Just as, for example, the houses for sale in Durban can be subdivided by suburb and cat food can be categorised by ingredients, so within the broader category of telemedicine, there are distinctions with regards to clearly identifiable types. These types have become known within telemedicine circles as store-and-forward applications, remote monitoring, and interactive services. Each one of the above types is designed to meet the needs of patients involved in remote medical treatment.
Store and forward telemedicine could well be referred to as a-synchronous telemedicine: this is to say that it involves the capturing of medical data (including imaging data and bio signals) for transmission to a specialist for viewing at an opportune time. The specialist therefore does not have to be online when the data is sent through, and can review the information offline, allowing for the fact that both parties do not need to be present at the same time (hence the term a-synchronous).
The specialties that are best suited to this type of consultation include dermatology, radiology and pathology. Owing to the fact that a physical examination and patient history are missing from the analysis, this type of consultation must include meticulous records and quality medical data. A medical record is an absolute necessity in this interaction as the only evidence that the clinician has to investigate is a patient history and audio or video of the affected area/ailment/etc.
Remote monitoring, is, as its name implies, the monitoring of a patient’s progress from a remote location. This type of telemedicine is also sometimes referred to as “self-monitoring” or “self-testing”. Remote monitoring is most often used as part of a programme designed to manage chronic diseases or conditions. These ailments/conditions include heart disease, diabetes mellitus, and asthma. This type of telemedicine can substitute for in-person meetings with clinical professionals, and as an added advantage, remote monitoring can be less time consuming for both the patient and doctor, and more cost effective.
The final type of telemedicine to be discussed here includes Interactive Telemedicine Services. This service provides a real time, synchronous interaction between a clinician and patient. Included within the gambit of interactive services, are telephone consultations, video conferencing, online communication and even home visits by the doctor. The types of diagnostic practices that can be completed via this telemedicine method include the taking or reviewing of patient history, a visual physical examination, psychiatric evaluations and ophthalmic assessments. These remote diagnostic tools produce the same conclusions that a face to face meeting will produce. This is to say that interactive services are comparable to personal examinations, but can save the patient and practitioner considerable time and money.
Another category of telemedicine that is performed on a regular basis is emergency telemedicine. This is to say that emergencies are often successfully handled through information communication services. Emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile, and Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.
There are, however, barriers that have frustrated the proliferation of telemedicine on a wider scale. Process based regulations have been slow to offer protection to both clinicians and patients with regards to malpractice recourse. The commercial environment and the medical insurance industry (specifically) have created several financial obstacles that have essentially placed the burden of telemedicine investment in private hands. The final barrier to be overcome is that of social and cultural mistrust of new technologies. This mistrust, somewhat unexpectedly, is found in both camps: that is, both patients and doctors have been slow to embrace the possibilities opened up by telecommunications technologies.