TELEMEDICINE IN VETERINARY PRACTICE

Vivek R. Kasaralikar

Telemedicine is a rapidly developing application of clinical medicine wherein medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

Care at a distance (also called in absentia care), is an old practice which was often conducted via post; there has been a long and successful history of in absentia health care, which, thanks to modern communication technology, has metamorphosed into what we now know as modern telemedicine.

The terms e-health and tele-health are at times wrongly interchanged with telemedicine. Like the terms "medicine" and "health care", telemedicine often refers only to the provision of clinical services while the term tele-health can refer to clinical and non-clinical services such as medical education, administration, and research. The term e-health is often, particularly in the UK and Europe, used as an umbrella term that includes tele-health, electronic medical records, and other components of health IT.

Types of Telemedicine

Telemedicine is practiced on the basis of two concepts: Synchronous and Asynchronous.

· Synchronous or Real-time telemedicine : This could be as simple as a telephone call or as complex as robotic surgery. It requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telemedicine. There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination. For instance, a tele-otoscope allows a remote physician to 'see' inside a patient's ear; a tele-stethoscope allows the consulting remote physician to hear the patient's heartbeat. Video conferencing has been successfully inducted as a mode of distance learning for veterinary students as well as practicing veterinarians at the College of Veterinary Medicine, University of Tennessee (USA).

· Asynchronous or Store-and-forward telemedicine involves acquiring medical data (like medical images, bio-signals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. A properly structured Medical Record preferably in electronic form should be a component of this transfer. Laboratory diagnosis by radiologists or pathologists extensively depends on this method.

Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a "tele-" prefix; for example, telemedicine as applied by radiologists is called tele-radiology. Similarly telemedicine as applied by cardiologists is termed as tele-cardiology etc. Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.

The first interactive Telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients in cardiac arrest (defibrillation) was developed and marketed by MedPhone Corporation in 1989. A year later, the company introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.

Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems.

Tele-Radiology

Tele-radiology is the ability to send radiographic images (x-rays) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving / image review station. The most typical implementation is two computers connected via Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience. The tele-radiology process begins at the image sending station. The radiographic image and a modem or other connections are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.

Telemedicine in Veterinary Practice

Telemedicine has also picked up in veterinary practice and many private entrepreneurs have jumped into it as service providers. The prominent name in the field of telemedicine in veterinary practice all over the world is VDIC from USA. Kansas State University has officially sanctioned a project on “Proactive herd health management for disease prevention” and five professors are working on the project to deliver the goods to the end users. The goal of this project is to research and develop the technological and sociological infrastructure to support intelligent, mobile medical monitoring devices that continuously assess the health of cattle in concentrated and distributed herds. These monitoring systems will improve the ability of the animal sciences industry to react to and predict disease onset and its epidemiological spread, whether from natural or terrorist events. Trend analysis, information storage, and health prediction lessons learned from this effort will have immediate application to distributed medical systems targeted at assessing and predicting human state of health and the spread of disease in human populations.

In the Indian context, asynchronous telemedicine involving sending of case details and images/lab reports via e-mail to experts for a second opinion is gaining ground. Real-time telemedicine involving text/video chats with the experts has also become more feasible with the availability of broadband internet connections in rural areas also. Standardized systems need to be developed for the transmission of data like case history, ECG, ultrasound, radiograph, laboratory test reports etc. in order to minimize errors due to mis-communication. Creation of a website where field vets can upload their case details in a standard format and experts from Veterinary Colleges or anywhere across the globe can give their opinion would go a long way towards disseminating information on complicated cases and ensuring best possible veterinary care. Data collected on such a website over a period of time, including interventions carried out and the resultant effect, would help in evaluation of various therapeutic strategies and serve as a guideline for future reference.

Veterinary telemedicine is a technology whose time has come and we must adopt it with open arms in order to ensure that two-way flow of information is facilitated between field veterinarians and subject experts, thus resulting in an enriching experience for both.

Excerpt from 'Information Technology in Veterinary Science' (2009), New India Publishing Agency, New Delhi. ISBN 978-81-908512-4-4. More details here.