Development of Telemedicine beyond 2020 - Essay Example

RUNNING HEAD: TELEMEDICINE BEYOND 2020 Telemedicine beyond 2020 of the of the institute] Telemedicine beyond 2020 Introduction Telemedicine, or Tele-health as it is now called, is broadly defined as the use of telecommunication technology to provide health care services at distance from the caregiver. Telemedicine was initially designed with radiology and psychiatry services in mind in the 1960s. However, it was only in the 1990s that telemedicine programs were more widely implemented. Traditionally, interactive videoconferencing has been the most commonly used modality to deliver Tele-health services. Videoconferencing allows participants at two or more sites to "meet" for real-time interactions. (Loane et. all 2001) Telemedicine consultations typically involve consulting provider at one site, and the patient at another. For many consultations, the patient is accompanied by health professional, often nurse or mid-level provider, who presents the patient to the consultant. Stethoscopes, otoscopes, hand-held cameras, and other medical peripheral devices enhance the ability of the consulting provider to examine patients and recommend treatment during Tele-consultations. Document cameras and features such as remote camera control and white boarding make it possible for health professionals, educators, researchers, and administrators to easily share documents and other images between sites. Typically, videoconferencing has been delivered via telecommunication lines utilizing bandwidth of 384 kilobits per second (kbps), equivalent to 1/4 T1 line or 3 ISDN lines. Although less than broadcast quality, image quality is nonetheless considered adequate for the majority of face-to-face encounters. In general, the higher the bandwidth used, the clearer the picture. With less bandwidth, picture quality deteriorates and the system responds more slowly to the participants' movements, resulting in jerkier, fuzzier image. Still images, however, can be captured and transmitted clearly at low bandwidth. As technology has improved, many telemedicine programs have begun experimenting with lower bandwidth solutions. (Woods et. all 2000) It is becoming more common for some telemedicine applications, such as mental health consultations, to be delivered over ISDN at 128 kbps. Very low bandwidth video, so called Plain Old Telephone Service (POTS)-based video, which uses standard analogue phone lines, is being widely implemented in Tele-home health applications. At the beginning of the 1990s, videoconferencing equipment was expensive, cumbersome, and built around proprietary standards. By the end of the decade, the cost of roll-about room videoconferencing system dropped from roughly $60,000 to less than $10,000, and the cost continues to fall. Today, POTS based video units can be purchased for $300-$500. Other videoconferencing solutions such as set-top units, portable, and desktop systems fall into price range between $1,000 and $5,000. (Riley et. all 2003) Types of accessible systems The majority of the accessible telemedicine systems is clearly "low tech" and slow. Presently, most of the teleconferencing is reliant on communication via usual phone line, T-1 line ( 24-channel, high-capacity circuit for data, voice, and video transmission), or in unusual cases an OC3 fibre optic cable connection ( 243-channel, high-powered fibre optic circuit for data, voice, and video broadcast). Sadly, the T-1 communications connection is insufficient for high-resolution, real-time clinical interactions. conventional telephone line and modem provide data transmission at maximum rate of 64 kb/sec. T-1 line will provide maximum data transmission rates of from 1.5 to 2.0 megabytes (Mb) per second, and fibre-optic OC3 line is able of supporting rates of up to 155 Mb/sec under optimal circumstances. Unfortunately, these rates of data transmission are rarely achieved in custom daily use. (Taylor et. all 2003) good example of the problems intrinsic with present telemedicine systems is understanding of clinical radiographic films. Using currently accessible Tele-radiology system and T-1 line takes about 11 minutes to transmit digital mammogram, which contains only 128 Mb of data. Transmission of more complex imaging study, for example magnetic resonance imaging (MRI) that contains as much as 1 gigabyte of data, will require 1 1/2 hours! These time necessities are obviously unacceptable for the most clinical activities, mainly in an emergency or trauma setting. On the contrary, the similar digital mammogram and MRI data would require simply 6.4 seconds and 52 seconds, in that order, using an OC3 line. Broadcast of the similar data sets over an OC48 line would need only 0.4 seconds and 3.3 seconds, correspondingly. High-speed land lines, for example OC3 fibre optic cables, are not extensively accessible currently. Modern availability is narrow above all to large urban areas. Sadly, patients getting care in rural hospitals that could advantage mainly from teleconferencing are not possible to be entitled for these services because lack of fibre optic communications. (Smith et. all 2003) Satellite-based telemedicine could quickly fill the gap now at hand in the area of high-speed data broadcast. The Advanced Communications Technology Satellite (ACTS), which is competent of 622-Mb/sec transmission rate, was freshly used in an testing that linked physicians at Phoenix Children's Hospital in Phoenix, Ariz, with consultants at the Mayo Clinic in Rochester, Minn. Using ACTS and high-speed fibre optic land lines, essentially real-time consultative evaluations of 38 patients with congenital heart disease, together with review of cineangiograms, were done. These long-distance consultations were supposed to be comparable to in-person, "hands on" consultations. comparable test sponsored by the National Aeronautics and Space Administration's Ames Research Centre in May 1999 provided "virtual clinic" that linked quite few remote or rural hospitals, for instance the Northern Navaho Medical Centre (Indian Health Service) in Shiprock, NM, with clinical consultants at medical universities, for instance Stanford. This computer-based program used combination of high-speed fibre optic land lines and communications satellite to supply concurrent contribution of physicians at manifold hospitals who performed actions for instance radiographic diagnosis, understanding of 3-dimensional images, and practice of effective operations. (Kennedy et. all 2003) Rising technology As technology continues to be developed, considerable hard work have been directed in the direction of expansion of Tele-presence as an attachment to having physicians on spot, or in some instances, as substitute for on-site physician knowledge. Tele-presence may be described as the aptitude to carry out "virtual assessment or involvement" for patient over distance, made likely by telecommunication technology. Whilst the prospective for Tele-presence to recover patient care is palpable, vigilance must be exercised, as this idea remains in its develop-mental infancy. So far, the utmost impediment to schedule use of telemedicine and, mainly, Tele-presence interventions for example operations has been the lack of cost-effective, reliable, good-bandwidth communication and data links. Availability of high-speed fibre optic land lines and satellite up-link and down-link services will really make easy additional progress of telemedicine and Tele-presence communication. On the other side the latest advancement in artificial intelligence will carry us on new journey of telemedicine in coming 50 years. It will help us to solve our health problems in an easy way. (Panait et. all 2004) Cost and Access Although starting to change in the last several years, the initial high capital costs for equipment and the high ongoing operational costs (line charges) have represented significant barriers to entry into telemedicine. Traditionally, federal and state funding has provided the capital for many programs to develop telemedicine network. This is becoming less of an issue as the variety of products increases and their costs decrease. Ongoing telecommunications costs, so-called line charges, are typically distance-sensitive, and therefore highest to rural areas. (Picot 2000) The Telecommunications Act of 1996 provided for the development of the Universal Service Program to reduce costs of line charges for rural health care providers. Implementation of this program has been slow, but it is now up and running as intended, providing significantly lower monthly line charges. An example from our network: line charges for T1 line for one rural hospital decreased from $2,400 per month to $580 per month. Finally, whilst access to increased bandwidth and lower-cost transmission modalities are becoming readily available in urban areas, the telecommunications options for rural areas remain very limited. (Berman & Fenaughty 2004) Telemedicine's e-Future Between 1994 and 1999, the number of active telemedicine programs increased from 24 to 170, and the average number of Tele-consultations per program increased from 88 to 608. Throughout this period, the variety of technical modalities and clinical applications of telemedicine expanded dramatically. (Lavrentyev et. all 2004) The development of telemedicine combined with the emergence of the electronic medical record, the rise of medical informatics and development of decision support systems, the explosion of the use of email and the Internet, have precipitated shift in the way health care is delivered. The e-health care revolution has arrived, although it is unclear just what that means and what the implications are for health care. As recently noted by Douglas Perednia, M.D., Director of the Telemedicine Research Centre in Portland, Oregon, "Telemedicine is one of host of technologies which have developed faster than our understanding of how to use them in rational way" Although some are predicting the demise of telemedicine in the rush to embrace e-health care, it is likely that telemedicine will evolve as component of e-health care. It seems certain that the future of telemedicine will be Internet-based and increasingly wireless. Videoconferencing will be conducted via the Web and will be more fully incorporated into health care delivery system that integrates suite of technologies. The challenge will be to rationally and thoughtfully manage the transition in this rapidly evolving health care environment. (Rafiq et. all 2004) References Loane MA, Oakley A, Rademaker M, Bradford N, Fleischl P, Kerr P, Wootton R. (2001) A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional car: J Telemed Telecare; 7(4):233-238. Berman M, Fenaughty A. (2004) Technology and managed care: patient benefits of telemedicine in a rural health care network. Picot J. (2000) Meeting the need for educational standards in the practice of telemedicine and telehealth: J Telemed Telecare; 6(suppl 2): S59-S62. Rafiq A, Moore JA, Zhao X, Doarn CR, Merrell RC. (2004) Digital video capture and synchronous consultation in open surgery: Ann Surg; 239(4):567-573. Lavrentyev V, Rafiq A, Merrell RC. 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British Journal of Ophthalmology; 87(4):502-3 Taylor P, Kennedy C, Murdoch I, Johnston K, Cook C and Godoumov R. (2003) Assessment of benefit in tele-ophthalmology using a consensus panel: Journal of Telemedicine and Telecare, 9(3): 140-5. Read More