experts develop applications suitable for Telemedicine".

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