Telemedicine - Internet Concepts

What is Telemedicine?

Telemedicine is the use of telecommunications infrastructure in the practice of medicine.

• Level I Telemedicine = Use of the telephone and fax technology for patient consultation and referrals (also includes the 911 system)
• Level II Telemedicine = File transfers for interactive still images, store and forward images, or video conferencing over low band width connections:
  • 56K dedicated or leased data lines
  • 56K or fractional T-1 frame relay lines
  • BRI ISDN (Integrated Signal Digital Network) lines
• Level III Telemedicine = Full motion video images that permit a full range of interactive diagnostic services (requires fractional T-1 or higher band width)
   

Benefits to the Patient

• Rapid access to tertiary center health resources
• Receive specialty care while under direct care of family physician
• Remain close to home where family and friends can provide support
• Avoids costly and traumatic patient transfer when possible
• Receiving facility can coordinate preparation and transfer of patient
   

Cost Benefits:

• Remote underserved low-income areas can access specialty services
• The cost of a specialist can be shared by low incident users
• Reduced transfers keeps more money for local providers
• Reduced travel expenses
   

Benefits to Practitioners:

• Access to real-time specialty consultations
• Assists with maintaining primary provider skills during consultation
• Improves access to continuing education opportunities without absence from practice
• Enables professional networking and collegial support
• Allows primary care physicians to directly manage the care of their patients with support from specialists
   

What is the Internet?

The Internet is the use of telecommunications infrastructure to provide wide area networking to a computer users in the general public.
 

• The Internet is a wide area network of leased lines that are resold to individual or business users by an Internet Service Provider.
• The Internet uses existing telecommunications facilities provided by telephone companies or owners of wide area networks.
• Internetworking is not new.   What is new is the remarketing of leased lines by Internet Service Providers (ISP) to individual or business users on a dial-up basis.
   

What are the Features of the Internet?

• The primary feature of the Internet is its availability to a local user for a fixed or minimum fee to access any connected computer anywhere in the world.
• The second primary feature of the Internet is that it is a development platform for sharing information without concern for the different types of computer equipment being used.
• The Internet has established standard protocols to be used in the transfer of information between computers.
   

What are some of the Internet technologies that can be used for Telemedicine?

• The primary desktop application of the Internet is the Browser which provides a graphic user interface to the Internet. Browsers can display:
  • Text
  • Pictures in GIF or JPEG format (including animations)
  • Charts
  • Audio
  • Video
     
• FTP - File Transfer Protocol enables files to be sent or received from another computer connected to the internet.   You can also FTP files through a dial up connection to another computer.
• Chat - Users are able to type messages that will be viewed real time on another connected computer.
• Email - Email is sending or receiving electronic messages between computers.
• Conferencing - Programs such as Microsoft NetMeeting enable users to chat and display applications on a whiteboard for markup or modification.
• VoiceIP - The upcoming market development in the Internet will be the ability to make telephone calls anywhere in the world for no long distance charges (only free for now).
   

Benefits to Telemedicine:

• Low cost connection between specialists and primary care providers
• Ability to share patient records real time in audio and graphic form
• Publishing of shared data
   

What is the difference between Telemedicine and the Internet?

• Telemedicine had its origins prior to the popular commercialization of the Internet and relied on expensive leased lines.
• The Internet is a reselling of leased lines through Internet Service Providers. Internet connections are made when ever one computer makes a request for information from another, then the connection is broken to enable others to use the bandwidth.
• For applications that require continuous unbroken connections, leased lines or frame relay services are more appropriate. 
• The difference between Telemedicine and the Internet are primarily terminologies originating from different telecommunication user groups; and telemedicine is an application strictly used by the medical profession

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