TELEMEDICINE

INTRODUCTION TO TELEMEDICINE

The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities. In simple words, telemedicine facilitates the provision of medical aid from a distance. It is an effective solution for providing specialty healthcare in the form of improved access and reduced cost to the rural patients and the reduced professional isolation of the rural doctors. Telemedicine can enable ordinary primary care doctors to perform the function of specialist doctor’s tasks under the supervision of the specialist through telemedicine.

Telemedicine is an effective interface between Information Technology and Medical Science. The Telemedicine system consists of simple hardware and software at both the Patient and Specialist doctor ends with some of the Diagnostic Equipments like ECG, X-ray and pathology Microscope/Camera provided at the patient end.

They are connected through a Very Small Aperture Terminal (VSAT) system and controlled by the Network Hub Station of ISRO. The patient data, medical images and other information pertaining to the patients can be sent to the specialist doctors, either in advance or on a real time basis through the satellite link in the form of Digital Data Packets. These packets are received at the specialist centre, the images and other information is reconstructed so that the specialist doctor can study the data, perform diagnosis, interact with the patient and suggest the appropriate treatment during a Video Conference with the patient end. Telemedicine facility thus enables the specialist doctor and the patient separated by thousands of kilometers to see visually and talk to each other. This enables the specialist doctor to assess the physical and psychological state of the patient and suggest treatment.

ADVANTAGE OF TELEMEDICINE

One of the major advantages of Telemedicine technology has been

  1. a) saving money
  2. b) saving time and
  3. c) effort to the rural patients, as theyare not required to travel long distances for obtaining consultation and treatment.
  4. d) specialist consultation

APPLICATION OF TELEMEDICINE

Application of telemedicine is much more valuable in case of

  1. a) emergency, when time is a critical factor in the outcome of the diseases
  2. b) during disaster situation, a specialist can provide his services through telemedicine in disaster affected area
  3. c) post operation (Post Surgery) follow up since the patient is not required to travel unnecessarily and hence saving money and time.
  4. d) providing training for primary health doctors
  5. e) monitoring national health programs
  6. f) providing medical care in custodial settings such as prison, juvenile home, rehabilitation centers etc.

In this way, the systematic application of Information and Communication Technologies to the practice of healthcare has changed the medical practice and training.

NIMHANS TELEMEDICNE

The Indian Space Research Organisation (ISRO) has implemented the Karnataka Telemedicine Project, to bring multi-specialty healthcare, to a significant section of the rural population of the state of Karnataka, India. Technology wise, this network would be state-of-the-art and unique. This network would also serve as a model for the utilization of “Healthsat” proposed for launch in the future. In this phase the state-of-the-art “Server/Browser-based, Multi-point-to-Multi-point” type of Telemedicine System/Network (provided by TeleVital) is put into operation. This Multi-Specialty Network has a network consisting of a pool of specialty hospitals. Under this network specialty hospital for Psychiatry, Neurology, Neuro-surgery, Cardiology, Oncology, Gynaecology, Nephrology, etc provides telemedicine service to various district hospital across Karnataka.

This new era of consultation was initiated by Indian Space Research Organisation (ISRO) in the form of a Telemedicine Pilot Project in the year 2001. Later, National Institute of Mental Health Sciences (NIMHANS), Bangalore also adopted this novel initiative in 2005 to provide for the rural patients through tele-consultation.

This collaboration between National Institute of Mental Health Sciences (NIMHANS), Bangalore and Indian Space Research Organisation (ISRO) has successfully linked many hospitals across India and almost all District hospitals across Karnataka to provide tele-consultation. Thus, connectivity between non-specialist doctor at remote end (District Hospital) and the specialist doctors at NIMHANS centers has been effectively established.

Types of telemedicine consultation from technical aspects

Asynchronous teleconsultation (store and forward) – in which Specialist and Client center work independently; physician ordering consultation prepares patient’s medical test results and after interpreting them, forwards them to a specialist. At this stage, it is possible to arrive at an initial diagnosis with the request for its verification. After receiving test results, specialist makes a diagnosis, which is forwarded, to the physician who requested it. Electronic mail seems to be the most appropriate way of conducting teleconsultation in this case.

Synchronous teleconsultations (live/real time tele-video conference) – in which Specialist and Client center communicate simultaneously in a joint session using video-conference. Synchronous ones significantly improve the quality of consultation: depending on the capabilities of the system, participants may use voice calls, chat, video call or interactive pointer which may point to significant areas of interest.

NIMHANS telemedicine is using both Asynchronous tele-consultation (store and forward) and Synchronous tele-consultations (live/real time tele-video conference).

Types Of Tele Consultations From Personnel Involved

Tele consultation can occur between

i. two doctors (primary care doctor and specialist at the tertiary care)

ii. doctor and a para-medical personnel, (between a specialist and para-medical staff such as nurse, pharmacist, care-giver etc)

iii.  doctor and a patient

iv. NIMHANS, tele-consultation is between two doctors (i.e. primary care doctor and specialist at the tertiary care).

Beneficiary of the tele-consultation

Tele-consultation is method in which a specialist assisting the primary care physician/ district hospital doctor in rendering a diagnosis, treatment and rehabilitation. This service is available only for government institute/hospitals. This may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.

NIMHANS  tele-consultation is between two doctors, in which NIMHANS specialist assisting the primary care physician/ district hospital doctor in rendering a diagnosis, treatment and rehabilitation.

To be specific, patients who are getting benefit from tele-consultation are

  1. a) Patients visiting District Hospital (Government) in Karnataka
  2. b) Regional Rehabilitation Center, Bangalore
  3. c) Bangalore Central Prison patients, Bangalore

Number of Tele-consultation with district hospital across karnataka done till date

YEAR

PSYCHIATRY

NEUROLOGY

NEURO

SURGERY

OTHERS

2010

4

2

2011

2

32

35

2012

7

18

31

13

2013

157

107

18

97

2014*

116

48

2

96

TOTAL*

282

207

90

206

Tele-consultation with Regional Rehabilitation center and Central Prison Bangalore

PLACE

PERIOD

PSYCHIATRY

NEUROLOGY

NEURO-SURGERY

REGIONAL REHABILITATION

CENTER, BENGALURU

OCT 2013

TO SEP 2014*

448

CENTRAL PRISON,

BENGALURU

JULY 2014

To

SEP 2014*

25

8

3