I wrote this article back in 2005. It is about State of the Arts: Telemedicine for a subject called Health Informatic. From this observation, I guess library could play a big role the telemedicine. You read this artilce first, I will share another essay where Library plays roles in the states of the art: telemedicine.
Introduction
Today, healthcare decision makers are struggling with the ramifications of the managed care environment for their patients. But, technology advances rapidly, for example in a classic Information Communication Technology (ICT) such as telemedicine, is now being deployed in many venues to ease their struggles. It has appeared to be one of the potential solutions to alter the landscape of the healthcare industry. Thus, this essay presents the experience of evolution, conceptualizing, benefits and barriers of the States of the Art in telemedicine with the support of two case studies.
Evolution in Telemedicine
The notion of using telecommunications in the healthcare industry goes back to the early 1900’s. Telemedicine can be streamed in three major eras, which are associated information technology, telecommunications and computers. First, shortly after the invention of telephone, several attempts were made to obtain heart and lungs sounds to train personnel who could access the state of the organs. However, poor transmission systems made the attempts a failure. Willem Einthoven, father of electrocardiography, discovered the mechanism of the electrocardiogram from the uses of telephone line in 1906. Telemedicine can be dated back to 1920s. Radios were used to link physicians on duty at shore stations to assist ships at sea that had medical emergencies. In 1955, the University of Nebraska designed a simple one-way closed circuit system using televisions for lectures and instructional purpose. More than 1,000 students at the Medical College of Nebraska received instructions via this network, which was later linked, connected the Nebraska Medical Center with the Omaha Veterans Administration Hospital and VA facilities in two other towns.
The National Aeronautics and Space Administration (NASA) also played a vital role in the early development of telemedicine by pioneering the development of telemedicine since the early 1960s. It developed telemedicine for biomedical monitoring and medical care for astronauts in the human space flight program. These early efforts and the enhancement in communication satellites have fostered the development of telemedicine and medical devices in the delivery of healthcare today. NASA had also used the Application Technology Satellite-6 (ATS-6) to provide S-band television, education and support for agriculture and health particularly in India. The second phase of telemedicine had shifted to the use of digital compression and transmission technologies in the late 1980, allowing point to point interactive video conferencing. In 1998, AT&T had brought telemedicine to the highest point on Earth. AT&T had built a network that would allow doctors to monitor climbers on an expedition to Mount Everest’s peak. The data would travel by satellite, transoceanic fiber and global ISDN networks.
Today, telemedicine has even explored further into the integration of medical fields and technology. Efforts are now being put into conveying even more information across as telemedicine is changing rapidly.
Concept in Telemedicine
Telemedicine is defined as “the use of telecommunications to provide medical information and services.” Telemedicine is actually a ‘virtual’ medical consultation, where the other party of medical experts collects the necessary information for decision- making, analysing and serves to implement the necessary action and treatment from remote sources. It is a novel concept in the field of healthcare, where Information Technologies (IT) is being used by medical centres to provide specialised services to patients living in the different parts of the world.
There are actually three different generic areas of applications where telemedicine is concerned. The first area, that is, administrative application, is used for transferring digital images from one location to another including medical records, examination data like x-rays, CT scans or MRIs, and financial information. For instance, the University of Arizona in States has taken telemedicine further by integrating all with the telemedicine network to improve rural healthcare and prison inmates in 1996.
The other widely used applications is clinical application, including handling urgent consultation, scheduled consultations, remote visits of patients, the video reviews of certain studies done in advance and even performing telepresence surgery. These applications use video conferencing equipment at two difference locations, allowing a ‘real time’ consolation to take place. The Centre for Online Health’s collaboration with University of Queensland and the Royal Children Hospital is an ideal example, where they have been trailing the uses of video-conferencing in the treatment of chronic child illness in Australia.
Lastly, educational application includes applications that facilitate the process of sharing the material available for training, teaching and examination purposes in the medical field. A pilot project by Dalhousie University, the Cape Breton Healthcare Complex and physicians at Queen Elizabeth II Health Science in Canada have benefited from a telemedicine project, which includes a continuing medical education component like videos from the operation theaters or images for the dermatology consultations.10 The interesting cases from clinicians and patients are scattered throughout the network are presented using this technology.
Benefits in Telemedicine
Telemedicine has produced a number of benefits. According to Telehealth Magazine, in an extensive report in 1999, Kincade had discovered that both medical staffs and patients had positive views about the use and roles of telemedicine tools.11 In fact, these results motivated the telemedicine researchers to research more in depth, bringing the best out of each project implementation.
In addition, telemedicine has reduced the cost of service delivery. Partners Health System in Boston, for instance, is building a system tools set that will permit all clinical consultations, such as X-Rays, MRI and CT scans to be sent directly to Partners through any browser in any location.11 It can be accessed easily and quickly by 600 teleconsultants and specialists to give the best specialised approach in consulting the situations. These will also lead to a cost effective post treatment consultation at the later stage.
Another benefit reaped from the telemedicine project is the travel time reduction. The Apollo hospitals in India have set up a pilot project using Telemedicine to provide expert care between the main hospital and the village medical centre.It serves the objective as the clinical consultations are sent to the main hospital for further analysis. With the availability of better network infrastructure, they will embark with the concept of “net-meeting” in future.
Barriers in Telemedicine
Although the results of the practice of telemedicine have been positive, there are still barriers to it. There are still a need for privacy and security of information transmission, clinical standards and guidelines for practice, technical interoperability of systems and technology and other keys factors.
According to Moore, the barriers can be categorized into three main areas: professional practice issues, quality of care issues and financial resources issues.The lack of practice standards, provider resistance, coordination and the use of non-physician providers are part of the issues faced in the professional practice. The quality of care concerns the mechanism or mode by which treatment is delivered which is followed by the evaluation of the entire structure of the process of care and how the system has made an impact on the effectiveness. Lastly, like any project, financial resource is one of the main issues as the ability to generate sufficient revenue.
Case Study 1
Telemedicine Centre of the Medical Collage of Georgia
Telehealth Magazine (www.telehealthmag.com)
In 1999, Dr. Randles from the Telemedicine Centre of the Medical Collage of Georgia in Augusta, States had reported that telemedicine had changed how diagnostic tasks were performed and improved teamwork between distant physicians. Technically, two components of telemedicine had been focused in these projects. They were information sharing and information process.
The increase in information sharing was partially due to the specialists’ involvements in the collection of patient data, allowing them to be focused on the analysis of diagnostic information that remote physicians shared with them. At the same time, video conferencing permits greater interaction between physicians in spite of the distance. Information processing was much faster since remote physicians were able to release the summary in a short time to the patient with the support from the specialists. Furthermore, the patient often feels more comfortable talking to the remote physician. Thus, telemedicine could be an alternative solution to solve distant treatments for certain areas.
Case Study 2
The Queen Elizabeth Hospital, Australia
AusTelemed Conference 1998
As for the Renal Unit from The Queen Elizabeth Hospital in South Australia, telemedicine has begun with the first installation in September 1994. The research project reveals the extensive range of clinical, educational and administrative applications of telemedicine in the renal unit. The research also reveals the complex sets of needs, expectations, attitudes and concern of patients, which have been accounted when managing a telemedicine network.
The Network also suggests how imbalances in accessing to medical expertise between rural and urban centre might be redressed in future. This is especially when IT and telecommunication technologies have improved in functionary, quality, price competitiveness and ease of use.
Future in Telemedicine
Although telemedicine is changing rapidly, there is still room for improvements. Currently, there are projects and experiments, which enhance the integration of telemedicine and the medical field. Experiments, such as telepresence surgery at Ohio State University, allow experienced surgeons, trained residents and medical students to learn new techniques in the concept of education. In addition, relief operations using telemedicine are organised. Recently, on 11 April 2005, Australia has joined a group of countries in developing a hi-end medical kiosk that will deliver immediate treatment and advice to tsunami survivors in Bandar Aceh refugee camps in Indonesia.With the potential capabilities of a telemedicine, they are able to aid the whole kiosk project better.
In future, telemedicine will not only play the key role contributing in the medical space, naval assistance or in health centers and institutes, but also fast relief operations and even into the stage of military areas.
Conclusion
Since its existence in 1906, telemedicine has been evolving. It integrates two fields into a system, aiding the process of treatment in medical world. Hence, telemedicine has the potential to revolutionize the whole healthcare industry. This can be achieved by building bridges such as developing virtual communities between clinicians and patients. Most importantly, the status of healthcare has been upgraded and improved tremendously, saving lives and curing patients at faster rate, using the state of the art technology in telemedicine.
Reference:
1. Willem Einthoven – Biography [Homepage of Nobelprize.org], [Online] (Copyright 2005), Available: http://nobelprize.org/medicine/laureates/1924/einthoven-bio.html [Access: 19th April 2005]
2. Definition & History of Telemedicine, [Homepage of University of Athens, School of Medicine], [Online] (Last Update 23rd May 2000), Available: http://users.forthnet.gr/ath/giovas/telemed/ [Access: 19th April 2005]
3. Section 1: History & Recent Developments [Office for the Advancement of Telehealth], [Online] (Copyright 2005), Available: http://telehealth.hrsa.gov/pubs/mental/section1.htm [Access: 19th April 2005]
4. National Aeronautics and Space Administration’s Efforts, [Online] (Copyright 2005), Available: http://www.quasar.org/21698/nasa/contrib.html [Access: 19th April 2005]
5. The 1998 EH&S Report [Homepage of AT&T- AT&T Today & Yesterday], [Online] (Copyright 2005), Available: http://www.att.com/ehs/annual_reports/ehs_report/report98/attt/tbl_2.html [Access: 19th April 2005]
6. Nancy Brown, Telemedicine Coming of Age [About Telemedicine], [Online] (Updated May 3, 2002), Available: http://trc.telemed.org/telemedicine/primer.asp [Access: 19th April 2005]
7. B. Bowonder, Mohit Basal and A. Sharnitha Giridhar, A Telemedicine Platform: A Case Study of Apollo Hospitals Telemedicine Project, [Online] (Copyright 2005), Available: http://www.planningcommission.nic.in/reports/ sereport/ser/stdy_ict/13_apollo.pdf [Access: 19th April 2005]
8. Kathy Kincade, Top 10 Telemedicine Programs For 1999: Experience Pays Off, The Telehealth Magazine December 1999 issues, [Online] (Copyright 1999), Available: http://www.telehealthmag.com [Access: 19th April 2005]
9. Matthew Liddy, Digital Doctors (Homepage- Health Matters), [Online] (Published 03/07/2003), Available: http://www.abc.net.au/health/regions/features/digital/default.html [Access: 19th April 2005]
10. Lori MacLean, Patients Benefit from Telemedicine, [Online] (Copyright 2003), Available: http://www.gov.ns.ca/health/media/1997/apr4.htm [Access: 19th April 2005]
11. Kathy Kincade, Top 10 Telemedicine Programs For 1999: Experience Pays Off, The Telehealth Magazine December 1999 issues, [Online] (Copyright 1999), Available: http://www.telehealthmag.com [Access: 19th April 2005]
12. Dr. K. Ganapathy, Telemedicine in India- the Apollo experience, [Online], Available: http://www.thamburaj.com/telemedicine.htm [Access: 19th April 2005]
13. Michael B. Moore, Implication for Clinical Practice, An Introduction to Telemedicine [Online], Available: http://home.earthlink.net/~michaelbmoore/telemedicine_introduction.html [Access: 19th April 2005]
14. Theodore J Randles, R Kevin Gigsby, Video Conferencing Fosters Teamwork Among Physician, The Telehealth Magazine December 1999 issues, [Online] (Copyright 1999), Available: http://www.telehealthmag.com [Access: 19th April 2005]
15. John Mitchell and Dr. Alex Disney, Insight from the 3 Years Longitudinal Study of Renal Telemedicine, Available: http://www.jma.com.au/insights.html [Access: 19th April 2005]
16. Wayne Drash, Where Virtual & Reality Meet In The Doctor’s Office, Telemedicine, (Copyright 2001), [Online], Available: http://archives.cnn.com/200/HEALTH/01/02/inet2.demo.story [Access: 19th April 2005]
17. Dr. Pradeep Ray, Telemedicine Aids Tsunami Victims, (Published 11 April 2005) [Online], Available: http://www.abc.net.au/ra/innovations/stories/s134300.html [Access: 19th April 2005]
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