On a global basis there aren’t enough physicians and specialists available to meet the healthcare needs of nearly seven billion people. Telemedicine has the potential to address a lot of the barriers of access caused by the geographical separation between patient and Healthcare.

As defined by the American Telemedicine Society (ATS), Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. It is the technology that is slowly transforming the way healthcare is delivered across geographic, time, social and cultural barriers.

At i2i TeleSolutions we provide the software tools and services for lossless transmission of medical images and data in the fastest and most secure manner in the industry.

For Telemedicine to work successfully the patient wellness cycle (prevention, screening, diagnosis, treatment and monitoring) as shown below has to intersect the healthcare delivery cycle, using reliable closed loop communication.

In addition to the actual delivery of treatment, there are six vital elements that has to link patients with the service providers.

Telemedicine Stack
The Six Vital Elements

1. Monitoring and Screening
Portable, low power and easy to use devices designed for use by non-specialists are beginning to appear in neighborhood stores, in clinics and primary healthcare centers. A number of them come with standard Bluetooth wireless or USB port interfaces for connecting to a PC, a cell phone or a companion aggregation device.

Major medical OEMs are introducing laptop and PDA sized ultrasound machines, ECG monitors and advanced retinal cameras for remote telemedicine applications. Increasingly, screening and monitoring can be carried out by paramedics, technicians or general practitioners in the absence of a specialist. Medical devices are becoming available for home use also where individuals are able to capture and monitor vital parameters by themselves and send on to medical specialists.

This becomes the source of medical data and images and perhaps the most important part in the Telemedicine stack for effective healthcare cycle to begin.

2. Patient Parameter Aggregation
When there are several medical equipments involved in the monitoring or screening of a patient, some form of aggregation is often necessary to consolidate the data in a way that can be forwarded, analyzed and reported on by the specialist remotely. These aggregation devices can take the form of a simple PC or can be dedicated hardware with a variety of connectivity options. Several devices are already available in the market ,some designed as set top boxes connected to the internet via DSL broadband link or via the cellular network. Some come with local display panels or the ability to connect to a TV monitor.

3. Video / Audio Conferencing
In a live Telemedicine consultation session, video and/or audio conferencing links are often established when the specialist is available on line. Typically these tend to be restricted to consultation and counseling sessions only, unless backed up by sophisticated real time exchange of patient data and images. Follow-up sessions can also be conducted after store and forward mode of data exchange prior to the session.

4. Data/ Image Compression and Transmission
Before effective diagnosis can take place, detailed patient data and especially medical images are required at the expert end. Depending on the modality, the amount of data can be prohibitively large for electronic transmission. Along with the need for fast exchange of data the need for maintaining fidelity and security is paramount in healthcare applications. The Telecom service providers have a critical role to play in ensuring adequate and reliable wireless connectivity. There are several technologies to choose from but few offer the lossless image quality that is vital for accurate medical diagnosis.

5. Data/ Image Archival and Work Flow Management
In any large scale deployment of Telemedicine or indeed in meeting some of the statutory stipulations on maintaining patient records, the need for secure, server based storage facility is critical. However, storing patient data is meaningless unless it can be managed in real Telemedicine workflow environments that can allow fast on-demand access, routing, expert reporting and tracking in a totally secure manner. This is often overlooked and can become the weakest link in any Telemedicine transaction. Without this vital layer in the stack patient data is often exchanged as email attachments and end up on physician’s hard disk drives around the globe.

6. Hospital Information Systems/ Electronic Medical Records / PACS
At the expert end of the Telemedicine stack is the critical Hospital Information Systems. A Telemedicine system needs to integrate seamlessly with HIS before any formal diagnosis, reporting, treatment, billing or medical insurance transaction can be established between healthcare service provider and patient who may be located thousands of miles away.

At i2i TeleSolutions our tools and services provides the system integration capability for connecting the six vital elements of the Telemedicine stack. In most Telemedicine deployments today at least one or more of the six elements are either missing or exist in some unsatisfactory form. Successful deployment requires close interaction and seamless integration between hardware and software from different vendors to bridge the gaps. Customized workflow management for specialized care can be provided through our hosted, web-based CONNECT services.

Open standards and interfaces like DICOM, HL7 and emerging ones being proposed by the Continua Alliance that allow communication of clinical data and images between medical equipments and hospitals is critical to driving cost effective solutions. Our CARE platform provides solutions with standard interfaces for maximum interoperability.

Compliance to HIPAA guidelines on privacy and security standards on patient information will help in safeguarding networked access to scarce healthcare resources. At i2i Telesolutions our software processes follow these guidelines.
We are collaborating with medical OEMs, standards bodies, specialists in healthcare services and government institutions to remove the barriers to Telemedicine caused by the separation between patient and Healthcare.