What is Telemedicine?

Telemedicine refers to relying on computer technology, remote sensing, telemetry, and remote control technology to give full play to the advantages of medical technology and medical equipment in large hospitals or specialized medical centers, and to treat injuries and illnesses in remote areas, islands or ships with poor medical conditions For remote diagnosis, treatment and counselling.

A brand new medical service aimed at improving the level of diagnosis and medical treatment, reducing medical expenses, and meeting the health needs of the general public. At present, telemedicine technology has developed from the initial television monitoring and remote diagnosis of telephones to the use of high-speed networks for comprehensive transmission of digital, image, and voice, and has realized real-time voice and high-definition image communication, providing modern medical applications. Broader development space. The development of foreign countries in this field has a history of more than 40 years, and our country has only been valued and developed in recent years.

Chinese name: Telemedicine
Foreign name: Telemedicine

Presenter: hospital
Applied discipline: medicine

History of Telemedicine

Telemedicine in a broad sense: the use of telecommunications technology, holographic imaging technology, new electronic technology and computer multimedia technology to take advantage of the medical technology and equipment of large medical centers to provide long-distance medical information to poor medical conditions and special environments and service. It includes all medical activities including telediagnosis, teleconsultation and nursing, teleeducation, telemedicine information services. In a narrow sense: it refers to telemedicine, including remote imaging, remote diagnosis and consultation, remote care and other medical activities. The development in this field abroad has a history of nearly 40 years, and it started relatively late in China.

In the late 1950s, American scholar Wittson first used the two-way television system for medical treatment; in the same year, Jutra et al. Founded teleradiology. Since then, people in the United States have continued to use communications and electronic technologies for medical activities, and the term "Telemedicine" has appeared. Now domestic experts have uniformly translated it into "telemedicine". The American futurist Alvin Toffgong had predicted many years ago: "In future medical activities, doctors will face the computer and diagnose and treat patients based on the various information of patients from a distance displayed on the screen." This situation has arrived. It is expected that global telemedicine will make greater progress in the not too long future.

Telemedicine research content

Telemedicine includes telemedicine consultations, telemedicine education, and the establishment of a multimedia medical consultation system. Telemedicine consultation establishes a new connection between medical experts and patients, so that patients can receive consultations with remote experts at the same place and the original hospital, and treat and care under their guidance, which can save doctors and patients a lot of time and money . Telemedicine uses computers, communications, medical technology and equipment to achieve long-term face-to-face consultations between experts and patients, experts, and medical staff through long-distance transmission of data, text, voice, and image data. Telemedicine is not only a medical or clinical problem, but also includes various aspects such as communication networks and databases, and they need to be integrated into network systems.

United Airlines is putting into operation a telemedicine system that provides a full range of vital signal detection, including heart, blood pressure, and breathing. During the flight, medical support from around the world can be obtained in time through the mobile communication system. The field telemedicine system developed by the University of Maryland consists of field doctors, communications equipment vehicles, satellite communications networks, field hospitals, and medical centers. Each soldier wears a medical bracelet, which can test the soldier's blood pressure and heart rate and other parameters. There is also a GPS locator, which can help doctors find him quickly when he is injured, and get diagnosis and treatment through the telemedicine system.

Some qualified hospitals and medical colleges in China have also carried out this work. For example, Jinshan Hospital of Shanghai Medical University has published a list of telemedicine consultation experts online. Xi'an Medical University established the "Telemedicine Center" with the support of the "Bridge to Asia" in the United States, and successfully conducted a Sino-US telemedicine demonstration for US Secretary of State Albright. Recently, the first telemedicine center in the southwest of China-"Golden Guiyang Telemedicine Consultation Center in China" was established in Guiyang.

Telemedicine can enable patients in remote areas and without good medical conditions to obtain good diagnosis and treatment, such as rural, mountainous, field survey sites, air, sea, and battlefields. It can also enable medical experts to consult patients at different spatial locations at the same time.

Key Features of Telemedicine

1. Using telemedicine in the right place and home health care can greatly reduce the time and cost of transporting patients.

2. Emergency medical services in remote areas can be well managed and distributed, which can be achieved by transmitting photos to key medical centers.

3. It can enable doctors to break through the limitation of geographic scope and share patient medical records and diagnostic photos, which is conducive to the development of clinical research.

4, can provide better medical education for medical staff in remote areas.

In general, huge and expanding telemedicine applications can greatly reduce the barriers to patient access to medical care because geographic isolation is no longer a medically insurmountable obstacle.

Telemedicine basic uses

First, to some extent, the current situation of China's expert resources and China's extremely uneven population distribution has been alleviated. 80% of China's population is distributed in underdeveloped medical and health resources, while 80% of China's medical and health resources are distributed in large and medium-sized cities. The development of medical standards is uneven. Mostly distributed in large cities. Even in big cities, patients still want to go to tertiary hospitals for specialist treatment, causing patients in primary hospitals to flow into municipal hospitals, increasing the burden on municipal hospitals, causing tension in beds, and leaving idle beds in the grassroots, eventually leading to the distribution of medical resources. Uneven and wasteful. The use of remote consultation systems can enable patients in less developed areas to receive treatment from specialists at large hospitals. In addition, through distance education and other measures can also improve the level of doctors in small and medium hospitals to a certain extent.

The second is to alleviate the problem of high referral rate and high cost of patients in remote areas. China is a vast country with a large population. Patients in remote areas often have to be sent to higher-level hospitals for specialist consultations because of the backward medical conditions there. In this way, transportation costs for visiting clinics, expenses for family accompany, medical expenses for hospitalization, etc. increase the financial burden on patients. At the same time, the bumps in the road also caused more discomfort to the patient's body, and many patients who did not have the condition to visit the large hospital delayed the diagnosis and treatment, causing physical and mental pain to the patient and family. According to surveys, the proportion of patients in remote areas transferred to higher-level hospitals is quite high; the average cost is very expensive, and other costs (including diagnostic costs, various examination costs, travel expenses, escorts, accommodation, meals, etc.) other than treatment costs Thousands of dollars are needed, making the patient almost unable to afford it. The remote consultation system allows patients to receive corresponding treatment locally, which greatly reduces the cost of consultation.

Telemedicine applications

The goals to be achieved by telemedicine technology mainly include: a telemedicine diagnosis system for inspection and diagnosis, a telemedicine consultation system for consultation and consultation, a telemedicine education system for teaching and training, and a home bed.

Remote bed monitoring system.

The purpose and requirements of the application are different, and the equipment configured in the telemedicine system and the communication network environment used are also different. The remote medical diagnosis system is mainly configured with various digital medical instruments and corresponding communication interfaces, and mainly runs on the local area network of the hospital. End-user devices include electronic scanners, digital cameras, and microphones and speakers. The telemedicine education system is similar to the medical consultation system. It mainly uses video conferencing to operate on broadband networks. No matter which type of telemedicine system, computers and multimedia equipment are essential.

Telemedicine has a wide range of applications, and is often used in many cases such as radiology, case, dermatology, cardiology, endoscope, and neurology. The application of telemedicine technology is very extensive, so this technology has a huge space for development.

Telemedicine media

The application of multimedia technology in telemedicine depends on the support of various multimedia digital devices. In telemedicine, multimedia technology is mainly applied in the following areas:

(1) Media collection. High-resolution images can be acquired with a digital camera (head).

(2) Media storage. Audio, video, and medical images need to be temporarily or permanently stored in the computer. This can be achieved with magnetic or opto-magnetic devices (such as hard disks, floppy disks, and optical disks).

(3) Compression / decompression. The popular JPEG image compression standard can achieve 10: 1 to 20: 1, and the diagnosis results show that it is not harmful to the image.

(4) Image processing. Its basic functions should include angle rotation, horizontal and vertical telescoping, correction of acquisition errors, and clear images with the naked eye under clinic conditions.

(5) User interface. Graphical interfaces are the most common in medicine because they can reflect more medical information (visual information), so monitors, keyboards, mice, and window management software are the most basic telemedicine user interfaces. In addition, multimedia equipment is also needed.

Telemedicine communication

(1) Network interface. Different telemedicine needs and communication environments also have various choices of communication networks, so the network interface speeds are also different.

(2) Network protocol. ATM (Asynchronous Transfer Mode) interconnection protocol is widely used in telemedicine systems. H.324 video conference protocol can be used to transmit medical images on the telephone network. The TCP / IP protocol can be used for LAN and WAN interfaces, and uses it to access medical images and remote medical information sources.

(3) Video transmission. According to different telemedicine requirements, the video transmission rate is also different. It can be roughly divided into two types: low-rate and high-rate transmission. The former is used for video conference and the latter is used for diagnosis video transmission.

(4) Audio transmission. In addition to video, there is also audio transmission in the telemedicine system. It can also be divided into two types: low-rate and high-rate transmission. The former is used for consultation and the latter is used for diagnosis.

(5) Still image (film) transmission. Generally, the transmission of static images (slices) is one-way communication, the transmission rate is calculated in a single frame, and the traffic is bursty.

(6) Medical records. It is also one-way transmission, and is mainly text information, so the transmission bandwidth is not high.

(7) Backbone network. There are many options for the backbone network of telemedicine, but with the expansion of the network, it is necessary to interconnect each LAN into a WAN through a bridge or router.

Telemedicine

Telemedicine has been widely used in rural and urban areas of China. He has also played an active role in the treatment of cardiology, brain surgery, psychiatry, ophthalmology, radiology, and other medical specialties. The communication technology used in telemedicine may be different, but common factors include patients, medical staff, experts and their different forms of medical information signals. Telemedicine has strong vitality and is also required for economic and social development. With the development of information technology, the application of high and new technology (such as telemedicine guided surgery, television intervention, etc.), and the gradual improvement of various laws and regulations, the telemedicine industry will definitely get unprecedented opportunities for development.

Development status of telemedicine

Telemedicine abroad

In the late 1950s, American scholar Wittson first used two-way television systems for medical treatment; in the same year, Jutra et al. Established teleradiology. Since then, people in the United States have continued to use communications and electronic technology for medical activities, and the term Telemedicine has appeared. Now domestic experts have uniformly translated it into "telemedicine (or telemedicine)."

First Generation Telemedicine

Telemedicine activities from the early 1960s to the mid-80s were considered the first generation of telemedicine. Telemedicine development at this stage is slow. From an objective analysis, the information technology at that time was not yet developed enough, the information highway was in a new stage, the amount of information transmission was extremely limited, and telemedicine was restricted by communication conditions.

Second Generation Telemedicine

Since the late 1980s, with the continuous improvement of modern communication technology, a large number of valuable projects have been launched, and their momentum and influence far exceed the first generation technology, which can be regarded as the second generation of telemedicine. Judging from the number of documents collected by Medline, in the 10 years from 1988 to 1997, the number of documents in telemedicine increased geometrically. In the implementation of the telemedicine system, the United States and Western European countries have developed the fastest. The contact methods are mostly through satellite and integrated service data network (ISDN). Great progress has been made in military medicine.

In 1988, the United States proposed that the telemedicine system should be an open and distributed system. In a broad sense, telemedicine should include modern information technology, especially two-way audiovisual communication technology, computers, and remote sensing technology to deliver medical services to distant patients. Or information exchange between doctors. At the same time, American scholars also defined the concept of telemedicine system as follows: Telemedicine system refers to a whole, which provides medical services to specific groups through communication and computer technology. This system includes remote diagnosis, information service, distance education and other functions. It is based on computer and network communication, and is based on multimedia technology for medical data. It performs long-distance video, audio information transmission, storage, query and display. The Georgia Educational Medical System (CSAMS) is currently the world's largest and most extensive distance education and telemedicine network, which can perform wired, wireless and satellite communications activities. Telemedicine network is part of it.

Europe and the EU organized large-scale telemedicine system promotion experiments involving 3 biomedical engineering laboratories, 10 large companies, 20 pathology laboratories, and 120 end-users, which promoted the popularity of telemedicine. Australia, South Africa, Japan, Hong Kong and other countries and regions have also carried out various forms of telemedicine activities. In December 1988, a strong earthquake struck the former Soviet Union s Armenian Republic. With the support of the United States-Soviet Joint Working Group on Space Physiology, NASA conducted the first international telemedicine, bringing a hospital in Armenia into consultation with four US hospitals. This shows that telemedicine can cross international political, cultural, social and economic boundaries.

Although telemedicine in the United States started early, its judicial system once hindered the full development of telemedicine. The so-called remote is limited to a certain state, because the United States requires medical practice to obtain the medical license of the state in which it resides. Interstate medical practice involves legal issues. According to statistics, in 1993, about 2,250 patients in the United States and Canada visited the telemedicine system, of which 1,000 were renal dialysis consultations conducted by designated doctors in Texas for only 3 to 5 minutes; the average consultation time for other diseases was about 35 minutes.

U.S. telemedicine projects have special funds, partly funded by states and federal funding agencies

Smart blood pressure monitor, personal medical prevention expert Committee will provide. In the 1994 fiscal year, at least 13 different federal funding programs allocated $ 85 million for telemedicine, and Georgia alone allocated $ 8 million to build a telemedicine network in six regions.

Third Generation Telemedicine

Since 2010, telemedicine has gradually entered the community, moved towards the family, and is more oriented towards individuals, providing targeted and personalized service development. According to Qidi.com's smart home industry report, telemedicine is closely synchronized with the development of smart phones, the development of Internet of Things technology and the popularity of smart phones, telemedicine has also begun to integrate with cloud computing and cloud services, and many smart health medical products are gradually With the advent of remote blood pressure monitors, remote electrocardiographs, and even remote fetal heart rate monitors, ordinary users have provided more convenient and intimate daily medical prevention and medical monitoring services. Telemedicine has also progressed from disease treatment to disease prevention.

Google launches telemedicine service

On October 13, foreign media Recode reported that Google (537.94, 4.73, 0.89%) is quietly marching into the increasingly popular telemedicine field. Google's official Weibo confirmed that it has begun testing telemedicine services and that patients can see a doctor via video ^[1] .

Telemedicine China

China is a vast country with obvious regional differences in medical standards, especially in the vast rural and remote areas. Therefore, telemedicine is more necessary for development in China.

China has only begun to explore telemedicine since the 1980s. In 1988, the PLA General Hospital conducted a remote neurosurgery case discussion with a German hospital via satellite. In 1995, the Shanghai Educational Research Network and the Shanghai Medical University Remote Consultation Project were launched, and the Remote Medical Consultation Research Lab was established. At present, dozens of hospital websites in more than 20 provinces and cities nationwide, including the Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences and the Fuwai Cardiovascular Hospital of the Chinese Academy of Medical Sciences, have been put into operation. Patients conducted remote, remote, real-time, dynamic live TV consultations, successfully broadcasted large international conferences, and organized domestic and international special lectures, academic exchanges and surgical observations dozens of times, which greatly promoted the development of telemedicine in China. .

According to the national health informatization master plan, the Ministry of Health of the General Logistics Department of the PLA has proposed the "three major projects" for the informatization construction of the military health system, and they have been listed as national "Jinwei Project" military words No. 1, 2, and 3, Among them, the No. 2 project is to build the army's medical and health information network and telemedicine consultation system.

Although China's telemedicine has achieved initial results, it is still far from the level of developed countries. It still needs to be continuously improved in terms of technology, policies, regulations, and practical applications. At the same time, the general public's understanding of telemedicine remains to be Further improve.

The development of telemedicine technology is inseparable from the progress of communication and information technology. China has a vast territory, especially the low level of medical treatment in the vast rural and remote areas. Telemedicine is more necessary for development, but it is still restricted by technology, laws and knowledge.

In order to achieve the monitoring of critically ill patients, most early hospitals adopted the method of television monitoring, which is the embryonic form of telemedicine. The development of computer technology and communication technology, especially the development of the Internet, has provided a technology platform for remote diagnosis, remote treatment and remote surgery. As a result, telemedicine in the modern sense was proposed as a new application technology, and it quickly gained widespread attention.

Telemedicine telemedicine policy pilot

The NDRC website released a notice yesterday. The National Development and Reform Commission and the National Health and Family Planning Commission have decided to cooperate with Ningxia Hui Autonomous Region, Guizhou Province, and Tibet Autonomous Region and the People's Liberation Army General Hospital, Inner Mongolia Autonomous Region and Peking Union Hospital, and Yunnan Province and China-Japan Friendship Hospital Pilot work on telemedicine policy. The notice proposes that all pilot provinces and regions should study and formulate relevant policies, mechanisms, regulations and standards applicable to the development of telemedicine in terms of telemedicine operation specifications, liability determination, incentive mechanisms, service charges, and expense reimbursement, etc., and explore market-oriented Telemedicine service model and operation mechanism. ^[2]