Telemedicine or Medicine and Healthcare over the Internet

What is it, who is it, where is it?

What role is Internet technology going play in the future world of medicine? Telesurgery, Telepresence Surgery, Nanotechnology, Medical Robots... the stuff of science fiction is quickly becoming reality.

We are seeing many levels ranging from regular checkups over the internet to high-tech nanorobots entering the body and repairing the human anatomy.

We are seeing virtual surgery where a robot, local to the patient, becomes the remote highly expert surgeon's hands that may be physically located in another town, region or even country.

We are seeing tiny tiny robots capable of entering our body at the cellular and molecular levels. Tiny little robots made of atoms, that are directed along in a person's bloodstream and may be controlled via accoustic signals on the Internett. This nanorobot would allow a person to hold their breath under water for close to four hours.

Massive on-line Medical Databases bring enormous amounts of Telemedicine knowledge to medical practitioners. It's been said that if a diligent doctor read five articles a night on new treatments, after one year he or she would be 800 years behind! But is the real danger as Nobel-prize winning economist Herbert Simon famously noted, "a wealth of information creates a poverty of attention."

How fast is Telemedicine being accepted?

A recent article in the Journal of the American Medical Association, reported a sharp increase in the use of the remote equipment, both in and out of the home, from 1,715 consultations in 1993 to a projected 90,000 last year. In the last several years, the magazine reported, usage has doubled each year.

Virtual Hospital, a digital health services library, has had 110 million pages accessed on its web site. For January of this year it has had almost 8 million accesses to it web sites

How long has Telemedicine been around?

Words like Telemedicine, Telediagnosis, Teleconsulting, and Teleoncology, medical buzzwords that are concepts that have been around for quite some time now but are combining with technology that is cutting edge. Greater computing power, fiber optics, the Internet and robotics are just a few of the technological advances that are changing the face of medicine.

It has been suggested that because of the size of the ever-growing body of medical knowledge there is a changing nature between a doctor and his or her patient. It's been said that if a diligent doctor read five articles a night on new treatments, after one year he or she would be 800 years behind!

How is Telemedicine being deployed?

Telemedicine is already improving lives by spreading medical information to remote areas around the world. Doctors are being educated by virtual libraries, cable channels and in virtual classrooms. Virtual surgery is currently in trial situations on humans. The race between biotechnology and nanotechnology will only have one winner: humananity.

The telemedicine field is using Internet communications technology for medical diagnosis, patient care, and as a medium for delivering medical services over long distances. Medical information is travelling the Information Super Highway using everything from standard telephone service to high-speed, large-bandwidth fiber optic cables and satellites. More and more people in remote locations will have access to higher levels of medicine.

For instance sophisticated and tiny video cameras record surgeries, such as gall bladder removals. That video can then be shown over Internet at remote locations to teach experienced surgeons new techniques as well as train residents and medical students. It is a demonstration of how medical students can get real-time experience that can be shown in an auditorium or all over the world."

http://www.cnn.com/2000/HEALTH/10/02/inet2.demo.story/

What Types of Telemedicine are in wider use today?

Telediagnosis enables the physician to make a medical assessment based on data (such as X-rays, MRI, CT scans and real time video) transmitted from a remote location. Prison inmates, airplane passengers, citizens of third world countries can all receive medical care that would otherwise be out of reach.

Artificial Intelligence: Software programs are being produced so that databases can be searched according to given perameters and a diagnosis produced. Results are showing that patients are less hesitant in giving details of their illness leading to a quicker diagnosis.

Teleoncology allows doctors in the field of Oncology to confer on specific cases, discuss new treatments and improve patient care. Dr. Gary Doolittle, a member of the 1998 Telemedicine 2000 Advisory Board and the Kansas Telemedicine Project has conducted over 300 cancer patient visits using the University of Kansas Medical Center computers.

Teleresearch: Large medical databases such as The National Library of Medicine are now accessable and searchable on the web allowing medical studies and case information to be accessed by millions.

What role will Internet technology be playing in the future world of medicine?

The prevalence of technology will become apparent on many levels ranging from regular checkups to high-tech nanorobots entering and repairing the human anatomy.

Telesurgery involves a surgeon in a remote location working with an assistant who is in contact with the patient. Using audio and/or visual the surgeon is able to use his expertise and guide the procedure.

Telepresence surgery, the most advanced and futuristic form of telesurgery, is also called virtual surgery. "A robot, local to the patient, becomes the surgeon's hands, while an intricate interface conveys the robot's senses to the surgeon."(1) The Advanced Real Time Motion Analysis (ARTMA) Virtual Patient System integrates live video data with overlaid virtual data (such as bone structure). This example of Augmented Reality allows for extreme precision because the surgeon is capable of viewing a magnified image with his hand movements being scaled down and of rotating the image for a better perspective.

Biotechnology is working on manipulating genes in hopes of curing disease, repairing the physical body, and increasing human longevity. An example of biotech is the Human Genome Project, which is using advances in computing power to crack our biological code.

Nanotechnology involves more indepth technology in hopes of controlling the agent that enters our body at the cellular and molecular levels. An example of nanotechnology is a nanorobot call a "respirocyte". Designed by Robert Freitas, it is comprised of 18 billion atoms, which float along in a person's bloodstream. The respirocyte is essentially a tiny pressure tank which can deliver 236 times more oxygen per unit volume than a natural red cell. Acoustic signals sent from a doctor will direct the respirocyte's direction and behavior within patient's body. This nanorobot would allow a person to hold their breath under water for close to four hours.

What are some concrete Examples of Telemedicine?

Pulmonary Treatment

The U.S. Department of Defense (DOD) began with a group of beneficiaries suffering from obstructive pulmonary disease. The network provides around-the-clock medical monitoring, interactive consultation, and uses tele-medical equipment to provide treatment analysis and outcomes. Patients and providers will use the Internet to receive patient records, treatment results, and educational information.

Organ Transplant System

Cabletron Systems has recently released a working version of Smart Switch System, an Internet-based communication tool that allows medical professionals to access interlinked databases. The high-speed network infrastructure will allow uninterrupted, 24-hour access to a central database of more than 50,000 patients and 460 nationwide organ transplant organizations.

Radiology Systems

Bergen Medical Imaging Centers (BMIC) has created an Internet-based application and software program that will allow doctors to retrieve and review results from radiological tests. The BMIC system, the "pacemaker" for tele-radiology, uses Windows NT-based servers to send data to private folders and then over the Internet to a doctor’s remote PC.

http://www.crbj.com/articles/1999/05101999/Tele%20medicine.htm

Is there a consumer side to Telemedicine

Healthfinder http://www.healthfinder.gov is an example of a more consumer-oriented health information source. Note however that while such international information sources may be very accurate, the treatments suggested may not be appropriate locally, or indeed available under Medicare. At best this means you waste your time, and at worst it can lead to expectations about your treatment that can't be satisfied.

In a way, this is a clash between the new global free market in health information on the Web, and the local controlled market we have in public healthcare. Finally, as with any form of publication, information coming from organisations seeking to make a profit from us should always be treated with great caution.

How does Telemedicine affect patients?

For example, the CareGroup Healthcare System composed of six hospitals, uses the Web to let physicians and patients get information.

If a patient plans to undergo a certain surgical procedure, that patient can go to the system's secure Web site and watch video of a similar surgery to get an idea of what to expect. At the same time, the doctor can look at the patient's records.

The site currently gets about 3 million hits per month.

What is fueling development in the field of Telemedicine?

As the head of Johns Hopkins International, the not quite year-old corporate arm of Johns Hopkins Medicine, it is Thompson's job to make sure physicians and medical clinics around the globe know they can link to the Hopkins wealth of medical knowledge.

With more U.S. medical organizations expanding their influence outside the country's borders, Thompson said being a pioneer in global telemedicine by selling Internet access to medical minds at Hopkins becomes an important mission for his office.

How do our doctors deal with information overload in Telemedicine?

Enrico Coiera is a Professor in the Faculty of Medicine at the University of NSW and an Adjunct Professor of Computer Science at the same institution suggest one solution to this information overload is to put summarised information about best medical practices for doctors on the Web. Internationally, the Cochrane Collaboration is perhaps the best known organisation writing these treatment summaries, and some of these are now available on the Web.

However, a GP might only have a few minutes to research a condition, and patients can spend much longer finding out about their illness. It may soon be common for patients to come to their doctor already armed with the information they found on the Web. Then, side by side, the doctor and patient will sift through this information, along with anything else the doctor thinks needs consideration.

This may seem far-fetched to some, but in a world where we are faced with an exponential growth of information, all of it competing for our limited attention, how Herbert do you decide where to look for answers? As the Nobel-prize winning economist Simon famously noted, "a wealth of information creates a poverty of attention."

So, we may soon no longer regard doctors as experts who know everything about medicine. Of necessity, doctors will be seen as experts at knowing where and how to find the information we need. More than ever before, they can be experts at assessing and interpreting health information, and help consumers make informed choices about their care.

Is there a darker side of Telemedicine?

On the flip side of this utopian view are the reports of patients coming to harm because of poor quality information on the Web, or because of medications they bought for themselves on the Internet. So, are we on the threshold of a great information revolution in healthcare, where patients finally take control of their health, or are we witnessing the beginning of an 'epidemic' of misinformation spread by the Internet?

Breaches of Patient Confidentialty

People worry that hackers could intercept the string of numbers that identify their credit card accounts, if sent via the Net to finance their own purchases.

A worse scenario is the potential for illegal access and misuse of online medical or psychiatric data, whether in transit or stored. An incident was reported several years ago in which a patient discovered detailed mental health notes in his own electronic record, along with physical health data.

Should we be cautious of general Health Information on the net?

The truth is that we don't know. Many studies show that most of the health information on the Web is poor, but no work has shown what effect it has on the general public. We don't know for example if Web information is somehow different to that in other media like radio, television or print, or that reading it leads to different health decisions by the public. All we do know is that the potential for misinformation and harm is there on the Web.

So, it pays to be cautious when you find health advice on the Internet, because at the moment there is no easy way to tell the good from the bad. We don't for example have labels that can be put on information telling us that experts have checked. Going to Web sites that come from reputable professional organisations can help consumers. For example, the Australian Medical Journal http://www.mja.com.au/ is available on the Web, and while it's intended for professionals, contains links to many useful sources of information.

Arthur Hissey
Computer Research & Technology
www.crt.net.au