Telemedicine may be as simple as two health professionals discussing a case over the telephone and as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. It can be applied to a varied number of specialties of clinical care like anesthesia, psychiatry, oncology, dermatology, radiology, cardiology, critical care, continuing medical education, home monitoring, and patient education. The list is increasing with new avenues opening up every day with the progress of medical science and technology.
The most challenging aspect of a neurosurgical emergency comprise of establishing the diagnosis and safe transportation of the patient in time with all due precautions and commencing intervention and treatment required at the earliest. This challenge can be very well met by telemedicine by reducing time of transportation by early diagnosis and communication of emergency situation. Correct diagnosis at the shortest possible time and interaction between the treating specialists at the distant center with the neurosurgery expert can save precious minutes and enable starting crucial treatment at the site. The specialist care in the presence of the virtual specialist and expediting transfer of the patient requiring neurosurgical care are the two important factors to ensure prevention of secondary injury. An interaction in real time would require a state of the art software module with access to good internet connectivity.
The global leaders in telemedicine are in developed countries that have large segments of their populations living in remote areas, such as Canada, Australia, and Norway. India faces a shortage of doctors, particularly in rural areas, where nearly 70% of the population lives. Doctors and hospitals are largely concentrated in cities, and as a consequence, health care in rural India is inadequate or in a wanting state. The judicious use of information and communication technology can overcome some of the limitations imposed by scarce resources. Multimedia messaging service can be used to transmit important scan images to experienced staff to facilitate accurate and prompt diagnosis and commence optimal treatment.
Advancement in telecommunication, information science, and technology provides an opportunity to exchange knowledge and skill across geographically dispersed organizations. The common theme in neurological emergencies lies with prompt diagnosis, rapid access to scans, accurate scan interpretation, and quick institution of appropriate treatment. Failure in any one of these vital steps can result in devastating and permanent neurological deficits or death.[3
Availability of indigenous satellite communication technology and the government policy of free bandwidth provision for societal development sector have added strength to set up infrastructure to pilot several telemedicine educational projects across the country. Rough calculations suggest that only about 0.1% of the potential telemedicine demand from the developing world is being met.[1
] Possible reasons include the referrers being too busy and a perceived loss of control. Efforts are taking place in the field of medical e-learning by establishing digital medical libraries. Some institutions that are actively involved in telemedicine activities have started curriculum and noncurriculum telemedicine training programs. Teleradiology is the best method to avoid unnecessary transportation or deleterious delays before transfer. Limitations of telemedicine can be reduced by uniform standard care dependent on availability of an excellent infrastructure. Such infrastructure includes qualified teachers, knowledge resources, learning materials, and advanced education technology, which is a challenge in developing countries due to financial and logistic constraints. As the practice of telemedicine spreads, maintaining standards, security and privacy will be a challenge especially with regard to legal and regulatory measures in cases of failure of telemedicine system during emergency that should be made responsible? Is it the surgeon, the satellite provider, or the software/hardware engineer? The legal status of telemedicine-based diagnosis and treatment needs to be established and constantly updated in terms of rapidly changing scenario of this growing field.[4
There are a few practical problems related to telemedicine as exemplified by Krishnan Ganapathy,[5
] Joint Secretary of the Telemedicine Society of India and President of the Apollo Telemedicine Networking Foundation who says “I can tell a patient in a village what drug to take, and I can fax a prescription. But where will the patient buy the drug?”, Moreover, telemedicine has obvious limitations when it comes to both diagnosis and surgery. For any of the “major problems”, he needs to meet his patients’ face-to-face. “It is very difficult to convince someone that I can check their pulse from 5000 miles away”, he says.