E-Medicine

"e-medicine is the ability to provide interactive healthcare utilizing modern technology

and telecommunications." Basically, e-medicine allows patients to visit with physicians live
over video for immediate care or capture video/still images and patient data are stored and
sent to physicians for diagnosis and follow-up treatment at a later time. Whether you live in
the center of Los Angeles or deep in the Brazilian Amazon, e-medicine is an invaluable tool in
Healthcare.
Here's an example of how e-medicine works everyday. Say you have a horrible sore throat and
visit your healthcare provider (could be a general practice physician, nurse practitioner, or
unlicensed health worker in a village depending where you live), who does an examination and
is concerned with what he sees. Your provider recommends a referral to an ENT specialist for a
follow up diagnosis and treatment plan. Well, instead of traveling to the nearest specialist,
which depending where you live could be anywhere from a 45-minute drive or an 18-hour boat
ride up the Amazon River, your provider connects you directly to the ENT specialist via emedicine.
Here are some of the major benefits of a e-medicine Consultation:

The specialist actually hears your medical history and current condition directly from you
and your provider instead of the specialist receiving a dictated note in the mail.
With the use of ENT medical peripherals such as a nasopharyngoscope, your provider
can pass this medical peripheral into your nasal passage which will allow your provider
and the ENT specialist simultaneous crystal clear video of your throat and vocal cords.

The specialist may ask you to cough, pronounce letters, etc. in order to get the best
outcome for the diagnosis.

The specialist can diagnose and recommend treatment immediately.

Your provider has the opportunity throughout the examination to ask questions and learn
from each and every consultation. The continual education of your provider via medical
consultations is an immeasurable benefit to all his patients.
e-medicine Usage Models
Real-Time:
This is the most common use in e-medicine. Like the example above, live video allows the provider, patient
and specialist to all communicate together to achieve the best outcome for the patient.

In or outpatient specialty consultation

Physician supervision of non-MD clinician
Generally require higher bandwidths (minimum 256kb)
Store and Forward (asynchronous):
Used when both health providers are not available or not required at the same time. The provider's voice or
text dictation on the patient's history, current affliction including pictures and/or video, radiology images,
etc., are attached for diagnosis. This record is either emailed or placed on a server for the specialist's
access. The specialist then follows up with his diagnosis and treatment plan.

Home Health e-medicine

When a patient is in the hospital and he is placed under general observation after a surgery or other
medical procedure, the hospital is usually losing a valuable bed and the patient would rather not be there
as well. Home health allows the remote observation and care of a patient. Home health equipment consists
of vital signs capture, video conferencing capabilities, and patient stats can be reviewed and alarms can be
set from the hospital nurse's station, depending on the specific home health device.
Usually low bandwidth analog Plain Old telephone System (POTS). Some newer systems do support
higher bandwidth capabilities.
Disease management, post-hospital care, assisted living, etc.

Summary of Benefits of e-medicine

To Rural Physicians and clinics (spoke sites)

Receive education from the specialist/provider

Better health outcome for their patients
Enhanced community confidence in local healthcare
Attend continuing medical education courses from their clinic

To Patients
Loved ones remain in their community with family support
Cost savings from not having to travel extensively
Immediate urgent care
Confidentiality of specialty examination or visit (Because the patient visits the
general practice doctor, he can be seen for any specialty care without anyone else
knowing)
Patient education courses (nutrition, oncology, etc.)
Properly stabilize patient prior to transport
Early Diagnosis prior to escalated medical episode

Rural Patient's Community - Rupees follow the patient : Patients that routinely travel
to visit doctors in large urban areas tend to purchase their goods and services from those
cities, e-medicine keeps those Rupees local.
To e-medicine Providers (hub sites) :
Expand patient outreach

Major surgical procedures resulting from the initial e-medicine consultation

Reduction in ER visits

Promotion of Hospital

Charge tuition for clinician education courses (CME, CNE, etc.)

E-Medicine is not an evolutionary concept but a revolutionary concept in itself. It represents a

very innovative approach in providing quality health care whenever and wherever needed, but is seen
lacking reliability, user friendliness & most importantly governmental support.
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 advantages 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.
What is E-Medicine ?
It has been defined as the use of telecommunication to provide medical information and
services. It may be as simple as two health professionals discussing a case over the telephone, or as
sophisticated as using satellite technology to broadcast a consultation between providers at two
distant locations, using videoconferencing equipment.
The simplest definition of E-Medicine is that it uses multimedia technology (voice, video and
data) to deliver medical services. The lower cost of band- width and improvement in video and data
compression standards have increased the number and types of medical services that can be
delivered from a distance to include virtually every specialty.
E-Medicine is an application and not a technology. It uses a hybrid technology incorporating
elements of television, telecommunication, computers, engineering and medicine. Services can be
delivered on a combination of technologies with a variety of equipment.
Objectives of E-medicine :
E-Medicine is not an evolutionary concept but a revolutionary concept and at the heart of
every revolution, there is the need for a sudden massive change, at the core of which is the human
mind. By taking into consideration Health For All, well discuss some objectives for which EMedicine has originated.
1. To make high quality healthcare available to traditionally under privileged population - In India,
there is a large rural based population separated by large distances which need access to
regular quality medical care. E-medicine can enhance citizens equality in the availability of
various medical services and clinical health care, despite these economic and geographic
barriers.

2. Save the time wasted by both providers and patients in traveling from one geographic location
to another to avail services on time- Think of a patient who requires immediate specialist
consultancy, and there is no specialist available to cater to him. This is where e-medicine could
be utilized for effective healthcare delivery.

3. Reduce costs of medical care The ever- rising cost of healthcare is becoming a prime
concern. The incidental expenses related to patient care, i.e. the cost associated with factors
other than the actual medial care such as travel, accommodation for relatives, food etc also
contribute substantially to the overall cost of treatment. In a country where health insurance is
yet to catch up, all these are borne by patients, in many cases by selling property and
livestock. If hospitals can reduce these costs associated with treatment, it would go a long way
in reducing the burden of care on the patient. E-medicine seems to be the answer.
Initiatives taken by healthcare organizations;
There are many activities that are going to contribute to the spread of E-Medicine in India. Of
which APOLLO (Hyderabad) and ASIA HEART FOUNDATION (Bangalore) are emerging as key
players. Madras Medical College is the first government medical college to have E-Medicine installed
in INDIA.
Organizations such as ISRO, have taken innovative approach to facilitate healthcare delivery
by launching an exclusive health satellite. It provides almost 100% uptime, making it the best medium

for a country such as India with diversity in terrain. General Electric and Wipro are also undertaking emedicine stations in Chennai and Hyderabad.
Grudges and Hindrances:

Perspective of medical practitioners : Doctors are not fully convinced and familiar with emedicine. They cannot understand how their jobs can be performed more effectively and
efficiently through the use of e-medicine. The very thought of diagnosing a patient when
he/she is physically absent just on basis of the data provided through the net turns them
blue. Similarly practitioners in remote areas feel threatened that they will be surpassed due
the reach of brand names like APOLLO, Asia Heart Foundation etc.

Patients fear and unfamiliarity : There is a lack of confidence in patients, about the
outcome of E-Medicine. The main problem is that any treatment consist of two factors; first
is chemotherapy i.e. treatment by medicines and the other is psychotherapy that means
treatment by emotions which is absent in e-medicine.

Financial unavailability: There has been several isolated initiatives from various
organizations and hospitals for the implementation of e-medicine projects. But the
technology and communication costs being too high, make it financially unfeasible.

Lack of basic amenities: In India, nearly 40% of population lives below the poverty level.
Basic amenities like transportation, electricity, telecommunication, safe drinking water,
primary health services, etc. are missing. Any technological advancement cant change a
bit when a person has nothing to change.

Literacy rate and diversity in languages : Only 65.38 % of Indias population is literate
with only 2% well-versed in English. So the rest of the people are facing a problem in
adopting E-Medicine. Also, the presence of a large number of regional languages makes
the applicability of a single software difficult for the entire country.

Technical constraints : E-medicines supported by various types of software and

hardware, still needs to mature. For correct diagnosis and pacing of data, we require
advance biological sensors and more band-width support.

Quality aspect : Quality is the essence and every one wants it, but can sometimes create
problems. In case of health care, there is no proper governing body to form guidelines in
this respect and motivate the organizations to follow, it is solely on organizations how they
take it.

Government Support : The government has limitations and so does private enterprises.
Any technology in its primary stage, needs care and support. Only the government has the
resources and the power to help it survive and grow. But in India we are not the favored
ones. There is no such initiatives taken by the government to develop it.

Biological consistency : Diagnosis itself is a complex process and symptoms of disease

are not consistent in all the patients. The consultant makes a disease diagnosis on the
basis of information gleamed from the patient. In e-medicine the consultant tests the
hypothesis, it may be right or wrong.

SNEA (I) UPE

The importance of right strategy planning- A specific approach for each case

Provide basic facilities- like Transportation, Electricity, Primary health care centers (PHC)
etc.
Integrate E-Medicine with other daily facilities- like Education, Health, Banking services etc.
Training- it is essential to train the literate people from rural areas.
ood and Effective advertising campaigns- by video or by audio, which can be
understood by rural people.

Technical - User-friendly technology like Graphical User Interface.

- Flexibility and adaptability in terms of technology.
- Involving the user from the beginning of project.
- Quality control and proper standardizations.
- Making expert systems to help users as well as patients.
Social and Political - Active participation of society.
- Strong political will.
- Involve NGO volunteers with these activities.
Educational - Providing continuous Medical Education (CME) for users like doctors.
- Training programs for health care professionals, patients and other persons.
Financial
- The government has limitations and so does the private sector. A combined effort from both is
needed. In private sector- software, hardware companies, computer education institutes and
corporate hospitals can play a major role in it.
Conclusion :
To witness a successful revolution in E-medicine, we need to bring these array of activities together. If
these experiments work in India over the next decade, the vast population living in developing
countries will be winners and bear the fruit of our success.