In fact the main challenge facing website administrators, software engineers, system developers & medical practitioners is to develop strategies that will give e-care a reliable environment to exploit opportunities and make it more feasible & cost effective.
The current synergy between health reform initiatives (which are defining how health care services are accessed and delivered) and advances in technologies (that support e-medicine projects) has resulted in proliferation of e-medicine projects. The existing scenario demands that the development of e-medicine strategy be based on a sound knowledge of the present and future potential of e-medicine to improve health care access and quality, while reducing health care costs.
There are various definitions of telemedicine and every forum and article spawns a new definition. This is mainly due to this branch being a developing field and the various definitions represent various stages of evolution.
According to the Centers for Medicare & Medicaid Services (CMS), the definition of telemedicine under Medicaid is "the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health." http://www.cms.hhs.gov/Telemedicine (accessed Mar 20, 2009).
Electronic communication means "the use of interactive communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at a distant site."
Often the terms e-health, cybermedicine, and telemedicine are used interchangeably or are confused, but the main distinction relates to the amount of interaction that occurs between individuals and health care practitioners.
E-health is described as "an emerging field in the intersection of medical information, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies." Gulick, G., 12 Alb. L.J. Sci. & Tech. 351, 355 (2002). If an individual seeks and receives personalized medical information from a physician over the Internet, this type of interaction is called cyber medicine. Fleisher & Dechene, Telemedicine and E-Health Law 1-6 (ALM Properties, Inc., Law Journal Press) (2004). Therefore telemedicine is a broader concept than cyber medicine, and e-health encompasses them both.
Telemedicine has been developing for over thirty-five years, but has received greater scrutiny in the past two decades due to rapid development in telecommunications and technology. Increased governmental support and the need for greater access and affordable care have also played an important role.
Many legal issues are raised by the practice of telemedicine, and while some are common to all areas of healthcare, others are unique to telemedicine. This becomes a very important issue, as perceptions about the same aspect may vary between the health care provider and the patient. We also have a new confounding factor-technology!
Most of the doctors still prefer the age old tried and tested method of treating patients instinctively and having ‘a feel’. Whether technology will evolve to a stage when technological expertise will be able to address this problem, still remains a moot question. Till then we may still remain at the present rudimentary level of telemedicine.
As stated it has numerous definitions. Telemedicine is a phrase first coined in the 1970’s by Thomas Bird, referring to health care delivery where physicians examine distant patients through the use of telecommunications technologies.
The European Commission’s health care telematics programme defines telemedicine as:
"rapid access to shared and remote medical expertise by means of telecommunications and information technologies, no matter where the patient or relevant information is located."
There are many other definitions from simple one-line statements to full reports.
American Heritage Dictionary defines it as’ The use of telecommunications technology to provide, enhance, or expedite health care services, as by accessing off-site databases, linking clinics or physicians' offices to central hospitals, or transmitting x-rays or other diagnostic images for examination at another site.’
One offered by Bauer and Ringel states that ‘Telemedicine is the combined use of telecommunications and computer technologies to improve the efficiency and effectiveness of health care service by liberating caregivers from traditional constraints of place and time and by empowering consumers to make informed choices in a competitive marketplace [Bauer99, 8].
The World Health Organization (WHO) describes telemedicine as:
The practice of medical care using interactive audiovisual and data communications including medical care delivery, diagnosis, consultation and treatment, as well as education and the transfer of medical data.
This definition is comprehensive and thus does cover most of the aspects of telemedicine, including an emphasis on collection, collation and dispersal of medical data.
Telemedicine is the provision of healthcare services, through use of ICT, in situations where the health professional and the patient (or two health professionals) are not in the same location. It involves secure transmission of medical data and information, through text, sound, images or other forms needed for the prevention, diagnosis, treatment and follow-up of patients.
Telemedicine encompasses a wide variety of services. Those most common are teleradiology, telepathology, teledermatology, teleconsultation, telemonitoring, telesurgery, telecardiology and teleophthalmology. Other potential services include call centres/online information centres for patients, remote consultation/e-visits or videoconferences between health professionals.
US Health Dept
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states may choose to cover. This definition is modeled on Medicare's definition of telehealth services located at 42 CFR 410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telemedicine as a distinct service.
In this, we will look at why definitions are so often the focus of our energy, compared to other jobs, which use definitions. We believe, the act of defining a problem is the problem.
Medical care has evolved from a state when it was available to a few lucky people to a level where we are looking at providing medical cover universally. The final aim of making it ubiquitous can only be achieved with the help of technology. Providing even basic medical care is a herculean task and extremely resource intensive. It is extremely expensive and requires investment in the form of manpower, medicines and hospitals. India is a country, where the majority of the population lives in rural settings and even the cities are poorly and haphazardly planned.
It is here in our settings that we expect telemedicine will make an impact. The concept of telemedicine goes beyond the idea of providing medical care to rural populations and encompasses various other aspects that involve cutting edge technology. The subject is still evolving and every new innovation brings about newer and hereto unheralded methods of providing medical care. To our mind, the WHO definition comes the nearest to a comprehensive definition.