1. Telemedicine Chapter 4

2. Telemedicine Telemedicine uses computers and telecommunications lines to deliver health care at a distance. Telemedicine may use store-and- forward technology to transmit still images or interactive videoconferencing for real-time consultation.

3. Figure 4.1a MEDI PORT Source: Courtesy of C-PORT Solutions.

4. Figure 4.1b QUADPORT are “mobile computing platforms enabled with high definition video conferencing capability.... The device allows remote medical specialists to interact with patients and provide expert counsel, which is especially important for rural clinics and field hospitals with limited medical staff. Live surgeries can be shared remotely for purposes of mentoring and better clinical outcomes are enabled via bedside access to patient data and web-based resources.” Source: Courtesy of C-PORT Solutions.

5. Interactive Videoconferencing A telemedicine consultation involves a doctor at one site with the patient at another site.

6. Figure 4.2 A telemedical consultation. Source: Corbis Bridge/Alamy.

7. Telemedicine Continues to Grow By 2010, there were about 200 telehealth networks in place in the U.S. They linked more than 2,500 institutions.

8. Telemedicine Continues to Grow The Veterans Health Administration has 50 health management programs in 18 integrated networks (2011). It has found that remote monitoring reduces the number of bed days by 25% and the number of admissions by 20%.

9. Telemedicine Continues to Grow Telemedicine has been used in prisons for years, and the prison population is growing.

10. Bluetooth Technology Can connect various devices so that, for example, when the pacemaker senses a dangerous event, the cell phone automatically calls 911.

11. Subspecialties Teleradiology Telepathology Teledermatology Teleophthalmology Telecardiology

12. Subspecialties Teleneurology, including telestroke and the treatment of epilepsy and Parkinson's Disease Telehome care, using remote monitoring devices

13. Teleradiology Oldest use of telemedicine Telecommunicating radiological images  Can be store-and-forward  Can be real-time

14. Telepathology Viewing microscopic images at a distance on a monitor  Store-and-forward  Real-time

15. Teledermatology and Teleophthalmology Teledermatology is the practice of dermatology over telecommunications networks  Store-and-forward  Interactive videoconferencing Teleophthalmology is using telemedicine to study the eye

16. Telecardiology 1960s  It became possible to transmit heart sounds accurately and to fax ECGs. 1990s  Echocardiograms could be telecommunicated.

17. Telecardiology Second opinions via telecardiology are one of the most common requests in telemedicine.  People come into rural emergency rooms with chest pains, and many ER doctors want an expert consultation.

18. Telecardiology In 2009, a study in Italy found that telemedicine could correctly diagnose heart attacks in elderly people at home. The use of telecardiology both improved diagnosis and delivered treatment more quickly.

19. Telecardiology A major area of growth for telecardiology is in the diagnosis of infant congenital heart disease.

20. Teleneurology Uses e-mail and videoconferencing, so that a neurologist can diagnose at a distance. Teleneurology is also using e-mail for making referrals. Video can be used to study gait.

21. Teleneurology Telestroke  Telemedicine is particularly important when time is a consideration.  Telestroke patients can be evaluated by experts miles away to see if they need tPA (a clot-busting drug which needs to be administered within a few hours of a stroke).

22. Teleneurology Epilepsy  In 2005, a study found that outcomes were the same for patients treated by telemedicine accompanied by a nurse as for those treated in person by a physician.

23. Teleneurology Parkinson's disease  Recent studies and pilot programs (2009–2011) have shown that telemedicine can be useful in the evaluation, monitoring, and treatment of patients with Parkinson's disease.

24. Telepsychiatry Used in areas with few psychiatrists. It can be an effective treatment for some conditions. It is not appropriate for all conditions.

25. Remote Monitoring Devices Make it possible for patients to be monitored at home from afar. New experimental devices embed sensors in wearable fabric.

26. Figure 4.3 Data from a digital spirometer can be directly transferred to the electronic health record. Source: Courtesy of Midmark Diagnostics Group.

27. Telewound Care Elderly, frail patients and patients in poor health are more likely than others to suffer from problematic wounds. Increases healing rates and decreases complications.

28. Telehome Care Involves a link between the patient's home and a hospital or central office that collects the data. Equipment (which now may be as small as a smartphone) is used in the patient's home.

29. Telehome Care In 2010, approximately 31,000 people used VA telehome care. Automated robots are being used to make house calls. Homes can be equipped with sensors that allow adult children to monitor their parents' movements. CardioCam uses “slight variation in skin tone” to measure the pulse.

30. Telehome Care The patient can telecommunicate vital signs to a nurse at a distant location, and can also speak to the nurse. Telehome care has been found to cut rehospitalizations and ER visits, and to reduce hospital stays.

31. Telemedicine in Prisons Cost effective Enhances security Improves medical care Both inmates and prison officials appreciate it

32. Other Uses of Telemedicine Baby CareLink RetCam to diagnose retinopathy of prematurity Treatment of Alzheimer's (using motion detectors to monitor patients) In daycare Teletrauma in Vermont and Arizona

33. Other Uses of Telemedicine Weight management Pain management Spinal cord injury Podiatry Teleoncology systems  Help cancer patients avoid lengthy trips to the doctor and feel more secure because they have a 24-hour link to health care.

34. Other Uses of Telemedicine SATELLIFE uses smartphones and PDAs to deliver information to health care workers in remote areas. Telenurses and doctors are using the eICU Smart Alerts or other eICU systems to monitor intensive care patients from afar and send alerts to the ICU personnel.

35. New Developments in Telemedicine Virtobot helps perform autopsies by scanning the body and taking high- definition images which are then combined with images from the CT scanner to create a 3D image of the cadaver.

36. New Developments in Telemedicine Silken brain implants to monitor and control epileptic seizures have been developed at the University of Illinois, Tufts, and the Pennsylvania School of Medicine. The iBrain (in clinical trials) is used for people with sleep apnea. The Q Sensor measures stress levels.

37. Telenursing Teletriage Telecommunication of health-related data Remote house call Monitoring of chronic disease

38. Smartphones New health-related applications for smartphones are being developed:  Airstrip OB  Tumor analysis  Fitness and weight control programs  Stress-reduction programs  Medication reminders

39. Figure 4.4 Set of touch-screen smartphones. Source: Oleksiy Mark/Shutterstock.com

40. Tablet Computers Are telehealth mobile computing devices Uses  Taking notes  Accessing records  Accessing medical references  Viewing medical images

41. Tablet Computers Clinical apps  Medication checker  Drug databases HIPAA compliant

42. Figure 4.5 A modern tablet computer with application icons ready for mobile connectivity. Source: iQoncept/Shutterstock.com

43. Technical, Legal, Insurance, and Privacy Issues An appropriate telecommunications infrastructure must be in place. In addition, several issues need to be addressed such as:  Licensing  Medical liability  Insurance  Privacy concerns  Reimbursement

44. Is Telemedicine Effective? There are many studies, but few solid conclusions:  Telecardiology is both effective and efficient.  There are ongoing studies. It has the potential of making high- quality health care available to anyone, regardless of distance to major medical centers.