The emergence of telemedicine as a core necessity. Can a case of the flu be diagnosed over Skype? Is it possible to learn the results of your computed tomography scan after midnight? Can a young mother receive care where a trained pediatrician can’t visit? The answer to all of these questions is yes. With the latest revolution in information technology and the availability of advanced computer systems worldwide, telemedicine has made all of this possible.

1. STUDENT’S CORNER
4 ieee pulse ▼ NOVEMBER/DECEMBER 2014
C
an a case of the flu be diagnosed over
Skype? Is it possible to learn the re-
sults of your computed tomography
scan after midnight? Can a young mother
receive care where a trained pediatrician
can’t visit? The answer to all of these ques-
tions is yes. With the latest revolution in
information technology and the availability
of advanced computer systems worldwide,
telemedicine has made all of this possible.
In the past few decades, hospitals have
become smarter, safer, and more sophisti-
cated, which has accentuated health care
costs and generated a rural-urban health
care divide. Telemedicine has stepped in as
an instrument to bridge the gaps and pro-
vides the ability to exchange medical in-
formation, such as patient health records,
using telecommunication technology,
including video calls, smartphones, and
wireless tools [1]. The use of telemedicine
offers huge potential in disease diagno-
sis, consultation, monitoring, treatment,
education, and management; thus, it
makes the emergent intelligent health
care infrastructure universal and more ac-
cessible to the common masses (Figure 1).
As most economies steer in the direc-
tion of unsustainable health care costs,
telemedicine offers significant promise
as an efficient health care delivery and
management tool. Limited access to ad-
equate medical care, especially in remote
settings, the growing pressure of aging
patient populations, increasing life ex-
pectancies, the increasing prevalence of
chronic conditions, and the shortage of
medical professionals continue to burden
health care systems worldwide.
There is growing evidence to support
the cost-effectiveness of implementing
telehealth technologies. For example, a
research article published by the Center
for Information Technology Leadership in
November 2007 observed that the savings
MakingHealthCare
UniversallyAccessible
Theemergenceoftelemedicineasacorenecessity
NiharikaMidhaandSubhamoyMandal
Digital Object Identifier 10.1109/MPUL.2014.2355316
Date of publication: 14 November 2014
FIGURE1 A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have
been relentless and still continue today.The years after 1976 are the period of maturation and rapid growth of telehealth technologies.
First Exposition on
Telehealth Care
1924
Photophone
1880
Transatlantic
Wireless
Transmission
1901
Electric
Telegraph
1844
1840 1900 1940
Digital (Binary)
Transmission
1949
Telephone
1875
Television
1884
(First Patent)
First ECG
Transmission
1906
The Internet
ISRO (India)
Telemedicine Project
2001
First Internet
Transmission
1969
TCP/IP
Goes Global
1989
1980
2000196019201880
Telerobotic Remote
Surgery Service
2003
NASA (U.S.) ATS-6
Satellite
1974

2. 6 ieee pulse ▼ NOVEMBER/DECEMBER 2014
generated by eliminating the transfer of
patients between emergency departments
could fund the installation of hybrid tele-
health technologies across all emergency
departments in the United States. The au-
thors reported that 2.2 million patients
are transported each year between emer-
gency departments at a cost of US$1.39
billion and that telehealth technologies can
avoid 850,000 transports at a cost savings
of US$537 million annually [2]. Recent re-
ports from HealthCursor Consulting Group
observe that remote health
care and E-health can give
hospitals an easy return on
investment with a lucra-
tive profit margin in a short
period of time. Health care
operators such as Apollo
and Fortis in India are lured
by the pan-India reach, and
lower operating costs have
escalated their entry into
the vast untapped domain
of telemedicine.
Moreover, newer and smarter health
devices have provided an impetus to the
industry’s growth. Heart and blood pres-
sure monitors can now wirelessly trans-
mit the patient’s data to mobile phones or
to a central online database accessed by
telemedicine centers [3]. This has encour-
aged more academic research on point-
of-care devices [4], and more companies
are coming out with devices with mobile
health care capabilities [5].
The consumer demand (see “Indus-
try Outlook”) for high-quality health
care has also played a fundamental role
in the overall acceptance, as well as in-
tegration, of these technologies. In ad-
dition, patient satisfaction has gained
vital importance in this expanding era
of personalized medicine. Some studies
suggest that telemedicine has been able
to achieve high levels of patient satisfac-
tion as it allows for easy and rapid ac-
cess to health care. A study by Gustke
et al. concluded that 98.3% of patients
(n = 495) were satisfied with interactive
telemedicine clinical con-
sultations [6].
According to Global-
Data’s estimates, the tele-
health and telemedicine
market will increase at a
compound annual growth
rate of 14% to be worth
an estimated US$32.5 bil-
lion by 2018. Telehealth
pilot programs and regu-
latory and standardiza-
tion initiatives to attract
investment by private organizations have
been adopted by governments in several
regions of the world. One sector where
telemedicine has been accepted rapidly is
disease diagnosis. For example, teleradiol-
ogy has witnessed considerable growth in
recent years.
Teleradiology encompasses medical im-
aging information systems that improve
theeaseofcapturing,storing,andexchang-
ing medical images between providers,
including remotely located medical prac-
titioners and patients, through integrated
electronic health records. Picture archiving
and management systems equipped with
clinical decision support systems enable
the efficient management of remote di-
agnosis and faster clinical management.
Teleradiology is gradually being adopted
throughout the world to meet the growing
gap between the demand for and supply
of trained radiologists. Furthermore, it has
also opened avenues for making specialists
available around the clock. For example, if
an emergency occurs at a time when Eu-
ropean radiologists are not available, their
counterparts in Asia can evaluate the pa-
tient to provide immediate assistance.
However, as with most new technolo-
gies, data security and privacy concerns
have been raised and are key impedi-
ments to the adoption of telehealth so-
lutions and services. Inadequate data
security and transmission could lead to
inaccurate diagnosis and erroneous prog-
nosis. These issues negatively impact the
overall utilization of telemedicine. In ad-
dition, the penetration of telemedicine
solutions and services in the emerging
markets is currently limited by the sparse
availability of broadband technologies. As
most of these developing countries have
a significantly larger rural population,
the low penetration levels and the asso-
ciated higher up-front costs substantially
limit the deployment of telehealth mod-
els. Thus, we can conservatively opine
that, while the information technology-
enabled approach to health care can
Industry Outlook
Modern computing, communications, medical devices, and health
informatics technologies, when integrated in a holistic manner to create
telemedicine and e-health services with skill development and business
model, have the potential to solve the health care delivery problems that
the large population of the world faces. Today, teleradiology can be
considered as an established telemedicine model where technology, cost,
quality, convenience, and information safety aspects have been
addressed. Simultaneously, there is a range of areas where telemedicine
practices are being newly applied. Some of these areas include, but are
notlimitedto,ophthalmology,surgery,dentistry,dermatology,pathology,
and public health. The success of public–private partnership programs
offering telescreening services to rural and semiurban premature infants,
viz., Karnataka Internet Assisted Diagnosis of Retinopathy of Pre-maturity
(KIDROP) in India, stands testimony to the emergent trend. In this
government-funded program, the health care industry provides medical
expertise and helps in skills development, whereas technology
companies provide the customized communications, storage, and
computing services along with innovative features that improve
diagnosticvalueoftheinformationbeingcommunicated[7].
Another novel application of the telemedicine solutions has been
found in continuing medical education (CME). CME that is vital for
professional development is also a mandatory requirement for
extending license practice in many countries. CME helps those in the
medical field to maintain competency and learn about new and
developing areas of their field. Currently, a significant portion of CME
activities takes place as live events such as conferences, publications,
and e-learning or online CME, which is a convenient, cost-effective
alternative with the potential to reach a wider audience, and is
expected to seize the majority market share in the near future [8].
(Input from: Hrushikesh Garud, Texas Instruments, India.)
Teleradiologyis
graduallybeing
adoptedthroughout
theworldtomeetthe
growinggapbetween
thedemandforand
supplyoftrained
radiologists.
(continued on page 47)

3. NOVEMBER/DECEMBER 2014 ▼ ieee pulse 47
The closer our relationships, the more we
favor those individuals; the farther apart
we are, the more we recognize the differ-
ences. We treat diversities as excuses to
direct our positive attitudes elsewhere,
especially if we consider dissimilar indi-
viduals as competing for limited finan-
cial, physical, or emotional resources.
One troubling form of discrimination
is racism. Racism exists in many forms
and many places; it is especially noted
whenever different races come in close
contact with each other. Fortunately,
I have observed over the course of my
lifetime that racism in the United States
has diminished somewhat, although no
one dares to say that racism is even close
to being eradicated in our country. Hav-
ing lived through the time of the civil
rights marches 50 years ago, listened to
and taken to heart the words of Martin
Luther King, Jr., and admired the cour-
age and resolution of Rosa Parks, I am
very happy with this trend. And it seems
that the acceptance of other races is
being led by the younger generations,
who seem to be much more tolerant
than their parents.
Discrimination may be a natural con-
sequence of our genomes, but discrimina-
tion does not have to turn into racism.
To keep that from happening, we should
become more familiar with the other
people so that the differences become
less important compared to the similari-
ties we discover. If we no longer consider
relationships as competitive, then we
can act in a more generous and tolerant
way. Engineering success, which should
be based on merit and cooperation, can
become a model of the way that we wish
society in general to behave. In this case,
we can exercise another deeply ingrained
biological attribute—that of fairness and
altruism—also embedded in our genomes
[2], [11]. That should make it easier to
move beyond the extremes of discrimina-
tion originating with our genes.
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virtually extend the services of the tertiary
hospital to urban homes and remote rural
health care centers, there is a sea of chal-
lenges—both technical and human factor
related—that needs to be surmounted
before we develop a truly intelligent sys-
tem that connects the teeming millions
across geographical boundaries.
Niharika Midha received her M.Sc. degree in
biomedical engineering with a focus on medical
physics from Imperial College London. She is a
medical devices analyst based in GlobalData’s
Singapore office. Before joining GlobalData,
she was a health care journalist for BioPharm
Insight, which is part of the Financial Times
Group, and a research assistant at Imperial
College London. Subhamoy Mandal is cur-
rently a DAAD Ph.D. scholar with the Institute
of Biological and Medical Imaging at the Tech-
nical University of München and Helmholtz
Zentrum München. He was the recipient of the
IEEE Education Society Student Leadership
Award in 2013 and the IEEE Computer Society
Richard E. Merwin Scholarship in 2014.
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STUDENT’S CORNER (continued from page 6)