Telehealth or Telemedicine

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					Telehealth or Telemedicine


        Telemedicine is the use of electronic communications and information technology to
provide clinical services in which the participants are in different places. Closely associated with
telemedicine is the term telehealth.

        This term is often used to include a wider application of technology for distance
education, the proliferation of consumer and other applications where electronic communications
and information used in support of health care. Videoconferencing, transmission of still images,
e-health including patient portals, remote monitoring of vital signs, continuing medical education
and nursing call centers are considered part of telemedicine and telehealth.

        Within the existing health facilities, some of the key personnel have often led to clinical
development of telemedicine applications. The results offered the first telemedicine reflects the
clinical specialties heads. The best examples in the past have included radiology, dermatology,
cardiology and pathology.

        Telemedicine is not a separate medical specialty, but rather is a tool that can be used by
health professionals to extend the traditional practice of medicine outside the walls of medical
practice. In addition, telemedicine a way to help transform health care itself, encourage greater
consumer participation in decision making and provide new approaches for maintaining a
healthy lifestyle.
       Most definitions focus on improving access to health care through the use of
telecommunications technology. Logan (1998) defines telemedicine as "simply a tool that has
made a more equitable distribution of specialty and subspecialty comprehensive health care to
remote populations." Other definitions include the use of medical knowledge and remote access
if necessary to seek or give advice on care.

       It is so obvious that telemedicine is a diversified and broad concept that includes the
transfer and sharing of medical information via telecommunications technology. Beyond the key
concepts of the individual patient / physician interface and Craig Patterson (2006) describes the
natural extensions which may include electronic links between services to support multi-center,
local, national or international, announces the terms "telemedicine" and "Remote Assistance".

       Other terms used when talking about technology in the healthcare sector include
telemedicine, which refers to the provision of health information via telecommunications
technology. Tele Healthcare delivery can be as simple as two health professionals discussing a
case by telephone, or as sophisticated as using videoconferencing between providers at facilities
in both countries, or even as complex as robotic technology.
Types of Services

The delivery of distance health services are used for different purposes:

1. Specialist referral services typically involves a specialist to help, ask a doctor to
diagnose. This may mean that a patient "seeing" a specialist over a live, remote
consult or the transmission of diagnostic images and / or video, and later with the patient to a
specialist for viewing.

2. Direct care, such as sharing of audio, video and medical data between a patient
and health professionals to make a diagnosis, treatment, prescription or advice. This may
include patients who are at a remote clinic, doctor's office or at home.

3. Remote patient monitoring uses devices remotely collect and transmit data to a
monitoring station for interpretation. Such "home telehealth" applications, the use of
telemetry equipment for a number of vital functions like blood pressure, glucose, ECG, weight or
record. Such services may be used to the use of the appearance to fill nurse.

4. Medical training and coaching, from the supply of medical education credits for health
professionals and special medical education seminars for the public in an interactive expert
advice to other professional services of the medical procedure.

5. To receive medical and consumer health information on the Internet for health
information to consumers and online discussion groups to obtain peer-to-peer support.
Areas for Collaboration between Telemedicine and Health IT

       Lessons learned over 30 years of telemedicine networks, providing medical services in
remote and learned that it is important to understand and use to meet national targets for
participation in HIT. 200 institutional networks and hundreds of local and remote health
monitoring programs in existence, to leave all advanced HIT established telemedicine networks
contain a rich source of information.

       Over the years, the developers of these networks and programs of technical and
operational protocol configuration is based on the conditions of their service area in the
participating institutions that are part of the network are met. To take into account the lessons
learned from telemedicine to understand the organizational and technical decisions have been
made, and that led to success is important. Four main areas of experience the necessary rest, and
have developed over the years.

First create and maintain the organization of network connections,
       There are many telemedicine networks of several independent companies to work
together toward a common goal, the medical supply. The development of telemedicine networks
had international agreements and organizations that negotiate to issues such as governance,
fiduciary responsibility and supervision in an environment where multiple partners, same, very
similar to the proposed structure of the regional information Health (RHIOS) or health care
organizations to share information. Telemedicine network should focus on building trusting
relationships between the institutions, professionals and patients on the treatment of a doctor at
another institution. Often the doctor / patient relationship exists in remote regions where they are
the provider and the patient's autonomous institutions that have never met face to face.
          Most telemedicine networks form a natural alliance with the radio does not always
normal to the limit. The relationships often begin with the demolition of the existing institutions
and networks and links that do not compete for patients to adapt the network to patient transfers
and payment services through reimbursements, contracts, grants, and the signing of the health
system. A number of successful networks were telemedicine network in all major medical
facilities (usually in a limited geographical boundary), the distributed network management, such
as basic infrastructure, which connected every node network to another user on the system
without penalty can be and the Payment Network membership is acquired, fees, contracts and

          Both networks are based on a critical understanding of the current political and economic
structure of health care in the region and was part of the success of the telemedicine programs in
a number of possible areas of cooperation: the existing networks for telemedicine can be used as
the initial criteria and examples used, the mechanisms of exchange of health data (eg. RHIOS),
building on existing networks of clinical care and safe use of established networks and
bandwidth for other applications in medical technology. However, regional approaches to
development is the establishment of uniform health information by patients and unified billing
system is essential for the full realization of the benefits of clinical services at a distance.

Second overcoming the resistance
          Health is an organization historically, the technology takes over. The delay in adoption
curve proved to be an obstacle to any initiative, under which the use of technology in the
application. Accelerate the adoption of all forms of medical technology is considered essential to
achieve better results, better access and greater efficiency. While telemedicine focuses on the use
of medical and telecommunications technology to the direct patient care, the development and
deployment of technologies of information, including electronic records and billing systems are
an integral part of the development of health care and essential successful implementation of
remote medical services.
       Telemedicine projects in the difficulty of organizational change in the adoption of the
new system. The problems include a change is that the medicine can be practiced, and requires
that the local leaders to identify and maintain the highest administrative support to ensure that
change takes place. Telemedicine initiatives also had problems with training a new system of
organizations involved in health care. The training of nurses, doctors and billing clerks, among
other things, was an important step in the successful implementation of the telemedicine

       The possible areas of cooperation: Champions for the development of remote health
services and medical care, and implementing advanced HIT are often from different departments
in different sets of individual and organizational relationships. New alliances have in the
technology leaders such as health, clinical medicine and public health will be taken to overcome
resistance, and develop joint plans for the association of health information networks.

3. Surmounting the Absence of Standards and Guidelines
       The question has long been a telemedicine standards. Telemedicine advocates have to
contend with incompatible software and development tools with proprietary standards and lack
of agreement on the protocols, policies and corporate strategies. Until recently, the market
advanced medical devices for telemedicine is not large enough to great economic effort to win to
establish uniform standards. Has in some cases, telemedicine, the technical standards defined in
the related markets received. For example, the use of ANSI H.32x regime of large video
conferencing interoperability, which may lead to further growth in this market, a strong decrease
in the cost of equipment and capabilities of the interactions between independent parts of that
hardware. Naturally, the development of HL7 and DICOM standards, a big advantage.
       There is still much to do. Interoperability is not in the fast-growing applications areas
such as home monitoring TeleHealth and distances for patients and consumers are
available. Fortunately, the recent expansion of the telemedicine market is falling cost of new
technologies and the convergence of telemedicine and other HIT applications offers new
opportunities for the technical specifications.
       In addition to the technical standards, the telemedicine community must continue to
develop common protocols and guidelines for the clinical and administrative activities related to
patient care at a distance. The need for standards is especially true in the rapidly growing
application areas such as mental health.

       The possible areas of cooperation: the increasing maturity and size of the telemedicine
market and the new government to focus on the implementation of HIT, chances are the manager
and other applications of telemedicine HIT work. Specific areas of mutual cooperation should be
based on the quality and technical criteria necessary to focus communication networks to ensure
interoperability on several levels. These allow sharing different medical record systems to patient
information, so that connected the various remote medical devices with each other or the same
system, allowing health professionals to remotely power on instant access patient history.

       Of course, not all standards that are being made to the development of important
telemedicine. ATA is currently working on the specific clinical and administrative guidelines for
telemedicine. But there are important areas of cooperation would not be wise, and to identify
representatives of telemedicine and HIT on areas of cooperation.
4th The financial sustainability
       A final point is the common concern is the need for sustainability. Obviously, it is
necessary that the ECS is an attractive business model. The same problem is also asked of great
importance for many applications of telemedicine, especially for those willing to pay for the
necessary technology and services are not necessarily those that benefit income. In telemedicine,
many established models of sustainability and political decisions can be instructive. For example,
many programs offer telemedicine services in a sustainable way into the prisons, the transport
cost savings by prisoners to avoid costly medical centers take. Some telemedicine network to
implement a membership model, require that all participants pay a fee to cover expenses related
facilities infrastructure.Elsewhere, a package has been developed that prices are supported at
TeleHealth Services and Information System.

       Other models were built in the insurance business hours in the emergency room or the
provision of services with limited mental health of a company is not sufficient to provide
additional infrastructure costs. These models of sustainability should be able to provide useful
insights can the infrastructure for healthcare organizations, RHIOS and exchange of information
and the National Health Information Network (NHIN). Public policy decisions contributed to the
development of telemedicine and distance learning in health care in Arizona, Kentucky and
Missouri State persuaded to support telemedicine a match from the state budget, is successful
with the argument that the public benefit. Several other states have undertaken private insurers to
pay telehealth services (eg California).More should be done, and the cooperation between the
telemedicine and relevant organizations, significant progress in promoting both the telemedicine
and HIT, including integrated business models, to determine what the cost-benefit factors, and to
properly identify the technical, clinical, and administrative follow.
Benefits of Telehealth or Telemedicine

        The Telehealth system is designed to generate revenue, significantly reduce cost and to
improve the quality and timeliness of the delivery of medical services. With additional use of the
equipment, it will improve access to education for medical professionals and improve
communication between medical practitioners. There are a range of benefits of telehealth, which
directly apply to individual patients, family members, and healthcare providers, as well as to
community organizations, healthcare facilities, and governments.

        Direct and indirect benefits of telehealth include improving the way patients and their
families access information; improving health outcomes for patients; empowering consumers and
communities by providing accessible health education and decision-making options; improving
the way healthcare providers deliver care and access information; enhancing recruitment and
retention of healthcare providers in rural/remote areas; lowering healthcare costs, reducing
travel, minimizing time off of work, and decreasing patient wait time; decreasing patient anxiety,
eliminating unnecessary repeat diagnostic procedures or tests; improving early diagnostic
capabilities; improving administrative and communication capabilities; and improving
emergency triage.

        The economic benefits of telehealth are job creation, increased research and development
investment; new business for existing and new healthcare providers, companies and solo medical
practices; and increased national competitiveness at various levels including local, regional,
national and international.Additionally, telehealth benefits patients in areas in which traditional
delivery of healthcare services are negatively affected by distance and/or lack of specialist
clinicians to deliver services.
       These also can be divided into benefits for the patient, remote (sending) health care
provider, central (receiving) health care provider and the health care payer (insurer).

Benefits - Patient

      Improved access to medical specialists
      Quicker , more accurate diagnosis and treatment ---> improved patient outcomes
      Reduced travel
      Decreased stress
      Decreased cost (travel, meals, accommodation, lost work)

Benefits – Remote Health Care Provider

      Improved access to medical specialists
      Increased confidence in management
      Increased opportunities for education (CME at a distance, students can attend classes
       virtually, can attend
      conferences virtually)
      Decreased professional isolation
      Collaborative research
      "Electronic housecalls"

Benefits – Central Health Care Provider

      Decreased need to travel - "see patients, not the road"
      Improved screening of patients
      Improved follow-up
      Increased educational opportunities
      Collaborative research
Benefits - Health Care Payer

      Decreased overall health care costs (per patient)
      Reduced patient travel costs
      Reduced physician travel costs
      Improved patient outcomes
      Less admissions to hospital
      More patients treated at remote site or at home
      More specialists can visit region, more often, at less expense
      Human resources are used more efficiently, "Do more with less"
      Health professionals are attracted to and kept in the region
      Back-up nurse practitioners

Disadvantages of Telemedicine

      Have not demonstrated that it has the ability to save money
      Health policy and strategy have yet been established.
      Many states won’t allow out-of-state physicians to practice medicine unless they’re
       licensed in that state
      Underlying fears of malpractice suits for physicians engaged in telemedicine because
       there is a lack of hands-on interaction with patients.
      The Centers for Medicare and Medicaid (CMS) have placed restrictions on the amount
       given in reimbursements for telemedicine procedures, and many private insurance
       companies will not reimburse at all for this technology.
      Technological problems. Telephone lines and rural areas not having cable.
The Future of Telehealth

          Telehealth was built with the premise in mind that telecommunications technology is a
tool that can drastically improve the distribution of medical care services. The utilization of
telehealth systems in the United States will undoubtedly continue to rise upward. According to
the aforementioned survey on telehealth, 84% of agencies stated that fewer than one in ten of
their patients refused such systems, and fewer than 1 in 20 people refused telehealth services.
Based on surveys such as this, as well as the overall consensus of telehealth in the healthcare
industry, it is clear that consumers are clearly ready for telehealth in the home. Not only do
telehealth services increase patient satisfaction, but they also produce far greater quality
outcomes and a reduction in on-site visits, unplanned hospitalizations, and emergency room

          In terms of telehealth’s benefits to physicians, telehealth technology contributes to
healthier, more satisfied patients, which thereby equates to cost savings and maximized
operational efficiencies. In addition, telehealth allows healthcare providers well-organized access
to a larger pool of patients because of their increased range of services – a big plus in today’s
competitive market.

        Telemedicine is the practice of giving medical care through the use of videoconferencing,
Internet, and so on. There is no need for the physician and patient meet. The main function of the
Telemedicine Act 1997 is to provide rules and regulations on telemedicine. This act must be read in
conjunction with the Medical Act 1971. Telemedicine has video communications, audio and data as well.
If any of these items are not met, it may not be in terms of tele-medicine in our country. The primary role
of telemedicine is the health care, although it was a question of distance between patient and physician.
Basically, the most important questions regarding telemedicne are on the consent of the patients who
participated in the licensing of professionals and the confidentiality of information.

         Before the doctor can practice telemedicine telemedicine, they must first get approval from their
patients. It was laid down in § 5 of the Act and the consent must be in writing. Although the issue of
confidentiality of information is not specified in this Act is, however, the rules that regulate the Malaysian
Medical Council Code of Professional Conduct. There is rapid development in Malaysia in terms of
telemedicine, the 4 stages, the mass of information on health and personalized education (MSPHIE),
Continuing Medical Education, tele-counseling, life adapts Health Plan.

         Telemedicine in the United Kingdom is known as a cyber-doctor and basically the same. The
consultation paper will be involved in practice and the patient's condition, may even have been transferred
to other countries, but was protected by the Privacy Policy of the OECD. The situation in the U.S. is
different because there are several States, the practice of one doctor for telemedicine to become fully
allowed. This has reduced the number of practitioners in the United States. The doctor may even cross the
border of telemedicine practice, provided you have the license.

         Malaysia has established the Telemedicine Act 1997. Although this act was given royal assent on
June 18, 1997 and then was 30th in the Gazette in June 1997, but still cannot be applied until now.
However, the government may modify or add more than one section, several chapters; the solution in
terms of what was the penalty for the professional telemedicine, if there was negligence, if the doctor is
liable if the cause of the negligence of the issue of technology and the question of giving the competition
because they were professionals from abroad. This applies also needs had been met, there is no reason
why this act should not be forced.

Alaszewski A & Cappello R (2006) Piloting Telecare in Kent
County Council: The key lessons final report – 2006. Centre for
Health Services Studies, University of Kent.

Bowes A & McColgan G (2006) Smart Technology and
Community Care for Older People: Innovation in West Lothian,
Scotland. Age Concern Scotland.

Brownsell S & Bradley D (2003) Assistive Technology and
Telecare: Forging solutions for independent living. Bristol:
Policy Press.

Clark M & Goodwin N (2010) Sustaining Innovation in
Telehealth and Telecare. WSD Action Network. London: King’s

Comas-Herrera A & Wittenberg R (Eds) (2008) European
Study of Long-Term Care Expenditure. Report to the European
Commission, Employment and Social Affairs DG. London:
Personal Social Services Research Unit, London School of
Economics. PSSRU Discussion Paper 1840.

Coyte P, Goodwin N & Laporte A (2008) Policy Brief. How
can the settings used to provide care to older people be balanced?
Denmark: WHO Regional Office for Europe.

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