Summary of the technology

1. This paper is divided into three sections which contain the introduction, literature review and conclusion.

2. Introduction

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This section contains a brief introduction of telemedicine and its application. The history of telemedicine is also briefly outlined.

3. Literature review

This section will be divided into three parts which include the methods of telemedicine where a few of the methods used in telemedicine technology will be discussed that is the mobile health (m-health); paper based micro fluidic devices and mobile satellite communication telemedicine technologies among others. The benefits that are achieved from the incorporation of telemedicine technology in health care delivery systems will also be elaborated with reference to a few instances. Also the legal and ethical issues associated with telemedicine technology will also be discussed in this section.

4. Conclusion

This will include a brief summary of the technology and future recommendations to be implemented to further improve telemedicine technology.

Introduction

            Globalization has increased the gap between rural and urban sectors of the economy  because most of the economic incentives such as health care, education facilities, employment opportunities, good infrastructure systems and insurance cover of business enterprises among others that are only found in the urban sector1. This has contributed to the provision of poor health care delivery systems in the rural areas because of lack of adequate resources such as capital and manpower as very few medical, practitioners agree to be stationed in the remote areas of the country[1]. Also geographical factors of a country have limited the delivery of sufficient health care to every part of the country because of poor transport and terrain systems[2].

            However, industrial revolution that the world has faced has enabled incorporation of advanced technology into health care which has improved the medical care given to residents in the rural areas, for instance telemedicine which is the provision of clinical medicine education to patients and health care practitioners via telecommunication and information technology with the aim of improving health conditions of the society6. Telemedicine has greatly benefited those living in the remote rural areas where health care delivery is minimal or not even provided because of poor infrastructure and long distances between the residents and the nearest health care centre. Patients are therefore accorded the required consultative, diagnostic and treatment services9.

            Moreover, telemedicine has been able to avert emergency related deaths due to lack of specialty care and wasting a lot of time transporting patients to health care units. Furthermore, telemedicine has enabled the attraction and retention of health care practitioners in rural areas because of the ongoing training and collaboration with other health care professional[3]. Also more advanced technology such as radiology, dermatology and mental health care services have been improved both in the rural and urban settings. Telemedicine technology has played a part in improving the economy of countries because of increase in medical tourism due to the decrease in travel and time costs3.

            Telemedicine technology has also been able to curb jurisdiction conflicts resulting from cross border regulations, for instance in US every doctor is registered by the present state where he is working therefore it would be illegal for him to treat patients from other states without the consent of the law and medical practitioners of that state[4]. This has enabled equal delivery of health care delivery services in the country regardless of the economic status, location or geographical nature of the state4. Therefore, this report will discuss telemedicine technology in health care delivery system, the benefits of the technology and the legal and ethical issues that curb the development of this technology.

History of telemedicine

            Telemedicine can be associated with in absentia care which is care at a distance[5]. The concepts incorporated in telemedicine can be related to the traditional use of smoke signals to pass information. In Africa, communities used this method to warn other neighbouring communities of the health hazards in their location because of outbreak of diseases such as measles5. In 1906 Einthoven introduced the use of ECG transmitter over telephone lines. His concept was later utilized in the 1920s by sailors to request for medical assistance from medical practitioners at the shores[6].

            Telemedicine at first focused only on medical care in the 1970s where telemedicine technology based on broadcasting and television technologies was incorporated into clinical aspects6. The Nesbraska Psychiatric Institute used closed circuit television to link its operations with the Omaha Veterans Administration Hospital and VA facilities both in different locations in 19716. Later on in the late 1970s ATS-6 satellites were used by paramedics in remote parts of Alaska and Canada to link up with medical practitioners at the main hospitals in the urban sectors6. In the 1990s because of industrial revolution an era of digitization was established diversifying telemedicine technology to utilize Integrated Service Digital Network (ISDN) lines6. The use of postal and telegraphic methods to deliver medical information between different geographical locations was implemented to fasten the traditional method of communication which relied on signals, for instance the Australia Royal Flying Doctor Services relied on two way radios using power dynamo to communicate with their patients and other medical practitioners6.

            Later on telephone and fax machines were introduced to further simplify and modify the communication method. This was followed by an era of telephony and computing merger to further increase the scope of communication and decrease the time taken to communicate.

This era introduced the notion of conducting medical examination and evaluation over telecommunication networks, for instance when lung and heart sounds were transmitted to trained experts for further evaluation which drastically failed due to poor transmission6. This was followed by the implementation of cheaper, faster and more accessible technological networks which enabled an improvement in the quality of services provided by telemedicine. Currently telemedicine has used the availability of internet protocol (IP), wireless/mobile and ubiquitous system technologies which has lead to the attraction of more scholars and industry researcher that are aiming at improving telemedicine to avert the technical deficiencies it is facing which include diagnosis doubt because of lack of formulation of complete solutions, difficulty in relating the information transmitted to the medium, system failures and improved equipment efficiency especially in the developing countries[7].

Literature review

Methods of implementing telemedicine

            The variation in the use of telemedicine in health care has resulted to formulation of different types of telemedicine technologies to provide effective medical care on the medical field that it is implemented. Introduction of diversified telemedicine technology has enable health care practitioners to easily access patients records when on duty, add observations that are different from those recorded into the central database to enable other medical practitioners who will be on duty at a later time to easily monitor the progress of patient recovery and to check on the available medicines in the health care pharmacy among others[8]. However, strategies that will help controversies, such as the problem to be solved by the technology, which methods of the technology ought to be incorporated to effectively solve the problem and the challenges that the prospective organization intends to incorporate the technology into its structure faces (that is if the challenges will enable the implementation of the technology to be successful) or it will lead to its failure, to be solved should be formulated8.

            Mobile health (m-health) telemedicine technology which revolutionized wireless medical devices that curb geographical constraints which harbour delivery of efficient health care systems in a country and wearable medical devices that enable health care professionals to easily and directly monitor their patients without disrupting their normal duties has been adopted4. The process comprises of a Body Area Sensor Network (BASN) which interconnects devices enabling the interrelation of information and resources from the sensors worn or implanted in the patient’s body to computer electronic devices for the health professionals to evaluate it and send back a reply or warning messages if necessary4. Other examples of mobile health technology include use of cellular systems which rely on digital transmission technology such as time division multiple access (TDMA), Frequency division multiple access (FDMA) and code division multiple access (CDMA)4.

               a) PDA-based                                   b) mobile-phone-based.

            Fig 1: Wireless and cuffless blood pressure meters from Taniar, D. (2008),                         Mobile computing: Concepts, methodologies, tools and applications.

            Mobile Satellite Communication (MSC) telemedicine technology is another example which relies on picture and voice transmissions that have been incorporated into an ECG transmitter. This enables the transfer of audio signals, psychological signals and coloured images which are multiplexed and transmitted into a satellite that de-multiplexes them into a monitoring systems where health professionals evaluates its and transmits results or instructions back through the same process4. This technology has enable telemedicine to be practiced in areas where cable communication is difficult. MSC has also enabled the medical care to be accorded to patients in motions, many people have been saved by being given the required medical care in cases of catastrophic disasters such as earthquakes or floods and the psychological state of patients under observation can also be determined4.

            Another telemedicine technology which is especially essential to developing countries because of limited resources such as trained health care professionals and capital for effective adaptability is paper based micro fluidic device which is used to carry out analytical chemical analysis on many samples at the same time11. A digital scanner or camera is used to intensify the colour of the calorimetric assay which then transmits the information to an off-site laboratory for the evaluation by medical practitioners who diagnoses the information and sends back the results through the same process. An example of this method is the use of paper based micro fluidic devices made from a hydrophilic polymer containing hydrophilic channels on the walls and a camera phone that can quantify the calorimetric results too detect the concentrations of glucose and proteins in urine to determine diabetes and kidney failure  instances11.

 Uses of telemedicine

            Telemedicine is used by health care units to support emergency nurses in rural areas as previous conducted studies have depicted telemedicine provides the same safety measures provided by on site minor injury treatment, therefore the clinical effectiveness of this technology in providing satisfactory standards of care[9]. For instance in 1996 the UK government relied on telemedicine to develop emergency nurses who could order and interpret radiographs in an attempt of curbing the shortage of medical practitioners that had been worsened by the close down of about 30 emergency departments1. The government also aimed at improving health care delivery to the rural communities in the country by attracting and retaining more emergency nurses1.

            Telemedicine has also found use in the prenatal diagnosis of congenital heart disease where a four dimensional spatio-temporal image correlation (STIC) through an internet link is used. This technology has helped medical practitioners to be able to examine the heart of a foetus to determine its normality or abnormality10. Digital photographs that show the condition of the cardiac system of the foetus can be send to others physicians to get second opinions at fast rates without the need of compressing or fragmenting the pictures. Also general obstetricians are able to perform echocardiography to the foetus by relying on information about the practice from sent emails10. This practice is highly used in Chile because of its geographical nature which makes access to specialists and second opinion from other medical professionals difficult because it is time consuming and expensive as most of the country’s resources such as neonatal cardiac surgery equipments are located in the capital city, Santiago. The country also has very few echocardiographers thus the high rate of reliance to telemedicine by obstetricians in acquiring echocardiographic information[10].

            Telemedicine has also helped health care units to increase their experience in Chronic Obstructive Pulmonary Disease (COPD) to help them effectively treat, care and support COPD patients9. This has helped to decrease the number of people suffering from chronic diseases because decrease in the medical costs of treating chronic related diseases, health care practitioners can now continuously follow up on their patients after discharge to monitor their recovery progress, the necessary information can be passed on to all health care professionals regardless of their calibre, medical practitioners are able to follow up on the treatment accorded to every patient in regards to chronic diseases thus improvement in data storage and patient empowerment where they can be able to take care of themselves that is primary health care8. Also patients do not require to keep regularly visit the health care units for re-evaluation during recovery time which could worsen their conditions. However, this practice is highly limited by the high costs of integrating home based telemonitoring equipments9.

            Telemedicine technology is economical because both the patients and the medical practitioners are able to cut down on their costs because of reduction in the overall number of personal trips and urgent cases6. For instance the cases study performed in Peruvian jungle of Alto Amazonas for four years depicted the technology to be effective and cost saving3. This is because developing countries find it hard to rely on information communication technology because of economic sustainability. However, EHAS program in the Peruvian Jungle managed to save approximately $115 per month because medical activities, training programs, submission of reports and delivery of drugs among others was done by the rural medical practitioners among others3. Most studies that have been conducted have proved that email based form of telemedicine is the most cost effective method of implementation of this technology4. Furthermore, the emails contain the full medical history of the patients, they can be easily forwarded to the concerned physician, it is easy to monitor the email medical cases and thus work on them on time and emails can be flagged depending on their importance and complications to attract the attention of more physicians. For example the study conducted to study two organizations that used two different types of telemedicine technology; organization A used personal email while organization B used commercial-off-the-shelf (COTS). Organization A had more consultation services and the telemedicine technology implemented was more cost effective than of organization B9.

Table 1: Total costs associated with operating each email counselling service at the two                    organizations from Khosrowpour, Medhi (2006). Cases on the human side of                     information technology.

Email consultation per annum
COTS ($)
Purpose-written ($)
1000
19,930
31,925
2000
39,860
51,855
3000
64,650
71,785
4000
86,200
91,715
5000
107,750
111,645
6000
207,141
193,029
7000
228,691
212,959
8000
250,241
232,889
9000
271,791
252,819
10,000
293,341
272,749

Fig 2: Graphical representation of the total costs associated with operating each email       counselling service at the two organizations from Khosrowpour, Medhi (2006). Cases      on the human side of information technology.

            Telemedicine technology has also helped in the reduction of duplication services on treatment of patients which greatly decreases overhead costs and encourages peer contact to facilitate continuous education on health care which helps to maintain health care in the society. This is because telemedicine technology supports primary health care which helps to mobilize the community easier by ensuring each member of the community plays their part in maintaining health care9. Prison correction facilities have also benefited from telemedicine technology as transporting inmates to the nearest health care units which mainly is the provisional centre was difficult because of security reasons, time consuming and consumption of prison resources for example capital that could have been used to improve other areas of the correction facility, such as increase of community based work. However, the basic principles that protect inmate/doctor relationship must be adhered to. This is ensured by outlining telemedicine policies and procedures in accordance to the stipulated regulations of the National Commission on Correctional Health Care’s Standards for Health Services which govern health care delivery systems of prisons, rehabilitation centres and juvenile institutions8.

            Telemedicine has also enabled the control and cure of hepatitis C in the world through training facilities and education programs that educate communities on the effective measures to implement in an attempt of curbing hepatitis C or preventing its spread5. With such progress in the near future it will be easy to curb and treat diseases that cause global threat to the health of individuals for example the Mexican health practitioners are using telemedicine technology to liaise with other health practitioners from the world to help them curb swine flu which has depicted the potential of population elimination. On the other hand medical health professionals from other countries do not have to travel to Mexico to offer their second opinions that regard the disease.

Legal and ethical aspects of telemedicine

            Telemedicine technology has however raised ethical and legal questions concerning the responsibility and liability of medical practitioners. It is not ascertained that the medical services provided are secure as ethically required so as not to cause any harm to patients and if risk management strategies implemented results to effective risk reduction, for instance fraudulent acts that may endanger the life of the patients like change in medication or dosage can occur easily12. Although telemedicine enables medical professional to improve health care delivery systems especially in the developing countries which face limited budgetary provisions, provide the required medical care regardless of the location of patients and are able to manage complex systems of health while efficiently storing the collected information, the process does not advocate for creation of client friendly relationship13. International Code of Medical Ethics and legal laws demand a high degree of confidentiality services that do not disclose any information related to their patients even after death not unless the patients gives them the authority to do so13. However, the use of information communication technology does not fully guarantee patients total confidence, for example when using BASN instances of eavesdropping are prudent13. Telemedicine has also increased intellectual property infringement cases because of software piracy by unscrupulous businessmen due to the loopholes in the intellectual property rights which comprise copyright laws, patents, trademark and design rights among others13.

Conclusion

            Telemedicine technology is growing at a rapid rate as its expansion can be depicted by the implementation of the technology concept in surgery, radiotherapy and ophthalmology among others. The implementation cost of the technology is decreasing as the world is rapidly undergoing globalization which supports incorporation of technological advancement. However, there are still areas in medicine field that need formulation of new telemedicine technology to be effectively dealt with in the future for instance reverting disastrous medical outcomes and effective telemedicine risk management. Also many private insurers do not provide health medical cover to institutions that practice telemedicine as they regard most accidents and misfortunes to have resulted from the malpractice of the health care practitioners. This is because they do not interact face to face with their patients therefore do not offer customer friendly services thus end up losing more clients who prefer to visit medical care centres where they will meet face to face with the medical health practitioner, as they will give them undivided attention which makes them feel relaxed and further trust the diagnosis the medical practitioner will formulate. Furthermore, more research should be conducted to help increase the security and confidentiality of the telemedicine which currently raises ethical and legal concerns that are against medical practices and norms.  Also more research should be conducted to enable formulation of other adequate and cost effective telemedicine technologies as most of the current technology used is not sufficient for instance telephone lines do not have the required bandwidth which is essential for the society to maximally benefit from the telemedicine technology. Therefore, the government should take essential steps and support telemedicine technology to enable effective delivery of health care systems to all regions of the country. Also the government should set aside funds that will act as insurance cover to medical facilities that offer telemedicine services and have not yet been offered health care insurance cover.

Word Count: 3035

Bibliography

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1             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005a). Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 9:66–72.
[1]             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005a). Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 9:66–72.
[2]             Martinez, A., Lopez, D. M. and Saez, A., et al. (2005). Improving epidemiologic surveillance and health promoter training in Rural Latin America through ICT. Telemed J E-Health 11:468–76
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
9             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
[3]             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005b). A study of a rural telemedicine system in the Amazon region of Peru. J. Telemed Telecare 10:219–25.
3             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005b). A study of a rural telemedicine system in the Amazon region of Peru. J. Telemed Telecare 10:219–25.
[4]             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
[5]             Wootton, Richard, Craig, John and Patterson, Victor (2006). Introduction to telemedicine.  2nd Ed. Wimpole Street, London: RSM Press.
5             Wootton, Richard, Craig, John and Patterson, Victor (2006). Introduction to telemedicine.  2nd Ed. Wimpole Street, London: RSM Press.
[6]             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
[7]             Burke, Lilian and Weill, Barbara (2005). Information technology for the health professions. 2nd Ed. London: Pearson Prentice Hall.
[8]             Hall, Jesse, Schimidt, Gregory and Wood, Lawrence (2005). Principles of critical care. NY: McGraw-Hill.

8             Hall, Jesse, Schimidt, Gregory and Wood, Lawrence (2005). Principles of critical care. NY: McGraw-Hill.

4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
1          1             Colwell, Janice, Goldberg, Margret and Carmel, Jane (2004). Fecal & Urinary diversions: management principles. NY:Elservier Health Sciences.
1          1             Colwell, Janice, Goldberg, Margret and Carmel, Jane (2004). Fecal & Urinary diversions: management principles. NY:Elservier Health Sciences.
[9]             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
1             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005a). Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 9:66–72.
1             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005a). Analysis of information and communication needs in rural primary health care in developing countries. IEEE Trans Inf Technol Biomed 9:66–72.
1          0             Mann, William (2005). Smart technology for aging, disability and independence: the state of the science. Hoboken, New Jersey: John Wiley and Sons.
1          0             Mann, William (2005). Smart technology for aging, disability and independence: the state of the science. Hoboken, New Jersey: John Wiley and Sons.
[10]          Mann, William (2005). Smart technology for aging, disability and independence: the state of the science. Hoboken, New Jersey: John Wiley and Sons.
9             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
8             Hall, Jesse, Schimidt, Gregory and Wood, Lawrence (2005). Principles of critical care. NY: McGraw-Hill.

9             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
6             Cullen, Rowena (2006). Health information on the internet: a study of providers, quality and users. Westport, CT: Greenwood Publishing Group.
3             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005b). A study of a rural telemedicine system in the Amazon region of Peru. J. Telemed Telecare 10:219–25.
3             Martinez, A., Villarroel, V., Seoane, J. and Pozo F. (2005b). A study of a rural telemedicine system in the Amazon region of Peru. J. Telemed Telecare 10:219–25.
4             Taniar, D. (2008), Mobile computing: Concepts, methodologies, tools and applications. Hershey, PA: Idea Group Inc (IGI).
9             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
9             Khosrowpour, Medhi (2006). Cases on the human side of information technology. Hershey, PA: Idea Group Inc. (IGI).
8             Hall, Jesse, Schimidt, Gregory and Wood, Lawrence (2005). Principles of critical care. NY: McGraw-Hill.

5             Wootton, Richard, Craig, John and Patterson, Victor (2006). Introduction to telemedicine.  2nd  Ed. Wimpole Street, London: RSM Press.
1          2             Lin, Carolyn and Atkin, David (2007). Communication technology and social change: theory and implications. NY: Routledge.
1          3             Cowen, Perle and Moorhead, Sue (2006). Current issues in nursing. 7th Ed. NY: Elsevier Health Sciences.
1          3             Cowen, Perle and Moorhead, Sue (2006). Current issues in nursing. 7th Ed. NY: Elsevier Health Sciences.
1          3             Cowen, Perle and Moorhead, Sue (2006). Current issues in nursing. 7th Ed. NY: Elsevier Health Sciences.
1          3             Cowen, Perle and Moorhead, Sue (2006). Current issues in nursing. 7th Ed. NY: Elsevier Health Sciences.

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