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Temedicine is a rapidly developing application of clinical medicine where medical information is transferred through ICT for the purpose of consulting, remote medical procedures or examinations. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and videoconferencing equipment to conduct a real-time consultation between medical specialists on earth and in outer space. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and interactive services.

Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology, radiology, endocrinology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The store-and-forward process requires the clinician to rely on the history report and the audio/video information in lieu of a physical examination.

Remote monitoring ,also known as self-monitoring/testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters supply greater satisfaction to patients than store-and-forward telemedicine, and are cost-effective.

Interactive telemedicineservices provide real-time interactions between patient and provider, to include phone conversations, video conferencing, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services are less costly than in-person clinical visits.
Telemedicine is most beneficial for providing health services at the doorstep of populations under Assisted living or populations living in isolated communities, remote regions; and for populations gathered in large numbers for religious congregations like Kumbh mela, Rath yatra, Haj, Church services etc. for monitoring public health & hygiene. Telemedicine is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a "tele-" prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as Telecardiology, etc.

Monitoring patients at home using known devices like blood pressure monitors, ECG etc. and transferring the information to a caregiver is a fast emerging service all over the world. These remote monitoring solutions currently have a focus on high morbidity chronic diseases and are mainly deployed for the First World owing to high costs. Thus there was/is a need to evolve a new way of practicing telemedicine whereby a doctor needs to use devices remotely to examine and treat a patient. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems because Primary Remote Diagnostic Consultations will not only monitor an already diagnosed chronic disease, but has the promise to diagnose and manage the diseases at patient’s door for which the patient will typically visit a general practitioner for.

ECG or electrocardiograph can be transmitted using telephone and wireless. Einthoven, the inventor of the ECG, actually did tests with transmission of ECG through telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In addition, Electronic stethoscopes can be used as recording devices for heartbeats and a radiographic image scanner can be used to scan x-rays to be recorded on a computer and transmitted to doctor’s computers connected via Internet. Thus, it was/is very much feasible to have an integrated telemedicine system to capture the vital parameters of any patient and transmit them to a doctor through the use of computers.

The first interactive Telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was first developed and marketed in 1989. A year later a mobile cellular version was launched. Since then the technology has developed leaps & bound. Fuelled by the simultaneous growth of Internet the Telemedicine technology has become an important healthcare tool. To make it affordable to all, the government of India research initiatives in Telemedicine has resulted in the design, development & integration of low cost telemedicine equipment by School of Telemedicine and Bioinformatics, SGPGI, Lucknow. The product is called ‘ mHealth4U’.


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