Telemedicine

Telemedicine is a part of the field of telematics in health care and referred diagnosis and therapy, bridging a spatial or temporal ( " asynchronous" ) Distance between doctor (Tele doctor ), therapist (Tele therapist ) pharmacists and patients or between two consulting physicians via telecommunication.

General

Telemedical procedures were tested on a large scale since the 1980s. Driving force for telemedicine is a spatial separation between doctor and patient or physician and medical specialist, such as in space (also telemetry ) during expeditions ( Arctic / Antarctic ) or in military operations. Even large countries with a small population in remote areas have early seen a need for telemedicine applications. For this reason, many researches have been made in Norway. In addition to the telemedicine, other forms of care, such as the Flying Doctors of Australia exist. A disadvantage of telemedicine is often the lack of therapeutic options, since a specialist is not on site.

In the medically well -served areas telemedicine is used with the goal of quality improvement, for example by obtaining a second opinion or to improve the quality of life of patients saved paths to the doctor and prevention of emergencies through observation apparatus. In addition, telemedicine may also contribute to the improvement of education, training and continuing afford.

The fact that the treatment success is based not just on improved technical conditions, showed a three-part randomized study of Group Health Center for Health Studies in Seattle, among others. According to the publication in the U.S. doctors journal JAMA in June 2008, only the patients experienced a direct personal Internet consulting a statistically significant increase in treatment success ( adjusted hazard ratio of improved blood pressure control: 3.32, 95 percent confidence interval 1.86 -5.94 ).

Areas of application

Telesurgery
Teledermatology
Telediagnostics
Telecardiology
Teleconsultation
Telemetry
Telemonitoring
Tele EUR Logie
Teleoperation
Telepathology
Telepsychiatry
Teleradiology
Telerehabilitation
Teletherapy

Challenges

Telemedicine has to deal with medical, technical, organizational, economic and legal challenges as well as subjective concerns:

Medical challenges

Telemedicine is not necessarily with telematics, but always to bring medicine combined and has to meet their basic needs. These include the efforts of the various health service providers such as ( According to the World Health Organization, " a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity ) to get doctors, visiting nurses, physical therapists and the multitude of other health practitioners health for the take care of patients or restore. This can lead to a local division of labor for medical reasons, where for example Patient, examined medical specialist ( such as a radiology technologist ) and specialty care are not, but well connected by a common medical treatment contract with each other in the same place. Medically here is essential that the specific duties, obligations and rights of the different professional groups involved for the patient defines transparent and conducted quality assurance. All listed below aspects should help to support the core medical processes, this program possible. Through the use of modern information and communication technologies, many new opportunities are created but also risks of this form of medicine.

Technical challenges

Telemedicine is the use of communication tools and thus includes the requirement of interoperability between the communication partners. Here, for example, video conferencing standards have been established in recent years. However, the technical effort is often large, especially if radiological modalities ( NMR) must be connected to remote workstations and archives using the DICOM standard. Another problem is the quality of data that can be changed by obtaining the data, the transmission or the compression of data. Telemedical method should be clinically validated. Due to the extremely restrictive regulations for the transfer of patient data to ensure data is a challenge for telemedicine. Personal data may be anonymized usually exchanged or a pseudonym. Technical solutions for these are also encryption of the data stream, but require appropriate equipment at the transmitter and receiver.

Organizational challenges

The communication partners must make arrangements, such as the data to be exchanged. In synchronous transmission fixed times to be agreed. This is to ensure in clinical practice not always. Likewise, the teleconsultation requires the documentation, which can possibly lead to additional costs.

Economic challenges

Telemedicine caused fixed costs (equipment purchase ) and operating costs ( connection costs, personnel costs). This raises the question of who bears these costs. Thus, the compensation and settlement in many places still an obstacle for the introduction of telemedicine dar. Many funded projects are therefore no longer operated after the eligibility period.

Legal challenges

In general, one distinguishes a "first opinion " and a complementary second opinion. During the second opinion legally caused less concern, a purely supporting telemedicine Erstmeinung may be legally problematic. Such a situation may be, for example, no specialist on the spot, and the diagnosis is carried out solely by a telemedical consultation from a remote specialist. Data quality is also crucial for the legal assessment. Therefore, a validation of the procedure should be performed.