Telemedicine, e-health and telecomunications [605016]

Telemedicine, e-health and telecomunications
Aliona Tihon
Affiliation 1: State University of Medicine and Pharmacy "NicolaeTestemitanu"Chisinau, Republic of
Moldova , [anonimizat]
Affiliation 2: Technical University of Moldova (TUM), [anonimizat]
Abstract – Telemedicine gaining popularity due to
the provision of ubiquitous health care services
that is a fundamental need for every society.Big
data analytics which is one of most rapidly
expanding field has started to play a vital role in
the field of healthcare From the invention of the
telephone, medical practitioners have employed
electronic communication to facilitate patient
care. With the advent of computer networks,
communication of clinical information both within
and between institutions has entered a new era.
Telemedicine, tele-health, and e-health have the
capacity to increase access to quality, timely, and
cost-effective specialty health care. These
technologies may not only revolutionize the way
physicians care for patients but also change the
way clinical care is structured with changes in
workflow, quality management, and transmission
of patient data. And major goal of telemedicine is
to eliminate unnecessary travelling of patients and
their escorts. Data acquisition, data storage, data
display and processing, and data transfer
represent the basis of telemedicine.
Keywords-Telemedicine, tele-health, e-health,
communication, management.
I. INTRODUCTION
Telemedicine is the delivery of health care
and the exchange of health-care information across
distances. The prefix ‘tele’ derives from the Greek for
‘at a distance’; hence, more simply, telemedicine is
medicine at a distance. As such, it encompasses the
whole range of medical activities including diagnosis,
treatment and prevention of disease, continuing
education of health-care providers and consumers,
and research and evaluation.
Telehealth or telemedicine? Health
informatics (also called health care informatics,
healthcare informatics, medical informatics, nursing
informatics, or biomedical informatics) is a discipline
at the intersection of information science, computer
science, and health care.
It deals with the resources, devices, and
methods required to optimize the acquisition, storage,
retrieval, and use of information in health and
biomedicine.
Health informatics tools include not only
computers but also clinical guidelines, formalmedical terminologies, and information and
communication systems. It is applied to the areas of
nursing, clinical care, dentistry, pharmacy, public
health, occupational therapy, and (bio)medical
research.
E-health (also written e-health) is a relatively recent
term for healthcare practice supported by electronic
processes and communication:
– Dating back to at least 50’years (from the first
computers).
– Usage of the term varies: some would argue it is
interchangeable with health informatics with a broad
definition covering electronic/digital processes in
health
– Others use it in the narrower sense of healthcare
practice using the Internet.
The terms e-Health and tele-health are at
times incorrectly interchanged with tele-medicine.
Like the terms "medicine" and "health care", tele-
medicine often refers only to the provision of clinical
services while the term tele-health can refer to
clinical and non-clinical services such as medical
education, administration, and research. Includes the
use of mobile devices in collecting aggregate and
patient level health data, providing healthcare
information to practitioners, researchers, and patients,
real-time monitoring of patient vital The term e-
Health is often, particularly in the U.K. and Europe,
used as an umbrella term that includes tele-health,
electronic medical records, and other components of
health IT. The term can encompass a range of
services or systems that are at the edge of
medicine/healthcare and information technology
(IT)s, and direct provision of care (via mobile tele-
medicine). M-health includes the use of mobile
devices in collecting aggregate and patient level
health data, providing healthcare information to
practitioners, researchers, and patients, real-time
monitoring of patient vitals, and direct provision of
care (via mobile tele-medicine).
Mobile applications may be either automatic
(e.g. passive monitoring of activity using room
sensors) or require the patient to take action (e.g.
transmitting home-measurement values using
conventional telephones or increasingly, and in
particular, smart phones). Educational applications
depend on web access of personal computers (PCs) or
smartphones and are widely applied in medicine for
distance learning and information. Such applications
will turn out to be particularly useful for primary and
secondary prevention of cardiovascular disease.
Another important application includes the remote

control of devices such as internal cardioverter
defibrillators (ICDs) and/or pacemakers.
Transmission of data from the device to a central
database with the opportunity to survey patient data
such as heart rhythm has benefit in increasing patient
safety and, hopefully also, comfort. However, the
evidence base for the value of eHealth and
telemedicine in managing a wide range of
cardiovascular diseases is, on the whole, still weak
and contradictory.
E-Health and telemedicine are excellent
examples of innovative technology. They will rapidly
evolve and become an important component of
today’s medical care. They have the potential to
reduce healthcare costs by reducing the burden of
disease, the risk of complications, hospitalizations,
recurrent events and premature death and to improve
quality of life. eHealth and telemedicine have a
particular potential in cardiovascular disease
prevention but also in the long-term care
management of patients with cardiovascular disease.
An important challenge for those involved in these
new technologies will be to keep the main focus on
patients’ individual needs and not to be overwhelmed
by the enormous speed of progress in technology and
informatics and to continue to carefully evaluate the
evidence behind the practice.
Telemedicine is not a technology or a
separate or new branch of medicine, or for that matter
even new. It is also not the panacea that will cure all
of the world’s health-related problems or a means by
which healthcare workers can be replaced. It is also
not an activity for antiquarians or Luddites, who
range from those who are simply not at ease with the
use of electronic machinery, right through to those
who feel that telemedicine threatens the very fabric of
the practice of medicine, and as such should be
actively opposed. Equally, however, it is not the sole
territory of ‘computer nerds’ or ‘technophiles’. In
fact, the tendency of these individuals to concentrate
on the technical rather than the practical when
discussing telemedicine may explain the antipathy of
some clinicians towards practising medicine this way.
Sensible, practical presentations by those who have
actual experience of telemedicine have the potential
to change the minds of those health-care workers who
feel that telemedicine is not for them, either because
it is ‘gimmicky’, industry-driven and therefore ‘less
than respectable’, or unfathomable. Finally, and
probably most important, for the most part
telemedicine is far from being a mature discipline,
and much work remains to be done to establish its
place in health-care delivery.
One of the great challenges facing
humankind in the 21st century is tomake high-quality
health care available to all. Such a vision has been
expressed by the World Health Organization (WHO)
in its health-for-all strategy in the 21st century.
Realizing this vision will be difficult, perhaps
impossible, because of the burdens imposed on a
growing world population by old and new diseases,
rising expectations for health, and socioeconomic
conditions that have, if anything, increased disparitiesin health status between and within
countries.Telemedicine is the delivery of health care
and the exchange of health-care information across
distances. It is not a technology or new branch of
medicine.
Telemedicine results from the contribution
of Information and Communication Technology
(ICT) towards heath care, and the improving health
and welfare of society. This is achieved by providing
ubiquitous health care services to remote regions.
Telemedicine has many advantages. The biggest
considerable advantage of telemedicine is the savings
of time (travel to appointments, requirements for both
patient and professional to be available,
administrative tasks, etc.), cost (organizational work
load, administrative resources, reduced travel,
utilization of consultation services at a distance, etc.),
and effort for a patient.
Telemedicine has been around ever since
patients and doctors have exchanged information
from remote locations. Recent developments in
computing, imaging, and telecommunications,
however, have increased the effectiveness and uses of
telemedicine. Almost any medical area can be
practiced from a distance. Noteworthy areas of
telemedicine include medicine, telecommunications,
virtual presence, computer engineering, informatics,
artificial intelligence, robotics, materials science, and
perceptual psychology. People are naturally
concerned about their own health as well as the
health of family and friends. Telemedicine will
continue to have a growing influence on personal and
public healthcare. The importance for everyone to
learn about these significant technologies is obvious
since we are all users, consumers, and managers of
the technologies employed in our own
healthcare.Telemedicine may be classified on the
basis of: a) the interaction between the client and the
expert (i.e. realtime or prerecorded), b) the type of
information being transmitted (e.g. text, audio,
video).
There are basically two conditions under
which telemedicine should be considered: a)when
there is no alternative (e.g. in emergencies in remote
environments), b)when it is better than existing
conventional services (e.g. teleradiology for rural
hospitals).
For example, telemedicine can be expected to
improve equity of access to health care, the quality of
that care, and the efficiency by which it is delivered.
Research in telemedicine increased steadily in the
late 1990s, although the quality of the research could
be improved – there have been few randomized
controlled trials to date.
Most telemedicine has clearly occurred in
the last 20–30 years, concomitant with advances in
information technology. If, however, telemedicine is
considered to be any medical activity performed at a
distance, irrespective of how the information is
transmitted, its history is much older. An early
example of medicine at a distance, be it one of the
first public health surveillance networks, was in the
Middle Ages, when information about bubonic

plague was transmitted across Europe by such means
as bonfires. With developments in national postal
services in the mid-19th century, the means by which
more personal health-care delivery at a distance could
be performed was facilitated, and the practice of
physicians providing diagnosis, and directions for a
cure, was established.
In the mid-19th century, telegraphy –
signalling by wires – also began and was quickly
deployed by those providing and planning for
medical care. This included its use in the American
Civil War to transmit casualty lists and order medical
supplies, with later technological developments
permitting X-ray images to be transmitted. In much
of Europe and the USA, the telegraph was rapidly
superseded by the telephone as a general means of
communication, but in Australia it survived for much
longer because of the enormous distances involved.
The telephone has been used for delivering
health services since its invention in the late 19th
century, and for 50 or so years remained the mainstay
of communication for such purposes. However, it was
realized as early as 1910 that the telephone could be
used for purposes other than voice communication;
amplified sounds from a stethoscope were transmitted
through the telephone network and similar devices
are still used today. Other uses for the ordinary
telephone network have since been realized and
include the transmission of electrocardiograms
(ECGs) and electroencephalograms (EEGs).
The next development of widespread
significance was at the end of the 19th century when
communication by radio became possible. This was
done initially by Morse code and later by voice. Use
of the radio to provide medical advice for seafarers
was recognized very quickly, and in 1920 the
Seaman’s Church Institute of New York became one
of the first organizations to provide medical care
using the radio, with at least another five maritime
nations establishing radio medical services by 1938.
One of these was the International Radio Medical
Centre (CIRM), whose headquarters are in Rome,
Italy. It was set up in 1935 and in its first 60 years
assisted with over 42,000 patients, making it the
largest single organization in the world to use
telemedicine to provide health care to seafarers.Radio
medical advice for passengers on long-distance air
journeys has also been provided more recently. For
inflight medical incidents that require professional
assistance, and which occur at a rate of about 1 in
50,000 passengers carried, assistance can be obtained
from oncall health-care workers on the ground
The common thread for all telemedicine
applications is that a client of some kind (e.g. patient
or health-care worker) obtains an opinion from
someone with more expertise in the relevant field,
when the parties are separated in space, in time or
both. Telemedicine episodes may be classified on the
basis of:
– the interaction between the client and the expert,
– the type of information being transmitted.
The type of interaction is usually classified
as either prerecorded (also called store-and-forward)or realtime (also called synchronous). In the former,
information is acquired and stored in some format,
before being sent, by an appropriate means, for expert
interpretation at some later time. Email is a common
method of storeand- forward interaction. In contrast,
in realtime interactions, there is no appreciable delay
between the information being collected, transmitted
and displayed. Interactive communication between
individuals at the sites is therefore possible.
Videoconferencing is a common method of realtime
interaction. The information transmitted between the
two sites can take many forms, including data and
text, audio, still images and video pictures. In certain
applications, such asteleradiology, a technique that
involves the transmission of digital radiographs
between institutions, it is possible for the interaction
to be either prerecorded or realtime; the latter
requires that the expert be available to give an
opinion as the image is taken and transmitted.
In broad terms, telemedicine can be expected
to improve equity of access to health care, the quality
of that care and the efficiency by which it is
delivered, by enhancing communication. Widespread
adoption of telemedicine would permit
decentralization; work previously done in the
secondary sector, for example, could be performed in
primary care and work previously done in the
primary care sector could be devolved to the
community level. Such changes, if implemented in
the developing world, could potentially have the
greatest effect, allowing underserved people to
benefit from a greatly improved standard of health
care. In all remote or rural areas,however,
telemedicine could have a great impact, permitting
among other opportunities, better diagnostic and
therapeutic services, faster and easier access to
medical knowledge, and enhanced communication
between health-care workers.
II. METHODS
We performed an automated electronic
search using the MeSH terms identified in Medline.
The terms included the following: Telemedicine,
Tele-health, e- medicine, e-Health, mobile Health.
The search terms were used as keywords.
III. RESULTS
Telemedicine can be extremely beneficial for
people living in isolated communities and remote
regions and is currently being applied in virtually all
medical domains. Patients who live in such areas can
be seen by a doctor or specialist, who can provide an
accurate and complete examination, while the patient
may not have to travel or wait the normal distances or
times like those from conventional hospital.
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… Telemedicine is also useful as a
communication tool between a general practitioner

and a specialist available at a remote location.
•Telemedicine can be used as a teaching tool, by
which experienced medical staff can observe, show
and instruct medical staff in another location, more
effective or faster examination techniques. •It
improved access to healthcare for patients in remote
locations. •"Telemedicine has been shown to reduce
the cost of healthcare and increase efficiency through
better management of chronic diseases, shared health
professional staffing, reduced travel times, and fewer
or shorter hospital stays." •Several studies have
documented increase patient satisfaction of
telemedicine over past fifteen years.
IV. CONCLUSIONS
Effective telemedicine will dramatically
improve the ability of mid-level providers (e.g.
physicians assistants, nurse practitioners, etc.) to
participate in healthcare delivery to underserved
populations. Mid-level practitioners represent an
important resource for improving access to care with
a lower increase in healthcare costs. Effective
telemedicine will both improve the resources
available to these practitioners and decrease their
sense of isolation in underserved areas.
Developments in telemedicine should recognize this
important link and fully develop its potential.
With appropriate research into the
effectiveness and funding of telemedicine, it will be a
viable method of providing health care expertise to
primary care practitioners working in rural, medically
underserved areas. Although significant challenges
exist for telemedicine systems at this time, as the
practitioner population becomes more comfortable
with information technology, the current quality
assurance processes expand to cover entire health
care delivery systems, and reimbursement issues are
resolved, telemedicine can become the primary
method of medical communication. This will enhance
all areas of health care delivery, but especially the
health care delivery for underserved populations.
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