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Augmented Telehealth
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Augmented Telehealth

Category Link: Telehealth

Category Link: Augmenting Healthcare


Telehealth refers to the delivery of all health-related services and/or health information via telecommunication. Telehealth encompasses prevention of conditions or infirmities, promotion of medical ability and breakthroughs, as well as well as curative issues - telemedicine. Telehealth expands to all areas of healthcare that involve health provision when a specialist may not be physically present - including robotic carers, networked client monitoring, or patient information services.

The problem with implementing telehealth is that it cannot be deployed alone. In order to use remote delivered health care effectively, the entire health care system needs augmenting with other aspects of the same technologies, and methodologies changed slightly to be more time efficient and much more digital.

1 DICOM / PACS

DICOM is an American standard, and stands for Digital Imaging and COmmunication in Medicine. PACS is a British standard, and stands for Picture Archiving and Communications Standard. Both serve the same fundamental task. They allow medical data from any source - CAT, MRI, Ultrasound, Digital X-ray, ECG, et cetera, to be stored in digital format rather than taking up physical space in the hospital.

The simple act of digitising patient data safely, streamlines the allowance of more advanced techniques later on. Even just the ability to free up storage space in hospitals, from hundreds of thousands of archived X-rays, is a massive achievement for many institutions.

DICOM/PACS are compatible standards, used by different countries. Converters exist to transfer information between them, and, as more countries 'go digital' many more such standards are expected to emerge. DICOM/PACS have been widely adopted by hospitals and are making inroads in smaller applications like dentists' and doctors' offices. This means it is already in place, or soon will be in place in almost every medical market.

The effect both standards and others like them have, is that doctors and other health professionals can access all patient scans, and compare/contrast with previous scans at the touch of a button. Telemedicine is less than completely useful if the doctors or paramedics have to wait hours for archival staff to find previous scan charts and fax them over. With digital versions in standard formats, there is no waiting, no scans lost or misplaced, sitting in a GP's office where the hospital cannot find them. The complete medical history is available there and then, to augment the telehealth experience.

2. Patient Tagging

It seems pointless to have a system which allows easy access to guaranteed records for a patient outside the hospital with telehealth, and not use it inside the hospital as well. One solution to that would be to tag patients as they enter, so they can be dealt with in the exact same way as outside the hospital, just with the increased efficiency of hospital care staff.

Rhe benefits are obvious: Such would radically improve patient safety, and reduce misdiagnosis, and identity confusion in increasingly understaffed and overworked hospitals.

Heartlands Hospital, in Birmingham in the UK, has been the first to implement such a system, off the drawing board.

Each patient wears a tiny computer system, sewn into his or her wristband. Not solely an RFID chip, the system includes RFID capability, together with a strip of flexible, non-volatile flash memory with quite impressive data storage. The waterproof, immersion proof, shockproof, flexible wrist straps are capable of holding a digital photo of the patient, taken on arrival, along with a complete care history since they entered - diagnosis, treatment, medication they are currently on and dosage, any problems they have had, special requirements, all of it. In addition to this, the ID number and patient name stored on the strap, correlates to all the digital information stored on them by the PACS system the hospital uses.

The tags mean any member of staff caring for that patient can read the tag details using a PDA to check they are treating the right person. They can also see what checks the patient has had, or if they are ready for surgery, to ensure they get the right drugs, tests and operations via the checklist on the PDA.

An additional advantage is, since the patient's id code is right there on their wrist, if a blood sample is taken, or a biopsy during surgery, or any other extraction of fluid, the operator's terminal can read the tag information during the procedure, and automatically print out clear and precise labelling using the same code, for quick and easy identification throughout the hospital, or even in another.

Conversely, as the system is aware of the requirements of the patient from their tag, it can flag up an alert warning if a mistake is made, such as an attempted blood transfusion using the wrong blood type, or an attempt to prescribe a drug the patient has a known severe allergic reaction to.

3. Training on Digital Data

The side effect of using digital medicate for both telehealth and in-hospital care, is that the health system attains a steadily growing supply of detailed medical scans. The ability to match all scans of the same patient quickly and easily means that they can be readily combined into a very detailed virtual reality model of the patient.

There is no better way for a surgeon to train, than to train on an actual patient - or a copy of one that is as absolutely and completely real as is possible.

Machines like the Dextroscope, the Perspecta, and the Heliodisplay exist for just this purpose. All are holographic imagers. Some, like Dextroscope, are designed primarily for medicare, with the express purpose of enabling surgeons to view and interact with parts of the patient's body prior to any physical operation.

Rather than just a display screen, the technology now exists, in all holographic imagers, to recognise hand and body movements of a surgeon, and project a holographic image into the space directly in front of them in full 3D space.

This image - produced directly from medical scan data based on DICOM or PACS - not only sits in physical space, but will respond to hand movements and surgical tools, bending, and flexing or not as the actual tissues would do.

Thus, all the data the health service has on a patient, can be used to train a surgeon or, in the case of interesting cases, whole classes of up and coming surgeons, using real data, from real operations, in real-time. Time and time again, this has proven more effective than mere practising on cadavers, or even a highly experienced surgeon, going in cold to a delicate case, and not totally sure what they might find.

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