The world now driving by the ICT(information and communication technologies) based services, which include innovation, several applications in industries, such as financial services, telecom and IT, media and in health care industry. The most important critical questions concerns the organizing of service innovations processes is high-tech research, service innovation and the project management research, thus there is a need for more empirical research to understand and manage ICT based service innovations. Telemedicine uses ICTs to defeat environmental barriers, and increase access to health care services. This is particularly beneficial for rural and underserved communities in developing countries, the traditionally groups suffer from lack of access to health care[1]. Telemedicine is a service in this whole process it will providing medical expertise and health services to remote, rural, and transport less area communities in primary care, and in emergency conditions with the help of telecommunications. In telemedicine are will give continuous medical monitoring for many purposes like physicians needing to early diagnosis of depression or sports persons need to monitor their condition and performance. [Baker et al. 2007; Boric-Lubecke and Lubecke 2002;Varshney 2007].

1. TELEMEDICINE AND HEALTH INFORMATION
TECHNOLOGIES
Final Report -Assignment submitted to
Prof: Hsin-Tsai Wen
Department of health care Administration
Taipei Medical University
By
Alexander B. Rubashkyn
&
Vanitha Paramasivam
Health Care Administration
Taipei Medical University
Date:14/Jan/2013

2. Introduction
The world now driving by the ICT(information and communication
technologies) based services, which include innovation, several applications in
industries, such as financial services, telecom and IT, media and in health care
industry. The most important critical questions concerns the organizing of
service innovations processes is high-tech research, service innovation and the
project management research, thus there is a need for more empirical research to
understand and manage ICT based service innovations. Telemedicine uses ICTs
to defeat environmental barriers, and increase access to health care services.
This is particularly beneficial for rural and underserved communities in
developing countries, the traditionally groups suffer from lack of access to
health care[1].
Telemedicine is a service in this whole process it will providing medical
expertise and health services to remote, rural, and transport less area
communities in primary care, and in emergency conditions with the help of
telecommunications. In telemedicine are will give continuous medical
monitoring for many purposes like physicians needing to early diagnosis of
depression or sports persons need to monitor their condition and performance.
[Baker et al. 2007; Boric-Lubecke and Lubecke 2002;Varshney 2007].
Telemedicine is the use of electronic communications and information
technologies to provide clinical services when participants are at different
locations. They closely associated with telemedicine is the term Telehealth. It is
facilitated by access to an interoperable EHR that can allow the consultant to

3. review and evaluate all of the necessary information about the patient prior to
and while the patient is being seen.[2]
Definition:
Telemedicine can be defined as providing proper medication and health
tips through the physicians by using the latest technology such as
telecommunication or wireless, and it could be explained as the delivery of
health care services, where distance is a critical factor, by all health care
professionals using information and communication technologies for the
exchange of valid information for diagnosis, treatment and prevention of disease
and injuries, research and evaluation, and for the continuing education of health
care providers, all in the interests of advancing the health of individuals and
their communities [3].And it can be divide in to three types Direct patient care,
Tele-consultation and Distant learning[4]
Characterization of telemedicine:
(a) Geographic separation between client and provider) The use of
telecommunication technologies to establish communication and interaction
between client and provider to enhance clinical functions) An underlying system
for the delivery of care to be developed, including a division of labor and
specialization among the providers and staff; and) Clinical maintenance and
operational functions within the system which are specifically designed for this
mode of operation.
Image acquisition, storage, display, processing and transport form one
particular, common aspect of telemedicine and are becoming an integral part of
health care services in several countries including the USA, UK, Canada, Italy,
Germany, Japan, Greece and Norway. Thus one of the simplest applications of
telemedicine is teleradiology where images are transmitted to remote
destinations . At present, there are around 8,000 such units worldwide.

4. Telemedicine does not represent a separate medical specialty; rather it is a tool
that can be used by health providers to extend the traditional practice of
medicine outside the walls of the typical medical practice. In addition,
telemedicine offers a means to help transform healthcare itself by encouraging
greater consumer involvement in decision making and providing new
approaches to maintaining a healthy lifestyle.
Origins and History:
In 1920s, radio to link physicians and stations situated in shores to give
medical care in ships by 1930s AT&T experiments linking television and
telephone, in 1960s National Aeronautics and Space Administration (NASA)
telemedicine introduces when Human monitory like blood pressures and pulses
rates. In 1970s Developments of Satellite technology. In Alaskan and Canadian
remotes areas linked with hospitals to different town and cities. In 1988 USA
physician providing consultations remotely in the Armenian earthquake (USSR),
to transcended political, cultural, economic and social barriers to give medical
consultation. In 1990s interest have increased with the development of medical
devices and the Internet network like hospitals, clinics and schools, after 1990
advance in Telemedicine by leaps and bounds. In 1994, the medical centre
conducted video, and the telemedicine stated in advanced like capturing images
data in digital electronic type with high bandwidth, and high speed[5-6]. In the
last two or three years telemedicine has leaps and bounds.
Telemedicine Purpose
Specialist referral services typically involve a specialist assisting a
general practitioner in rendering a diagnosis. This may involve a patient
“seeing” a specialist over a live, remote consult or the transmission of diagnostic
images and/or video along with patient data to a specialist for viewing later.

5. Direct patient care such as sharing audio, video and medical data
between a patient and a health professional for use in rendering a diagnosis,
treatment plan, prescription or advice. This might involve patients located at a
remote clinic, a physician’s office or home.
Remote patient monitoring uses devices to remotely collect and send data
to a monitoring station for interpretation. Such “home telehealth” applications
might include using telemetry devices to capture a specific vital sign, such as
blood pressure, glucose, ECG or weight. Such services can be used to
supplement the use of visiting nurses.
Medical education and mentoring, which range from the provision of
continuing medical education credits for health professionals and special
medical education seminars for targeted groups to interactive expert advice
provided to another professional performing medical procedure.
Consumer medical and health information includes the use of the
Internet for consumers to obtain specialized health information and on-line
discussion groups to provide peer-to-peer support.
Telemedicine categories and Scopes:
Store-and-forward, Remote monitoring and (real-time) Interactive
services.Store-and-forward telemedicine involves acquiring medical data (like
medical images, bio signals etc.) and then transmitting this data to a doctor or
medical specialist at a convenient time for assessment offline. It does not require
the presence of both parties at the same time. Dermatology (teledermatology),
radiology, and pathology are common specialties that are conducive to
asynchronous telemedicine. A properly structured medical record preferably in
electronic form should be a component of this transfer. A key difference
between traditional in-person patient meetings and telemedicine encounters is
the omission of an actual physical examination and history. The 'store-and-

6. forward' process requires the clinician to rely on a history report and
audio/video information in lieu of a physical examination.
Remote monitoring, also known as self-monitoring or testing, enables
medical professionals to monitor a patient remotely using various technological
devices. This method is primarily used for managing chronic diseases or
specific conditions, such as heart disease, diabetes mellitus, or asthma. These
services can provide comparable health outcomes to traditional in-person patient
encounters, supply greater satisfaction to patients, and may be cost-effective.
Interactive telemedicine services provide real-time interactions between
patient and provider, to include phone conversations, online communication and
home visits. Many activities such as history review, physical examination,
psychiatric evaluations and ophthalmology assessments can be conducted
comparably to those done in traditional face-to-face visits. In addition,
"clinician-interactive”. interaction can go beyond than just exchange ideas. tele-
physical interaction with the patient is one example in a surgery addressed with
a robot commanded remotely.[7]
Scope of Telemedicine
Telenursing: Provide nursing services in care. Where patients have not
access to delivery, its applications cover the health care monitoring as well,
telenursing can solve the increasing shortages of nurses, keep patients out of
hospital, Telepharmacy,Provide pharmacist services, providing pharmaceutical
care to patients, it encompasses drug therapy monitoring. Telerehabilitation,
Giving clinical assessment (the patient’s functional abilities in his or her
environment), and giving clinical therapy. Its areas cover the neuropsychology,
speech-language pathology, audiology, occupational therapy, physical therapy
among others. One important part of telerehabilitation is the continuous
monitoring and the continuous follow up that we can develop with the patient

7. Teletrauma: Improve efficiency and effectiveness of delivery in trauma
environment. Trauma specialist can interact. Telemedicine is also being used in
some trauma ICUs to reduce the spread of infections. providers can see the vital
signs on the monitor, the respiratory ventilator, and the patient’s wounds.
Telecardiology: ECGs, or electrocardiographs, can be transmitted using
telephone and wireless, actually did tests with transmission of ECG via
telephone lines. This system enabled wireless transmission of ECG from the
moving ICU van or the patients home to the central station in ICU of the
department of Medicine.
Telepsychiatry: Utilizes videoconferencing for patients residing in
underserved areas to access psychiatric services. Such as educational clinical
programs, diagnosis and assessment, medication therapy management, and
routine follow up meetings. Teleradiology: Radiographic images (x-rays, CT,
MR, PET/CT, SPECT/CT, MG, US...) can be interchanged from one location to
another, it can be in real time or non-real time. Telepathology: Analyzing
pathology at a distance using telecommunications technology to facilitate the
transfer of image-rich pathology data giving support of diagnosis, education,
and research. Teledermatology: Probably one of the most common applications
of telemedicine it is oriented in this area, this scope allows to interact with the
general skin conditions, and giving information for consultation and
interpretation it can be on real time using health technologies of visual checking.
Teleophtalmology: Allow the transference of information of patient using
biomedical eye devices which allow the ophthalmologist take decision in long
distances. Tele-audiology Providing audiological services it may include the
full scope of audiological practice, Tele surgery Remote surgery (also known as
telesurgery) allows to the doctor to perform surgery on a patient even though
they are not physically in the same location. Remote surgery combines elements
of robotics, cutting edge communication technology such as high-speed data

8. connections and elements of management information systems. While the field
of robotic surgery is fairly well established, most of these robots are controlled
by surgeons at the location of the surgery.
Uses and advantages of telemedicine
There are various applications are used by the telemedicine technology
such as in surgery fields like telesurgery, telerobotics, telemonitoring, pre
referral screening, web scanning[8] Telemedicine allows rapid deployment of
healthcare to a developing population though relatively low cost clinics. Rather
than build and staff large numbers of sophisticated facilities, telemedicine
allows basic clinics to share the expertise of clinicians and clinical specialist
who may be located centrally or decentralized.
And disaster application, the benefits for Disaster Relief are similar to
rural health and mobile health. Telemedicine allows healthcare delivery
capability to move in quickly after a disaster. This allows the on-sight providers
rapid access to advanced expertise and capabilities for triage and care
electronically when and where it is most needed[9]. First of all, telemedicine has
an advantage in terms of ‘‘equal access’’. This implies that regional disparity
will be filled because wherever you are, in a remote place in the mountain or on
the sea, it is possible for everyone to receive suitable medical care.
The next advantage is the service for ‘‘point of needs’’. This means that
without going afar, one can receive specialist medical supplies locally. The
transmission of images or data from moving vehicles such as ambulances will
also reinforce cooperation with doctors, and quick yet appropriate medical care
supplies will lead to an increase in the number of lives saved. In the future,
international airlines and sea lanes will put the telemedicine system into place.
Thirdly, the existing disparity in medical care among the nations in the world is
expected to be written off.

9. Health Information Technology and Factors Facilitating Telemedicine
Networks already established for telemedicine should be used as the
initial test beds and role models of mechanisms to exchange health information
(e.g., RHIOs). the development of regional approaches to creating uniform
patient health records and a unified billing system is critical to fully realizing the
benefits of remote clinical services. Overcoming resistance from the technology
leaders until health technology, clinical medicine and public health to overcome
resistance and develop joint plans for unified health information networks
Surmounting the absence of standards and guidelines Such levels include
allowing different medical record systems to share patient data, assuring that
different remote medical devices can intercommunicate with each other or into
the same system and allowing health professionals providing distant care with
immediate access to the patient’s health history. Financial sustainability.
Governance level they planning and implementation of ehealth services
requires complex and extended intersecto-ral collaboration, with stakeholders
often coming from diverse backgrounds and with a range of priorities and
agendas. Policy in telemedicine policies and strategies can be used to outline the
visions and objectives regarding the application, provision, control, standards,
and ethics related to the national and international use of telemedicine solutions.
Scientific development, The involvement of scientific institutions in the
development of telemedicine brings with it a number of potential benefits. Such
resources to the development and testing of a variety of telemedicine initiatives.
Evaluation Conducting evaluations and disseminating results may be
particularly important to the field of telemedicine given the scarcity of empirical
evidence on its use.[10]

10. Comparisons
Colombia is a country with several barriers in health (access, quality,
resilience, internal) Around 28% of their total population located in rural areas.
Systematic review several projects developed in areas of Telemedicine. The
systematic Review focuses in assess Effectiveness, Reliability, Ease of use,
Acceptance, Sustainability, Improvement of the Diagnoses, Improvement of the
organization process, Utility variations, Accessibility of the projects. The main
areas of application of the projects were Teledermatology, Teleradiology,
Telecardiology, Internal Medicine, Teleambulatory care, Malaria and Dengue
Diagnose 99 Projects.The main findings are Several projects have failed because
the implementation have been centered more in the technology than in the
patients or the health provider. Other find show that most of the projects
implemented in Colombia have not evaluate the feasibility or the economic
impact, evaluation which is important for policy makers to address decisions.
Several Challenges are affecting the development of Information
Communication Technologies in Colombia is infrastructure, ICT Literacy,
Conflict problems.[11]
Explain the challenges and opportunities of Telemedicine in India.
According with the reviewers 0,1 % of the existent technologies are used in the
total potential utilization. The authors describe several barriers Lack of
inadequate infrastructure, Low computer literacy, Reluctance of physicians to
use Telemedicine, Policy Makers are addressing raw problems to address then
the access. It's evident that the TM is extremely useful in India, India is a rural
country,70% of the population live in remote areas. A new barrier is appearing
in the horizon, its related to the reluctance of health provider to give telehealth
services, because they have evidence their earn, and profit are affected, because
there is not clear the mechanism of reimbursement. In the other hand the policy
makers have not addressed clearly which is the target population[12-13].

11. Conclusion
Telemedicine as tool have an important role to play in the improvement
of the quality and efficiency of health systems in the world. It deserves special
consideration for the local Access should as well be focus on elements that help
introduce the telemedicine, (Infrastructure, Standards, Policies, ICT
technologies), even more when worldwide satellite communication is available
at reasonable cost, telemedicine can be used in many different ways such as
improving healthcare access, supporting health workers in isolated settings or
addressing the shortage of specialist doctors. Harmonized globally interoperable
standards fundamental to ensure global exchange of information in
Telemedicine. Telemedicine thus works toward the concept of medicine, which
transcends boundaries.
Referances :
[1] B. Bygstad, G. Lanestedt / International Journal of Project Management 27
(2009) 234–242
[2] Dena Puskin, Barbara and Stuart, [2006 The American Telemedicine
Association May 2006
[3] WHO definition: WHO. A health telematics policy in support of WHO’s
Health, 11–16 December, Geneva, 1997. Geneva, World Health Organization,
1998
[4] T.Takahashi :International Journal of Medical Informatics 61(2001)131–137
[5] Rosen, E. (1997), “The history of desktop telemedicine'', Telemedicine
Today, Vol. 5 No. 2, pp. 16-17, 28.
[6] Currell, Telemedicine versus face to face patient care: effects on professional
practice and health care Outcomes. Cochrane Database of Systematic Reviews,
2000.
[7] Strode SW, Gustke S, Allen A. Technical and clinical progress in
telemedicine. JAMA. 1999 Mar 24-31;281(12):1066-8

12. [8] Satva RM, emerging technologies for surgery in the 21st century,Arch surg
1999; 134:1197-1202
[9] Victoria Garshnek et al, J Am Med Inform Assoc.1999 Jan-Feb; 6(1): 26–37.
[10] Telemedicine: opportunities and developments in Member States: report on
the second global survey on eHealth 2009. WHO (Global Observatory for
eHealth Series, 2
[11] Carlos Rey-Moreno, Javier Simó Reigadas, Estrella Everss Villalba, Juan
Jose Vinagre† and Andrés Martínez Fernández, systematic review of, doi:
10.1258/jtt.2009.090709, J Telemed Telecare, April 2010 vol. 16 no. 3 114-119.
[12] Shabbir, Syed-Abdul, Scholl J., Jian W and Li Y. Challenges and
opportunities for the adoption of telemedicine in India, DOI: 10.1258/jtt Journal
of Telemedicine and Telecare Vol 17 No 6 2011 pg 336-337 October 2011.
[13] Siriginidi, Subba Rao, Achieving millennium development goals: Role of
ICTS innovations in India, Telematics and Informatics VL26 IS2 Sp127 Ep143
February 2008.