INTRODUCTION

The field of medicine during the recent years has made an explosion in the
recent years in collaboration with the field of technology. When considering medicine and
technology separately they have proved to be strong enough to stand alone as different
science helping the economic growth of our country.

In today’s health care environment, the health care workers have to be flexible,
innovative and informative, able to solve complex client problems by utilizing the best
available resources. For this, newer technologies are being introduced day by day and it has
grown to such an extent that it can be termed and treated as a separate field.

Telemedicine: refers to use of Tele communication for diagnosis and treatment of

disease. Emergent mode of delivery of health care at distance .Telemedicine provides healthcare
where there is none and improves the health care where there is some
 Tele health is such a field where the delivery of health-related services and
information via telecommunications technologies.

Tele health encompasses

 Tele-medicine
 Tele-nursing
 Tele-education

TELEMEDICINE

DEFINITION

 The practice of medicine over a distance where the patient and doctor
interact remotely, usually using a computer and computer- mounted
camera.

- (Medical Dictionary for the Health Profession and Nursing)

 Telemedicine is any healthcare provided to patients via technology

across a distance .
( Remmes, Thompson and Williams, 1996)

 Telemedicine as ‘the delivery of health care services, where distance

is a critical factor by all health care professionals using ICT for the
exchange of valid information for diagnosis, treatment and prevention
of disease and injuries, research and evaluation and for continuing
education of health care providers, all in the interests of advancing the
health or individuals and their communities.’

World Health Organization (WHO)

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
 Telegraphy and telephony was established -1920
 Wireless / RadioWireless / Radio -1950s
 TV - 1960s.
 Computer and Internet - 1990 -2000

 1906: ECG Transmission

 1920: Help for ships
 1924: The first exposition of Tele-care
 1955: Tele-psychiatry
 1967: Massachusetts General Hospital
 1970: Satellite telemedicine

OBJECTIVES

1. To make high quality health care available to traditionally under privileged

population.
2. To save the time wasted by both providers and patients in traveling from one
geographic location to another to avail services on time.
3. To reduce costs of medical care.

PURPOSES

 For clinical services

 Educational services
 Administrative application
TYPES OF TELEMEDICINE

 Real –time (Synchronous)

 Store-and- forward (asynchronous)

Real –time (Synchronous)

The Office of the National Coordinator for Health Information Technology

(ONC) defines synchronous telemedicine as "live video-conferencing," which is a "two-way
audiovisual link between a patient and a care provider."

Store-and- forward (asynchronous)

ONC defines asynchronous telemedicine as "store-and-forward video-

conferencing," which is the "transmission of a recorded health history to a health practitioner,
usually a specialist."

TELEMEDICINE APPLICATIONS

 Emergency Health Care

 Video Consulting
 Telecardiology
 Telemedicine as applied by cardiologis is called telecardiology.
 Telepathology
 Teledermatology
 Teleophthamology
 Teleoncology
 Telepsychiatry
 Teledentistry
 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.

TELEMEDICINE DEVICES

 Video Conferencing System

 Roll about systems
 Set top systems
 Desk top system
 Peripheral Devices
 Medicals Peripherals
 Non-medical peripherals

 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.

 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 menager resources and of the
same time can decrease patient work load on few referral centers.

 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.

 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.
 Which Data Can be Transferred
 Basically four types of data are used in telemedicine.

 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

 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.

THE ROLE OF TELEMEDICINE

 Telemedicine can be used when healthcare professionals and patients are unable to
meet face to face due to geographical distances, convenience or practicality.
 Providing individualised health information
 Enhancing decision making in clinical management;
 Facilitating communication between healthcare professionals.
 Offering support
 Educating patients, carers and relatives on managing health problems by facilitating
remote monitoring and information delivery.

BARRIRS OF TELEMEDICINE

 Poor infrastructure and inadequate regulation of telecommunications.

 Costs for services.
 Policies/protocols regulating the use of telemedicine.
 Licence regulations for practising telemedicine
 Maintaining quality of care.
 Professional regulation activities and implementing healthcare policies.
 Confidentiality due to increased (unauthorised) access to patient records

ADVANTAGES OF TELEMEDICINE

 FOR THE PATIENT

 Advanced medical facilities.
  Reduction in travel to distant referral medical centers.
 Reduction in cost of medicare.
 Better monitoring of chronic cases.
 Tele-counseling of selected psychiatric cases .
 FOR THE GROUP
 For a rural group 24 hr advice of specialist is a great support .
 Better diagnosis of diseases due to availability of specialist opinions.
 FOR THE STATE:
 Improved preventive health care measures
 reduction in urban migration from villages due to better care.
 early notification of communicable diseases.
 reduced cost of care.
 FOR THE DOCTOR:
 Doctors licensed to practice all over India.
 Motivation for computer literacy among doctors.
 Maximum Utilization of resources.(save time, money &travel)

TELE NURSING

Tele-nursing refers to the use of telecommunications and information

technology for providing nursing services in health care whenever a large physical distance
exists between patient and nurse, or between any numbers of nurses. As a field it is part of
tele-health, and has many points of contacts with other medical and non-medical applications,
such as tele-diagnosis, tele-consultation, tele-monitoring, tele-care etc.

DEFINITION:

 The practice of nursing over a distance using telecommunication

technology (National Council of State Boards of Nursing
NCSBN, 1997)
 Nurse/Patient interaction through a telecommunication device
  Telenursing – is the delivery, management, and coordination of
care and services provided via telecommunications technology
within the domain of nursing.
( American Association of Ambulatory Care Nursing (AAACN),
2004)

 Telenursing ‐is the use of telemedicine / telehealth technology

to deliver nursing care and conduct nursing practice.
( Encyclopaedia of Nursing Research, Fitzpatrick J. ed., 1999)

TELENURSING EXAMPLES

 Phone
 Interactive Video
 Phone Triage
 Internet Support
 Remote Telemonitor

USES OF TELE NURSING :

 Tele-nursing has been used as a tool in home nursing. For example people who are
immobilized or far away places, or living in difficult to reach places
 Citizens who have chronic aliments such COPD,DM,CHD etc
 Still other applications in home care is patients after surgeries with wound dressings,
ostomies, handicapped etc. can be assisted in care with help of telenurisng.
 Telenursing help to extend the nursing service to more patients. In home care
delivery, a nurse is able reach and care for 5-7 patients, but telenursing help her to
attend more in same amount of time.
 A common application of tele nursing is also used by call center separated by
managed care organizations which are staffed by managed care organizations, which
are staffed by nurse managers
  To perform patient triage in emergencies through call centres Expert assessment and
intervention by specialist clinical nurses
  Discharge services
 To do counselling and guidance services

NURSE INFORMATICS

 Collecting data from Patient

 Assessing data using knowledge
 Document all retrieved data
 Utilize critical thinking skills
 Provide nursing interventions
 Continue to monitor and utilize available technology

IMPLICATIONS OF TELENURSING

 FOR THE PATIENT

 Monitoring vital signs on daily basis at home setting and informing the care
specialist provides opportunity for early intervention.
 Reduces the number of visits to the doctor or emergency department
 Avoids unnecessary visits to or by providers
 Provides patient education
 Removes geographic barrier - Nursing can be provided to remote locations

 FOR THE PROVIDER

 Increases the Competencies and scope of practice
 More venue for monitoring Client safety in home care
 facilitates easy client decision-making
 Creates Professional practice environment
 Able to provide expert and specialized care from experienced staff and care
managers
 Able to take joint decisions regarding care by consultation with staff even at
far of places
  FOR THE HEALTH CARE SETTING

 Initial expense up front but as health improves the system will save money
 Decreased number of in-hospital days for patients with chronic illness who
have access to supportive telehealth
 Decrease number of in-hospital days reduces the required number of staff
(nursing in particular)
 Remove barriers of time and distance
 Proper training and administrative support is an vital responsibility for the
system

ADVANTAGES OF TELE NURSING

   Increase public access to health care

 Provide access in rural areas
 Decrease wait times
 Decrease unnecessary hospital visits
 Decrease Healthcare costs
 Increase continuity of care
 Increase patient compliance with aftercare

DISADVANTAGES OF TELENUSRING

 Decreased face-to-face interaction

 Risk of decreasing quality of care
 May increase liability
 Concerns with security
 Concerns with maintaining confidentiality

LEGAL ISSUES

 Maintaining patient privacy

 Verifying consent
 Compliance with HIPAA regulations
  Nursing Licensure across state lines
 Maintaining compliance with scope of practice

ETHICAL CONCERN

 Maintaining autonomy (identity, privacy)

 Maintaining patient’s integrity
 Prevent harm to a patient

LITERATURE REVIEW

Perspectives of Nurses Toward Telehealth Efficacy and Quality of

Health Care: Pilot Study

Telehealth nursing, or the delivery, management, and coordination of nursing

care services provided via telecommunications technology, is one of the methods of
delivering health care to patients in the United States. It is important to assess the service
quality of the involved health professionals as well as the telehealth nursing process. The
focus of this study is the innovative model of telehealth care delivery by nurses for managing
patients with chronic disease while they are living in their own residence.

Data were collected from nurses belonging to a home care agency based on
interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure
TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the
original instrument to suit the context. Follow-up interviews were conducted to validate
questions on the revised instrument.

The findings of this survey research were positive, based on mean differences
between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and
shows that the quality of the service is higher than what the respondents expect. The
Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a
statistically significant change between the median differences of perception and expectation.
The total number of respondents was 13. Results indicate that overall perceived service
quality is a positive value (0.05332). This means the perceptions of the level of service are
slightly higher than what they expect, indicating there is satisfaction with TNSQ

CONCLUSION

Advances in Tele communication and technologies are revolutionizing education

& health services globally, including the provision of nursing services. Decreasing time and
distance, these advances increase access to health and health care, especially underserved
populations and those living in rural and remote areas. They help to manage the demand for
services, ensure more effective use of human and health resources and facilitate education
and research activities.

REFERENCES

1. Kozier and erbs fundamentals of nursing, 9th edition ,published by pearson educations
,2018
2. Swarankar ,community health nursing,3rd edition ,N R Brothers publishers 2015
pagenumber;
3. I clement ,textbook of basic concepts of nursing procedures,
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993972/