UNIT V TELEMEDICAL APPLICATIONS

Telemedicine – health education and self care. · Introduction to robotics surgery,

Telesurgery. Telecardiology, Teleoncology, Telemedicine in neurosciences, Business
aspects - Project planning and costing, Usage of telemedicine.

IMPORTANT BIG QUESTIONS

 Briefly explain about robotics in surgery and Usage of telemedicine
 Describe in detail about Telecardiology and health education and self care
 Describe the application of Telemedicine in Neuroscience
 Briefly explain about Telecardiology and Telemedicine in neurosciences
 Identify the application of telemedicine, which aids in the diagnosis of injured
soldiers on or near the battle field and elaborate on the functions of the each
component involved.
 Explain the application of telemedicine in Telecardiology and Teleoncology.
 Explain the application of telemedicine in e health services, security and
interoperability.

Telemedicine – Health Education

 Telemedicine – Health Education and Self care
“Telehealth technologies can increase access to care, improve quality, decrease costs and
gain the most efficient use of the skills of healthcare professionals… Second-opinion services,
emergency department express care, virtual intensive care units (ICUs), telestroke with mobile
stroke units, telepsychiatry and remote services for postacute care are some examples” reads
a new Journal of American Medical Association report.
“Early telehealth focused on minor ailments such as coughs, colds and rashes, but now
telehealth is being used in broader applications, such as communicating imaging and
laboratory results, changing medication and most significantly managing more complex
chronic disease.”

What is self-care?
Self-care activities
 Introduction to robotics surgery

Robotic surgery comprises of a method wherein a surgery is performed with the help of very

small tools that are fixed to a robotic arm. The surgeon does not physically operate in

a robotic surgery but he controls the movements of the robotic arm via a computer.

During a robotic surgery, after administering general anesthesia to the patient, the surgeon

seated in front of a computer makes small incisions on the patient body to insert certain
instruments into it. All this is done by the surgeon by controlling the robotic arm in a

computerized manner.

The instrument inserted is fitted with a small thin tube with an attached camera at the end of

it (endoscope). This endoscope gives the surgeon a complete view (enlarged 3-D images)

inside the patient`s body to direct the robotic arms in conducting the surgery. So in a robotic

surgery, the robotic arm basically mimics the surgeon’s hand movements to perform the

operation.

Robotic surgery is advantageous since like laparoscopic surgery, it can be performed by

making smaller cuts than a normal open surgery. Also, the robotic arm ensures maximum

precision and can be free of human errors. The robotic arm once placed inside the abdomen,

ensures ease of usage of surgical tools than with laparoscopic surgery through an endoscope.

It also facilitates the surgeon to get a better and clearer view of the surgical area. Another

advantage of robotic surgery is the freedom of movement for the surgeon in the operating

theatre.

However, robotic surgery can be more time consuming than a normal one. Setting up the

robot prior to the surgery takes up considerable time. This is still an upcoming surgical

procedure and many hospitals still did not adapt this method.

Robotic surgery finds use in various different types of surgeries, which include the following:

 Bypass heart surgery

 Certain cancer surgeries in the blood vessels, nerves, or other important and

sensitive body organs.

 Removal of gall bladder

 Hysterectomy
  Kidney removal and fresh transplant

 Mitral valve repair

 Pyeloplasty (surgery to correct ureteropelvic junction obstruction)

 Pyloroplasty

 Radical prostatectomy

 Radical cystectomy

Ligation of reproductive tubes

Note: However, robotic surgery is not possible in certain complex surgical procedures.

Advantages:
As the surgical cuts made during a robotic surgery are small, you recover faster during the
postoperative period. Smaller incisions also mean lesser bleeding and post surgery pain. Also,
smaller surgical openings will have lesser risk of wound infection. Post a robotic surgery; you will be
discharged from the hospital faster than in a normal surgery. Last but not the least, your skin will
have negligible scars in a robotic surgery.

Disadvantage of robotic surgery:

Computer-assisted robotic arms are very expensive and that is why hospitals are not too keen on
their implementation. Furthermore, the surgeons need to undergo proper training for the complete
know-how of robotic instruments. When the surgeon starts using the robotics, initially the surgeries
might take more time since the surgeons will get accustomed with the new procedure.

The history of robotic surgery started in the 1980s with the PUMA 560 robot. It was used in
1985 to increase the precision of neurosurgical biopsies. That same robot was then used
later to perform a transurethral resection of the prostate. This lead to the development of
PROBOT, a robot designed specifically for transurethral resection of the prostate. Around
the same time another robot called ROBODOC was designed to machine the femur with
greater precision in hip replacement surgery and eventually went on to become the first
surgical robot approved by the FDA.

A number of medical robots are available currently in the United States. These medical
robots include the Mako robotic system, which is a single-purpose robot currently used for
orthopedic prosthetic implantation. They also include the Perfint Maxio Robot, which is
used for image-guided biopsy and ablation procedures coupled to a CT scanner.

Telesurgery
• Telesurgery means performing surgery via robotic tools, as opposed to traditional
laproscopy or even more traditional open surgery.

• This allows surgeons to perform ―minimally invasive‖ operations with more control
than ordinary laproscopy.
Da Vinci Robot

• The da Vinci Robot, build by Intuitive Surgical, has become the most commonly
used instrument for telesurgery.

• It has two parts: the control console and the patient side.

Remote Telesurgery

• Remote telesurgery is the same as normal telesurgery, except that the surgeon and the
patient are separated by significant distances.

• In 2001, Dr. Jacques Marescaux was able to perform a gall bladder surgery while he
was in New York and the patient was in France.

• Dr. Mehran Anvari has since performed many remote telesurgical cases in Canada.

Closing the Loop

• Ideally, we would like the entire loop (ie, the time between when the surgeon moves
his hand and when he sees the result) to be under 130 milliseconds.

• This would make the surgery seem ―real-time‖ to the surgeon.

Overlay Network Approach

• Most previous remote telesurgeries have used private networks. This is expensive
and not scalable.
• The only one that didn’t use a private network experienced latencies over 700 ms.

• By using an overlay network approach, we

• Greatly reduce both jitter and latency

• Increase reliability and availability

• Allow multicast, for educational purposes

Suurballe’s Algorithm

• For added reliability, we would like to send the video stream twice, on two disjoint
paths.

• Suurballe’s algorithm runs in O(E + V ln V) and gives two disjoint paths such that
the sum of their latencies is minimized.

• We would prefer an algorithm that returned two disjoint paths such that the latency of
the worse one was minimized.

• A gestural interface for controlling the da Vinci robot (created by Kelleher Guerin).

• Sends video from the da Vinci, using our codec, to another machine for remote
telesurgery.
 Latency Demo

• Here the user is separated from a task by a camera and video stream.

• We can vary the latency in the video stream.

• There is some inherant delay, due to the camera and display. Even at a nominal 0 ms
of delay, there is ~60 ms of delay.

Video Demo

• Sending video from Hackerman to NEB

• We losslessly compress the video with gzip and send it via UDP over the LTN
network

• We could compress it further, but this adds more delay

Advantages of telesurgery

• Allows inexperience surgeons to ask for help from more experienced surgeons

• Reduces patient travel time

• Multiplies the effectiveness of the most expert surgeons

Telecardiology
Telecardiology is a modern medical practice, which uses the power of telecommunications to
achieve remote diagnosis and treatment of heart disease. This includes coronary heart disease,
chronic and acute, as well as arrhythmias, congestive cardiac failure and sudden cardiac
arrest.
In this situation, doctors and other healthcare providers use electrocardiographic data, which
is transmitted remotely, in real time, for interpretation by a specialist. It enables specialist
care to be accessed by people in remote locations. Advancing technology is making it easier
and less expensive to set up wireless or satellite networks for this purpose, increasing their
effectiveness and ease.

Heart failure is a complex syndrome that results from any structural or functional
cardiac disorder that impairs the ability of the heart to function as a pump.It has a
major impact on longevity and quality of life.One to two percent of the general
population of developed countries have heart failure, and the average age at diagnosis is
76 years.Although the steady rise in hospital admissions for heart failure has slowed
recently, the management of heart failure still accounts for 1-2% of healthcare
expenditure in countries in the developed world.Improvements in cardiac imaging and
new biochemical assays have made diagnosis more straightforward.Major changes in
treatment have resulted from a better understanding of the pathophysiology of heart
failure and the results of large clinical trials.Improving outcomes now increasingly
depends on improved communication between healthcare professionals, education of
patients and carers and better chronic disease management.
How telecardiology works

The practice of telecardiology depends upon the availability of a specialized device, which
not only takes and records a 12-lead ECG in the primary care setting, but also transmits the
ECG image in the form of a sound signal over the telephone line.

At the other end, namely, the telecardiology facility, it is converted back into an image on
screen. After specialists interpret it, an oral report is quickly sent, while a written summary is
emailed or faxed to the patient hub. All ECGs are stored in an electronic database at the
telecardiology center, to enable future comparison of ECGs for the same patient over time.

Single-lead ECG machines are available in the form of a watch-like device to enable quick
monitoring when the patient needs it, while still at home. This allows for a better
interpretation and diagnosis of the disease condition.

This device can store the images recorded, and transmit them once the patient reaches the
GP’s office. The advantage is that the patient need not wait to reach the doctor’s office, but
can record the ECG as and when symptoms are present.

Benefits of telecardiology

The primary use of telecardiology is the support it gives to primary care practitioners in the
area of correct diagnosis, thus empowering them to manage cardiac patients with increased
confidence. This is good for the patient and the healthcare system.

It also improves the clinical training of the average practitioner, by increasing the clinician’s
level of knowledge at primary level. Thus it equips GPs to offer better care. This applies to
the diagnosis and management of pediatric heart disease, chronic cardiac failure and
emergency events like myocardial infarctions. It can cut down consulting time to a quarter,
and afford high-quality care when it is most needed.

Telecardiology also helps enormously to reduce the percentage of missed cardiac events. For
instance, the single-lead ECG device is more efficient at detecting or monitoring arrhythmias
than a Holter machine, because it can be worn all the time, and because it can be easily
switched on when the patient feels there is something wrong with the heartbeat. This helps to
pick up arrhythmias, as well as to monitor them during the course of treatment.
Telecardiology is very useful for long-term monitoring of multiple coronary heart disease risk
factors, such as hypertension or hypercholesterolemia. The results are comparable with those
of face-to-face monitoring.

The availability of telecardiology has also been shown to dramatically cut down on the door-
to-balloon time, which is the time that elapses between a patient’s hospital admission and
angioplasty, when required. Telecardiology makes a diagnosis to be made, and allows the
required personnel to be prepared for the patient even before admission, cutting down on the
time to surgery and preventing further muscle damage.

Telecardiology devices are small and portable, which means they can be easily moved to the
patient’s side to make a quicker and more accurate diagnosis. Telecardiology has the proven
ability to improve the quality of health care, increase cost-effectiveness and save lives.

It makes the diagnosis of acute coronary events faster and more convenient, increases access
to specialist care, ensures greater efficiency of patient triage and management, and lowers the
burden on secondary referral hospitals.

TELEONCOLOGY

Why use it ???

Teleoncology consulting would :

– Reduces travel burden

- Decrease costs/delay (referral for ongoing tests)

- Remote clinics get on

-line suggestion

- Comprehensive system for the management of cancer at the state/national level

. - Facilitate to detect cancer at the early stages

- Public awareness

– Paitents comfortable with local appointments only

– Rural/local staff skill development / involvement in cancer care

- Wide scope of application

- Townsville Cancer Centre (TCC) in Queensland (for cancer kids with working parents)

How will it work?

Tele-Oncology implementation in India

 ONCONET‖ Kerala(2003) by:- Department of Information Technology (DIT),

Government of India.
 Centre for Development of Advanced Computing(CDAC) Thiruvananthapuram &
ISRO asssistance
 Regional Cancer Centre, Thiruvananthapuram (RCC-T) & Malabar cancer care
society
 Ministry of Health and Family Welfare (MOHFW), GoI established National Tele-
Oncology network :25 RCC(regional cancer centers)&100 peripheral centers
Teleoncology In India
 Telemedicine in neurosciences
Teleneurology, used to improve access to neurologic expertise for patients in locations with a
lack of access to specialists or for those patients with neurologic disabilities restricting travel
or requiring time-sensitive care.

Teleneurology is the delivery of remote consultative services for any neurologic

emergency via a telemedicine platform that includes the following:
 Emergency stroke
 Neurocritical care
 Chronic neurologic diseases such as epilepsy,
 Parkinson disease
  Other movement disorders

Neurological teleconsultations benefit family physicians. Unnecessary investigations and

transfers are avoided, providing much needed family support at home. Telemedicine is
doable, safe, and cost effective. Telemedicine hinges on transfer of text, reports, voice,
images, and videos between geographically separated locations. Success relates to the
efficiency and effectiveness of information transfer. In the past, telemedicine was primarily
teleradiology – transfer of high-resolution medical images. Today, even a detailed clinical
examination can be conducted remotely. Telemedicine has been used in various
subspecialties of neurosciences. The doctor–doctor teleconsultation allows rapid resolution of
queries which otherwise causes stress to patients and increases the cost and complexity of
care.

Clinical studies in neurological conditions deploying telemedicine

Clinical trials have shown that teleneurological evaluation is as effective as face-to-face

evaluations. Hospital stay was significantly shorter with teleconsults in hospitals without
specialists. Childhood migraine, headache, and cervical spinal cord compression have been
assessed with interactive videos. Remote video surveillance (RVS) has been used to assess
relationship between lip position and drooling in cerebral palsy. Telemedicine enables
effective community-based research by narrowing the gap between the patient population and
the researcher. The gap may have occurred due to the distance, limited access, and lack of
resources.

Telestroke

Neurologists are increasingly using telemedicine in emergency stroke care as time is critical.
Response time for acute stroke assessment has significantly reduced with a multidisciplinary
collaboration. Telestroke and neurointerventional therapy have been become the ―mainstays‖
of therapy. Identifying and triaging patients safely and efficiently is done remotely. The
outcomes obtained after intravenous tissue plasminogen activator treatment via telemedicine
were similar to those with in-person evaluations. A regional telemedicine network for the
management of acute ischemic stroke is effective and safe.

A web-based telestroke system facilitates rapid treatment. Neurointerventional therapy and

poststroke telerehabilitation are now a reality. Telestroke is now recognized for
reimbursement. Whether or not thrombolysis was initiated attracts malpractice claims. Cost
effectiveness of the ―hub-and-spoke‖ telestroke networks, where the ―stroke therapist‖ at the
hub hospital interacts with the patient, and bedside physician performing the National
Institutes of Health (NIH) Stroke Scale assessment and reviewing images, has been
established. Studies have shown that a stroke center ―Vascular Neurology Nurse Practitioner‖
(VNNP) may administer an intravenous tissue plasminogen activator for stroke-in-evolution
even if the patient is far away from a neurologist, provided telemedicine facilities are
available.

Parkinson's disease and dementia

Studies have confirmed that valid motor assessments of Parkinsonian patients can be made
via Interactive Video Conferencing (IVC). In a study involving 9 patients, the unified
Parkinson's disease rating scale (UPDRS) score was determined by two movement disorder
specialists – in-person and via IVC 350 miles away by a teleconsultant. Individual patient
scores did not differ. IVC provides information and support to caregivers of demented
individuals. Computer-mediated information and support systems are viable complements to
Alzheimer's disease support centers. Telephone and e-mail have been used by specially
trained nurse/counselors who record the caller's query and provide emotional support, as well
as practical advice for demented patients. A telephone interview, although not a substitute for
a face-to-face diagnostic evaluation, is a reliable procedure for evaluating cognitive,
functional, and behavioral functioning in an elderly population with normal aging and
dementia.

Telerehabilitation

Virtual reality (VR) techniques through telemedicine have been used in the rehabilitation of
patients afflicted with cognitive impairment. VR has been used in stroke rehabilitation. A
platform for home rehabilitation controlled telemedically has been evaluated.
Telerehabilitation has also been achieved using web-based telecommunication. Providing
psychiatric backup to family physicians by telephone has also been reported.

Pediatric neurology

Members of the Child Neurology Society reported that the mean waiting period for a new
patient clinic visit in the United States is 49 days, and 12% of patients must wait 3 or more
months to be seen. The Hospital for Sick Children in Toronto is using a telephone nursing
line to expand its services. To respond to calls, a nurse is trained in effective telephone triage.
Long telephone calls (>10 minutes) were strongly associated with a diagnosis of epilepsy.

Advantages of deploying telemedicine in neurology

Advantages and limitations of teleneurology have been documented.Seizures have been

managed in rural communities remotely with no difference in the frequency of consultation,
hospitalization or emergency room visits. Email triages by neurologists of new referrals have
reduced physical visits by half. Wound infections were monitored via cell phone images in a
pediatric neurosurgery teleconsulting centre.

Occasionally, unfamiliarity at the patient/peripheral hospital end could contribute to the

reduced usage of telemedicine services. The relative unwillingness of specialists to dispense
with face-to-face consultation is still a limiting factor.

Neurohospitalists are site-specific subspecialty neurologists who care for patients in the
emergency department, general ward, and intensive care unit setting, Through telemedicine, a
neurohospitalist extends expertise to centers without specialists.

The US military has a limited number of neurologists – a store-and-forward consultation

system has enabled military neurologists to deliver far-forward battlefield care for service
members deployed overseas. Telemedicine provided follow-up care to veterans in rural
southwest United States.

Telemedicine in neurosciences in India

A teleneurological demonstration in February 2002 by the author convinced the then

chairman of ISRO (Indian Space Research Organization) to set up very small aperture
terminals (VSATs) in superspecialty and peripheral hospitals.
Of the 400 virtual grand rounds carried out between the various tertiary Apollo Hospitals,
using multipoint video conferencing, 95 were in neurosciences; 18.92% of teleconsultations
(13043 out of 68929) at Apollo Hospitals, Chennai, till Aug 31st 2017 were in neurology and
neurosurgery.

Tissue plasminogen activator (tPA) is a protein involved in the breakdown of blood clots.
ICH - Intracerebral hemorrhage

Schematic representation of teleconsultation link between stroke neurologist and rural

hospital.
Teleneurology in hospitals:
 Allows hospitals to treat stroke patients with confidence & clinical consistency
 Eliminates EMS diversions
 Reduces unnecessary patient transfers
 Satisfies staffing requirement for Primary Stroke Center certification
 Supports ER staff & improves department efficiency Provides a competitive
advantage in local marketplace
 Relieves the burden of on-call coverage for local neurologists Serves as a recruiting
advantage for physicians
The Business Aspects of Telemedicine
 USAGE OF
TELEMEDICINE

Here's a look at 10 ways that telemedicine technology is changing the delivery of

healthcare

1. Diagnose and Treat Strokes Faster

The sooner a stroke victim receives treatment, the better the chance of survival. In many
cases, treatment hinges on the capability to identify key symptoms and administer medicine
known as tissue plasminogen activator (tPA) within three to five hours of suffering a stroke.
Unfortunately, emergency room physicians don't always have the expertise to make these
decisions, and small or rural hospitals don't always have a neurologist on call.

 Patients treated in hospitals that were part of a telestroke network in Georgia received
tPA approximately 20 minutes faster than patients in hospitals outside the network.
 Telestroke helped facilities in remote parts of Alberta reduce ER transfers to the
University Hospital in Edmonton by up to 92 percent. Such ambulance or helicopter
transports are costly, time-consuming and sometimes dangerous.
 Videoconferencing led to more accurate diagnoses and treatments than telephone
conversations in the Imperial Valley of California and in Boston.
 Neurologists and radiologists in Arizona were able to use smartphone image-sharing
applications that proved to be as accurate as desktop-based picture archiving and
communication systems 92 percent of the time.

2. Provide ICU Physicians, Nurses a Second Set of Eyes

Telemedicine technology is increasingly making its way into the intensive care unit. Rather
than replace the physical ICU outright, the tele-ICU, as it's called, provides a "second set of
eyes" for nurses or physicians who must treat several patients at once amid alarms and other
distractions that may make them miss a medication dose, sudden change in blood pressure or
other important signal.

Staff of the tele-ICU have the same access to patient data such as vital signs, lab results and
physician's notes as on-site critical care staff, and they use one- or two-way cameras to
perform bedside assessments or confer with physicians. Because the remote physicians don't
face the same distractions as those in the hospital, they can more closely monitor a patient's
progress and suggest new treatment or drug options. As one patient at a Phoenix hospital told
the Arizona Republic in 2011, his remote physician provided better care than hospital
staff despite being based in Israel.

3. Let Patients Undergo Rehab at Home

When patients are discharged from the ER or the ICU, the care process is often just
beginning. This is especially true for patients who are recovering from a stroke or suffering
from other neurological disease such as multiple sclerosis, Parkinson's or dementia. In many
cases, these patients find it difficult to travel to a health care facility regardless of whether
they are in an urban or rural setting.

The use of telemedicine technology in rehabilitation addresses these issues in several ways—
conducting cognitive or psychiatric assessment, leading group therapy sessions (hosted at a
clinic or senior citizens' center, for example), providing patients with online resources and
remotely monitoring a patients' pedometer readings to ensure that an exercise regimen is up
to par.

Telemedicine can also assist in recovering from lung disease, as it lets patients participate in
online education sessions and attend supervised physical rehabilitation at a nearby satellite
location.

4. Help Patients Reduce Their Risk of Heart Disease

Cardiovascular diseases are the leading cause of death around the world. Drug treatments or
social/lifestyle changes can help prevent many cases. However, patients must work closely
with their doctors to quit smoking, lose weight, change their diet or begin an exercise
program, and making frequent office visits can be difficult for both parties. Here,
telemedicine technology may be the answer—for example, researchers in Philadelphia found
that patients were nearly twice as likely to participate in cardiovascular disease management
programs if they could send/receive information to/from a healthcare provider online (as
opposed to traditional paper- or office-based information sharing.)

5. Encourage Diabetics to Embrace Healthier Behavior

In the United States, healthcare costs related to diabetes—multiple inpatient and outpatient
visits, for example—are close to $100 billion a year. Research from the eHealth Initiative
suggests that telemedicine improves the health of diabetics, especially older adults.

To succeed, two things need to happen. First, a physician's interaction with a patient
must boost self-efficacy, or the belief that the patient can, in fact, engage in activities that
improve glycemic control.

Second, treatment plans must set goals for successfully changing patient behavior—which is
becoming increasingly easier thanks to mobile health technology that helps patients count
calories, keep an eye on vital signs, log workouts and monitor medication doses and
schedules—and nurses and dieticians must check in with patients regularly to monitor their
progress.
 6. Empower Patients to Manage Chronic Conditions

In addition to diabetes, the concept of patient self-management using telemedicine can be

applied to other long-term chronic conditions such as hypertension and a variety of digestive
diseases.

In the former case, something as simple as routine three-minute phone calls with a health care
provider will encourage patients to take blood pressure medication, refill prescriptions and
remember their appointments—all of which reduces the number of inpatient and ER visits
they must make.

In the latter case, patients can describe symptoms to physicians over email, perform a number
of self-tests and participate in step-by-step educational programs related to their particular
disease. In both cases, mobile health technology eases chronic disease management by
literally putting care management applications and devices in patients' hands.

7. Improve Oral Health With Store-and-Forward Telemedicine

Teledentistry typically makes use of store-and-forward telemedicine, which lets a doctor (or
dentist) acquire medical images or other relevant data, assess it and send it to another
physician for review. (Of the main types of telemedicine technology, store-and-forward is the
least interactive, as it does not require two or more parties, nor does it involve a physical
examination.)

The main benefit of telemedicine in dentistry, then, is sharing records among dentists and
dental specialists to determine if a certain procedure is necessary and, if so, how soon it must
take place. Specialists can also help dentists spot problem areas and suggest preventive
measures to a patient so that costly, complicated procedures can be avoided. As with other
uses of telemedicine, this collaboration helps patients in rural or other underserved
communities who don't otherwise have access to medical specialists.

8. Link Patients, General Practitioners to Dermatologists

Dermatology is a prime candidate for the use of store-and-forward telemedicine technology.

The information that is shared is often an image—and applications that help people share
images are not in short supply. The images tend not to contain any of the personal health
information (PHI) or personal identifiable information (PII) that raises HIPAA security and
privacy red flags.

Teledermatology is being used in two ways:

 Direct Dermatology, a company founded by a Stanford dermatologist, has introduced

technology that lets patients take a picture of a skin problem and send that to Direct
Dermatology along with their medical history; within two days, the patient will receive a
report back from the company, along with any necessary prescriptions. This use of
teledermatology targets rural patients without easy access to a medical lab or clinic and builds
on the findings of a 2010 study suggesting that online dermatology visits are as effective as
in-person appointments.
 Dermatologists in the Netherlands, meanwhile, have been using telemedicine
technology to confer with general practitioners since 2005. In this time, studies have shown
that daily consultations prevent unnecessary patient referrals in 74 percent of cases and
reduce the cost of care by 18 percent.

9. Provide Mental Health Consultations to Children

Traumatic events can have a dramatic effect on children, especially if they already suffer
from mental health disorders such as depression, anxiety or hyperactivity. That's why the
Robert Wood John Foundation and the University of Texas Medical Branch established
a Telemedicine for School-Based Mental Health program in Galveston, where the aftermath
of hurricanes Katrina and Rita in 2005 and Ike in 2008 left many children in emotional
distress.

A report prepared at the conclusion of the six-year project showed that the teleconferencing
counseling sessions were the first consultations with a mental health professional for many
students. (Sixty percent of participants did not have health insurance.) Overall, nearly 70
percent of parents and guardians said the sessions helped their children perform better in
school, and the telemedicine program as a whole helped Galveston County fill a need to treat
students with severe mental health challenges, the report says.

10. Improve Rural Healthcare Around the World

As stated, telemedicine technology offers much promise for patients in the rural United
States. Its biggest impact, though, may be felt in Africa and other parts of the developing
world where healthcare services are equal parts scarce and inaccessible. Remote consultations
can help address relatively minor conditions before they become major—treating cataracts
before they cause blindness, for example, or ensuring that new mothers receive the
educational resources they need to raise a child and take care of their own medical needs.

However, there remains a tremendous need for equipment such as computers, printers and
scanners at hospitals in rural areas that rely heavily on subsistence farming and lack business
and community development. That said, mobile health applications, including a bar code
scanner that can determine if a drug is counterfeit, may be the answer, as people in the
developing world are more likely to own cell phones than PCs.