Telemedicine

Telemedicine System Security

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

The vast majority of medical organizations providing telemedicine services use ancient equipment with outdated operating systems for this. According to Kaspersky Lab, this carries a direct risk of patient safety and personal data. This became known on December 30, 2021. Read more here.

What is telemedicine?

Telemedicine is a way to provide medical services at a distance using modern technology and special equipment. This is not a separate medical science, but only an auxiliary tool for diagnosing, treating and preventing diseases.

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

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

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

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

• 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 closely intertwined, the developer must have skills and expertise in a wide variety of development areas, including experience with embedded solutions, mobile, cloud, and medical industry-specific protocols.

Telemedicine technology

Information technology that provides:

• Remote interaction of healthcare professionals with each other, with patients and/or their legal representatives
• Identification and authentication of specified persons
• Documenting their actions during consultations, consultations, remote medical monitoring of the patient's health

Participants in relations in the field of telemedicine services

Doctor-doctor

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

As part of this scenario, doctors can collect consultations, being in different cities. In practice, this applies, for example, in situations when the patient is transferred from one medical institution to other. Doctors whose institution transfers the patient must review its documentation. Previously, for this I had to come to place, now, within the framework of telemedicine, everything can be issued remotely.

Doctor Patient

Telemedicine Physician-Patient

In this case, we are talking about remote control health conditions. For example, with a simple fracture (no displacement) on For an initial examination, the doctor will make an X-ray and immobilize injured area (plaster). Further in medical practice the doctor monitors the patient, removes the cast and prescribes a rehabilitation course. But during immobilization, the patient may experience discomfort, pain, in which case the patient may contact the doctor with using telemedicine technology.

Patient-physician teleconsultation: RISKS

• Lack of information about the patient: the doctor does not have access to medical documents, in any case in sufficient volume; 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 manage the therapy process over time, to assess the situation in dynamics.

The Whole Chain

• Medical organization
• Health Care Professional
• State Information Systems Operator
• Patient (legal representative)
• Operator of other information systems

Other information systems in the law

• Designed to: collect, store, process and provide information relating to the activities of medical organizations and the services they provide
• They can interact with: information systems in the field of health care and medical organizations in a manner, 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

In order to interact with the Uniform State Health Information System, programmatic technical and linguistic means of other information systems should, in particular:

• located on the territory of the Russian Federation
• ensure the placement of information in the state language
• ensure the protection of information
• ensure control over access to documents
• ensure compliance with the shelf life of medical records in the form of electronic documents
• use a secure communication channel
• and t p.

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

To connect another information system to the 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
The 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 the technical means and (or) communication channels of information technology networks of its information systems comply with the requirements specified in the Decree of the Government of the Russian Federation of 22.12.2012 No. 1382

Legal relations clinic-provider

Provider-Patient Legal Relationship

Legal relations clinic-patient

Telemedicine directions

Main areas 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 Systems and Project Catalog

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 patient's health. It is hardly worth saying that such attempts were unsuccessful.

When active space exploration began in the second half of the twentieth century, there was a need to remotely monitor the physiological parameters of astronauts. It was then that the first telemetry systems appeared, which then found their application in sports, aviation, and military medicine.

Teledoctor, 1954

In 1959, Canadian physician Albert Jutras first transmitted a video image from the hospital to his home receiver. Subsequently, he created a telemedicine system that connected two hospitals in Montreal in order to carry out television and radio diagnostics.

In the same 1959, for the first time, a remote demonstration of patients with a neurological disease was held to medical students at the Nebraska Psychiatric Institute. 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 different fields of medicine. Basically, these were experimental devices used in special cases.

An important stage in the development of telemedicine was the emergence of mobile medical stations, which 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 medical care in rural Papago). Thanks to this project, almost 4,000 people received medical care, who most likely would not have received it if not 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 towards 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 governing their use in medicine:

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

International telemedicine programs:

• MDIS, European bone marrow donor information system;
• EPIC - European model for integrated treatment;
• FEST - knowledge base for European telemedicine services;
• ISAAC - integrated telecommunications system;
• SHINE - Europe's Strategic Health Information Network ;
• TELEPRIM - telematics services for first aid;
• TRILOGY - telematics services of the health care system.

Today, telemedicine performs a wide range of tasks and is available to significantly more patients. This became possible thanks to the rapid growth in the penetration of smartphones - cellular communications and the Internet penetrated even where medicine is not always available. Easy access to mobile solutions and their usability have increased the attractiveness of telemedicine for 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: Perspectives 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, diagnosing diseases and an overall improvement in the quality of service. All this, accordingly, leads to a reduction in costs and an increase in profit.

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

The development of new technologies, such as the Internet of Things and 5G, as well as increased availability of cloud solutions, will contribute further to the improvement of 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 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 heart rate, glucose, etc.)
• Solving the problem of the shortage of medical personnel in various regions - redistribution of the burden on the regions provided with medical personnel

The main problems hindering the development of telemedicine

Among the key challenges hindering the further development of the telemedicine market are the following:

• lack of qualified personnel capable of high-quality and prompt interaction with telemedicine systems;

In 2011, according to leaders of medical industry organizations, the main problem faced by national health systems is the uneven distribution of medical specialists. That is why the collaborative work of health professionals and effective access to information are the two most promising areas capable of supporting the introduction of large-scale innovations in the health sector in the near future. In a study conducted by the PSRAI research organization, respondents highlighted telemedicine solutions, stressing that such solutions can cause large-scale transformation of national health systems. This term refers to new ways to share information, collaborate, and deliver services through a variety of information and communication technologies. The development of simple and effective healthcare business processes can be helped by solutions that combine data sharing 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 has already become widespread.

• Compatibility Issues^[2] and standardization of devices and technologies used in the field of telemedicine;
• insufficient regulatory framework and lack of international standards and, as a result, a large number of poor-quality and unreliable solutions;
• unavailability of patients to use a new type of medical care (to some extent this item is related to the previous one);
• Data protection and privacy issues^[3]
• telemedicine services are often not covered by insurance.

The development of telemedicine in the world

2026: World's first telemedicine robot released to bypass patients in hospitals - doctor communicates with patients through it

On March 10, 2026, VSee introduced the VSee AI robotic system. It is claimed to be the world's first fully autonomous AI telemedicine robot that allows doctors to make remote rounds and communicate with patients without the need for an on-site presence. Read more here.

2021:10 telemedicine innovations already in place

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

1. Remote screening and patient engagement

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

2. Digital entry 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 no-show. 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 Radiological Operations Control Center allows experienced specialists to remotely train colleagues and help them at the place of work. This minimizes the frequency of repeated examinations and also improves the accuracy of diagnosis.

Intensive care specialists with telemedicine monitor the care process from a dedicated surveillance center

4. Ultrasound at the bedside 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 bedside.

5. Field Training Opportunity

GPs performing minimally invasive procedures under visual supervision can use virtual collaboration platforms to get training on the ground. Experienced specialists can help colleagues in real time by observing the course of the intervention procedure through webcams installed on the ceiling.

6. Remote care for critical care teams

A critical care team can monitor the process of providing care or transportation remotely from a dedicated surveillance center. Using high-resolution cameras, telemetry sensors and advanced data imaging, doctors and nurses can help their colleagues wherever they are, with prognostic analytics alerting teams to the early signs of a worsening patient.

Online screening tools are actively used to triage and monitor patients before seeing a doctor

7. Wearable biosensors

These sensors, discreetly worn on the chest, can measure and transmit vital signs, such as breath and pulse data, to the doctor. 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-gynecologists can remotely monitor the vital signs of both mother and child.

9. Virtual dentist

Remote dentistry allows patients to get advice from a licensed dentist through a mobile application without leaving their homes. By sending high-resolution photos of their teeth and identifying specific issues, patients will be able to receive individual assessment and practical advice on improving oral health.

10. Virtual Medical Stations

It is important that innovations in telemedicine are underpinned by the creation of new access points, especially in communities with insufficient Internet service levels. The modular Virtual Care Station system will indent telemedicine services through nearby retail outlets or town halls.^[4]

2019: Emergency workers in Germany hooked up to telemedicine and better at saving lives

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 services and reduced risks, and therefore will soon become a national program.

In an emergency, rescue paramedics must act on their own and make decisions even if they lack medical knowledge. However, a system has been introduced in the city of Aachen to provide optimal patient care and minimize risks. Emergency services were connected to a telemedicine centre to provide emergency care to patients and could consult directly and without delay with highly trained specialists from the scene. In addition to telecommunications technologies, modern diagnostic methods were used in such cases.

Telemedicine support for ambulances in Germany has improved services and reduced risks, and therefore will soon become a national program

Since the advent of the telemedicine center, specialists have consulted 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 Health Minister noted the high potential of the new system and the huge benefits for patients and rescue services. Telemedicine allows for emergency medical expertise at the emergency site and facilitates the efficient use of resources.

Remote support for ambulance specialists also reduces the cost of emergency care. The responsible persons emphasize that without such a system, they would have to commission more ambulances. In addition, under the existing system, an emergency physician should only be called when his direct presence is actually required.^[5]

Notes