Information Technology (IT) has transformed the ways modern healthcare systems acquire, store, access and communicate medical information. These developments offer significant benefits to patients and healthcare providers, but they give rise to ethical and legal challenges in the protection of patient privacy and confidentiality. The traditional and humanistic concept of doctor-patient relationship is also under threat as IT is used to bypass the need for personal consultations. One effective approach to continue the use of IT in medicine while minimising its potential hazards is through legal reforms and setting public standards for accessibility and expression of patient autonomy. Ultimately, the role and limitations of IT as a tool to pursue the goals of medicine has to be carefully deliberated, clearly defined and judiciously delineated to ensure its effectiveness and safety.

Telemedicine

Telemedicine Means The Practice Of Medicine When The Patient And The Doctor Are Separated Or At A Distance From Each Other. It Includes Telepathology and Teleradiology

Sometimes telemedicine is best understood in terms of the services provided and the mechanisms used to provide those services. Here are some examples:

• Primary care and specialist referral services may involve a primary care or allied health professional providing a consultation with a patient or a specialist assisting the primary care physician in rendering a diagnosis. This may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.
• Remote patient monitoring, including home telehealth, uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility (RDTF) for interpretation. Such applications might include a specific vital sign, such as blood glucose or heart ECG or a variety of indicators for homebound patients. Such services can be used to supplement the use of visiting nurses.
• Consumer medical and health information includes the use of the Internet and wireless devices for consumers to obtain specialized health information and on-line discussion groups to provide peer-to-peer support.
• Medical education provides continuing medical education credits for health professionals and special medical education seminars for targeted groups in remote locations. 

Telepathlogy

• Telepathlogy, a part of telemedicine, involves viewing slides under a microscope, capturing images in a suitable format, transmitting them to a distant site over a communication medium and viewing them on a video monitor.
• With the increasing sophistication in computer and communication technology the transmission of voice, video and text has become a reality.
• The results have good reliability and reproducibility. Declining costs of equipment and increasing availability of infrastructure in India has further fuelled the development in telemedicine.
• Telepathology can now be used for remote primary diagnosis, consultations, second opinion, remote presentation, quality assurance, consensus diagnosis for pathological review in clinical trials and education. The use of Telepathology in management of patients is important since it allows faster diagnosis and consultations among remotely located specialist pathologists.
• The Nargis Dutt Memorial Cancer Hospital (NDMCH) with constant support from Tata Memorial Hospital through telemedicine, NDMCH has become an important cancer centre for delivering health care to the people living in the districts of Solapur, Osmanabad and Latur.

Tele Radiology

• After the success of telemedicine, we now have what is called Tele Radiology.  The advantages of Tele Radiology are many. 
• It will do away with the repeated visits to clinics for ultrasound, CT scan or X-Rays.
• Besides, it would enable a small town city dweller to confer with medical specialist in Delhi or even Washington.  The facility would be made available in Delhi soon. 
• The practice of Tele radiology is based on the new digital X-Ray machines which directly feed the report into the computer.  The name of the patient is attached to the report.  Doctors anywhere can see this report via the internet provided the hospitals are linked through networking. The ministry of health has made adequate plans to promote Tele Radiology in government run and private hospitals.  The practice is operating successfully in the city’s Trauma centre.

What Delivery Mechanisms Can Be Used?

• Networked programs link tertiary care hospitals and clinics with outlying clinics and community health centers in rural or suburban areas. The links may use dedicated high-speed lines or the Internet for telecommunication links between sites. ATA estimates the number of existing telemedicine networks in the United States at roughly 200 providing connectivity to over 3,000 sites.
• Point-to-point connections using private high speed networks are used by hospitals and clinics that deliver services directly or outsource specialty services to independent medical service providers. Such outsourced services include radiology, stroke assessment, mental health and intensive care services.
• Monitoring center links are used for cardiac, pulmonary or fetal monitoring, home care and related services that provide care to patients in the home. Often normal land-line or wireless connections are used to communicate directly between the patient and the center although some systems use the Internet.
• Web-based e-health patient service sites provide direct consumer outreach and services over the Internet. Under telemedicine, these include those sites that provide direct patient care.

Telemedicine has been growing rapidly because it offers four fundamental benefits:

• Improved Access – For over 40 years, telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices. Given the provider shortages throughout the world--in both rural and urban areas--telemedicine has a unique capacity to increase service to millions of new patients.
• Cost Efficiencies – Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.
• Improved Quality – Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consulations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.
• Patient Demand – Consumers want telemedicine. The greatest impact of telemedicine is on the patient, their family and their community. Using telemedicine technologies reduces travel time and related stresses for the patient. Over the past 15 years study after study has documented patient satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.

In India

India saw telemedicine in action on a large-scale for the first time in 2001 after the earthquake in Gujarat, when the Ahmadabad-based Online Telemedicine Research Institute established a communication system from Bhuj, one of the worst hit places and hence pretty inaccessible. Soon they had a disaster management system up and running that allowed for the electronic transfer of medical needs, data etc., and enabled medical specialists to provide consultations from far away places through video-conferencing.

Other government and private players in the telemedicine space in India, especially in connection with the semi-urban, rural poor/ isolated communities and tribes can be found in this 2008 report from ehealth-connection.org. They include:

• Department of Information Technology (DIT)&Centre for Development of Advanced Computing (C-DAC), which falls under the Ministry of Communications and Information Technology. DIT has been carrying out telemedicine pilot projects across various states such as West Bengal, Tripura, Kerala, Tamil Nadu, Himachal Pradesh and Punjab.
• ISRO, offering connectivity backbone through satcom applications such as  GRAMSAT
• The Ministry of Health & Family welfare and its National Rural Telemedicine Network working under the wings of the National Rural Health Mission
• Private hospitals such as Apollo (Ex: The Aragonda project)