Lifespan has increased in the whole world, and, at the same time, the number of people having one or several chronic diseases increased too. The need for long-term medical care rendering caused the development of new methods, which allow to carry out treatment and also observe the patient at home. Using the means of electronic communication, telemedicine revolutionizes those approaches by means of which medical care is carried out nowadays. Thus, in order to estimate the importance of telemedicine in the modern world, it is necessary to study its main features in more detail.
General Information about Telemedicine
Telemedicine is a method of service on medical care where the distance is a critical factor. Service is carried out by representatives of all medical specialties using information and communication technologies after obtaining the information needed for diagnostics, treatment, and disease prevention. Telemedicine is a rather new direction on a joint of various areas, namely, medicine, telecommunications, and information technologies. It is indisputable that one of the main advantages of telemedicine is an opportunity to provide the highly skilled help of specialists of the leading medical centers in the remote areas and thus save expenses of patients essentially. Therefore, in the USA, which territory is divided by more than six time zones, the development of telemedicine is caused by the geography of the country (“What is Telemedicine?”).
Telemedicine can be considered as a system providing the ordinary users with access to modern medical resources, including international ones. The considered system represents a set of means and complexes realizing potential of modern information and telecommunication technologies in health care, and also the corresponding financial and legal support. Besides, objectives of scientific researches and development in the field of telemedicine refer to the association of information and telecommunication technologies in such a way that medical resources outside the local organizations could be systematically used in the activities of health services (“What is Telemedicine?”).
Possibility of consultation with colleagues from the large medical centers removes a problem of professional isolation of medical workers in small settlements. In the course of regular consultation, practitioners get additional experience and knowledge. Due to telemedicine, they can attend video lectures or watch the course of the operation performed by the most authoritative experts being in hundreds and thousands of kilometers away at this moment (“What is Telemedicine?”). A large number of scientific researches in the field of telemedicine are conducted within funding support of the Government (Drew).
In the USA, the financing of telemedical projects is especially significant and is carried out both from budgetary funds of the U.S. Department of Health and funds of the U.S. Department of Defense. Herewith, the most intensive results of telemedical researches are implemented in the U.S. Department of Defense units. (Drew).
Importance of Telemedicine
Telemedical consultations are carried out by means of transfer of medical information on electronic communication channels. Consultations can be held both in the “postponed” mode by e-mail, which is the cheapest and simplest way of transfer of medical information, and in real time on-line using communication channels and video equipment. Planned and emergency video consultations are a direct communication between the consulting physician and the attending physician, and if necessary, with the participation of the patient. Moreover, the session of video conferencing can pass both between two subscribers and several subscribers in a so-called multipoint mode, i.e. the most difficult cases can be discussed in the form of the consultation of doctors from different medical centers (“Examples of Research Outcomes: Telemedicine’s Impact on Healthcare Cost and Quality.”).
Remote video consultation is about 20 times cheaper than a trip of the patient from one city to another nearby one, and in case of needed escorts of the patient by a medical worker, the cost of trip doubles. Depending on the distance between the cities, the ratio of these expenses can make to 50 times in favor of telemedicine. Telemedical systems allow to organize dialogue with the medical expert (videoconference) at any distance and transfer practically all medical information necessary for the qualified conclusion (an extract from the clinical record, radiographs, CT scans, ultrasound images, etc.) (Soyer, Binder, and Smith 34-35).
Necessary condition for real-time telepresence is existence of qualitative communication channels. The videoconference can be carried out both on the digital telephone ISDN lines and IP-based networks. Today, it is possible to use practically any digital channels of communication with rather wide bandwidth for videoconferences (Soyer, Binder, and Smith 34-35).
During the lectures, teachers have interactive contact with the audience. As a result of the use of information and communication technologies, doctors obtained a real chance of the continuous professional education, including both theoretical and practical trainings. Lectures, as well as video consultations, can take place in a multipoint mode; thus, lectures can be given to listeners from several regions at once. Application of network video cameras allows organizing surgery translation. This technology can be used also for “telementoring”, when a more experienced doctor can control the actions of the less experienced colleague remotely in real time (Blobel and Pharow 211-213).
Mobile telemedical complexes (portable, on the basis of the reanimobile, etc.) for work on places of accidents are developing. The American health care is very interested in small-sized mobile diagnostic complexes, which can be used in case of lack of telemedical offices and centers, directly where the need arises. Emergency doctors, family doctors, doctors of regional and rural hospitals, crews of medicine of accidents, sanitary aircraft and medical formations of the Ministry of Emergency Situations have to be equipped with these facilities. The modern mobile telemedical complex has to combine a powerful computer, which is easily interfaced to the various medical equipment, facilities of the near and far wireless communication, a video conference and IP-broadcasting (Xiao and Chen 372-375).
Telemedical systems of dynamic supervision are used for the supervision over the patients having chronic diseases. The same systems can be applied at industrial facilities in order to control the health of workers, for example, operators on nuclear power plants. The promising direction of remote biomonitoring development is integration of sensors into clothes, various accessories, and cellphones. For example, such technology can be maintained in a vest with a set of the biosensors registering an electrocardiogram, arterial pressure and some other parameters, or the cellphone with the possibility of registration of an electrocardiogram and its sending to the medical center by means of GPRS, and also with the possibility of determination of coordinates of the person in case of life threat (“Examples of Research Outcomes: Telemedicine’s Impact on Healthcare Cost and Quality.”).
Availability of means of communication and Internet services allows developing of such direction, as “home telemedicine.” Home telemedicine is a remote rendering of medical care to the patient who is out of the medical institution and receiving medical treatment at home. The special telemedical equipment carries out collecting and transfer of medical data of the patient from his or her house to the remote telemedical center for further processing by experts. An example is the system of patients monitoring with congestive heart failure requiring regular and frequent surveys, which cost of treatment significantly decreases due to the telemedicine use (Xiao and Chen 372-375). Besides, there are the complexes, which are turning on sensors taking body temperature, oxygen partial pressure, blood pressure, the respiratory function and ECG, connected to a desktop monitor, which in turn sends data to the control center automatically. For patients, it is an opportunity to get highly skilled advice quickly, at home, without tiresome and expensive trips. Besides, audiovisual contact with doctors is possible during consultations or diagnostic procedure (Blobel and Pharow 211-213).
Benefits for Doctors and Medical Establishments
Despite reduction of medical institutions, shortage of experts in the cities, aging of the population and constantly growing prices, telemedicine guarantees the solution to the issues associated with a reduction of expenses and remoteness of medical workers and patients from each other. The technology of HD-video is another survey instrument. A doctor can not only see and hear the patient, but also listen to a murmur in lungs and heart by means of a digital stethoscope, carry out diagnostics of the acoustical channel by means of an electronic otoscope, and perform integument inspection by means of the webcam. The joint communications, development of HD-video technology, reproduction of stream video, and archiving make medical education available at any time and in any place. Due to distribution of technologies of HD-video stream transfer, audio and text messages in real time, doctors get an opportunity to work from home, in the office, or in the educational center (Xiao and Chen 372-375).
Any health care organization, no matter whether it is a private hospital or government agency, applies maximum efforts in order to increase the efficiency of their work. Long distances, high fuel prices, transportation – all these factors compel to make the decisions connected with telecommunications. Today, it is difficult to imagine the meeting of shareholders, directors, or negotiations with suppliers without modern means of communication. Efficiency of daily communication in the organizations of health care is a key factor. The use of solutions of telepresence promotes productive cooperation of the organizations from different parts of the world and time zones, which was impossible earlier. Currently, the sharp increase in the share of telecommunication technologies is observed in the work of public institutions (“Examples of Research Outcomes: Telemedicine’s Impact on Healthcare Cost and Quality.”).
Nowadays, due to the shortage of the younger medical personnel, the demand for the use of communication technologies in real time is constantly growing. Every day, it becomes more noticeable that wireless systems in hospitals start venting traditional stationary phones. Besides the main function of online communication, modern wireless telesystems provide users with a number of additional opportunities: transfer of text messages, system of voice recognition, remote measurements, remote control of the state of the patient's health, system of the alarm notification, and location control in real time. Patients can call the nurse without getting up, and, if in the course of monitoring of the patient any problem is found, the signal also will be sent to the worker of medical institution (Blobel, and Pharowe 211-213).
Another additional benefit is that wireless phones help to eliminate the need for the notification by a public address system, which is rather inefficient and can have a negative impact on the health of the patient. The silent environment promotes better recovery. Implementing technologies of wireless communication, hospitals simplify the internal system of communication, i.e. reduce a waiting time, adjust a fast stream of information exchange between patients and medical personnel, reduce the noise level, and, as a whole, improve nursing process (Soyer, Binder, and Smith 34-35).
Essentially important feature of digital telemedical systems is that the transfer of medical information occurs practically without quality loss (it should be noticed that the use of analog communication systems inevitably brings in a transmitted signal a certain quantity of hindrances). Besides, characteristics of the usual television signal are initially limited to the parameters of the send-receive equipment, such as the amount of lines in a scan, impossibility of the exact adjustment of color rendition, etc. The essential advantage of digital telemedical systems is also a low cost of the used equipment in comparison with their analog predecessors. In addition, the most expenses at adjustment of digital communication are carried out only once, while in analog options, it is required to pay for commercial television (usually satellite) communication channel regularly (McConnochie, Wood, and Kitzman).
Prospects of Telemedicine Development
Though today, telemedicine remains, first of all, remote diagnostics, its potential opportunities are much wider. The telesurgery and remote inspection belong to the perspective directions of telemedicine. Active impact of the expert at a distance on the patient's organism is an essential factor. Currently, it is developing in two directions: remote control of the medical diagnostic equipment and remote therapeutic modality and surgeries on the basis of use of remotely operated robotics. Certainly, this trend makes the highest demands on all elements of telemedicine complex, especially on the reliability and quality of telecommunications (Pal and Mittal).
Nowadays, some options of the remote control are already in practice. The described above management of network video cameras that is effective at monitoring over the conditions of the patients in chambers of intensive therapy and remote control of surgeries can be an example. One more example of remote control is the control of a remote microscope, whereby the consulting physician has an opportunity to conduct pathohistological studies in full and examine all available material samples (telemorphology) (Burney, Mahmood, and Abbas).
Such direction as telesurgery is in the stage of experimental development. Telesurgery assumes the use of long-distance manipulators and their remote control directly when carrying out operations (handling a scalpel, laser, etc.). Currently, the most responsible and difficult direction from the point of view of realization is particularly experimental technique, the implementation of which in practice requires many technological innovations. However, there are already some examples of the experimental remote use of robotic manipulators: doctors of the medical center of South California University started performing trial surgeries by means of a surgical robot (McConnochie, Wood, and Kitzman).
The prospects of telemedicine are also associated with further miniaturization of control and measuring means, implementation of smart technologies, robotics, the latest developments of informatics, and applied aspects of nanotechnology. Quite proved tendency of development of telemedical technologies is formation of regional telemedical networks. Such networks, on the one hand, will be distributed deeper into territories, covering the increasing number of medical institutions, and, on the other hand, unite with each other. At creation of telemedical networks, almost all available means of communication, such as land and satellite, fiber-optical and wireless, broadband networks of data transmission and a network of mobile telecommunication, will be used (Burney, Mahmood, and Abbas).
Nowadays, in many countries and international organizations, numerous telemedical projects are developed. The World Health Organization develops the idea of creation of a global telecommunication network in medicine. This refers to the electronic exchange of scientific documents and information, its accelerated search with access through telecommunication networks to specialized databases, video conferencing, correspondence discussions and meetings (Burney, Mahmood, and Abbas).
Taking into account all abovementioned information, it should be noted that technical problems getting in the way of telemedicine development are solved successfully on the basis of use of the advanced information technologies and the most modern computer equipment. However, many economic, legal and ethical issues are somewhat more complicated. The existence of these issues is associated, first of all, with a lack of the legislative and regulatory base regulating questions of access to medical data on patients, assessment of quality of telemedical consultations defining rule, distributions of responsibility for their results, etc. Nevertheless, certain progress was also made in this area in recent years. In the USA, telemedicine development enters a transition phase from development of mainly experimental and theoretical character to the stage of practical implementation of its achievements into the national health care. Thus, medical institutions of the United States of America have to be prepared for telemedicine implementation in their daily practice due to a huge number of advantages of this technology.