Telemedicine was initially developed by the Space agency in Houston in support of its early astronauts. An attempt was made to introduce much of the new technology for the care of remote communities in the United States of America, but it was largely picked up and established in Newfoundland by Max House who had developed a system of remote medicine in support of the remote communities of Newfoundland and Labrador who were supported by a nurse speciality in The Memorial University of St Johns. They were not unlike early Offshore/Rig Medics.

Initially, a group of specialists sat round the table at the university and had an audio conference call with each site at mid-day. Telemetry was developed for the transmission of EEGs and ECGs to the main centre but tele-pictures were more difficult and only slow-scan pictures were available.

This was investigated between Aberdeen and Memorial by transmitting x-ray images across the Atlantic but only when digital technology became available did the concept of real patient support become possible and the whole areas of remote healthcare was transformed. It soon became clear that this medium was equally useful for education and this is the mainstay of remote education particularly as the technology has developed to allow whole courses to be deliberated at home or in a clinic by laptop. This is an area in which the Institute of Remote HealthCare has participated and developed over the years, and is now committed to for its international educational delivery.

Telemedicine Overview

Telemedicine is a vehicle for providing immediate specialized care to patients in remote or rural community hospitals or in a domiciliary environment where experienced or qualified clinicians are not available. Similarly, it is also useful for critically ill patients on the move or at emergency situations where time to reach a hospital with specialist care is extensive due to distance or congestion. Modern telemedicine systems involve not only video conferencing (i.e. video and speech), but also the transmission of vital signs ECG, SpO2, Pulse Rate, Blood Pressure etc. together with video, audio, images and text. With the development of communication technologies with high bandwidths for data transmission over fixed (leased lines, broadband etc.) and mobile (GSM/GPRS, 3G) networks, deployment of high quality telemedicine solutions has become a reality.

Provision of specialized care through telemedicine to remote and rural community hospitals, Polyclinics and “lone worker” General Medical Practitioners from regional hospitals can not only significantly improve the quality of care that is received by the patients of these communities who would otherwise not have immediate access to experienced and well qualified clinicians, but also gives rise to significant cost savings to the state or government by not necessarily having to transfer patients from these communities to the regional hospitals. As an indirect result, congestion in the regional hospitals could be reduced.

Definitive pre-hospital care is vital for the survival of a critically ill patient in an emergency situation. A tele-medical physician consultancy system can greatly improve pre-hospital care if the patient’s condition can be readily transmitted to the medical specialists for diagnosis; such specialists might be located at substantial distances from the actual emergency scene. A mobile multimedia transmission system capable of sending video, image and medical telemetry coupled with electronic patient record acquisition and transmission will facilitate an efficient tele-medical consultancy service for the emergency care professionals.

For critically ill patients either in an intensive care unit or in an emergency scene, providing the correct treatment immediately is vitally important. In both of these cases, there is a possibility that in some instances, like out of service hours, a consultant is not available to deal with the emergency immediately. If the consultant’s advice could be made available to the carers or the clinicians dealing with the patient, it would greatly improve the survivability of the patient. Availability of broadband services to households can enable consultants to provide immediate assistance to emergencies through the use of telemedicine by acquisition of medical telemetry data of the patient from home during out of service hours.

Usually community hospitals and the regional hospital have a mobile work force consisting of doctors, medics, paramedics, ambulance crews and community paramedic officers, community nurses, midwives etc. It is important to have constant communications with the hospital management (control centres) to know the status of these mobile healthcare practitioners to manage them efficiently. Mobile messaging (SMS) coupled with a message dispatching system can provide the means for managing the mobile medical practitioner efficiently. The remote practitioner can send their status via SMS messages using their mobile phones. Such messages can be received and responded (commands will be dispatched) via a PC based dispatching system.

Different Components of Telemedicine

The above block diagram shows the different components and interconnections involved in  telemedicine system. It specifically shows connectivity of the following;

1. Remote hospital to regional hospital using fixed solution
2. Regional hospital to second hospital using fixed solution
3. Ambulance to hospital connectivity using mobile and dispatching solution
4. Regional hospital to consultant’s home using mobile solution
5. Videoconference between Regional Hospital/Medical School and international consultants

Footnote

Professor Nelson Norman and Alan Kennedy-Bolam both IRHC executives have extensive clinical and technical experience in the areas of mobile telemedicine. They have advised on implementation of a telemedicine systems in South America and the Middle East. They provide consultancy under the banner of the IRHC and can be contacted at consultancy@irhc.co.uk for further information and advice.