Telemedicine

TELEMEDICINETELEMEDICINE

Rapidly developing application of clinical medicine. Rapidly developing application of clinical medicine.

Tele Tele == ‘far’ ‘far’ (Greek) and (Greek) and Mederi Mederi == ‘to heal’ ‘to heal’ (Latin). (Latin). The use of The use of communications and ITcommunications and IT for the for the delivery of clinical delivery of clinical

carecare..

phone / internetphone / internet Medical info consulting, remote medical Medical info consulting, remote medical procedures / examinations.procedures / examinations. SimpleSimple (2 health professionals discussing a case over (2 health professionals discussing a case over

telephone); telephone); Complex Complex (real-time consultation b/n medical specialists in (real-time consultation b/n medical specialists in

different countriesdifferent countries via via satellite technology & satellite technology & videoconferencing equipmentvideoconferencing equipment). ).

Also calledAlso called In absentiaIn absentia care care • Care at a distance;Care at a distance;• old practice often conducted old practice often conducted via postvia post. . • in absentia health care has in absentia health care has evolved into modern telemedicineevolved into modern telemedicine..

‘ ‘Use of Use of medical informationmedical information exchanged from exchanged from one site to anotherone site to another,, via via electronic communicationelectronic communication for the for the health and educationhealth and education of the of the patientpatient and/and/or or health care providerhealth care provider, and , and for for the purposethe purpose of of improving patient improving patient carecare.’.’

Telemedicine • Provision of Provision of clinical services onlyclinical services only..• Focuses on Focuses on curative aspectscurative aspects..

Telehealth • Refers to Refers to clinical and non-clinical servicesclinical and non-clinical services (medical (medical

education, administration, and research). education, administration, and research). • Expansion of telemedicineExpansion of telemedicine..• Focuses on Focuses on preventive, promotive and curative aspectspreventive, promotive and curative aspects..

e-health – Umbrella term (includes telehealth, – Umbrella term (includes telehealth, electronic medical records, and other components of electronic medical records, and other components of health IT); particularly in the UK and Europe. health IT); particularly in the UK and Europe.

11stst interactive Telemedicine system interactive Telemedicine system • Operated Operated over standard telephone linesover standard telephone lines; ; • For remotely diagnosing and treating patients requiring For remotely diagnosing and treating patients requiring

cardiac resuscitationcardiac resuscitation (defibrillation); (defibrillation);• Was developed and marketed by Was developed and marketed by MedPhone CorporationMedPhone Corporation in in

19891989 under the leadership of S. Eric Wachtel. under the leadership of S. Eric Wachtel.

HOW DID TELEMEDICINE DEVELOP SO RAPIDLY?????HOW DID TELEMEDICINE DEVELOP SO RAPIDLY????? 1990s – development of medical devices suited to capturing 1990s – development of medical devices suited to capturing

images and other data images and other data inin electronic formelectronic form. . Development of Development of high speed communication systemshigh speed communication systems around around

the world.the world. CLASSIFICATIONCLASSIFICATION → → Store-and-forwardStore-and-forward →→ Remote monitoringRemote monitoring → → Interactive servicesInteractive services

Store-and-forwardStore-and-forward

A A properly structured Medical Recordproperly structured Medical Record ( (electronic electronic formform) is a key component of this transfer. ) is a key component of this transfer.

NO actual physical examination and history takingNO actual physical examination and history taking.. Clinician relies on a Clinician relies on a history report and AV infohistory report and AV info for for

the physical examination.the physical examination.

MEDICAL DATA (medical images,

biosignals)

Doctor / Medical specialist(for offline assessment)

Remote monitoringRemote monitoring self-monitoring/testingself-monitoring/testing; ; Enables medical professionals to Enables medical professionals to monitor a patientmonitor a patient

remotelyremotely using various using various technological devices.technological devices. Primarily used for managing Primarily used for managing chronic diseases or chronic diseases or

specific conditions specific conditions (like heart disease, DM or BA). (like heart disease, DM or BA). Can provide Can provide comparable health outcomescomparable health outcomes to to

traditional in-person patient encounters. traditional in-person patient encounters. Greater patients satisfaction; cost-effective.Greater patients satisfaction; cost-effective.

Interactive telemedicine servicesInteractive telemedicine services provide provide real-time interactionsreal-time interactions between the patient between the patient

and providerand provider (includes phone conversations, online (includes phone conversations, online communication and home visits).communication and home visits).

History review, P/E, psychiatric evaluations and History review, P/E, psychiatric evaluations and ophthalmology assessments ophthalmology assessments can be conducted can be conducted comparablycomparably to those done in traditional face-to-face to those done in traditional face-to-face visits. visits.

‘‘Clinician-interactive’ telemedicine servicesClinician-interactive’ telemedicine services may be less may be less costly than in-person clinical visits.costly than in-person clinical visits.

Medical consultationMedical consultation • specialist reviews specialist reviews still images and video-clipsstill images and video-clips (low (low

bandwidth is sufficient). bandwidth is sufficient). • Real time telephone voice interaction + images + Real time telephone voice interaction + images +

video-clipsvideo-clips (greater bandwidth required). (greater bandwidth required).• Real-time interactive videoReal-time interactive video is applicable to reviewing is applicable to reviewing

cardiology videos (cardiac catheterizations or ECGs); cardiology videos (cardiac catheterizations or ECGs); highest bandwidth is required.highest bandwidth is required.

F.Y.I.F.Y.I. Bandwidth is used for Bandwidth is used for data transmissiondata transmission, and is , and is directly directly

related to costrelated to cost.. Digital data (transferred through ordinary telephone Digital data (transferred through ordinary telephone

line); line); Telemedicine (better bandwidth needed). Telemedicine (better bandwidth needed).

TELEMEDICINE INTERACTIONSTELEMEDICINE INTERACTIONS SimplestSimplest : : • optical disk system at hospital transmits images, optical disk system at hospital transmits images,

text and other data to a physician’s home. text and other data to a physician’s home. (physician requires little bandwidth and specialized (physician requires little bandwidth and specialized equipment).equipment).

LecturesLectures : : medical student education course given from medical student education course given from

hospital location to students in another region. hospital location to students in another region. One-way videoOne-way video [students can only view the lecture]. [students can only view the lecture]. 2-way video2-way video [students can also take part]. [students can also take part]. Instructor can transmit sound , video, text and Instructor can transmit sound , video, text and

images to multiple classrooms.images to multiple classrooms. Minimum bandwidth required (moderate to high).Minimum bandwidth required (moderate to high).

Modalities of data transmission in telemedicineModalities of data transmission in telemedicineSystemSystem Data speedData speed Adv./ Disadv.Adv./ Disadv.

Public telephone networkPublic telephone network

ISDN (Integrated service digital ISDN (Integrated service digital network)network)

ISDNISDN

SatelliteSatellite

WirelessWireless

MicrowaveMicrowave

Leased linesLeased lines

ATM (asynchronous transfer ATM (asynchronous transfer mode) ormode) orADSL (asynchronous digital ADSL (asynchronous digital subscriber line)subscriber line)

56 Kb/s56 Kb/s

128 Kb/s128 Kb/s

2 Mb/s2 Mb/s

2 Mb/s2 Mb/s

< 2 Mb/s< 2 Mb/s

< 20 Mb/s< 20 Mb/s

64 Kb/s64 Kb/s

155 Mb/s155 Mb/s

Economical, easily available, Economical, easily available, slow.slow.

Cheap, flexible, slow.Cheap, flexible, slow.

Fast, high quality, expansive, Fast, high quality, expansive, patchy availability.patchy availability.High quality, remote access, High quality, remote access, expensive.expensive.

Convenient, free movement, Convenient, free movement, new technology.new technology.Good quality, inexpensive, to Good quality, inexpensive, to run line of sight only.run line of sight only.

ReliableReliable

High bandwidth, expensive.High bandwidth, expensive.

BENEFITS & USESBENEFITS & USES Most beneficial for populations living in Most beneficial for populations living in isolated communities isolated communities

and remote regions.and remote regions. Currently being applied Currently being applied in virtually all medical domainsin virtually all medical domains. .

[Teleradiology, telecardiology, etc].[Teleradiology, telecardiology, etc]. Useful as a communication tool b/n a Useful as a communication tool b/n a general practitioner general practitioner

and a specialistand a specialist available at a remote location. available at a remote location. Monitoring a patient at homeMonitoring a patient at home (using devices like B.P. (using devices like B.P.

monitors) and monitors) and transferring the information to a caregivertransferring the information to a caregiver is a is a fast growing emerging service.fast growing emerging service.

Primary Remote Diagnostic VisitsPrimary Remote Diagnostic Visits • In developing countries;In developing countries;• A doctor uses devices to remotely examine and treat a A doctor uses devices to remotely examine and treat a

patient. patient. • holds big promises to solving major health care delivery holds big promises to solving major health care delivery

problems. problems.

TELECARDIOLOGYTELECARDIOLOGY ECG is transmitted via telephone and wireless.ECG is transmitted via telephone and wireless. Barr (1958)Barr (1958) – transmitted ECG tracings to about 40,000 feet. – transmitted ECG tracings to about 40,000 feet. Teletransmission of ECG using indigenous methodsTeletransmission of ECG using indigenous methods• Dr. Ajai Shanker et al (GR Medical college; Gwalior 1975 –Dr. Ajai Shanker et al (GR Medical college; Gwalior 1975 – first time in India.first time in India. It enabled It enabled wireless transmission of ECG from the moving ICU wireless transmission of ECG from the moving ICU

van or the patients home to the central station in ICU of the van or the patients home to the central station in ICU of the department of Medicine. department of Medicine.

Transmission was done Transmission was done through telephone lines through telephone lines using using frequency modulationfrequency modulation (using a (using a modulator which modulator which converted converted ECG into high frequency soundECG into high frequency sound) ) which also which also eliminated noise. eliminated noise.

ECG outputECG output was was connected to the telephone inputconnected to the telephone input (which (which contained a contained a DemodulatorDemodulator ). ).

DemodulatorDemodulator reconverted the sound waves into ECG with reconverted the sound waves into ECG with good accuracy. good accuracy.

ECG was converted to sound waves with a frequency varying ECG was converted to sound waves with a frequency varying from from 500 Hz to 2500 Hz500 Hz to 2500 Hz (500 Hz at baseline). (500 Hz at baseline).

TELERADIOLOGYTELERADIOLOGY Ability to send Ability to send radiographic images (x-rays) from one radiographic images (x-rays) from one

location to another. location to another. 3 essential components3 essential components : : Image sending stationImage sending station Transmission network Transmission network Receiving Receiving // image review station image review station

Most typicalMost typical : : 2 computers are connected via Internet2 computers are connected via Internet. . Computer at receiving end requires Computer at receiving end requires high-quality display high-quality display

screen and a printerscreen and a printer.. Process Process ::• begins at the image sending station (radiographic image and begins at the image sending station (radiographic image and

modem or other connection required).modem or other connection required).• scanned imagescanned image is sent (via the network connection) to the is sent (via the network connection) to the

receiving computer.receiving computer.

ON TO THE NEXT ON TO THE NEXT LECTURE !!!LECTURE !!!

TELEMEDICINE – IITELEMEDICINE – II

1. 1. Real time telemedicine (synchronous)Real time telemedicine (synchronous) Requires …Requires …

• the the presence of both partiespresence of both parties at the same time at the same time • communications link b/n themcommunications link b/n them (that allows a (that allows a real-time real-time

interactioninteraction to take place). to take place).• Video-conferencing equipmentVideo-conferencing equipment (aids in interactive (aids in interactive

examinations like tele-otoscope, tele-stethoscope). examinations like tele-otoscope, tele-stethoscope). • Peripheral devicesPeripheral devices (can be attached to computers). (can be attached to computers).

TelenursingTelenursing EquipmentsEquipments: : low resolution videophone, electronic low resolution videophone, electronic

stethoscopestethoscope and and digital BP monitordigital BP monitor

2.2. Store-and-forward telemedicine (asynchronous) Store-and-forward telemedicine (asynchronous) Acquiring Acquiring medical datamedical data (eg: medical images). (eg: medical images). Transmitting this data to a doctor or medical specialist at a Transmitting this data to a doctor or medical specialist at a

convenient time convenient time for assessmentfor assessment. . A A properly structured Medical Record ( electronic form)properly structured Medical Record ( electronic form) is vital. is vital.

Electronic referralsElectronic referrals Referrals dealt by electronic messages (Referrals dealt by electronic messages (e-mailse-mails).). Much cheaperMuch cheaper method than the conventional method. method than the conventional method. A study has shown that the direct costs of a visit to an outpatient A study has shown that the direct costs of a visit to an outpatient

clinic in internal medicine were clinic in internal medicine were seven times greaterseven times greater per patient per patient than those of an electronic consultation.than those of an electronic consultation.

TeleconsultatioTeleconsultationn

A general practitioner A general practitioner retains a patient in primary careretains a patient in primary care and manages the problem by and manages the problem by teleconsulting a specialistteleconsulting a specialist. .

Useful Useful when a conventional referral to a hospital/tertiary when a conventional referral to a hospital/tertiary centre involves much travel on the part of the patient or centre involves much travel on the part of the patient or doctors concerneddoctors concerned..

Enable patients as well as doctors Enable patients as well as doctors in rural areasin rural areas to get to get advice from specialists (often in urban areas).advice from specialists (often in urban areas).

The computer allows real time videoconferencing. The computer allows real time videoconferencing.

ADVANTAGESADVANTAGES1. 1. For the consumerFor the consumer Improved Improved access to healthcareaccess to healthcare and and reduced number of reduced number of

unnecessary visitsunnecessary visits to physician's offices. to physician's offices. Enhanced delivery & quality of home careEnhanced delivery & quality of home care.. Provides Provides patient educationpatient education on early symptoms management. on early symptoms management. Provides potential for Provides potential for early interventionearly intervention. .

2. 2. For the Health Care providersFor the Health Care providers Reduced number of visits.Reduced number of visits. Avoids unnecessary costly visitsAvoids unnecessary costly visits by specialists. by specialists. Provides a Provides a potential for early intervention.potential for early intervention. Prevention of repeat hospitalizationPrevention of repeat hospitalization..

Other benefitsImproved patient documentation

Use of telemedicine ensures that patient data is stored electronically. Medical history of patients, X-rays, test results can be transmitted using standard protocol. Ensures better documentation –more accurate and complete.

Increased range of care & education

Implementation of telemedicine creates a system that can service the needs of local, regional, national and international communities. These provides access to new patient population, research and collaboration.

DISADVANTAGESDISADVANTAGES

Unrestricted use may lead to Unrestricted use may lead to abuse of the systemabuse of the system where where persons without the proper qualifications or training may persons without the proper qualifications or training may offer offer unsolicited opinion unsolicited opinion (can be harmful to patients and (can be harmful to patients and possibly lead to increased costs). possibly lead to increased costs).

Poor patient-doctor relationshipsPoor patient-doctor relationships. No direct contact . No direct contact between doctor and patient. Interaction can be improved by between doctor and patient. Interaction can be improved by real-time interaction.real-time interaction.

Cultural and other barriersCultural and other barriers which may lead to which may lead to misunderstandings misunderstandings between the patient and the physician. between the patient and the physician.

Lack of local expertsLack of local experts involvement. involvement. Need for Need for expensive equipmentsexpensive equipments.. The information on the virtual world has some risks of being The information on the virtual world has some risks of being

‘‘stolenstolen easily’easily’..

Telehealth Telehealth in in

MalaysiaMalaysia

THE NEED FOR A TRANSFORMATION….THE NEED FOR A TRANSFORMATION….

A changing pattern of diseases fromA changing pattern of diseases from infectious infectious diseases to lifestyle diseases.diseases to lifestyle diseases.

Rural to urban migrationRural to urban migration

Increased life expectancyIncreased life expectancy

Increased expectations of consumersIncreased expectations of consumers

Rising healthcare costsRising healthcare costs..

Telehealth Flagship ApplicationTelehealth Flagship Application

Consists of four sub-applicationsConsists of four sub-applications::

Lifetime Health Plan (Lifetime Health Plan (LHPLHP)) Mass customised and Mass customised and

personalised health information personalised health information and educationand education ( (MCPHIEMCPHIE))

Continuing medical education (Continuing medical education (CMECME) ) Teleconsultation (Teleconsultation (TCTC))

Integrated TelehealthIntegrated Telehealth An individual requiring health services could log An individual requiring health services could log

into the consumer health (into the consumer health (MCPHIEMCPHIE) portal & find ) portal & find information on maintenance of health, information on maintenance of health, prevention of diseases & diagnosis & treatment of prevention of diseases & diagnosis & treatment of symptoms or diseases. symptoms or diseases.

A A directory of health care facilitiesdirectory of health care facilities permits permits selection of a suitable facility for careselection of a suitable facility for care and the and the requesting of an appointment. requesting of an appointment.

Integrated Telehealth (contd.)Integrated Telehealth (contd.)

The MCPHIE portal also provides The MCPHIE portal also provides health risk health risk assessmentsassessments which are either which are either life stage-based life stage-based oror condition-specificcondition-specific. Completing the relevant life stage-. Completing the relevant life stage-based health risk assessment would generate a based health risk assessment would generate a customised Lifetime Health Plancustomised Lifetime Health Plan. At periodic health . At periodic health visits to a doctor, this health plan would be visits to a doctor, this health plan would be personalised and validated. personalised and validated.

The MCPHIE portal is therefore the The MCPHIE portal is therefore the consumer’s access consumer’s access to his/her own Lifetime Health Planto his/her own Lifetime Health Plan. .

Alerts, reminders and customised health informationAlerts, reminders and customised health information can be channeled to the individual through this portal.can be channeled to the individual through this portal.

ELEMENTS OF MCPHIEELEMENTS OF MCPHIE

Mass Customised Personalised Health Information Education

Virtual CommunityTools/Facilities

VirtualResources

Directory ofProducts/Services

& Facilities

Quizzes

Risk Assessment

Special Interest

Generate profiles

Health Related - general awarenessDetailed disease description- modularized to enable relevant part/s to be extracted based onindividual risk assessment outcome (personalised)

• Chat• Discussion List• Electronic newsletter


An individual with a need for health services could An individual with a need for health services could present himself at a health facility (present himself at a health facility (primary health primary health centre/hospitalcentre/hospital) where the episode of care would be ) where the episode of care would be documented using an documented using an electronic clinical support electronic clinical support systemsystem (minimal or comprehensive depending on the (minimal or comprehensive depending on the facility) and stored in the facility’s facility) and stored in the facility’s Electronic Medical Electronic Medical Record system.Record system.

A summary of the episode would be stored in an A summary of the episode would be stored in an electronic electronic Lifetime Health RecordLifetime Health Record which can be which can be retrievedretrieved during a future health visit at during a future health visit at the samethe same or a or a different health facilitydifferent health facility. Based on the findings of the . Based on the findings of the health visit, the doctor would health visit, the doctor would modify the Lifetime modify the Lifetime Health PlanHealth Plan or create one where none exists. or create one where none exists.


Integrated Telehealth (contd.)Integrated Telehealth (contd.) If the healthcare provider is in need of information at If the healthcare provider is in need of information at

the point of care he could log into the the point of care he could log into the Continuing Continuing Medical EducationMedical Education (CME) portal (CME) portal and have access to and have access to over 50 over 50 CPGsCPGs from the Academy of Medicine Malaysia, from the Academy of Medicine Malaysia, 58 full text journals58 full text journals and and 36 textbooks36 textbooks, , Medline Medline and the and the Cochrane Database.Cochrane Database.

Every registered healthcare provider can record Every registered healthcare provider can record his/her his/her continuing professional development activities in a CPD continuing professional development activities in a CPD diarydiary, and , and access postbasic and postgraduate courses access postbasic and postgraduate courses online without leaving his online without leaving his // her place of work. her place of work.

This is important in This is important in retaining much needed doctors and retaining much needed doctors and nurses in the more distant parts of the countrynurses in the more distant parts of the country who who would have to otherwise leave for medical faculties and would have to otherwise leave for medical faculties and other training centres in the larger cities other training centres in the larger cities for longer for longer periods of timeperiods of time..

Institutions of Higher Learning and Teaching Hospitals

GP Clinics Health Clinics

Health Professional

Homes

CME Service Centre

CONTENTElectronic textbooks, journals

CME video on demand

Clinical practice guidelines

Structured education programs (postgraduate, postbasic)

Discussion groupsKnowledge databases

Research support

Objective: To utilize multimedia and telecommunication to integrate and deliver continuing education, to ensure a high

standard of healthcare

Continuing Medical Education

Behind the Behind the screen…….screen…….What is needed?What is needed?

General & professional standardsGeneral & professional standards Data protection & utilizationData protection & utilization

LegislationLegislation HR developmentHR development

Ethical considerationsEthical considerations FinanceFinance

ResearchResearch Monitoring & evaluationMonitoring & evaluation

Structure & organizationStructure & organization

General standardsGeneral standards All aspects of telehealth including use of All aspects of telehealth including use of

equipment, telecommunication technology, equipment, telecommunication technology, qualifications and training of personnel, work qualifications and training of personnel, work processes & management of data processes & management of data must meet must meet the accepted standards of regulatory or the accepted standards of regulatory or professional bodies.professional bodies.

The provision of healthcare must be The provision of healthcare must be oriented oriented towards quality to ensure optimal outcome. towards quality to ensure optimal outcome.

Professional standardsProfessional standards All healthcare professionals involved in providing All healthcare professionals involved in providing

telehealth services must …telehealth services must …• have the have the proper qualificationsproper qualifications..• be be registered with the appropriate authorities.registered with the appropriate authorities. • be be credentialed by their respective professional credentialed by their respective professional

bodiesbodies. .

The level of care should be as provided by the The level of care should be as provided by the appropriate practice guidelinesappropriate practice guidelines, which should, , which should, where possible, be based on evidence.where possible, be based on evidence.

Data protection and Data protection and utilizationutilization

1. 1. Ownership, custody and controlOwnership, custody and control By By Government of MalaysiaGovernment of Malaysia (rather than privately held (rather than privately held

by commercial entities). by commercial entities). Presently, ownership, custody and control of data rest Presently, ownership, custody and control of data rest

with the with the body from whom the data originatesbody from whom the data originates, or who , or who collects and stores the data. collects and stores the data.

For the For the Lifetime Health Record (LHR)Lifetime Health Record (LHR) to be functional, to be functional, the various care providers must be able to both the various care providers must be able to both read read from as well as write to the LHRfrom as well as write to the LHR. The formulation of the . The formulation of the LHR dataset should LHR dataset should include input from all health sectorsinclude input from all health sectors and should form a common minimum core dataset. and should form a common minimum core dataset.

Data protection and utilizationData protection and utilization

2. 2. Confidentiality and privacyConfidentiality and privacy The The confidentiality and privacy of the individual’s confidentiality and privacy of the individual’s

recordrecord should be ensured at all time. should be ensured at all time. A system should be developed to ensure the security of A system should be developed to ensure the security of

data against data against data loss, tampering and unauthorised data loss, tampering and unauthorised accessaccess..

The individual’s health record contains much The individual’s health record contains much information, which the individual considers to be information, which the individual considers to be sensitivesensitive and not to be revealed to others and must and not to be revealed to others and must therefore be kept confidential.therefore be kept confidential.

The The rules and procedures regarding usagerules and procedures regarding usage of this of this information must also take into consideration the information must also take into consideration the safeguarding of the individual’s right on confidentiality safeguarding of the individual’s right on confidentiality and privacy. and privacy.

Data protection and utilizationData protection and utilization

3. 3. Accuracy and reliability Accuracy and reliability All data and information collected stored and All data and information collected stored and

transmitted must be transmitted must be accurate, complete, reliable and accurate, complete, reliable and validvalid. (For data to be useful, the user must be assured . (For data to be useful, the user must be assured that the data is accurate, complete, reliable and valid). that the data is accurate, complete, reliable and valid).

Otherwise, the usefulness of the data is limited and the Otherwise, the usefulness of the data is limited and the data will not be utilized for the purpose for which it was data will not be utilized for the purpose for which it was first collected and stored.first collected and stored.

A common dataset will be established that A common dataset will be established that complies complies with national and international standards. with national and international standards.

A common protocol (technical specification) for the A common protocol (technical specification) for the collection, storage and transmission of data will be collection, storage and transmission of data will be established and action taken to ensure that established and action taken to ensure that implementation of any information systems complies implementation of any information systems complies with such standards.with such standards.

LEGISLATIONLEGISLATION There shall be adequate legal provision to ensure There shall be adequate legal provision to ensure

operationalisation of all the operationalisation of all the Telehealth ApplicationsTelehealth Applications..

In order to control the quality of care as well as to In order to control the quality of care as well as to ensure that ensure that only qualified health professional only qualified health professional undertake/deliver telehealth assisted healthcareundertake/deliver telehealth assisted healthcare, , appropriate existing and future acts and regulations appropriate existing and future acts and regulations (including licensing) need to be constructed.(including licensing) need to be constructed.

Threats and security issuesThreats and security issues related to outcome of data related to outcome of data mining from group data services need to be addressed. mining from group data services need to be addressed.

Existing laws and regulations regarding ownership, Existing laws and regulations regarding ownership, confidentiality, privacy and usage of data will govern all confidentiality, privacy and usage of data will govern all policies and procedures of telehealth programmes. policies and procedures of telehealth programmes.

THE ENDTHE END

Health & Medicine

Telemedicine