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telehealth and e-health are terms that are used interchangeably. However there
are some subtle differences in their definitions.
itself has been defined as the use of telecommunication to provide
diagnostic and therapeutic medical information between patient and doctor
without either of them having to travel.1
Telehealth on the other hand has
become a more generic term to describe a
wider definition of telemedicine. It is the use of information and
communication technology (ICT) to deliver health services, expertise and
information over distance.2
However e-Health is more broader than
either telemedicine or telehealth and can be
an emerging field in the intersection of medical informatics, public health and
business, that enables health services and information to be delivered or
enhanced through the Internet and related technologies.3
to all these definitions is that the use of information and communication
technology, such as the Internet, is required for long distance health services
delivery. The use of the Internet in telemedicine is likely to increase as more
healthcare organizations switch to broadband Internet connections.5
requirements for telemedicine include:6
advice must be available at site being referred to.
description of the problem being referred or services required from a medical
time should be given for assessment of all requests.
The amount of
time of would be required for a response from the expert from the other side
would depend on the type of telemedicine being practised. There are basically
two types of telemedicine:
- Store-and-Forward Telemedicine:
This is usually used for transferring digital images from one location to
another. Images are captured with digital cameras or still video, and sent to
another location. They are attached with a summary of the case in text (usually
by email). This type of telemedicine is usually not used in emergency
situations, as specialist review cases when convenient. There is no limit to
the physical distance between the origin and the destination of the image.
- Real-time video linking: This method is used when
a 'face-to-face' consultation is necessary. It is usually between the patient
and their provider in one location and a specialist in another location.
Specialized video conferencing equipment at both locations allows a
'real-time' consultation to take place. High bandwidth communication channels
(ISDN lines) are necessary, although this type of telemedicine is now within
reach of the desktop computers connected to the Internet.
It is possible to combine any of the two to suit the needs of the organization.
Benefits of telemedicine:7
It can lead to improved access to medical care for geographically or
socio-economically isolated patients.
It prevents unnecessary patient travel to secondary or tertiary health care
Promotion of education, prevention, clinical trials and other programs.
Facilitates community education concerning pertinent health care topics.
Augmentation of the quality, continuity and affordability of medical care.
Can assist preservation of the patient’s current provider-to-patient
relationship while facilitating access to specialty care.
Enhances continuing medical education and support for rural-based providers and
remove the obstacle of professional isolation.
Can effectively utilize medical resources by creating an integrated network of
primary, secondary and tertiary care.
May help secure the financial stability of rural hospitals and allow patients
to obtain medical consultation in their own community.
Barriers to telemedicine:8
- Local licensure rules may prohibit a physician
from consulting in another area.
- Reimbursements are slow to come through because of
complicated rules and requirements.
- Compliance to patient privacy laws such as HIPAA
and the Data Protection Act.
- Cultural resistance.
- Fear of malpractice.
- The cost and the exclusiveness of the appropriate
telecommunications technology is another hindrance.
- Regular telephone lines do not supply adequate
bandwidth for most telemedical applications. Many rural areas do not have high
bandwidth telecommunications access required.
Feliciani, F. Medical care from space: telemedicine ESA Bull.
University of Calgary. [WWW] 2002. What is telehealth?
Eysenbach, Gunther. What is e-health? Journal of Medical
Internet Research. 2001;3(2):e20.
John Mitchell & Associates. [WWW] September 1999. From
Telehealth and E-Health: The Unstoppable Rise of E-Health.
(25TH September 2003).
BBC News. [WWW] 17TH January 2003. Deal to bring
broadband to NHS. http://news.bbc.co.uk/1/hi/technology/2665167.stm
(25TH September 2003).
Fraser, Hamish S. F. [WWW] March 2002. Introduction to
telemedicine and healthcare communication.
http://dsg.bwh.harvard.edu/courses/hst950/13-1P.pdf (25TH September
University of Maryland Medical Group. [WWW] 28TH December
2001. What is telemedicine?
Goodwin, Kristine. [WWW] 31ST July 2000. Payment,
Licensure Are Barriers to Telemedicine.
http://www.ncsl.org/programs/health/barriers.htm (25TH September