1. 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.

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

3. 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.

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

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

6. 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.

7. 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%.

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

9. Subspecialties Teleradiology Telepathology Teledermatology Teleophthalmology Telecardiology

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

11. Telecardiology listening to the heart at a distance 1960s  It became possible to transmit heart sounds accurately and to fax ECGs. 1990s  Echocardiograms could be telecommunicated.

12. 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.

13. 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.

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

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

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

17. 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.

18. 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.

19. 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.

20. Telehome Care Several factors retard the adoption of telehome care. the attitudes of home health agencies, the initial cost of the equipment, reimbursement rates, and the fact there are few studies demonstrating that it is cost-effective

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

22. What Is Telenurse? The nurses use diagnostic software and are linked to databases, hospitals, primary care providers, and ambulances Nurses need to be familiar with computerized equipment and comfortable using it

23. What Is Telenurse? change the way nurses work. First, the nurses work in call centers, not clinical settings, and second, they do not examine the patient

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

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

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

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

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

29. 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

30. 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.

31. What technical, legal issues need to be addressed for telemedicine to fulfil its promise? On the technical side, require high-speed, broadband media On the legal side, issues include licensing, medical liability, and privacy concerns

32. RELATED WEB SITES The American Telemedicine Association http://www.atmeda.org http://www.atmeda.org The National Library of Medicine http://www.nlm.nih.gov can provide you with access to a great deal of information, including bibliographies http://www.nlm.nih.gov Telemedicine and Telehealth Networks: The Newsmagazine of Distance Healthcarehttp://www.telemedmag.com is a journal covering the field. Online access to past issueshttp://www.telemedmag.com