Telemedicine: A Part of Medical Team

The convergence of information and communication technologies (ICT) for improving health system through telemedicine addresses both changes in the access of healthcare information and services as well as wider dissemination of healthcare related skills and specialist expertise into community, into home and ultimately the individuals. The use of the internet and high-tech communications in health care has led to new approaches to medical treatment and to challenging legal questions. The health care providers, hospitals, pharmaceutical companies, insurers and their legal counsels are exchanging medical information through web-portal access using telemedicine. The application of telemedicine in health system improvement can be classified as the use of e-health in the provision of health services at a distance (tele-health), management of clinical and administrative information (health informatics), and sharing information with health care providers, patients, and communities (e-learning). Proven benefits of telemedicine include improved access to care, enhanced quality of services, and reduced costs of care for patients and health care systems. However, use of telemedicine within or between institutions involves a number of factors that require appropriate planning. Many of these issues cannot be addressed without the support of well-defined policies, rules, standards, or guidelines at the institutional, jurisdictional, and global levels. It is important for the planners of telemedicine at different levels to develop policies that could facilitate the adoption of telemedicine and prove its success through improvement in services and change in public health status.

Doctors have recently gained extensive knowledge of using telemedicine applications for consultations, education and training, and conferences. What is still lacking is systematic evaluation of these new approaches compared with traditional measures. Trials involving consultations for diagnostic, monitoring, and interpretative purposes should be blinded and multicentred, and should include tests of patients satisfaction as well as macro-economic considerations. The quality of educational programmes and conferences should be documented and compared with traditional teaching methods. International standards need to be developed for such evaluations, to allow valuation between trials performed at national and international levels. Pakistan is in a good position to contribute to these developments because of a well-integrated health care system and excellent telecommunication facilities. Through telemedicine, Pakistan possibly will resume a leading global position in the use of advanced information technology. There are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence. Further well-designed and targeted research that provides high-quality data will provide a strong contribution to understanding how best to deploy technological resources in health care. The identification of a number of critical requirements for the successful implementation of ICT projects and programs in the health sector of developing countries includes:

1. purpose, strategies, and scope of services to be provided;
2. audiences, customers, and users (targeted populations);
3. value of health and healthcare to the individual and community;
4. current ways to assess individual and collective health problems (community health);
5. needs of the individual, community, and nation;
6. institutional user needs and commitments; and
7. competencies of the organization implementing or hosting the ICT system. 

ICT have clearly made an impact on health care, includes:

• improved dissemination of public health information and facilitated public discourse and dialogue around major public health threats; 
• enable remote consultation, diagnosis and treatment through telemedicine;
• facilitate collaboration and cooperation, among health workers, including sharing of learning and training approaches;
• support more effective health research and the dissemination and access to research findings;
• strengthened the ability to monitor the incidence of public health threats and respond in a more timely and effective manner; and
• improve the efficiency of administrative systems in health care facilities.

Telemedicine now has the potential to make a difference in the lives of sick people. Depending upon the level of technology employed, telemedicine can reduce professional isolation of the rural primary practitioner in several ways. For instance, two-way interactive video consultation with specialists links the isolated practitioner with the specialist community of a large medical care. This virtual support system and contact with professional colleagues should enhance the integration of the rural or otherwise isolated practitioner. However, it must be noted that these contacts are only temporary, will occur only sporadically, and depend on the level of telemedicine technology employed. Therefore, the extent of the integrative possibility of telemedicine remains to be determined. The technology also has the potential to link the primary practitioner with on-line services which provides the opportunity to review the latest medical literature, thereby strengthening links to the professional medical community and improving the quality of care for the rural patient.