TELEMEDICINE AND TELE

NURSING

DEFINITION OF TELEMEDICINE
Telemedicine is defined as the use of tele
communications, the deliver health care expert
sharing of medical knowledge with persons are
distance locations.
It is transfer of medical data for

Consultations

Diagnosis

Support for Clinical Case

Containing Medical Educations

Medical Data Such as

High resolution photography

Radiological images

Sound and Patient records

Electronic signals via the internet

Intranet

Personal Computers (PLS)

Telephone Lines

HISTORY OF TELEMEDICINE

University of Nebrastea did first documented use of

visual telecommunication in health care in 1959.

Under first telemedicine program in December 1988,

the site of massive earthquake in Armenia was linked to
medical centers in United States for telemedicine
consultations.

The program was extended to Russia to provide

telemedicine consultation to burn victims after a terrible
train accident.

First internet based telemedicine trials wall conducted in

April 1955 when a Chinese studies zee Ling who was
studying in Beijing University fell sick and her condition

HISTORY OF TELEMEDICINE
1.

1920s

2.

Telegraphy and
telephony was
established
Wireless / Radio

3.

TV

1960s

4.

Computer and
Internet

1990/200
0

1950s

TELEMEDICINE APPLICATIONS

Emergency Health Care

Video Consulting

Telecardiology

Telemedicine as applied by cardiologis is

called telecardiology.

Telepathology

Teledermatology

Teleophthamology

Teleoncology

Telepsychiatry

Teledentistry

Distance Leaning

Medical education and the transfer of

medical data.

Medical care delivery, diagnosis,

consultation and treatment at a
distance.

Nursing homes or retirement centers.

Home monitoring for patients

Health care in the after of disasters.

MAJOR TELEMEDICINE PROJECTS

1

Staphac

Nasa

2
3

Space Pridge
North-West
Telemedicine
Project
Primetine III

Nasa
Australia

4
5
6

USA
Fines
Malasia

Telemedicine
Flagship Project
Appollo
Apollo
Telemedicine
Hospitals

Arisona,
USA
Armenia
Queen
Sland
Boghia
Malasia
India

TELE CONSULTATION

A doctor of a paramedic or even a patient

himself in remote area can have a consultation
with a specialist.
This requires certain procedures to be followed
the person initiating the requires needs to be
trained and more importantly the complete
process needs to be documented for the
patients and the doctors record.
Tele consultation also involves a family
doctors seeking help of specialist in an

TELE EDUCATION

The use of telemedicine technologies makes if

much better than just surfing websites for
information.
Doctors can attend clinical meetings as remote
places and also participate and present cases in
them. Some projects such as health net project of
Africa uses both internet and satellite
communications for doctors in remote area.
If this is dealt using telemedicine the approach is
real time, the referring doctor knows how the
specialist is dealing with the patient and thus
further his knowledge.
Tele consultation, video conferencing on surgery,
online clinical audit and containing medical
education are just some of the education
applications of tele education.

TELE MONITORING

Tele monitoring is the remote monitoring of patient

data. The patients status can be monitored.
Wherever he is whether in an aircraft or in remote
village as long he has a telephone access.
The data includes, blood pressure, pulse, ECG,
spirometry, ultrosound, CT scan and other
radiology data.
These can be transmitted using telephone lines or
through wireless with the use of appropriate
devices that can transmit these data over phone.
These devices are commercially available and can
be attached to any telephone line.

BENEFITS OF TELEMEDICINE

Resource utilization
Early intervention
Avoids unnecessary transportation
Community based care
Medical education and research
Cost saving
Improved patient documentation
Increased range of care and education.

RESOURCE UTILIZATION

First benefit of telemedicine is proper

utilization of resources.
In India doctor population ratio is 1:15000 in
comparison to 1:500 in developed nations, and
these doctors are not distributed equally.
80% Indian population lives in rural and semi
urban areas.
Telemedicine can help in cost effective
utilization of meager resources and of the
same time can decrease patient work load on
few referral centers.

EARLY INTERVENTION

One of the most effective means of providing medical

intervention is by early detection and treatment.

There are factors that inhibit the continuity of care.

Issues such as geographic location, inclement
weather, socioeconomic barriers.

Patient apathy are significant factors that delay and

even prevent the specialty care.

By providing these primary cure sites with the ability to

quickly access specialty consultation services.

Patients are able to reap the benefits of early

intervention while the health care system maintains
quality service and clinical efficiency.

AVOIDS UNNECESSARY
TRANSPORTATION

Local health provides discusses case

of a patient on phone with a specialist
and it specialist is not getting clear
picture.

After few questions he will able to send

the patient but if by video conferencing
he has clear picture of patient.

Unnecessary referral and patient

transport can be definitely avoided.

Which Data Can be Transferred

Basically four types of data are used in
telemedicine.
Text for patient notes, generally having a
file of less than 10 KB.
Audio electronic stethoscope, with file
size of around 10 KB.
Still image X-rays which are still images
having a size of around 1 MB.
Video movie ultrasound / patient
visualization movie images have a size
of 10 MB or more the patient can be
seen by a doctor at a remote place using
cameras.

COMMUNITY BASED CARE

Community based care is another big

advantage of telemedicine.

People like to receive high quality care

in their local community.

This reduces travel time and related

stresses associate with many referrals.

MEDICAL EDUCATION AND

RESEARCH
Telemedicine is also useful

in

medical

education.
When medical students are posted in rural area
they can be linked to medical college for grand
rounds and they can also do case presentation
to teachers in medical colleges.
In India Indira Gandhi National Open University
(IGNOU) carries out regular monthly session of
teaching of its diploma in maternal and child
health (PGDMCH) students.
Physicians living in different parts of the world
also use telemedicine in collaborative research,
they can also share data or can discuses current
trends.

TELEMEDICINE CONCEPTS

A video image has a rate of motion known as

the frame rate.
This standard video like the one seen of the
television has a frame rate of 30 frames per
second.
This 30 frames per second rate is required so
human eyes does not perceive any gaps in
information.
In video conferencing there is limitation or
restriction on the amount of information that can
be transmitted through digital lines.
This limitation on amount of information that can

MODALITIES OF DATA TRANSMISSION IN TEL

System

Data Speed

Advantages /
Disadvantages

PSTN (Public Service

Telephone Network)

56 kBpS

Economical Ubiquitous
slow, not suitable for high
resolution

ISDN (Integrated Service

Digital Network)

128 KBpS

Cheap, Flexible

Service Digital Network

ISDN

2 MBPs

Fast high quality,

expensive, patchy
availability.

Satellite

2 MBPs

High quality, remote

access expensive

Wireless

<2MBPs

Convenience, free
movement, new
technology, limited
standards

Microwave

<20 MBPs

Good quality, inexpensive

to run line of sight only
short distances.

Leased Lines

64 kBPs 50

Reliable

TELEMEDICINE DEVICES
(A) Video Conferencing System

Roll about systems

Set top systems

Desk top system

(B) Peripheral Devices

Medicals Peripherals

Non-medical peripherals.

LIMITATIONS TO SPREAD OF TELEMEDICINE

Poor patient Doctor Relationships

Patient Acceptance

Fear of Technology

Low Rates of Utilization

Infrastructure

BARRIERS TO TELEMEDICINE

There are still several barriers to

the practice of telemedicine. Many
countries will not allow but of
country physicians to practice
unless licensed in the country.
Many rural areas still do not have
cable wiring or other kinds of high
bunel width telecommunications
access required for more
sophisticated uses.

FUTURE OF TELEMEDICINE

Many medical centers in India are now

successfully running, telemedicine projects
and video conference.

Future of telemedicine in India is definitely

bright-with availability of internet every
where, with new information's technology
policies

and

telecommunication

with
network

improving
use

telemedicine is going to increase.

of

INDIAN SCENARIO OF TELEMEDICINE

Now with the availability of internet

connection in most cities of India interest in
telemedicine is increasing day by day but still
major

draw

back

in

India

is

that

communication network is not suitable for

most telemedicine applications.

ISDN lines are not available in most of the

places in India, which is basic requirement
for video conferencing.

Video conferencing technology will be limited to some

big cities and telemedicine technology that will be used
in most of the parts of India will be store and forward
technology.

It will be like sending radiological images, patients

records, sounds through e-mail or modern and getting
opinion of experts.

Many medical centers in India are now successfully

running telemedicine projects using video-conferencing.

India is an ideal place to use this technology as 80%

population in India lives in villages where treatment is
provided by queen and unqualified medical practitioners.

DEFINITION OF TELENURSING
Telenursing is a subset of tele health in
which the focus is an nursing practice via
telecommunication.
-By

American Nurses Association

Tele nursing is defined as the practice of

nursing

using

protocols

through

telecommunication technology.
- Arkansas Staff Board of Nursing

THE PRACTICE OF TELEPHONE NURSING

Standards and Quality Center is Telephone

Nursing.

Competencies Required in Telephone

Nursing

High Quality Practice Settings.

Decision Support Systems

Using Nursing Titles applies to telephone

nursing practice.

Designated Agent

LUNS and Telephone Nursing

GUIDELINES FOR TELENURSING

Nurses and midwives practising in telenursing

shall be registered nurses or midwives. Enrolled
nurses involved by telenursing need to be under
the supervision of registered nurse or midwife.
Nurses and midwives practising telenursing are
personally responsible for ensuring that their
nursing and or midwifery skills and expertise
remain current for their practise.
Nurses and midwives who are practises
telenursing in Australia are effected to practice
with is the frame work of the ANMC National
Competences standards of the midwife the ANMC
code of professional conducts for nurses in
Australia, code of ethics for nurses in Australia
and other relevant professional standards.

Nurses and midwives should inform consumers of

the telehealth process including other
persons/professionals who may be participations
or presence is the telehealth consultations and
urban consent before proceeding.
Nurses are midwives in televisions have a duty to
provide privacy and confidentiality in all
interactions.
Nurses and midwives practises in telenursing
should be aware of both the evidence base for
their practise and the areas or practice is need or
research.
Nurses and midwives practising telenursing should
engage in evaluation of their practise in relations
to issue of quality safety and patient outcomes.

ISSUES IN TELENURSING

Models of Case

Privatizations

Work line fro nursing staff

Patient safety

Cross Border License Issues

CLINICAL FUNCTIONS OF THE TELEHEALTH NURSES

Telehelath nurses are monitoring patients

with chronic diseases.

Helping patterns manage their symptoms

and co-ordinations care of patients who
require service from homeruns health
professionals.

BENEFITS OF TELENURSING

When patient stand seeing of their own

day, they stand connecting the data above
their processes.
Managing their disease better reduce their
utilization of acute case services such as
emergency department visits and
hospitalization.
Saving time achievable because driving
time to reach patient residence by
significantly reduced.
Nurses are able to spend more time on
direct patient care.

Telehealth Nurses Provide Nursing Care by

Using Clinical Algorithms, Protocols, or

Guidelines to Systematically Assess
Patient Needs and Symptoms.

Prioritizing the urgency of patients needs.

Collaborating and developing a plan or

care with the patient and supportive,
disciplines
which
may
include
recommendation for cure, call back
educations.

Evaluation outcomes.

Thank You