Enhancing Healthcare with Telemedicine

Healthcare for all is a major concern for every organization from governments to small companies. For governments, it is not only a poll issue, it also helps them run the show more effectively by portraying them as people-friendly. Small companies also need to implement healthcare initiatives to help their employees at times of need and to motivate them to serve the organization optimally.

However, providing healthcare properly to the entire population is not easy due to the widely dispersed nature of people, especially in remote villages, and the rough terrain often separating them. Again, all kinds of specialties may not be available even in metropolitan cities. Expertise in a particular medical case may be too far away to reach and the timely arrival of help may not be possible in most cases.

The advent of telemedicine is a big boon to society. Telemedicine is the use of communication networks for the exchange of healthcare information to enable clinical care according to popular definition. The tool becomes more effective and efficient in providing healthcare in the presence of a modern broadband telecommunications infrastructure.

Real time telemedicine application actually provides “virtual transportation,” allowing the patient and doctor to stay where they are. Medical care can be offered remotely, even in critical situations, saving many a life along with improving the quality of life of the people.

For poor countries, this comes as a boon as telemedicine links patients, doctors and hospitals by using technologies like ISD N and POTS lines. Developing countries will also benefit a lot from this exchange of clinical information.

In several Asian countries, healthcare services face problems like inadequate infrastructure and the presence of experienced doctors especially in rural areas. Although cities are well equipped, the population they serve is smaller. This forces people from towns and villages to travel to cities or even across the country for good medical care.

What is Telemedicine?

When a doctor feels that he needs a second opinion on the next course of action to take with respect to a patients’ case, he can opt to consult a specialist via telemedicine in case the other doctor is located elsewhere. Software for consolidating medical records is used to make an Electronic Patient Record or EPR . The EPR will be uploaded to the specialist’s computer and will be used by the doctors for tele-consultation.

The specialist can check the clinical information and then advise accordingly. For making the process more foolproof, the doctors can have a videoconference to make the diagnosis more accurate and decide on an appropriate course of treatment. The information shared between the doctors may be in the form of live bidirectional audio or video, recorded audio or video sent after the conference, medical records, medical images, sounds or output from medical devices such as pulmonary function instruments, electrocardiographs or ultrasound devices.

Some medical services seem to be well suited for telemedicine as they enable an easy exchange of information. Radiology reports need only low bandwidth messaging systems and remote psychiatric counseling to mentally ill patients is possible through videoconferencing alone. Echocardiograms, ultrasonographic images and electrocardiograms can be readily transmitted electronically in cases of heart ailments.

Many cases have been reported where successful surgeries have been conducted by doctors using audio guidance from specialists who can see the patient by video conferencing technologies. Even infants separated from parents and kept in specialty care centers can be monitored by parents. Telemedicine is also used to impart proper training via video conferencing to patients regarding asthma treatment and others.

In developed countries, medical care providers are able to remotely monitor patients, especially the elderly, for their pulmonary function or glucose concentration. If they find anything amiss they can immediately contact the patient or a family member by telephone, computer or TV to take remedial action.

The advancements in wireless technology have given the world wearable biomedical sensors, which allow remote monitoring of patients who can be mobile during the process. This helps detect early signs of health complications by offering doctors real time physiological data. This helps in the delivery of timely medical attention to terminally ill patients and the elderly.

Hurdles in the Way of Telemedicine Implementation

Wireless technologies like GPRS are not evolved enough to take on telemedicine services deployment. The costs of linking satellites and mobile devices are too prohibitive. The availability of secure connectivity also stands in the way of e-health services. Again, insufficient training and exposure to such technologies pose problems for most Asian countries unlike the West. The realization that telemedicine reduces the carbon footprint by avoiding medical travels is yet to gain ground.

Telemedicine data encompasses video, audio and conversational data from videoconferences. The data may be transmitted in real time or not. This necessitates a communication infrastructure that caters to all of the various types of applications.

WiMAX (Worldwide Interoperability for Microwave Access) technologies have been found to be suitable for the delivery of voice, video, ECG signals and medical scan information. It allows data transmission in various ways like point-to-point, point-to-multipoint and full mobile cellular access.

Telemedicine service providers in developing countries like India prefer point-to-multipoint access, as it has Non-Line-of-Site (NLOS ) capability and is cost effective. The multiplexing technology also allows the transmission and reception of data simultaneously. This enhances telemonitoring and telemedicine implementations. The high bandwidth, interoperability, scalability, compatibility, portability, reliability and support for various classes of service make WiMAX suitable for telemedicine operations.

Telemedicine in Developing Nations of the East

With a large population living in rural areas in this region the selection of a proper technology becomes imperative. WiMAX technologies have been adopted by countries like India, as it helps in telemonitoring and is useful for telecardiology applications. Video conferencing with good communication systems enhance medical services in rural areas in emerging economies.

During the Pacific Science Congress held in Japan in 2007 an Asia Pacific Telemedicine Initiative was launched. The goal was to implement e-Health services in developing nations to prevent child mortality, fight diseases and improve the quality of life. The participating countries decided to collaborate in the exchange of expertise and reduce obstacles in the form of time and distance in providing optimum healthcare to their populations.

Bhutan, Fiji, Germany, India, Indonesia, Japan, Korea, Nepal, Pakistan, the Philippines, the Russian Federation, Thailand, Vietnam, Ukraine and the United States were represented in the discussion pertaining to e-health services and solutions. Collaboration between healthcare and telecommunication service providers is a must for implementing e-Health services or telemedicine. Regional cooperation further enhances the service as it allows medicos in different countries to combine their expertise in delivering medical care.

Initiatives have been taken to promote regional cooperation among the Pacific Rim countries by bringing together government, public, private, national and international agencies. Efforts are being taken by international and regional organizations to impart necessary training and educational programs for healthcare-professionals. Examples of some such courses are the ITU Telemedicine Expert Training Course conducted at Tokai

University; courses in the School of Telemedicine & Biomedical Informatics at SGPGI MS, Lucknow, India; and the telemedicine course at Holy Family Hospital in Pakistan.

Aid agencies like USAID , Japan’s ODA and AusAID are working on making telemedicine a success. Also, ethical, political and copyright and patent issues are being resolved by international telecommunication agencies as technologies and software have to be used in making the deliverance of telemedicine smooth in developing countries.

Even small countries like Nepal have begun investing in telemedicine as the solution of the future to reach remote areas on mountains, etc., where there is only one doctor per 6,000 people. Nepal launched a project to study the feasibility of telemedicine in pathology, dermatology and radiology some years back.

Local healthcare workers were brought under the scheme to develop and operate telemedicine projects. Nepalese living in Butwal, Jhapa and Bhaktapur are being served by telemedicine projects. Health professionals at HealthNet Nepal and the Ministry of Health came together to make this project a success.

Dr. Alok Roy, Chairman & Managing Director of Medica Synergie Pvt. Ltd., was instrumental in conceptualizing and implementing the Integrated Telemedicine and Telehealth Project or ITTP , Asia’s telemedicine initiative. According to him, telemedicine not only takes medical care to far flung places by eliminating impediments like time and distance, but it also helps in critical care treatment. The timely intervention of a specialist many miles away may help save a precious life. Specialists can keep themselves informed about a case and provide medical guidance to the patient and the doctor attending to him/her without any of them leaving their towns.

According to Sajeesh Kumar, PhD (Telemedicine), from the Centre of Excellence in e-Medicine, University of Western Australia, for telemedicine to see more success in the Asia-Pacific region, local skills and infrastructure have to be leveraged based on local demand. Technology management, staff development and the education of concerned people are important requirements.

In the Asia-Pacific region, most specialists live in capital cities and rural areas remain underserved. There is a tremendous growth in telecommunication channels and Internet in this region, making telemedicine a viable solution to enhance medical care. Proper coordination between the telecom and health care industries will increase consumer confidence and promote e-health.

Telemedicine has been found to be successful in providing wound care remedies with better healing. Patients are also satisfied, as this means less time spent waiting and traveling to far off hospitals. Doctors can monitor and help in the treatment of patients by examining the patient by video conference and guide a nurse or doctor to take proper action all from a remote location. Telemedicine also increases collaboration between specialists and helps arrive at treatments for new maladies and enables them to attempt new methods of treatment based on consultations and deliberations.