- Whenever any person on the farm had any health-related problem, they could call up their
doctor on the wireless radio that every farm had.
- The patients would explain their condition and seek advice.
- The doctor would communicate via the wireless as to how relief may be sought.
- Each farm had a well-stacked medicine chest with numbers identifying each medicine. The
doctor also maintained a concurrent list.
- If however the situation so warranted, the doctor would physically fly out to the farm
and do the needful as warranted.
- Some provider of care would still need to be physically present at the side of the
patient to actually deliver the care (in the form of nursing, taking samples for
investigation, noting the vitals (vitals include pulse rate, respiration rate,
temperature, blood pressure, size of pupils, or do dressings, etc.). [Top]
- Telemedicine employs information technology, through the judicious use of computers,
related softwares, and telecommunications systems comprising of compatible telephone
lines, fibre-optic cables and satellite link-ups, etc., to provide premium quality health
- Currently, computer technology is helping medical personnel in delivering more efficient
health care in lesser amounts of time and consequently at lesser expenses.
- Distance is no barrier to better diagnosis and management of a patient with this
technology. In other terms, it is remote telemetric health care.
- Telemedicine is not one specific technology but a means for providing health
services at a distance using telecommunications technology, medical expertise and computer
- It spans every echelon of health care, from the first responder (e.g., GP) or emergency
medical systems to tertiary (Third level - usually refers to the hospital, i.e.
institutions, in medical sciences) medical speciality consultations to performing invasive
and/or surgical procedures to delivering home care.
- In areas where quality health care is available, this technology would make it possible
to allow access to even higher standards of health care.
- Already telemedicine is being increasingly utilised by health care providers by a
growing number of medical specialities like dermatology (study of the diseases of the
skin), oncology (study of cancerous diseases), radiology, surgery, cardiology, psychiatry
and home health care.
- The technology is also expected to fine tune the overall management of health care and
resource allocation for remote health care emergency programs by transmitting images to
medical centres for long distance evaluation by the appropriate medical personnel.
Improvement of medical education in the form of continuing medical education is also made
possible by linking several community hospitals together with the sponsoring medical
- In summary, telemedicine is a high-tech solution to the universal problem of access to
health care. By the term telemedicine network, one refers to a set of
functional relationships among telemedicine facilities, which in turn refers to
locations where telemedicine services are provided and/or received. [Top]
Telemedicine is a technology that permits
medical data to be stored, retrieved, exchanged and analysed with ease anytime anywhere.
For instance, consider an electronic bill sent to a purchaser of care services as a claim
for care provided to a patient. For the purposes of ensuring that the message is delivered
and acknowledged, the message must contain such data items as:
- the patient identification
- the date(s) when and place(s) where these services were rendered
- the amount of payment claimed
- What is required is the value of that attribute in the full blood count.
- every type of message has a defined purpose
- each message type requires a predefined set of data elements to fulfil that purpose
- every element has a defined meaning (e.g. ICD or as in a national data dictionary or
- the data elements must be in a predefined position in the message, indicating to what
- each data element must be presented in a predefined way (i.e., a preferred format)
coupled with predefined 'dimensions' (e.g. x10,000 cells per mm3, grams/Litre,
Messages are to be kept as short as possible for four
- to minimise network traffic and therefore peak traffic capacity required
- to minimise connection times and therefore user costs
- to make it easier to find an error in a rejected message [Top]
- The technology that telemedicine offers not only allows for easier and better patient
management while concomitantly offering better supervision of the prescribed care.
- Whether a particular provider can afford (or not) to have such a technology on hand for
improved patient management, and
- Telemedicine embraces within its ambit the whole concept of information systems in
health care industry, plus some more.
- Telemedicine is an emerging field that could have a revolutionary impact on the delivery
of medical care.
- The goal is to improve access to and the delivery of high-quality medical care at an
- However, policy makers, health care organisations, and providers are successfully
challenged to distinguish excitement and hyperbole from the practical implications of this
new suit of technologies and applications.
- Geography would not be an encumbrance to providing quality health care and management
- Hopefully, with the increase interest in this technology and all that it can do for the
health care industry, the ground conditions would alter favourably.
- High technology areas are treacherous when they are simple, and telemedicine is most
- High costs, at least initially. General efficiency of the health care system can be
created by the use of this technology with successful computerisation yielding many
tangible benefits to the health care management.
- Telemedicine would also help in transforming the health care industry into an integrated
system as a whole supporting the continuum of health care.
- Remote access to archived electronic scans and patient-related health data as well as
other relevant records, and the provision of health care information (pre-operative,
antenatal care, various support groups, etc.) direct to patients home would also be
made possible through this technology.
- Emergent technology (ET) in the field of Information Systems (IS) will further enhance
the quality, quantity and efficiency of telemedicine.
- Telemedicine allows the active participation of the family in the management and care
process of the patient concerned.
- It would also cause increased patronage by the remote and rural centres allowing the
organisations possessing telemedicine technology to export their various skills to them.
- This one technology truly can create an effective global health village, albeit in
"virtual reality", and make health for all a real possibility.
- Once telemedicine is accepted and used as a viable technology, with the utilisation of
existing technology and facilities, it would soon be able to demonstrate its usefulness to
the health care industry and its customers and provide an ample glimpse about its immense
- As with any technology, telemedicine too should be gradually be phased-in,
as the older and essentially conservative system is 'phased-out'. Additionally,
telemedicine would allow an organisation to position itself favourably in the market. [Top]
- The road to implementation will be long and arduous.
- Various project leaders have identified several problems.
- Communication links during telemedicine consultations may also suffer such ignominies
from time to time.
- A number of very serious efforts at developing and implementing various telemedicine
projects is on right now in various parts of the world.
- The only thing that is lacking is the overall shapes that telemedicine technology would
- It currently has a low market share with an expected high technology growth rate. It
will cause large negative Discounted Free Cash Flows (DFCFs) right now.
It will become a cash cow before its technology growth rate falls. [Top]
- Administration of the telemedicine network should however not be in the hands of the
- As the medical fraternity is in direct contact and in constant interaction with it,
practically on a daily basis, the state-level medical councils must act as the liasing
body to such a network.
- The various payers would not necessarily be interested in every detailed bit of
information that exists within the network but might seek information on certain details
from time to time.
- A dedicated telemedicine network may be developed and then opened up for the whole
There would however be the requirement for monitoring of the
ultra-sensitive data and the legal compulsions of treating a patient who not only happens
to be residing in a foreign country but also is actually a citizen of yet another foreign
country. In the US there is a further consideration of cross state legal requirements that
needs to be kept in mind.
In my opinion, the ultimate responsibility should remain with the
medical professional who actually prescribes the medicine, no matter whom or from where he
has received advise and/or guidance, and is actually in-charge of the day-to-day
management of the patient. The telemedicine service provider should ensure this and make
it absolutely clear in no uncertain terms. [Top]
Resource Planning - ERP
- The ERP systems that are currently available are said to belong to the client-server
- The databases are built using relational database technology while the business logic is
split depending on the product architecture to be executed on the client or server or both
- With suitable communications infrastructure, these systems could be deployed in a
distributed environment and the business processes may span across multiple geographical
- The current generations of database systems are based on relational technology (RDBMS).
- These database systems support data seeking using standard query language known as
Structured Query Language (or SQL - pronounced as "seequell").
- ERP systems built on this technology will support organisations with the need to set-up
distributed systems that are considerably less dependence on a centralised information
- In concert with simultaneous data warehousing on a global scale, ERP will allow the
analytical manipulations of the atomic data contained therein. [Top]
and Datawarehousing in Health Care
A data warehouse has been defined as a
collection of data in support, principally of, decision making process that is:
- Data is subject to constant change and is seldom consistent
- Provide a multi-dimensional, conceptual view of data
The broad differences between Transaction Processing and
Data Warehousing are as follows:
- A datamart has data specific to a business area/development.
- The data may be captured from operational systems or enterprise data warehouse.
- Metadata is an information repository of the datamart.
- The metadata stores the definitions of source data, target data and source to target
- Management of information about the enterprise data is as important as the data itself.
- An important aspect of the data warehouse environment is the metadata.
Simply stated, metadata is
- data about the data
- the structure of data in the transaction processing environment
- the structure of data within the datamart
- the source of data feed into the datamart
- the transformation information of the data as it passes into the data warehouse
- extraction information - extraction is the first phase of moving operational data into
the datamart [Top]
for Datamarts and Datawarehousing in Health Care
- Data warehousing technology helps in effective management of scattered data, by
validating and organising it at one place - the data warehouse.
- Consequently, an increasing number of organisations are rapidly embracing data
warehousing for faster solutions to ad hoc queries and business problems.
- The data warehousing technology significantly changes the way information system (IS)
departments function. [Top]
of Datamarts and Datawarehousing in Health Care
A doctor wishes to see the details of the
past illnesses of a patient. If the doctor then seeks some additional details, then he
quite simply has had it. I describe a possible sequence of data storage/retrieval/analysis
using data warehousing and datamarting technology below:
- The doctor/carer collects all the necessary details from the
- He feeds in these information into the system
- A snapshot summary in the form of web page(s) with suitable links for seeking of the
data, that is collected and inserted, is compiled and stored immediately (hence the
necessity of having computers equipped with fast processors for such servers)
- This very summary is also displayed on the screen of the doctor and he may immediately
use this summary for analysing the case that is presented by the patient.
- This data is stored in that server or a data warehouse that collects every data that
emanates from a locally connected server. Further links are available to help in the
interpretation or display of the findings of the ECG tracing.
- The patient does not remember the date, but the data stored within the smart card of the
patient accurately noted it.
- Thereafter the patient's smart card is updated with the currently obtained data.
- Most of the times however, the doctor will be satisfied to see the principal complaints,
date and time of the complaints, broad negative/positive physical and investigatory
findings, diagnosis made, treatment administered and the various medicines prescribed. [Top]
- Smartcards with encrypted security codes in the form of passwords would undoubtedly
prove to be a boon for one and all..
- Such cards should only have the patient vital statistics (names, unique reference number
valid for telemedicine network, pulse rates, BP, temperatures, and respiration rates for
the past year,), and only such information only that are required for emergency purposes
(like drug allergies, presence of diabetes/haemophilia/hypertension, etc.).
- Restricted viewing of data will allow ultra-sensitive data to be permanently masked to
all unless it is the person who put the data in originally or the person whose data is
being put in.
- Instead of a smartcard, one may use miniaturised flash-ROM chips capable of storing
large amounts of information of a variegated nature ranging from the details of driving
license to a complete recording of one's favourite song.
- The good part is that the chances of loss or some unscrupulous person gaining wholly
unwarranted access to the information contained therein is almost negligible.
- The responsibility of verification and authentication of the data however lies with the
person who actually collects computes and inserts the data.
- There is always the opportunity of building up a separate network dedicated wholly,
solely and exclusively to telemedicine network. [Top]
Since hardly any software solely dedicated
for telemedicine purposes is available in the market, although a number programmes are are
already in the market which, if seamlessly interconnected then, could be made into a fully
functional telemedicine product, I am enumerating the ideal components and the
capabilities of such software(s) in this section.
The ideal software solution for telemedicine would
consist of the following components, with their capabilities on an individual basis, are
as ut infra:
- The database is physically located on a local server with mirror sites carrying the same
information located at various parts of the globe.
- There are suitable firewalls built to guard against hostile data access.
- The front-end is ergonomically built that is able to process information to display data
and graphics on screen, generate and print reports and labels on the fly, automatically
format or generate and then display. Such pages may be displayed using DHTML with CSS or
ASP (for Windows® environment) or PHP (for all environments since even LINUX has PHP
support) to help in the interpretation and/or display of the various tracings.
- The package must allow for intelligently querying of the database.
- The database tables on the local server is updated at a time when the server is
processing the least data-access work - the server may automatically determine this.
- The central data warehouse may update the database tables from data extracted from the
views located on the local server.
- The database of the central data warehouse should also store the summary web page(s).
- These in combination would help in speedy and efficient data-access by other servers
that are remotely connected to it via central data warehouses located at other places.
- The front-end must allows access to word processing and spreadsheet packages. CDSS
packages for intelligently interpreting datas related to health.
- A suitable data warehousing package that would help in the efficient administration of
the telemedicine system.
- Software manufacturers could help by providing data warehousing capabilities to their
client-server software itself, even if only a limited extent like creation of metadata,
the physical storage of data in multi-dimensional form, SQL based querying.
- This package must also be capable to automatically access the local central data
warehouse and upload the data and snapshots of summary reports at a specified time.
- Information kiosks - the software required for these would need some special handling.
- Transmission of data - I prefer the object mode of data handling for then
incompatibility amongst various softwares installed on to the computers of the end users
be minimised. [Top]
- Straightforward transmission of HTML (or ASP or CGI-Perl or PHP or JSP that can create
dynamic web pages on-the-fly) based web pages that can be easily viewed with the help of
- The transmission lag time should not be significantly different from that the end-user
already faces in using the Internet and hence end-user should not perceive any significant
difference in using this product and any other Internet-related product.
- The ability to use SQL will dramatically improve the overall capability of the package.
- Data will be more secure as only the correct front-end, displayed, as a web page on the
users screen, will be able be able to correctly display the information in the right
- If the data is transmitted as objects instead of raw data then it automatically becomes
more secure and the transmission time much reduced.
- This also helps the Software Company to protect its product, as the customer will have
to buy the particular software only from them.
- A hub-and-spoke concept is my method of choice for telemedicine networking.
- A primary hub at the local/zip level is connected to secondary hubs at the
district/county/regional level by LAN method and these secondary hubs are in turn
connected to tertiary hubs at zonal/state/country level which serve large areas by WAN
- The client-server technology is the method of choice for building up the basic
- The various end-users will be the "clients", while the data is stored in the
- Software manufacturers are most worried about the shelf-life of their products, so
getting ones product first into the market is what is upper most in the
marketing/finance department and the managements mind.
- There is a very good possibility that WAP would ultimately prove to be the mode of
transmission of data of all types, while the software would be built using the
platform-independent Java, for all telemedicine programmes in the future. [Top]
- The incessant march of scientific discovery and the motivation for discoveries is
derived from the successful implementation of them. Remember fire?
- Telemedicine is fascinating. If the health care industry repudiates it because of its
present inefficiencies, a golden chance of being able to provide the best of available
care anytime anywhere would be lost for a generation or several generations, and that
would be one of the greatest tragedies to befall mankind. [Top]