The writer Dr. N K Singh, a Manipuri, is the Director of Tele Cardiology and Tele Health at the famous Narayana Hrudayala (Cardiology Hospital), Bangalore. Narayana Hrudayala was established under the leadership of the renowned Heart specialist Dr. Devi Shetty.

"Today, new forms of communications and information technology like the Internet are becoming an important part of the national infrastructure for health care around the world," - Dr. Salah Mandil, health informatics director at the World Health Organization (WHO).

THE CONCEPT:
Telemedicine is the use of information and communications technology (ICT) for medical diagnosis and patient care. It involves the use of information and telecommunications technology as a medium for the provision of medical services to sites that are at a distance from the provider. The concept encompasses everything from the use of standard telephone service through high speed, wide bandwidth transmission of digitized signals in synergistic conjunction with computers, fiber optics, satellites, and other sophisticated peripheral equipments and software. The traditional barrier of geography and time is overcome with.

Telemedicine is of immense help as an aid in clinical decision-making or in collaborative arrangements for the real-time management of patients at a distance. As an aid to clinical decision-making, telemedicine Includes areas such as remote expert systems that contribute to patient diagnosis or the use of online databases in clinical practice for delivering health care services. Patient information, comprising of text, graph, static images, dynamic images etc could all be transmitted using the electronic medium in a few seconds, from a remote site to an expert end for specialist opinion and care. It can also include transmittal of grand rounds for medical education purposes or teleconferences for continuing education. Collaborative arrangements consist of using technology to actually allow one practitioner to observe and discuss symptoms with another practitioner whose patients are far away. This raises important issues of referral and payment arrangements, staff credentialing, liability, and licensure potentially crossing state lines. Two-way workstations that provide smooth digital motion pictures have been integral to the long distance, real-time treatment of patients. As new technology is found, collaborative real time arrangements are the future of telemedicine.

The certified elimination of smallpox from the face of the earth in 1986 was the greatest public health success story in the world. The second - but less well known - success story was the use of IT and telecommunications in the control of river blindness in West Africa earlier this decade. It involved sensors, telephone lines, satellite links and computers for the surveillance and tracking of the deadly black fly larvae living along 50,000 kilometers of the Volta river, which runs through 11 West African countries.

A Multidisciplinary Approach:
Around the world, costs of health care are going up - but IT and telecom costs are dropping. Governments are also coming under increasing pressure to cut costs, make their services more economically affordable, and privatize sectors like telecommunications and health care.

Telemedicine in actual terms is thus the harnessing of innovative ICTs solutions in the delivery of quality health care, thereby resulting in improved equity in access to high-quality health care. Telemedicine requires a multidisciplinary approach involving varied sectors like telecommunications, IT, medical experts, general practitioners, hospitals, equipment suppliers, logistics companies, government agencies, social workers and universities. It also brings to the table a wide range of technologies like radio, analog landlines, e-mail, Internet, ISDN, satellites, and tele-sensors.

Apart from its use in providing care, Telemedicine systems also harness information and communications technologies in several ways like for example in administration and management of health care systems, transferring and storing of clinical data, surveillance during epidemics, publication and search of medical literature, and education and training for healthcare workers, students and individual citizens.