1. TELEMEDICINE AND TELE NURSING

2. DEFINITION OF TELEMEDICINE
Telemedicine is defined as the use of tele
communications, the deliver health care expert
sharing of medical knowledge with persons are
distance locations.
It is transfer of medical data for
• Consultations
• Diagnosis
• Support for Clinical Case
• Containing Medical Educations

3. Medical Data Such as
 High resolution photography
 Radiological images
 Sound and Patient records
 Electronic signals via the internet
 Intranet
 Personal Computers (PLS)
 Telephone Lines

4. HISTORY OF TELEMEDICINE
 University of Nebrastea did first documented use of
visual telecommunication in health care in 1959.
 Under first telemedicine program in December 1988,
the site of massive earthquake in Armenia was linked to
medical centers in United States for telemedicine
consultations.
 The program was extended to Russia to provide
telemedicine consultation to burn victims after a terrible
train accident.
 First internet based telemedicine trials wall conducted in
April 1955 when a Chinese studies zee Ling who was
studying in Beijing University fell sick and her condition

5. HISTORY OF TELEMEDICINE
1.1. Telegraphy andTelegraphy and
telephony wastelephony was
establishedestablished
1920s1920s
2.2. Wireless / RadioWireless / Radio 1950s1950s
3.3. TVTV 1960s1960s
4.4. Computer and InternetComputer and Internet 1990/20001990/2000

6. TELEMEDICINE APPLICATIONS
 Emergency Health Care
 Video Consulting
 Telecardiology
 Telemedicine as applied by cardiologis is
called telecardiology.
 Telepathology
 Teledermatology
 Teleophthamology
 Teleoncology
 Telepsychiatry
 Teledentistry

7.  Distance Leaning
 Medical education and the transfer of
medical data.
 Medical care delivery, diagnosis,
consultation and treatment at a
distance.
 Nursing homes or retirement centers.
 Home monitoring for patients
 Health care in the after of disasters.

8. MAJOR TELEMEDICINE PROJECTS
11 StaphacStaphac NasaNasa Arisona,Arisona,
USAUSA
22 Space PridgeSpace Pridge NasaNasa ArmeniaArmenia
33 North-WestNorth-West
Telemedicine ProjectTelemedicine Project
AustraliaAustralia Queen SlandQueen Sland
44 Primetine IIIPrimetine III USA FinesUSA Fines BoghiaBoghia
55 Telemedicine FlagshipTelemedicine Flagship
ProjectProject
MalasiaMalasia MalasiaMalasia
66 Appollo TelemedicineAppollo Telemedicine
ProjectProject
ApolloApollo
HospitalsHospitals
IndiaIndia

9. TELE CONSULTATION
 A doctor of a paramedic or even a patient
himself in remote area can have a consultation
with a specialist.
 This requires certain procedures to be followed
the person initiating the requires needs to be
trained and more importantly the complete
process needs to be documented for the
patients and the doctors record.
 Tele consultation also involves a family
doctors seeking help of specialist in an

10. TELE EDUCATION
 The use of telemedicine technologies makes if
much better than just surfing websites for
information.
 Doctors can attend clinical meetings as remote
places and also participate and present cases in
them. Some projects such as health net project of
Africa uses both internet and satellite
communications for doctors in remote area.
 If this is dealt using telemedicine the approach is
real time, the referring doctor knows how the
specialist is dealing with the patient and thus
further his knowledge.
 Tele consultation, video conferencing on surgery,
online clinical audit and containing medical
education are just some of the education
applications of tele education.

11. TELE MONITORING
 Tele monitoring is the remote monitoring of patient
data. The patients status can be monitored.
 Wherever he is whether in an aircraft or in remote
village as long he has a telephone access.
 The data includes, blood pressure, pulse, ECG,
spirometry, ultrosound, CT scan and other
radiology data.
 These can be transmitted using telephone lines or
through wireless with the use of appropriate
devices that can transmit these data over phone.
 These devices are commercially available and can

12. BENEFITS OF TELEMEDICINE
 Resource utilization
 Early intervention
 Avoids unnecessary transportation
 Community based care
 Medical education and research
 Cost saving
 Improved patient documentation
 Increased range of care and education.

13. RESOURCE UTILIZATION
 First benefit of telemedicine is proper
utilization of resources.
 In India doctor population ratio is 1:15000 in
comparison to 1:500 in developed nations, and
these doctors are not distributed equally.
 80% Indian population lives in rural and semi
urban areas.
 Telemedicine can help in cost effective
utilization of meager resources and of the
same time can decrease patient work load on
few referral centers.

14. EARLY INTERVENTION
 One of the most effective means of providing medical
intervention is by early detection and treatment.
 There are factors that inhibit the continuity of care.
Issues such as geographic location, inclement
weather, socioeconomic barriers.
 Patient apathy are significant factors that delay and
even prevent the specialty care.
 By providing these primary cure sites with the ability to
quickly access specialty consultation services.
 Patients are able to reap the benefits of early
intervention while the health care system maintains
quality service and clinical efficiency.

15. AVOIDS UNNECESSARY TRANSPORTATION
 Local health provides discusses case
of a patient on phone with a specialist
and it specialist is not getting clear
picture.
 After few questions he will able to send
the patient but if by video conferencing
he has clear picture of patient.
 Unnecessary referral and patient
transport can be definitely avoided.

16. Which Data Can be Transferred
 Basically four types of data are used in
telemedicine.
- Text for patient notes, generally having a
file of less than 10 KB.
- Audio – electronic stethoscope, with file
size of around 10 KB.
- Still image X-rays which are still images
having a size of around 1 MB.
- Video movie – ultrasound / patient
visualization – movie images have a size
of 10 MB or more the patient can be
seen by a doctor at a remote place using
cameras.

17. COMMUNITY BASED CARE
 Community based care is another big
advantage of telemedicine.
 People like to receive high quality care
in their local community.
 This reduces travel time and related
stresses associate with many referrals.

18. MEDICAL EDUCATION AND RESEARCH
 Telemedicine is also useful in medical
education.
 When medical students are posted in rural area
they can be linked to medical college for grand
rounds and they can also do case presentation
to teachers in medical colleges.
 In India Indira Gandhi National Open University
(IGNOU) carries out regular monthly session of
teaching of its diploma in maternal and child
health (PGDMCH) students.
 Physicians living in different parts of the world
also use telemedicine in collaborative research,
they can also share data or can discuses current
trends.

19. TELEMEDICINE CONCEPTS
 A video image has a rate of motion known as
the frame rate.
 This standard video like the one seen of the
television has a frame rate of 30 frames per
second.
 This 30 frames per second rate is required so
human eyes does not perceive any gaps in
information.
 In video conferencing there is limitation or
restriction on the amount of information that can
be transmitted through digital lines.
 This limitation on amount of information that can

20. ODALITIES OF DATA TRANSMISSION IN TELEMEDICIN
SystemSystem Data SpeedData Speed Advantages / DisadvantagesAdvantages / Disadvantages
PSTN (Public Service TelephonePSTN (Public Service Telephone
Network)Network)
56 kBpS56 kBpS Economical Ubiquitous slow, notEconomical Ubiquitous slow, not
suitable for high resolutionsuitable for high resolution
ISDN (Integrated Service DigitalISDN (Integrated Service Digital
Network)Network)
128 KBpS128 KBpS Cheap, FlexibleCheap, Flexible
Service Digital Network ISDNService Digital Network ISDN 2 MBPs2 MBPs Fast high quality, expensive, patchyFast high quality, expensive, patchy
availability.availability.
SatelliteSatellite 2 MBPs2 MBPs High quality, remote accessHigh quality, remote access
expensiveexpensive
WirelessWireless <2MBPs<2MBPs Convenience, free movement, newConvenience, free movement, new
technology, limited standardstechnology, limited standards
MicrowaveMicrowave <20 MBPs<20 MBPs Good quality, inexpensive to runGood quality, inexpensive to run
line of sight only short distances.line of sight only short distances.
Leased LinesLeased Lines 64 kBPs – 50 MBPs64 kBPs – 50 MBPs ReliableReliable
ATM (A Synchronoous transferATM (A Synchronoous transfer
mode)mode)
ADSL (Asynchronous digitalADSL (Asynchronous digital
Subscribes line)Subscribes line)
155 MBPs155 MBPs High band width, expensive, mayHigh band width, expensive, may
be superseded.be superseded.

21. TELEMEDICINE DEVICES
(A) Video Conferencing System
 Roll about systems
 Set top systems
 Desk top system
(B) Peripheral Devices
 Medicals Peripherals
 Non-medical peripherals.

22. LIMITATIONS TO SPREAD OF TELEMEDICINE
 Poor patient – Doctor Relationships
 Patient Acceptance
 Fear of Technology
 Low Rates of Utilization
 Infrastructure

23. BARRIERS TO TELEMEDICINE
 There are still several barriers to
the practice of telemedicine. Many
countries will not allow but of
country physicians to practice
unless licensed in the country.
 Many rural areas still do not have
cable wiring or other kinds of high
bunel width telecommunications
access required for more
sophisticated uses.

24. FUTURE OF TELEMEDICINE
 Many medical centers in India are now
successfully running, telemedicine – projects
and video conference.
 Future of telemedicine in India is definitely
bright-with availability of internet every
where, with new information's technology
policies and with improving
telecommunication network use of
telemedicine is going to increase.

25. INDIAN SCENARIO OF TELEMEDICINE
 Now with the availability of internet
connection in most cities of India interest in
telemedicine is increasing day by day but still
major draw back in India is that
communication network is not suitable for
most telemedicine applications.
 ISDN lines are not available in most of the
places in India, which is basic requirement
for video conferencing.

26.  Video conferencing technology will be limited to some
big cities and telemedicine technology that will be used
in most of the parts of India will be store and forward
technology.
 It will be like sending radiological images, patients
records, sounds through e-mail or modern and getting
opinion of experts.
 Many medical centers in India are now successfully
running telemedicine projects using video-conferencing.
 India is an ideal place to use this technology as 80%
population in India lives in villages where treatment is
provided by queen and unqualified medical practitioners.

27. DEFINITION OF TELENURSING
Telenursing is a subset of tele health in
which the focus is an nursing practice via
telecommunication.
-By American Nurses Association
Tele nursing is defined as the practice of
nursing using protocols through
telecommunication technology.
- Arkansas Staff Board of Nursing

28. THE PRACTICE OF TELEPHONE NURSING
 Standards and Quality Center is Telephone
Nursing.
 Competencies Required in Telephone
Nursing
 High Quality Practice Settings.
 Decision Support Systems
 Using Nursing Titles applies to telephone
nursing practice.
 Designated Agent
 LUNS and Telephone Nursing

29. GUIDELINES FOR TELENURSING
 Nurses and midwives practising in telenursing
shall be registered nurses or midwives. Enrolled
nurses involved by telenursing need to be under
the supervision of registered nurse or midwife.
 Nurses and midwives practising telenursing are
personally responsible for ensuring that their
nursing and or midwifery skills and expertise
remain current for their practise.
 Nurses and midwives who are practises
telenursing in Australia are effected to practice
with is the frame work of the ANMC National
Competences standards of the midwife the ANMC
code of professional conducts for nurses in
Australia, code of ethics for nurses in Australia
and other relevant professional standards.

30.  Nurses and midwives should inform consumers of
the telehealth process including other
persons/professionals who may be participations
or presence is the telehealth consultations and
urban consent before proceeding.
 Nurses are midwives in televisions have a duty to
provide privacy and confidentiality in all
interactions.
 Nurses and midwives practises in telenursing
should be aware of both the evidence base for
their practise and the areas or practice is need or
research.
 Nurses and midwives practising telenursing should
engage in evaluation of their practise in relations
to issue of quality safety and patient outcomes.

31. ISSUES IN TELENURSING
 Models of Case
 Privatizations
 Work line fro nursing staff
 Patient safety
 Cross Border License Issues

32. CLINICAL FUNCTIONS OF THE TELEHEALTH NURSES
 Telehelath nurses are monitoring patients
with chronic diseases.
 Helping patterns manage their symptoms
and co-ordinations care of patients who
require service from homeruns health
professionals.

33. BENEFITS OF TELENURSING
 When patient stand seeing of their own
day, they stand connecting the data above
their processes.
 Managing their disease better reduce their
utilization of acute case services such as
emergency department visits and
hospitalization.
 Saving time achievable because driving
time to reach patient residence by
significantly reduced.
 Nurses are able to spend more time on
direct patient care.

34. Telehealth Nurses Provide Nursing Care by
 Using Clinical Algorithms, Protocols, or
Guidelines to Systematically Assess
Patient Needs and Symptoms.
 Prioritizing the urgency of patients needs.
 Collaborating and developing a plan or
care with the patient and supportive,
disciplines which may include
recommendation for cure, call back
educations.
 Evaluation outcomes.

35. Thank You