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An introduction to Tele Medicine An introduction to Tele Medicine where are we now?where are we now?
Vijay SardanaVijay Sardana MD,DM (neurology)MD,DM (neurology)
Professor &HeadProfessor &Head
Deptt of Neurology,Deptt of Neurology,
Medical College, KotaMedical College, Kota
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Tele MedicineTele Medicine
Definition-Method-patient can be Definition-Method-patient can be examined, monitored & treated with examined, monitored & treated with patient and doctor located at patient and doctor located at different placedifferent place
Tele (Greek) –distanceTele (Greek) –distanceMederi(latin)-to healMederi(latin)-to healHealing by wireHealing by wireSimplest e.g.-telephoneSimplest e.g.-telephoneAdvanced video conferencing Advanced video conferencing
between two continentsbetween two continents
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Tele Medicine: HistoryTele Medicine: History
1876-Alexender graham bell1876-Alexender graham bell1910- 11910- 1stst electrical stethoscope electrical stethoscope
&telephone relay&telephone relay1959-11959-1stst video communication for video communication for
medical consultationmedical consultation
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The Rapid changes that characterise The Rapid changes that characterise medicine &computing give us the chance medicine &computing give us the chance to be behind not one but two fast to be behind not one but two fast changing fields.changing fields.
In the information age, In the information age, knowledge is your best weaponknowledge is your best weapon
The problem the future is that it is always The problem the future is that it is always ahead of scheduleahead of schedule
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Tele Medicine: JustificationTele Medicine: Justification
Neurological care-450/1075 millionNeurological care-450/1075 million1500 Neurologist1500 Neurologist100 Neurologist/year100 Neurologist/year50% of medical college have 50% of medical college have
Neurology/Neurosurgery deptt.Neurology/Neurosurgery deptt.15 centers of excellence15 centers of excellence
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Tele Medicine: JustificationTele Medicine: Justification
City based specialists-unwilling for suburban/ City based specialists-unwilling for suburban/ Rural placesRural places
Lack of infrastructureLack of infrastructure
Quality of lifeQuality of life
Professional isolationProfessional isolation• Improper distributionImproper distribution
Delhi>North eastern IndiaDelhi>North eastern India
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Unpreceduted growth of information Unpreceduted growth of information technologytechnology
-decreased Computer prices-decreased Computer prices -Internet through cables-Internet through cables -Fibro-optic cable-Fibro-optic cable -Satellite transmission-Satellite transmission -increase brand width-increase brand width -Improvement in video+data compression -Improvement in video+data compression
licensing of private internet servicelicensing of private internet service providersproviders
Telecommunication infrastructure in Telecommunication infrastructure in suburban/rural- easier specialist suburban/rural- easier specialist placement-difficultplacement-difficult
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Tele Medicine: AdvantagesTele Medicine: Advantages
Suburban/rural patient careSuburban/rural patient care Max. utilization of suburban hospitalsMax. utilization of suburban hospitals Prim care physician doesn't loose patientPrim care physician doesn't loose patient Up to 95% normal interaction can be Up to 95% normal interaction can be
establishedestablished Cost saving of unnecessary transferCost saving of unnecessary transfer Continuing education for rural practitionersContinuing education for rural practitioners Motivation for computer literacyMotivation for computer literacy
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Tele Medicine: problemTele Medicine: problem
No hands on interaction with patientNo hands on interaction with patientConfidentiality of patient interactionConfidentiality of patient interactionReimbursement constraintsReimbursement constraintsaccuracy of diagnosis from remote placeaccuracy of diagnosis from remote placewho should take up? Time constraintswho should take up? Time constraints
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Tele Medicine: RequirementTele Medicine: Requirement
PCPCScannersScannersDigital camerasDigital camerasModified softwareModified softwareAppropriate networking systemAppropriate networking systemAppropriate telecommunication Appropriate telecommunication
technologytechnology
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Tele Medicine: technologiesTele Medicine: technologies
Store and forwardStore and forwardTwo way interaction television/Two Two way interaction television/Two
way interactive video conferencing.way interactive video conferencing.
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Telemedicine- TechnologiesTelemedicine- Technologies
ISDN linesISDN lines Internet protocolInternet protocolSatelliteSatellite
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Tele MedicineTele Medicine
StrokeStroke
-</.5%acute stroke treated with -</.5%acute stroke treated with Thrombolytic therapyThrombolytic therapy
Tele-stroke management.Tele-stroke management.
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Tele Medicine: UsesTele Medicine: Uses
Parkinson’s diseaseParkinson’s diseaseDementiaDementiaEpilepsyEpilepsy
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Tele Medicine: UsesTele Medicine: Uses
NeurotraumaNeurotrauma
-decrease unnecessary transfer-decrease unnecessary transfer
-Early therapeutic interventions -Early therapeutic interventions taken before transfertaken before transfer
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Tele Medicine:TelepathologyTele Medicine:Telepathology
Intra-operative PathologyIntra-operative PathologyRoutine Surgical PathologyRoutine Surgical Pathology22ndnd opinion opinion?FNAC?FNAC?Autopsy?Autopsy
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Tele Medicine: Indian scenarioTele Medicine: Indian scenario
620 million- rural India620 million- rural IndiaBed populationratio-1:13330 (1991)Bed populationratio-1:13330 (1991)
-ideal-1:1500-ideal-1:15002 million beds required. available 0.7 2 million beds required. available 0.7
millionsmillions
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Tele Medicine: Indian scenarioTele Medicine: Indian scenarioARAGONDA (population 5000)ARAGONDA (population 5000)
First secondary care rural hospital using First secondary care rural hospital using telemedicine-Apollo chennaitelemedicine-Apollo chennai
40 bedded- physician, surgeon, 40 bedded- physician, surgeon, pediatrician, 3 GDMOspediatrician, 3 GDMOs
USG, Echo, ECG,Automated laboratory, CT USG, Echo, ECG,Automated laboratory, CT scan, OT, Telemedicine unitscan, OT, Telemedicine unit
Web camera-ISDN linesWeb camera-ISDN lines
Digital camera-VSATDigital camera-VSATD-microscopeD-microscope
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Tele Medicine: Indian scenarioTele Medicine: Indian scenario
ISRO- 200 hospitalsISRO- 200 hospitals
J&K, Karnataka, NE, Lakshadweep, Army,J&K, Karnataka, NE, Lakshadweep, Army,
OrrisaOrrisa Apollo hospital- chennai, Delhi, Hyderabad Tele Apollo hospital- chennai, Delhi, Hyderabad Tele
medicine centers medicine centers --Guwahati, Kolkata, Kohima, Portblair, Guwahati, Kolkata, Kohima, Portblair, Silcher, Mysore, Madurai, Military hospital Chennai, Silcher, Mysore, Madurai, Military hospital Chennai, Dhaka Dhaka
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RajasthanRajasthan
Population-56.5 millionPopulation-56.5 millionPopulation growth rate-Population growth rate-
28.33(21.43)28.33(21.43)Rural: Urban- 77:33Rural: Urban- 77:33Large distancesLarge distances
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Rajasthan Telemedicine programmeRajasthan Telemedicine programme
One of Biggest Tele medicine One of Biggest Tele medicine network in Indianetwork in India
Population-56.5 mPopulation-56.5 mRural: urban- 77:23Rural: urban- 77:23Growth rate India:raj- 21.43:28.33Growth rate India:raj- 21.43:28.33
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Rajasthan Telemedicine programmeRajasthan Telemedicine programme
ISRO + GovtISRO + Govt32 district hosp., 6 medical colleges, 6 32 district hosp., 6 medical colleges, 6
mobile vansmobile vansVSAT at each locationVSAT at each location INSATINSAT
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MBS Tele medicine unitMBS Tele medicine unit
2 PCs2 PCsTVTVVideo conferencing SONY camera with Video conferencing SONY camera with
360 degree tilt360 degree tiltDigital BP recorder, Digital ECG, Digital Digital BP recorder, Digital ECG, Digital
microscope, Digital PFTmicroscope, Digital PFTSitting capacity-30Sitting capacity-30384 Kpbs384 Kpbs
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Tele Medicine: Learning PartsTele Medicine: Learning Parts
Telemedicine here to stay despite Telemedicine here to stay despite advantages and disadvantagesadvantages and disadvantages
Not a goal itself. should be used as a Not a goal itself. should be used as a support to treat patientssupport to treat patients
Practical Problems-underutilized world Practical Problems-underutilized world overover
Specialist consultation in sub urban and Specialist consultation in sub urban and rural India & Rajasthan is now a mouse rural India & Rajasthan is now a mouse click awayclick away
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