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Telemedicine, telehealth and e-health are terms that are used interchangeably. However there are some subtle differences in their definitions.

Telemedicine 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 described as 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 4

Central 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

Other basic requirements for telemedicine include:6

  • Expert advice must be available at site being referred to.

  • Sufficient description of the problem being referred or services required from a medical opinion.

  • Adequate 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 centers.

  • 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.

Telemedicine Subspecialties



  1. Feliciani, F. Medical care from space: telemedicine ESA Bull. 2003 May;114:54-9.

  2. University of Calgary. [WWW] 2002. What is telehealth? http://www.fp.ucalgary.ca/telehealth/What_Is_Telehealth.htm (25TH September 2003).

  3. Eysenbach, Gunther. What is e-health? Journal of Medical Internet Research. 2001;3(2):e20.

  4. John Mitchell & Associates. [WWW] September 1999. From Telehealth and E-Health: The Unstoppable Rise of E-Health. http://www.noie.gov.au/projects/ebusiness/developing/ehealth /rise%5Fof%5Fehealth/unstoppable%5Frise.htm (25TH September 2003).

  5. 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).

  6. 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 2003).

  7. University of Maryland Medical Group. [WWW] 28TH December 2001. What is telemedicine? http://www.mdhealthnetwork.org/main/article/article.asp?sID=18 (25TH September 2003).

  8. Goodwin, Kristine. [WWW] 31ST July 2000. Payment, Licensure Are Barriers to Telemedicine. http://www.ncsl.org/programs/health/barriers.htm (25TH September 2003).

Useful Links



International Medical Informatics Association
American Medical Informatics Association
UK Health Informatics Society
British Computer Society Health Informatics Committee
European Federation for Medical Informatics
American Nursing Informatics Association
American Telemedicine Association

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Last Updated: 10 August 2006.

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