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Telehealth Technology

Telesurgery is a remote surgical procedure where surgeons operate robotic instruments from a distance using high-speed internet and a camera feed, offering benefits like accessibility, improved precision, and reduced recovery time. However, it faces challenges such as reliance on connectivity, safety concerns, and regulatory issues. Telecardiology, teleoncology, and teledermatology are other telemedicine applications that enhance patient access and collaboration while addressing the shortage of specialists in various fields.

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8 views46 pages

Telehealth Technology

Telesurgery is a remote surgical procedure where surgeons operate robotic instruments from a distance using high-speed internet and a camera feed, offering benefits like accessibility, improved precision, and reduced recovery time. However, it faces challenges such as reliance on connectivity, safety concerns, and regulatory issues. Telecardiology, teleoncology, and teledermatology are other telemedicine applications that enhance patient access and collaboration while addressing the shortage of specialists in various fields.

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dharmiga32020
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Download as PDF or read online on Scribd
[Link] *Telesurgery, also known as remote surgery, |s a surgical procedure performed by # surgeon ‘who is not physically present in the operating room with the patient. Instead, the surgeon ‘operates using robotic instruments and a high-speed internet connection to control the instruments from a remote location, The surgeon views the surgical site through a high- definition camera feed and provides instructions to the robotic instruments in real lowing for precise, minimally invasive surgery «Telesurgery was first Introduced in the 1990s, and since then, it has advanced significantly due to advances in computer technology, robotics, and communication networks. Telesurgery offers several benefits, including: ‘Accessibility: Telesurgery can bring surgical expertise to underserved areas or regions where there Is a shortage of trained surgeons. This can be especially useful in remote areas, disaster zones, orin countries with inadequate medical infrastructure. ‘Improved Precision: Robotic instruments used in telesurgery are designed to provide high: precision movements with amuch greater range of motion than the human hand. This allows surgeons to perform complex procedures with greater accuracy, reducing the risk of human error and improving patient outcomes. «Reduced Recovery Time: Telesurgery is often minimally invasive, which can lead to faster recovery times and reduced post-operative pain and scarring. * Cost-Effective: In some cases, telesurgery can be less expensive than traditional surgery because it requires fewer support staff and less time in the operating room. Additionally, patients may require less post-operative care, further reducing costs, DISADVANTAGES: ‘Connectivity: Telesurgery requires a high-speed and reliable Internet connection to ensure that the surgeon's instructions are received and executed correctly. Poor internet connectivity or network downtime can lead to delays, miscommunlcations, and potentially dangerous situations. Safety: Telesurgery requires advanced software and hardware systems to ensure that the surgical instruments and the patient are both safe during the procedure. Any failure or malfunction of the technology could lead to serious complications, making It important to have backup systems in place, Regulation: The use of telesurgery is subject to strict regulations by health authorities, and not all countries allow remote surgery. There are also concerns about liability and malpractice in the event of errors ar complications. In conclusion, telesurgery has the potential to revolutionize the field of surgery, offering improved precision, reduced recovery times, and increased accessibility to medical care. However, it Is important to continue to address the challenges associated with the technology to ensure its safety and efficacy. What is Telecardiology? Cardiology is the branch of medicine that concerns the diagnosis and treatment of heart diseases. Telecardiology pairs cardiology with emerging technologies like video conferencing and secure digital record sharing. The end- product is a remote visit with a cardiologist. Some of the benefits include: Flexibility Prior to the growth of telemedicine, all appointments had to take plat in the doctor's office. Telecardiology allows a cardiologist the flexibility to take appointments from any location. This expands the hours the physician is available to meet with patients. Time Savings Telecardiology appointments save patients time because they do not have to drive to the office or clinic, find parking, and then wait to be seen. Since most doctor's offices are open during normal business hours, the patient also benefits by not having to take time off from work. Improved Patient Access The U.S. has a growing need for cardiologists. Heart disease and strokes are two of the top five causes of death in the U.S. each year. This is due to a large number of smokers and people with pulmonary diseases, both of which cause cardiac diseases. Not every patient has access to a cardiologist and the wait time for an appointment could be long. Telecardiology allows anyone to meet with a cardiologist, as long as they have access to a computer or smartphone and reliable internet access. This can be particularly beneficial for rural patients or the elderly, who could face long trips or find travel difficult. Primary and Secondary Care Collaboration Telecardiology allows for collaboration between a patient's primary care provider and the remote cardiologist. The telecardiology advice helps the primary care provider make a better diagnosis and provide better care. Comfort Of Home With the ongoing pandemic, communicating at home through telecardiology is preferable for some. For patients who don't speak English or it isn’t their primary language, conducting the visit from their home is advantageous. They can have a family member or friend accompany them on the teleconference to help with communication. What Telecardiology Services Are Offered? Telecardiology relies on the same features as other areas in telemedicine. These features require input that is forwarded from the patient and local healthcare providers. Real-Time Teleconferencing Real-time teleconferencing allows the patient to communicate directly with their cardiologist. This takes the place of the face- to-face visit and allows for questioning and consultation. Store and Forward Many providers in telehealth use a delivery system called “store and forward”. This system is a two-step process where a patient first has their clinical information gathered at a local facility. It is then electronically forwarded to a cardiologist. Specific to telecardiology, this would be an electrocardiogram (ECG) reading, but it could also include lab results. There are technology platforms that facilitate the transfer of medical data during this process. These platforms feature HIPAA software to ensure the process meets federal compliance laws. Remote Monitoring Telecardiology providers use remote patient monitoring to track the patient's status during their day-to-day activities. Patients wear a smartwatch or other wearable device that constantly measures their ECG signals. Should the cardiologist notice any abnormal results, they contact the patient and tell them to seek help. Moblie Heath Applications Mobile Health applications, also referred to as mHealth, are downloaded onto a smartphone or laptop to aid with remote monitoring. They can be set to send daily reminders to enter health information which your cardiologist will review. Other Considerations For Telecardiology As with an emerging medical practice, there are considerations that need to be made by both a patient and cardiologist. Some are unique to the telemedicine forum and others apply to traditional in-person service. Insurance Coverage Insurance coverage can vary drastically between providers. Many private insurers only cover the teleconferencing visits. This means that the cardiologist or patient will need to pick up the cost for the other services. Medicare does offer reimbursement for remote physiologic monitoring. But while this sounds similar, it isn’t categorized with telemedicine. Patients should review their insurance plans to see what services are covered. Medical Licenses Conflicts State laws and licensing regulations vary greatly. This can complicate telecardiology, especially when the patient and cardiologist are in different states. _— Limitations In Service Despite all that telecardiology offers, some instances may require an in-person visit. Any invasive cardiac procedure will be performed by a cardiologist, requiring the patient to travel. What is Teleoncology *Cancer is 2"¢ leading cause of death worldwide(WHO report) Cancer, experts say, is likely to emerge as the largest killer in India by 2020 if present trend continues. -Appilication of telemedicine in cancer care ‘TYPES OF CANCERS- «Breast «Colorectal «Lung “Gl cancer -Ovarian,testis cancer +Blood cancer . «Cervical cancer ° Why use it ??? Teleoncology consulting would: - Reduces travel burden - Decrease costs/delay (referral for ongoing tests) - Remote clinics get on-line suggestion = Comprehensive system for the management of cancer at the state/national level. _ Facilitate to detect cancer at the early stages - Public awareness - Paitents comfortable with local appointments only - Rural/local staff skill development involvement in cancer care - Wide scope of application- Townsville Cancer Centre (TCC) in Queensland (for cancer kids with working parents) ) (= SSE (0b) edvence hard or soft copy of diognostic imoges, lab rests, ete transferred in advance Cee ae) ship Ws images sont slong phone line 0 few minutes belore conference SC) for category of user —_ potential benefits patients sna ‘and nurses Stokeholders other healthcare = speed roviders and + improved occess too * less travel time with Slax © decreased costs for meals and occommodotion © [ess time lost from work . oon ‘access and improved = more family involvement ond social support © decreased need for trevel; increased salety . eqn refer «etal voc ate ond sini opportunities . ‘adel thers + more needed referos possible © reduce unnecessary tests ond ecoderst . nded networ! opportunities for all prtiports speed yp medical process ond rie TABLE 1. Benefits and disadvantages of the teleoncology process different users" potential © depersonolization © stresses of © not hands-on; lock | exoms . of other healthcare providers for : Wp intel ce ty =e Bach specialty centre (RCC) includes the following infrastructure: Telemedicine network with high bandwidth connectivity. Video Conferencing System and Television. Telemedicine PC. Telepatholgy/Teleradiology system, Digital Microscope and A3 size X-ray film scanner with transparency adapter. Server(s) for telemedicine application, database and web application. Each nodal centre includes the following infrastructure: Telemedicine Network with high bandwidth connectivity. Video Conferencing System and Television. Telemedicine PC. Telepatholgy/Teleradiology system with PC, Digital Microscope and A3 size X-ray film scanner with transparency adapter. The central hub location includes the following infrastructure: Multipoint Control Unit (MCU). Video streaming servers. National web portal. Oncology resource centre (Digital Library). — internet leased line connectivity (2 ). Teledermatology + History / ~One of the first specialities to recognize the use of and adopt telemedicine (1960's) —Has acted as a model for telemedicine in all because transmission of other clinical fields all types of interaction + Taking to patients «+ Physical exam + Visual pattern recognition + Procedures Teledermatology « Why teledermatology? ~ Visual nature of the field i.e. vis of the skin — Scarcity of dermatologists in rural areas ~ Lack of comfort of GPs with dermatological conditions * Many rarities + Subtle differences between signs - Usefulness of storing sequential images for later retrieval (e.g. monitoring lesions) — Teledermatology ual inspection * Technologies — Store & Forward images ~ Interactive Video Examination (IATV) lav Teledermatology * Exact mode of examination depends on nature of lesion — Identifiable by visual inspection alone (rashes) — Requires “hand-on” examination (e.g. subcutaneous nodules) — Requires further tests (e.g. biopsies) ° May require an remote presenter to handle the patient = Requires training, but not up to the level of the dermatologist — IATV Advantages + Allows interaction with the patient — Take history, ask for clarification ~ Can examine regions of own choice rather than just those selected in advance — Improved patient experience + Can ask for clarification + More immediate feedback ¢ But: ~ Costs more & take encounter (who be ~ Needs appropriate & simultan NSsdwidih — s longer than face-to-face ars the cost?) eously available S&F Advantages Cheaper than IATV Asynchronous transmission, so easier to schedule Less pressure on speed of transmission (images can be transferred slowly for later retrieval) But: — Are the most appropriate images collected — Lack of patient-doctor contact TELEPATHOLO ers Tah ela) lcd aD eL 3 Significant areas of development Applications Technical aspects of telepathology Future of telepathalogy INTRODUCTI Tele is a Greek word meaning - distance Pathos is a Greek word meaning - suffering Logia - study Telepathology - practice of pathology at a distance. roscopic images fe ition of histological & mac roa es) for Oe (amcmrerse (eles telecommunication eno oD ¥ Diagnosis Page lied ¥Continuing medical education SATELLITE COMMUNICATION oy Ci HIGH RESOLUTION : ms, —* DIGITAL CAMERA c\ | \ MODEM / ETHERNET _ — — GLOBAL cE Internet RECEIVING jtelaphone, ISON , STATIONS COMPUTER WITH FULL COLOUR GRAPHIC DISPLAY \4 REGIONAL MEDICAL CENTRES oo | * Telepathology system comprises a mounted on a light microscope link between sending & receiving Bis at the receiving site with a high quality monitor to view the images ATLL ll Wr yertiediereny Coe ae eeu y) VCR yg | ey * Synonyms-Store & forward or Tedee abn (el ele ui Se 7-181 Cle | ties ¥ It is cheap, simple, need a standard telephone line / internet connection . Y¥Images are static * There is no facility for recipient control 2 ROBO tana Nea be) AALS Tar Taal telepathology PATHOLOGY Active Urey ae ae H) Real time telepatholoay Dynamic Robotic ——. Hi Ow ae El? — a ease using scope 4 @ Slides read in Lucknow 1 & E Sections made 1 issue examined/sectioned by Report reviewed, printed Pathologist in Agra. signed, faxed Ze 8 fm HISTKOM RIT mi Sh oo oa + User is able to control all the functions of the microscope , including the scanning stage , magnification & light intensity + Soft ware at the receiving station stitches the images together thus stimulating a moving image * This system provides remote stage management , focus , light intensity & magnification * It has the capability of functioning as a bidirectional telepathology system * Disadvantage of video conference technology in - its susceptibility to blurring - interruptions in image displays i - capable of both the static telepathology fod yer telepathology. 3. VIRTUAL SL TELEPATHOLOGY It requires fast slide scanner. Highest image quality & speed. Offers better user experience & diagnostic accuracy than robotic microscopy Examination & storage in one step. APPLICATIONS * In places where full time pathologist is not available telepathology helps in gaining a pathologist consultation * Telepathology helps in taking an expert pathologist (ey elan * Telepathology can overcome the delays associated with the postal service + External Quality Assessment & Teaching ¥ EQA programs has advantage in mass _ delivery . vRather than cut multiple sections , selective images for each case can be sent via E-mail vImages can be reviewed later v Educational cases can easily be distributed to trainees TECHNICAL ASPECTS ea + IMAGE ACQUISITION TELEPATHOLOGY STORAGE IMAGE COMPRESSION NETWORKING & LINE SPEEDS ee US aan Ae )s Le) IMAGE ACQUISITI * By camera mounted on the top of the microscope. * CCD(charge coupled device) sensor convert the images to an electronic form * Out put from the digital video cameras is converted back either to an analogue signal for viewing on an television monitor or sent unchanged to a computer hardware & software for recording. LJ STORA\ * 1. Short term storage - hard drive * 2, Small computer system interface (SCSI) — It handles multiple devices such as extra hard drives yscanners ,CD-ROM’S ,simultaneously along a single interphase. IMAGE COM re * DICOM (SM) - Digital Imaging & Communications in Medicine Standard- provides standardized formats for image capture & storage. * IMAGE FORMATS - ¥ Lossy algorithms — discard unnecessary data in the course of compression . ¥ Lossless algorithms — preserve data at the expense of compressed image size . JPEG - Joint Photographics Experts Group * GIF - Graphics Interchange Format * PNG - Portable Network Graphics aE ab WSQ - Wavelet Scalar Quantitisation * TIFF - Tagged Image File Format Fractals Compression COMPUTER NETWO * This is the key tool used by companies & institutions world wide . + LAN (Local area network) * WAN (Wide area network) N igh speed communications system desigr computers & data processing devices together with small geographic area .EX: ATM + Multiple LANs are linked together to form a WAN + Example of WAN is Telephone network, modems ,ATM , ISDN NETWORKI * Robotic telepathology is dependent on telecommunication transmission speed. Plain old Telephone Services (POTS) Integrated Services Digital network (ISDN) Asynchronous Transfer mode (ATM) T -1/T-3 Carriers Cable Modems / Digital Subscriber Lines(DSL) Definition: Let Pen uss Preller Tec SL Ae such as X-rays, CT and MRI, from one locati 1 Pires damn cle OLN hd ham § consultation. Goals of Tele-radiology fel Resale Ae Tela eke Mah radiologic services. 2- Making radiologic consultations ava on-site radiologic support. 3- Facilitating radiologic interpre ut aCe = 4- Supporting telem 7. Goals of Tele-radiology Geet Ree ect ey eat ae practicing radiologists. 6- Promoting efficiency and quality improvement. 7- Providing interpreted images to referring providers. 8- Providing supervision of off-site imaging

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