Telemedicine.+service+delivery+to+isolated+and+remote+areas

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**Additional Information By: Lana Bilani**



[|TELEMEDICINE]
 “Telemedicine is the use of electronic or digital communication technologies as a method of delivering health/ medical education and medical care”. These methods of communication can include: still images, audio feeds, telephone calls, e-mails, or video transmissions. Through the use of telemedicine, specialists aim to bring their services to the patients instead of having the patients come to their services. For example, telemedicine allows specialists to care for their patients in their homes or even on vacation. It also greatly aids those who live in inaccessible or underdeveloped areas who would normally not have access to good, reliable health care. Telemedicine helps destroy different barriers such as distance, location, time, weather, and economics.
 * What is Telemedicine?**

The first form of Telemedicine took place after the invention of the telephone in 1906. Through the use of the telephone, sick patients could vaguely communicate with the doctor or specialist and inform them of their condition. Unfortunately the doctor could not actually see the patient and could only rely on the information the patient provided them. In the 1900s, people living in isolated areas of Australia used two-way-radios to communicate with the Royal Flying Doctor Service of Australia for medical purposes. Years later, in the 1920s, ship radios were used to link physicians with sailors at sea during medical emergencies. The first facility to use closed-circuit television for health reasons was the Nebraska Psychiatric Institute in 1955. Almost fifteen years later, in the 1970s, paramedics in isolated areas of some Alaskan and Canadian villages were able to link to hospitals in urban towns via satellite to perform lifesaving techniques. Today however with the use of newer technology, specialists and consultants are able to react faster and more efficiently to those in need.
 * A Brief History of Telemedicine**

 This type of Telemedicine does not require the presence of both the doctors/ specialists and the patients and works best for non-emergency situations. Patients can be in both urban and rural areas. Store and Forward usually takes the form of a ‘multimedia email’ that contains medical information including: medical images, biosignals, or videos. This email is then sent to a consultant or medical specialist. As the specialist is not online with the patient, they may review the information on their own or consult other specalists. Once the specialist has reached a conclusion, they will then send back their reply to the paitent. Real time telemedicine requires the presence of the patients and the consultant/ specialist and can be as simple as a phone conversation or as complicated as robotic surgery. A communication link allows them to communicate in real time. Video conferencing is the most common form of communication. Many times during the session, peripheral devices are attached to computers to aid the specialist. For example a tele-otoscope would allow the specialist to see inside to patient’s ear and a tele-stethoscope allows the spiciest to hear the patient’s heartbeat. This type of telemedicine has to do with x-rays. Teleradiology is the ability to send x-rays from one location to another for diagnostic purposes. Once the x-ray has been sent by one party and received by another, it can be viewed on the computer or printed out. This type of Telemedicine is basically a conference/ consultation between a doctor/ specialist and a patient. It involves both parties communicating to each other live over long distances via web cams. This type of Telemedicine is helpful for both the patient and the doctor as the patient can digitally show the doctor what is wrong with them. The doctor can then base their decision what they see, instead of what they hear over the phone or read in emails. This type of Telemedicine is especially helpful for those who cannot leave the comfort of their home for medical or physical reasons. Home Care allows patients to communicate live to their doctor/ specialist via video or voice links on their home computer. Through the use of their home computer, the patient can also send their doctor their current medical situation such as their pulse, blood pressure, chest sounds, the content in their syringe, etc.
 * Types of Telemedicine**
 * **Store and Forward**
 * **Real Time**
 * **Teleradiology**
 * **Video Conferencing**
 * **Home Care**
 * Medical Fields Using Telemedicine**

The branch of medicine concerning the heart. “The branch of medicine dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness”. The section of medicine that focuses on the development, diagnosis, treatment, and prevention of tumors (cancer). The section of medicine concerning the skin (hair, acne, moles, nails, sweat glands etc) "The study/ diagnosis of disease through examining the organs, tissues, cells and bodily fluids" The branch of medicine that deals with the nervous system and its disorders.  Telemedicine is a positive factor for the patients, the specialists/ doctors and for the economy. It is positive for the patients because it allows more people to stay out of nursing homes and hospitals longer. This in turn, allows them to continue working longer and to avoid high medical costs. It also gives the patients the secure feeling that they can receive professional medical attention without having to leave their home. It is also positive for people living in isolated or rural areas who, through telemedicine, can receive the special attention they need. Telemedicine is beneficial for the consultants/ specialists because it allows them to communicate with other doctors in other counties and evaluate and diagnose their patients, thus weakening cultural borders. Telemedicine allows specialists to educate and teach each other new techniques and tricks. It also decreases the time the specialists must spend with their patients. They no longer have to wait for late patients for cancellations. The economy benefits from telemedicine because they no longer have to spend money on transporting patients to and from the hospital. It also benefits from the fact that people can stay in work longer.
 * **Cardiology**
 * **Psychiatry**
 * **Oncology**
 * **Dermatology**
 * **Pathology**
 * **Neurology**
 * The Uses of Telemedicine**


 * Advantages and Disadvantages**
 * Advantages**


 * Helps people in isolated areas receive health care
 * May keep people working longer
 * Keeps people from traveling to the hospital which in turn can save gas and stop pollution
 * Helps specialists communicate with other specialists in other countries
 * Can be used to educate rookie or armature doctors
 * A benefit for the physically disabled - do not need to leave their home
 * Can weaken geographical barriers
 * Disadvantages**


 * The distribution of technology is difficult – not everyone who needs it receives it
 * Specialists need to be trained to use telemedicine – which is not offered everywhere
 * Not everyone has access to a computer or video monitor
 * Language barriers may present a problem


 * Social & Ethical Issues**
 * 1. Reliability**


 * All hardware and software used in telemedicine MUST be reliable especially in an emergency situation. For example,what if in the middle of a consultation the hardware gives out leaving the patient alone to deal with their issues? Having unreliable hardware and software could be potenally dangerous for both the patient and the specialist.
 * In emergency situations, the specialist/ consultant should be a reliable one and not an imposter or armature right out of medical school
 * 2. Integrity of Data** -
 * 3. Security**


 * Since telemedicine is electronic and digital, it would be possible for someone to hack into a database and steal information on some of the patients. They could have access to recorded videos, telephone calls, pictures, and all sorts of medical information.
 * 4. Privacy and Anonymity**


 * If a patient is talking to a doctor, the network may not be secure and therefore it would breach the patient’s privacy.
 * Since doctors may share information to other doctor’s about their patient, the patient should be sure that their very personal information is kept private.
 * 5. Authenticity** -
 * 6. Intellectual Property** -
 * 7. Equality of Access**


 * Telemedicine helps many people in many different areas and locations.
 * Many people, not all, have access to quality education
 * Not everyone has access (due to cost or location) to the equipment and machinery used by a doctor to monitor a patient
 * 8. Control**


 * Telemedicine may soon come to control people. Especially those who are paranoid or hypochondriacs may abuse the system and constantly call or annoy their doctor. And since they do not have to leave their home it will make it easier for them.
 * 9. Globalization and Cultural Diversity**


 * Telemedicine helps reduce cultural and geographical boundaries
 * Specialists from different countries can assist those in remote locations
 * Specialists can communicate with other specialists and discuss their patient’s symptoms, disorders, or issues
 * Specialists can learn from other specialists without having to travel to meet them
 * 10. Policies and Standards**


 * Will there be new policies for giving out subscription drugs?
 * 11. People and Machines**


 * The use of telemedicine will benefit many people
 * It will make work for specialists/ doctors easier
 * May result in unemployment of ambulance drivers, secretaries, and nurses