Telemedicine

Telemedicine Security

2021: About a third of medical organizations around the world allow patient data leaks during a telemedicine session

What is telemedicine?

Telemedicine is a way to provide medical services at a distance using modern technologies and special equipment. This is not a separate medical science, but only an auxiliary tool for the diagnosis, treatment and prevention of diseases.

The subject of telemedicine is the transfer of medical information between distant points where patients, doctors, other medical care providers are located, between individual medical institutions. Telemedicine involves the use of telecommunications to connect medical professionals with clinics, hospitals, primary care physicians, distant patients for the purpose of diagnosis, treatment, consultation and continuous training.

Technologically, this kind of telecommunications should provide direct transmission of medical information in various formats (medical history, laboratory data, X-rays and results of CT scans, video images, ultrasound, etc.), as well as real-time videoconferencing between medical institutions or doctors and patients^[1].

The use of telemedicine allows, for example, the provision of counselling medical services in areas where patients do not have the opportunity to receive the assistance of narrow specialists directly from a medical institution. But in huge megacities and developed countries, telemedicine is no less important. Thanks to it, the cost of treatment is significantly reduced, the quality of diagnosis is improved and the possibility of remote monitoring of the state of health is realized. This is especially important for patients with chronic diseases and the elderly.

The global telemedicine market can be segmented by several criteria, including:

• Nature of remote interaction (clinic - clinic, clinic - patient's home)
• Technological parameters of interaction (monitoring systems, communication and communication channels, measuring instruments and sensors, video conferencing systems, databases, mobile and wearable technologies, etc.)
• Purpose of application (medical education, diagnosis, monitoring, consultation, treatment)

Depending on this, different approaches to the design and development of software solutions and, accordingly, different tools are used. But because these segments are tightly intertwined, the developer needs to have skills and expertise in a wide variety of development areas, including experience with embedded solutions, mobile, cloud technologies, and protocols specific to the medical industry.

Telemedicine Technology

Information technologies that provide:

• Remote interaction of health professionals among themselves, with patients and/or their legal representatives
• Identification and authentication of specified persons
• Documenting of the actions made by them when carrying out consultations, consultations, remote medical supervision behind the state of health of the patient

Participants of relations in the field of telemedicine services

Doctor-Doctor

Telemedicine: for patients of other diseases by type "Doctor-Doctor"

As part of this scenario, physicians can collect consiliums, being in different cities. In practice, this applies, for example, to situations where the patient is transferred from one medical facility to other. Doctors whose institution transfers the patient should review its documentation. Previously, for this I had to come to place, now, as part of telemedicine, everything can be issued remotely.

Patient Doctor

Telemedicine by "Doctor-Patient" type

In this case, we are talking about remote control health conditions. For example, with a simple fracture (no displacement) on first examination, the doctor will make an X-ray diffraction and perform immobilization injured area (will apply gypsum). Further in medical practice the doctor watches the patient, removes the plaster and prescribes a rehabilitation course. But during immobilization, the patient may have discomfort, pain, in which case the patient can contact the doctor with using telemedicine technologies.

Patient-Doctor Teleconsultation: RISKS

• Lack of information about the patient: the doctor does not have access to medical documents, in any case in sufficient amount; it is not possible to perform at least a physical examination.
• Lack of communication: there is no constant interaction between the patient and the attending physician.
• Lack of clinical influence: there is no way to control the process of therapy over time, to assess the situation in dynamics.

The whole chain

• Medical organization
• Medical worker
• Operator of state information systems
• Patient (legal representative)
• Operator of other information systems

Other information systems in the law

• Designed to: collect, store, process and provide information related to the activities of medical organizations and the services provided by them
• They can interact with: information systems in the field of healthcare and medical organizations in order, on conditions and in accordance with the requirements established by the Government of the Russian Federation

(Article 91, paragraph 5, of the Health Protection Act)

Requirements for other information systems

To interact with Uniform State Health Information System, software and linguistic tools of other information systems should, in particular:

• located on the territory of the Russian Federation
• Provide information in the state language
• Protect information
• Control access to documents
• Guarantee that medical records are kept in the form of electronic documents
• use a secure communication channel
• and t.

From the Decree of the Government of the Russian Federation dated 12.04.2018 N 447

To connect another information system to Uniform State Health Information System, the IIS operator submits an application for connection to the Ministry of Health of the Russian Federation
The Ministry of Health of the Russian Federation sends an application for connection within 10 working days after its receipt to the Government Commission on the Use of Information Technologies for approval
Operator of another information system is included in the list of other information systems
From the Decree of the Government of the Russian Federation dated 12.04.2018 N 447

After inclusion in the list, the IIS operator sends Ministry of Digital Development, Communications and Mass Media Russia to the application for connection to the Unified Identification System and (authentications ESIA)
provided that technical means and (or) communication channels of information technology networks of its information systems meet the requirements specified in the Decree of the Government of the Russian Federation dated 22.12.2012 N 1382

Legal relations clinic-provider

Provider-Patient Legal Relationship

Clinic-Patient Legal Relationship

Telemedicine Directions

Main directions of telemedicine use for 2020

Telemedicine (global market)

Main article: Telemedicine (global market)

Telemedicine (Russian market)

• Telemedicine (Russian market)
• Telemedicine regulation in Russia
• Telemedicine Service Catalogue of Systems and Projects

History of telemedicine

The term "telemedicine" was first used in 1974.

Telemedicine is not a new phenomenon, as it might seem. In fact, the idea of ​ ​ providing remote medical care arose 100 years ago. It was then, after the invention of the phone, that people tried to convey the sound of heart tones over the phone so that the specialist could assess the state of health of the patient. It is hardly worth saying that such attempts were unsuccessful.

When the active exploration of space began in the second half of the twentieth century, the need arose for remote monitoring of the physiological parameters of astronauts. It was then that the first telemetry systems appeared, which then found their use in sports, aviation, and military medicine.

Teledector, 1954

In 1959, Canadian doctor Albert Jutras first transmitted a video image from the hospital to his home receiver. He subsequently established a telemedicine system linking the two hospitals in Montreal for tele-radiological diagnosis.

In the same 1959, a remote demonstration of patients with a neurological disease to medical students of the Nebraska Psychiatric Institute was held for the first time. But perhaps the most striking achievement of this year is the transmission of a lung radiograph from the United States to Canada via coaxial cable.

In the 60-70s of the last century, a large number of telemetry systems and devices were created for various fields of medicine. Basically, these were experimental devices used in private cases.

An important stage in the development of telemedicine was the emergence of mobile medical stations that made it possible to provide remote assistance in remote regions thanks to the use of satellite technologies. This project was organized by NASA and was called STARPAHS (Space Technology Applied to Rural Papago Advanced Health Care, a program for applying space technology to provide health care in rural Papago). Thanks to this project, almost 4,000 people received medical care, which most likely would not have received it if it had not been for the development of technology.

Despite certain breakthroughs in the field of telemedicine in the second half of the twentieth century, we were able to observe a real boom in this branch of medicine only near the end of the last century and at the beginning of the new millennium.

This was facilitated by the global development of information technologies and the implementation of a number of international programs and documents regulating their use in medicine:

Regulations on the use of computers in medicine, medical examination, telemedicine and medical ethics, adopted by the World Medical Assembly in the 80s and 90s.

International telemedicine programmes:

• MDIS - European bone marrow donor information system;
• EPIC is a European model for integrated treatment;
• FEST - knowledge base for European telemedicine services;
• ISAAC - integrated telecommunications system;
• SHINE ‑ strategic information network of a zdravookhraneniyaevropa;
• TELEPRIM - first aid telematic services;
• TRILOGY is the telematic services of the healthcare system.

Today, telemedicine performs a wide range of tasks and is available to a significantly larger number of patients. This was made possible due to the rapid increase in the penetration of smartphones - cellular communications and the Internet have penetrated even where medicine is not always unavailable. Easy access to mobile solutions and ease of use have increased the attractiveness of telemedicine to patients, and the ability to reduce the time and material costs of treatment and diagnosis have become key factors in the growing interest in telemedicine among doctors and medical institutions.

Telemedicine: Prospects and Growth Factors

For medical institutions, the introduction of telemedicine technologies means reducing the number of visits of patients, the time of their stay in the hospital, the possibility of providing personalized medical care, disease diagnosis and a general improvement in the quality of service. All this, respectively, leads to a reduction in costs and an increase in profits.

Patients, in turn, can monitor their health at home, receive highly specialized care, even while in remote regions, control the use of drugs - all this allows improving the quality of life of patients.

The development of new technologies, such as the Internet of Things and 5G, as well as increasing the availability of cloud solutions, will further contribute to improving telemedicine and mobile healthcare solutions. It is no coincidence that the number of companies engaged in the development of mobile solutions in the field of medicine is already growing. These are both mobile devices for fitness and maintaining a healthy lifestyle, and medical devices for outpatient use, such as electrocardiographs, tonometers, glucometers, and solutions for remote transmission of medical information.

• Telemedicine significantly reduces the number of visits to medical institutions
• Constant necessary control of patients with chronic diseases such as diabetes, cardiovascular diseases (use of wearable devices that monitor the patient's condition (monitoring of heart rate, glucose, etc.)
• Solving the problem of shortage of medical personnel in various regions - redistribution of load to regions provided with medical personnel

Major challenges to telemedicine development

Among the key problems hampering the further development of the telemedicine market are the following:

• lack of qualified personnel capable of interacting qualitatively and expeditiously with telemedicine systems;

In 2011, according to the heads of organizations of the medical industry, the main problem faced by national health systems is the uneven distribution of medical specialists. That is why the collaboration of health professionals and effective access to information are the two most promising areas capable of supporting large-scale innovation in the health sector in the near future. In a study conducted by the research organization PSRAI, respondents highlighted telemedicine solutions, emphasizing that such solutions can cause a large-scale transformation of national health systems. This term refers to new ways of sharing information, working together and delivering services through a variety of information and communication technologies. The development of simple and efficient business processes in the field of health can help solutions that combine data exchange with support for human interaction. Such technologies include joint work in the field of diagnosis and treatment, electronic exchange of patient data, as well as remote training of medical personnel. At the same time, the study participants noted a large gap between the potential capabilities of telemedicine and the scale of its practical use. Only 9% noted that the collaboration of specialists and the use of electronic data had already become widespread.

• compatibility issues^[2] and standardization of telemedicine devices and technologies;
• inadequate regulatory frameworks and lack of international standards and, as a result, a large number of poor-quality and unreliable solutions;
• the lack of readiness of patients to use the new type of medical care (to some extent this paragraph is related to the previous one);
• Data protection and privacy^[3]
• Telemedicine services are often not covered by insurance.

Development of telemedicine in the world

2021:10 telemedicine innovations already in place

In early April 2021, Philips introduced ten telemedicine projects, which, according to the company, allow you to look into the future of medical care.

1. Remote screening and patient involvement

Online screening tools are convenient, involve patients in treatment and reduce the length of hospital stay, so they can be actively used to sort and monitor patients before a doctor visits.

2. Digital entrance to a health facility

Online planning tools allow patients to easily select a calendar interval that matches their tight schedule, and constant digital interaction with patients reduces the likelihood of failure to appear. During the pandemic, medical centers used personalized text messages to remind patients of upcoming examinations, shared links to safety protocols and other educational content.

3. Remote medical imaging support

The X-ray Operations Control Center allows experienced specialists to remotely train colleagues and help them on the job. This minimizes the frequency of repeated examinations and also improves diagnostic accuracy.

Telemedicine intensive care specialists monitor the process of providing assistance from a special observation center

4. Ultrasound at the patient's bed using remote interaction

Using a real-time collaboration platform that is integrated into the ultrasound system, an experienced specialist can remotely support a colleague when conducting an examination directly at the patient's bed.

5. Field Training Opportunity

GPs performing minimally invasive procedures under visual control can use virtual collaborative platforms to undergo on-site training. Experienced specialists can help colleagues in real time by observing the progress of the intervention procedure through webcams installed on the ceiling.

6. Remote care for critical care teams

A team of critical care specialists can monitor the process of assisting or transporting remotely from a special observation center. Using high-resolution cameras, telemetry sensors, and advanced data imaging, physicians and nurses can help their colleagues wherever they are, and predictive analytics alert teams to early signs of patient deterioration.

Online screening tools are actively used to sort and monitor patients before a doctor visits

7. Wearable biosensors

These sensors, inconspicuously worn on the chest, can measure and transmit vital indicators to the doctor, such as breathing and pulse data. In the long term, wearable biosensors will allow remote monitoring of chronic diseases such as COPD.

8. Remote fetal monitoring

Thanks to wireless systems and disposable electrodes applied to the abdomen, obstetricians-gynaecologists can remotely monitor the vital indicators of both the mother and the child.

9. Virtual dentist

Remote dentistry allows patients to receive advice from a licensed dentist through a mobile application without leaving the house. By sending photos of their teeth in high resolution and indicating specific problems, patients will be able to receive individual assessment and practical advice on improving oral health.

10. Virtual Medical Stations

It is important that telemedicine innovations be supported by the creation of new hotspots, especially in underserved communities. The Virtual Care Station modular system will provide an indentation to telemedicine services through nearby outlets or town halls.^[4]

2019: Ambulance workers in Germany connected to telemedicine, and they began to save lives better

At the end of May 2019, the experimental stage of the implementation of the telemedicine ambulance system, deployed in 2014 in the city of Aachen on the western border of Germany, was successfully completed. Telemedicine support for rescuers has improved service and reduced risks, and therefore will soon become a national program.

In an emergency, paramedic rescuers must act independently and make decisions, even if they lack medical knowledge. However, a system was introduced in the city of Aachen, providing optimal patient care and reducing risks to a minimum. Emergency services were connected to the telemedicine center to provide emergency care to patients and could directly and without delay consult with highly qualified specialists from the scene. In addition to telecommunications technologies, modern diagnostic methods were used in such cases.

Telemedicine ambulance support in Germany has improved service and reduced risks, and therefore will soon become a national program

Since the advent of the telemedicine center, specialists have conducted consultations in more than 15,000 emergencies. Thanks to the remote support system, doctors could advise paramedics at several sites at the same time.

The German Minister of Health noted the high potential of the new system and the huge advantages for patients and rescue services. Telemedicine provides emergency medical expertise at the site of an emergency and facilitates the efficient use of resources.

Remote support of ambulance specialists also reduces the cost of emergency care. Those responsible emphasize that without such a system, they would have to commission more ambulances. In addition, with the existing emergency physician system, you should only call when its direct presence is really required.^[5]

Notes