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Dear Readers,
Telemedicine and particularly tele-ophthalmology is our theme in this issue of Sitenews. Dr C K Prahlad the management expert has said that in a developing country with poor resources and problems on a larger scale it is imperative that we think innovatively apply a different set of strategies. Tele-ophtalmology offers us one such tool. With Vision 2020 the Right to Sight having provided a global direction in how we should focus our efforts in eye care the incorporation of tele-ophthalmology enables us to make a quantum leap in the way we offer our services.

The issue provides an eye opener to, what is telemedicine-its role, need and its requirement before moving onto what is tele-ophthalmology, its need and its applications? It then focuses on the various tele-ophthalmology models that today exists. It also provides detailed information for setting up a tele-opthalmology in an institute. The challenges of running and providing tele-opthalmology services are then discussed. Various case studies are presented which provides patients perspectives after receiving patient care via the tele-ophthalmology services. We also provide a wide number of weblinks and education and training opportunities which can help you to explore the emerging concept of tele-ophthalmology

The organization featured in this issue is the Indian Space Research Organisation which is playing a big role to ensure that telemedicine is applied for developmental purpose!

Happy Reading!

Regards,

Vision 2020 e-resource team
The Issue Features...
Tele-Ophthalmology
Vol. 3 No. 9 September 2006
•   Introduction to Telemedicine
•   Role of Telemedicine
•   Applications of Telemedicine
•   Need for Teleophthalmology
•   Role of Teleophthalmology
•   Teleophthalmology Models
•   Setting up Teleophthalmology
•   Challenges
•   Patients Perspective on Teleophthalmology
•   Training Teleophthalmology
•   Websites
•   Collaborating Partner

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Worldwide, people living in rural and remote areas struggle to access timely, quality specialty medical care. Residents of these areas often do not have access to specialty health care, primarily because specialist physicians are more likely to be located in areas of concentrated population. Because of innovations in computing and telecommunications technology, many elements of medical practice can be accomplished when the patient and health care provider are geographically separated. This separation could be as small as across town, across a state, or even across the world. Broadly defined, telemedicine is the transfer of electronic medical data (i.e. high resolution images, sounds, live video, and patient records) from one location to another. This transfer of medical data may utilize a variety of telecommunications technology, including, but not limited to: ordinary telephone lines, ISDN, fractional to full T-1's, ATM, the Internet, intranets, and satellites. Telemedicine is utilized by health providers in a growing number of medical specialties, including, but not limited to: dermatology, oncology, radiology, surgery, cardiology, psychiatry, Ophthalmology and home health care.
  • TELEMEDICINE FOR THE MEDICARE POPULATION UPDATE

  • Abstract:
    This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC), under contract to the Agency for Healthcare Research and Quality (AHRQ). The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. The goal of this report was to assess the peer-reviewed literature for telemedicine services that substitute for face-to-face medical diagnosis and treatment that may apply to the Medicare population.

  • A BRIEF HISTORY OF TELEMEDICINE


  • TELEMEDICINE

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Telemedicine can potentially play an important role in improving health services. The main role of Telemedicine is to
  • Provide access to health care specialists for patients in rural or remote areas.
  • Disease screening, diagnosis, monitoring, and management
  • Linking and sharing of diverse medical resources
  • Research and clinical trial collaborations
  • Distant learning and continuing education

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Telemedicine is practiced for over 30 years. Recent technological advances, however, have expanded the scope of medical interaction that may be achieved. Telemedicine has covered almost all fields like Disaster relief Dentistry, Emergency medicine, Nursing, Oncology, Perinatal and Obstetrics, Telecardiology, Teledermatology, Teleneurology, Teleophthalmology, Telepathology, Telepediatrics, Telepharmacy, Telepsychiatry & mental health, Teleradiology, Telesurgery, Veterinary and Other specialties.
  • TELEMEDICINE APPLICATION IN TELEOPHTHALMOLOGY

  • Abstract:
    This article describes in detail about the TeleOphthalmic network. It also describes in detail about the application of Telemedicine in TeleOphthalmic. It also describes in detail the process and the execution of TeleOphthalmic. It also describes in detail about the advantages of TeleOphthalmic.

  • TELEMEDICINE APPLICATION IN RADIOLOGY

  • Abstract:
    This article provides in detail about Teleconnectivity network plays a vital role in the field of Radiology. It also describes its application and the advantages of Teleradiology.

  • TELEMEDICINE APPLICATION IN CARDIOLOGY

  • Abstract:
    This article describes in detail about the Application of Telemedicine in the field of cardiology. This also gives a detailed sketch on the infrastructure and the connectivity requirement for Tele consultation. It also describes in details about the process of the application of telemedicine in the field of cardiology.

  • APPLICATION OF TELE MEDICINE IN SURGERY

  • Abstract:
    This article provides in detail about how Teleconnectivity network plays a vital role in the field of Surgery It also describes in detail about the applications of TeleSurgery.

  • TELEMEDICINE APPLICATION IN PATHOLOGY

  • Abstract:
    This article describes in detail about how the Teleconnectivity network plays a vital role in the field of Pathology. It also describes in detail about how the Tele pathology processes is performed using the Teleconnectivity network. It also provides in detail how the different types of Tele pathology process has been done and also its applications in consultations for the patients.

  • TELEMEDICINE THE SIMPLE ROUTE TO SPECIALITY HEALTH CARE

  • Abstract:
    This article describes in detail about how the Telemedicine tremendously brings the Speaciality Healthcare to the Community doorsteps. It also provides in detail about the health communication and the connectivity process interfaced together to providing high care and high quality service to the remote community.

  • TELEMEDICINE IN NEUROLOGY: UNDERUTILIZED POTENTIAL

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In developing countries, many dont have the privilege to Ophthalmic service, the reason for this is that majority of the Ophthalmologists are in cities whereas majority of the countrys population live in rural area. Further, this is compounded by inadequate medical facilities in the rural and inaccessible areas, problem of retaining Ophthalmologists in rural areas both due to the non availability of adequate facilities and also due to the feeling among them that they become professionally isolated and obsolete over a period of time if they remain in rural areas.

The magnitude of this problem is enormous. However the present day technology has the solution for this problem in the form of Teleophthalmology. The only requirement is that the concerned people must have a mind to adopt this.
  • E-HEALTH BRIDGING THE GAP

  • Abstract:
    This article describes in detail how the e-health bridges the gap between the community and the doctors in the urban population. It also details about the application and the implementation of Telemedicine and how it serves the rural public, how the medical awareness reaches home by home.

  • TELEOPHTHALMOLOGY IN INDIA

  • Abstract:
    This presentation describes in detail current ophthalmology status and also the vital need of the network in Teleophthalmology. It also gives a brief sketch about the Teleophthalmology practices in India, and its scope. It also gives Shanakara Netralaya as role model for conducting camps and effectively treating the community with the help of the mobile connectivity and also briefs how the Teleophthalmology helps in the field of ophthalmic research.

  • THE IMPACT OF INFORMATION TECHNOLOGY ON THE PRACTICE OF OPHTHALMOLOGY

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With Vision 2020 every human being will have the right to sight and teleophthalmology will play a vital role here. Teleophthalmology will enable early detection and treatment of diseases like glaucoma and diabetic retinopathy, brings closeness between doctor and patients and instills confidence in patients.
  • EYESTALK- BEYOND FRONTIERS

  • Abstract:
    This article describes in detail about the eyestalk, an Ophthalmic Software that software allows Ophthalmologists and other ophthalmic technicians to maintain complete confidentiality of patient information and creates a database for these consultations that automatically updates itself in the system. It also lists out the salient features of the software, the flowchart of workflow and the hardware and software requirements for the installation of the software.

  • ARAVIND TELEOPHTHALMOLOGY NETWORK

  • Abstract:
    This article describes in detail the evolution of Teleophthalmology. It also gives a detailed data about Teleophthalmology and also briefs how the Teleophthalmic network is serving the community needs at the primary, secondary and the Tertiary levels of ophthalmology. It tells in detail how the Teleophthalmic network is processed in Vision centers and Mobile vans to the community needs.

  • MOBILE TELEOPHTHALMOLOGY

  • Abstract:
    This article briefs about the Mobile Teleophthalmic network for treating Community at the primary level. It also describes in detail about the process of how the Community is treated using the Teleophthalmic network. It also tells how the Eye Camps are planned in regular systematic basics with the help of the Mobile screening unit.

  • E-LEARNING

  • Abstract:
    This article describes in detail how the Tele Connectivity plays a vital role in the distance learning. It also shows different models of distance learning through the Tele Connectivity network.

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The provision of Teleophthalmology is extremely important in Eye care for all nations in the world and especially as a humanitarian response for developing countries. International experience has demonstrated the clinical value and the technical feasibility of teleophthalmology based patient care and service. Various models of Telemedicine are proposed on the basis of the available technological driving forces, arrangements and current practices. We have provided you the Models of Aravind Eye care system, Sankara Nethralaya, Sanjeevani and Joslin for your reference.

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Setting up Teleophthalmology center has always been a critical component of any Teleophthalmology project. Improper planning can convert a seemingly simple task to an exceedingly complex project. Here we have provided you with the resources which talks of the methodology to be followed and the planning required to successfully setup up Teleophthalmology also the kind of devices and equipment that has to be used. We have also provided you with the software requirements of Teleophthalmology.
  • GUIDELINES AND STANDARDS FOR TELEMEDICINE

  • Abstract:
    This article provides in turn is a guide providing the need and the necessity for providing standards in telemedicine. It also gives a detailed list of hardware and software facilities and also network requirement for setting up the Telemedicine network.

  • SETTING UP A TELE-OPHTHALMOLOGY UNIT

  • Abstract:
    This article describes in detail about how to set up a Teleophthalmic unit. This article gives in detail about the hardware and networking requirements for setting up an teleophthalmic network. It also describes in detail about the networking setup and the manpower involved in setting up the teleophthalmic network.

  • HOW TO SETUP A TELEMEDICINE CENTER AND TELEMEDICINE DEVICES AND EQUIPMENT

  • Abstract:
    These article talks of the methodology to be followed and the planning required to successfully setup a telemedicine center followed by a discussion on what kind of devices and equipment that can connect to telemedicine systems and the planning required to put them together and make them work satisfactorily.

  • DEFINITIONS AND CONCEPTS USED IN TELEMEDICINE

  • Abstract:
    This article provided detailed definitions of the concepts used in Telemedicine.

  • NETWORKING REQUIREMENTS AND THE ROLE OF MULTIMEDIA SYSTEMS IN TELEMEDICINE


  • SATCOM BASED TELEMEDICINE NETWORK TECHNOLOGY EVOLUTION

  • Abstract:
    This article provides in detail how the communication satellite help in transferring the information throughout Telemedicine network. It also describes in detail about the Technology evolution of the Telemedicine network. It also tells in detail how the Telemedicine network has been interconnected. It also describes in detail about the applications of the Telemedicine in medical field

  • AUDIO VIDEO SYSTEMS FOR TELEMEDICINE

  • Abstract:
    This article describes in detail about the vital role of Audio Video systems in the field of Telemedicine. It also describes the various types of Audio, Video inputs used in the field of Telemedicine for Teleconferencing the system. It also describes in detail about the Teleconnectivity of the Audio and Video files in the field of TeleMedicine.

  • DETAILED SPECIFICATIONS AND STANDARDS

  • Abstract:
    This article provides a detailed list of standard hardware and the software standards, System configuration, video and the audio requirements, clinical devices etc required for setting up a Teleophthalmic network.

  • TELEMEDICINE PLANNING, EXECUTION AND FUTURE

  • Abstract:
    This article tells in detail how to plan a telemedicine department within the timeline. It also speaks in detail the how to plan and meet the financial requirement, infrastructure, set up requirement, teleconnectivity through the network. It also tells in detail how to meet the different levels of Patient care needs. It highlights how to effectively plan camps and meetings, executing the camps with the help of effective connectivity of the network.

  • THE COST-EFFECTIVENESS OF TECHNOLOGY TRANSFER USING TELEMEDICINE

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Immediate or widespread implementation of telemedicine often is hindered by many factors like lack of telecommunication infrastructure, affordability of programs, cost of equipment, accuracy of the medical and non-medical devices used, training of appropriate personnel, lack of guidelines and protocols, sustaining projects, reimbursement for telemedicine consultations, regulations regarding sharing of information, legal liability privacy and security.

But still to make telemedicine successful some measures should be under taken like the objective of program must be identified, technology support personnel should be consulted to clarify technical equipment specifications and facility requirements. Protocols and guidelines must be developed to provide clear direction for how to utilize telemedicine most effectively. The training to staffs should be enhanced.
  • TELEMEDICINE NETWORK IMPLEMENTATION: CHALLENGES AND ISSUES

  • Abstract:
    This article tells in detail about the Telemedicine network implementation. It also provides in detail about the elements of the telemedicine network and their interconnection, information transfer, information integration with the medical aspects from the satellites to the end-end-end networks.

  • COMMUNICATION BACKBONE FOR HEALTH CARE

  • Abstract:
    A.K.Sangal
    This article tells in detail about the use of communications and information technology for medicaldiagnosis and patient care in the field of Telemedicine. It also describes in detail how the Telemedicine bridge as a communication backbone between the "Patient end" and the "Specialist end" using the combination of video, computer and network communication technologies by transferring electronic medical data (i.e. live video, high-resolution images, voice, text and patient records). It also describes how the communication plays a vital role in the field of healthcare.

  • TOWARDS TELEMEDICINE FOR PRIMARY CARE

  • Abstract:
    This article describes in detail how the Telemedicine help in the Primary health care services.

  • TELEMEDICINE: WHERE IT IS AND WHERE IT'S GOING


  • TELE-OPHTHALMOLOGY IN INDIA. IS IT HERE TO STAY?

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We use advanced technology for the benefit of patients. But ultimately it should satisfy the patients. We wanted to know patients perspective on Teleophthalmology so here are few experience of the patients we interviewed with.
  • KRISHNA RAMANUJAM'S PERSPECTIVE ON VISION CENTER

  • Abstract:
    This article provides detail discussion with krishnaRamanujam, a follow-up patient in Amabasamudram Vision centre. It also describes in detail about the conversation with the patient about the treatment and hoe the Ambasamudram had facilitate the patient with good vision health.

  • RAMASWAMY'S PERSPECTIVE ON VISION CENTER

  • Abstract:
    This article provides detail discussion with Ramaswamy, a new patient in Bodi Vision centre. It also describes in detail about the conversation with the patient about the treatment and how the Bodi Vision center had facilitate the patient with good vision health.

  • RANGANAYAKI'S PERSPECTIVE - VISION CENTER

  • Abstract:
    This article provides detail discussion with Ranganayaki, a new patient in Vision centre. It also describes in detail about the conversation with the patient about the treatment and how the Vision center had helped her in taking preliminary treatment before her eye operation.

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Indian Space Research Organisation
ISRO is playing a catalytic role by providing proven technology for introducing SatCom based Telemedicine in the remote parts of our country through pilot projects. Government run hospitals and a few Trust/NGO-run hospitals are selected so that they get sufficient training and experience to run the facility and the users themselves can subsequently introduce telemedicine in an operational mode at national level. Presently ISRO telemedicine network covers 115 Hospitals 88 Remote/Rural/District Hospital/Health Centre connected to 27 Super Speciality Hospital located in the major cities.

ISROs Telemedicine initiative is aimed at
  1. Providing Telemedicine Technology and connectivity between remote/rural hospitals and Super Speciality Hospitals for Teleconsultation, Treatment and Training of doctors and paramedics.
  2. Providing the Technology and connectivity for Continuing Medical Education (CME) between Medical Colleges and Post Graduate Medical Institutions/Hospitals and
  3. Providing Technology and connectivity for Mobile Telemedicine units for rural health camps especially in the areas of ophthalmology and community health.