Making Health Care Universally Accessible
0 likes261 views
The document discusses the transformative impact of telemedicine on healthcare, providing solutions for remote diagnosis, consultation, and treatment, particularly in underserved areas. It highlights the potential cost savings and improved accessibility that telehealth technologies can offer, as well as the challenges such as data security and broadband availability. The growth of telemedicine is further evidenced by its integration into various medical fields and the rising demand for remote healthcare services.
![STUDENT’S CORNER
4 ieee pulse ▼ NOVEMBER/DECEMBER 2014
C
an a case of the flu be diagnosed over
Skype? Is it possible to learn the re-
sults of your computed tomography
scan after midnight? Can a young mother
receive care where a trained pediatrician
can’t visit? The answer to all of these ques-
tions is yes. With the latest revolution in
information technology and the availability
of advanced computer systems worldwide,
telemedicine has made all of this possible.
In the past few decades, hospitals have
become smarter, safer, and more sophisti-
cated, which has accentuated health care
costs and generated a rural-urban health
care divide. Telemedicine has stepped in as
an instrument to bridge the gaps and pro-
vides the ability to exchange medical in-
formation, such as patient health records,
using telecommunication technology,
including video calls, smartphones, and
wireless tools [1]. The use of telemedicine
offers huge potential in disease diagno-
sis, consultation, monitoring, treatment,
education, and management; thus, it
makes the emergent intelligent health
care infrastructure universal and more ac-
cessible to the common masses (Figure 1).
As most economies steer in the direc-
tion of unsustainable health care costs,
telemedicine offers significant promise
as an efficient health care delivery and
management tool. Limited access to ad-
equate medical care, especially in remote
settings, the growing pressure of aging
patient populations, increasing life ex-
pectancies, the increasing prevalence of
chronic conditions, and the shortage of
medical professionals continue to burden
health care systems worldwide.
There is growing evidence to support
the cost-effectiveness of implementing
telehealth technologies. For example, a
research article published by the Center
for Information Technology Leadership in
November 2007 observed that the savings
MakingHealthCare
UniversallyAccessible
Theemergenceoftelemedicineasacorenecessity
NiharikaMidhaandSubhamoyMandal
Digital Object Identifier 10.1109/MPUL.2014.2355316
Date of publication: 14 November 2014
FIGURE1 A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have
been relentless and still continue today.The years after 1976 are the period of maturation and rapid growth of telehealth technologies.
First Exposition on
Telehealth Care
1924
Photophone
1880
Transatlantic
Wireless
Transmission
1901
Electric
Telegraph
1844
1840 1900 1940
Digital (Binary)
Transmission
1949
Telephone
1875
Television
1884
(First Patent)
First ECG
Transmission
1906
The Internet
ISRO (India)
Telemedicine Project
2001
First Internet
Transmission
1969
TCP/IP
Goes Global
1989
1980
2000196019201880
Telerobotic Remote
Surgery Service
2003
NASA (U.S.) ATS-6
Satellite
1974](https://image.slidesharecdn.com/06955904-150317133539-conversion-gate01/85/Making-Health-Care-Universally-Accessible-1-320.jpg)
![6 ieee pulse ▼ NOVEMBER/DECEMBER 2014
generated by eliminating the transfer of
patients between emergency departments
could fund the installation of hybrid tele-
health technologies across all emergency
departments in the United States. The au-
thors reported that 2.2 million patients
are transported each year between emer-
gency departments at a cost of US$1.39
billion and that telehealth technologies can
avoid 850,000 transports at a cost savings
of US$537 million annually [2]. Recent re-
ports from HealthCursor Consulting Group
observe that remote health
care and E-health can give
hospitals an easy return on
investment with a lucra-
tive profit margin in a short
period of time. Health care
operators such as Apollo
and Fortis in India are lured
by the pan-India reach, and
lower operating costs have
escalated their entry into
the vast untapped domain
of telemedicine.
Moreover, newer and smarter health
devices have provided an impetus to the
industry’s growth. Heart and blood pres-
sure monitors can now wirelessly trans-
mit the patient’s data to mobile phones or
to a central online database accessed by
telemedicine centers [3]. This has encour-
aged more academic research on point-
of-care devices [4], and more companies
are coming out with devices with mobile
health care capabilities [5].
The consumer demand (see “Indus-
try Outlook”) for high-quality health
care has also played a fundamental role
in the overall acceptance, as well as in-
tegration, of these technologies. In ad-
dition, patient satisfaction has gained
vital importance in this expanding era
of personalized medicine. Some studies
suggest that telemedicine has been able
to achieve high levels of patient satisfac-
tion as it allows for easy and rapid ac-
cess to health care. A study by Gustke
et al. concluded that 98.3% of patients
(n = 495) were satisfied with interactive
telemedicine clinical con-
sultations [6].
According to Global-
Data’s estimates, the tele-
health and telemedicine
market will increase at a
compound annual growth
rate of 14% to be worth
an estimated US$32.5 bil-
lion by 2018. Telehealth
pilot programs and regu-
latory and standardiza-
tion initiatives to attract
investment by private organizations have
been adopted by governments in several
regions of the world. One sector where
telemedicine has been accepted rapidly is
disease diagnosis. For example, teleradiol-
ogy has witnessed considerable growth in
recent years.
Teleradiology encompasses medical im-
aging information systems that improve
theeaseofcapturing,storing,andexchang-
ing medical images between providers,
including remotely located medical prac-
titioners and patients, through integrated
electronic health records. Picture archiving
and management systems equipped with
clinical decision support systems enable
the efficient management of remote di-
agnosis and faster clinical management.
Teleradiology is gradually being adopted
throughout the world to meet the growing
gap between the demand for and supply
of trained radiologists. Furthermore, it has
also opened avenues for making specialists
available around the clock. For example, if
an emergency occurs at a time when Eu-
ropean radiologists are not available, their
counterparts in Asia can evaluate the pa-
tient to provide immediate assistance.
However, as with most new technolo-
gies, data security and privacy concerns
have been raised and are key impedi-
ments to the adoption of telehealth so-
lutions and services. Inadequate data
security and transmission could lead to
inaccurate diagnosis and erroneous prog-
nosis. These issues negatively impact the
overall utilization of telemedicine. In ad-
dition, the penetration of telemedicine
solutions and services in the emerging
markets is currently limited by the sparse
availability of broadband technologies. As
most of these developing countries have
a significantly larger rural population,
the low penetration levels and the asso-
ciated higher up-front costs substantially
limit the deployment of telehealth mod-
els. Thus, we can conservatively opine
that, while the information technology-
enabled approach to health care can
Industry Outlook
Modern computing, communications, medical devices, and health
informatics technologies, when integrated in a holistic manner to create
telemedicine and e-health services with skill development and business
model, have the potential to solve the health care delivery problems that
the large population of the world faces. Today, teleradiology can be
considered as an established telemedicine model where technology, cost,
quality, convenience, and information safety aspects have been
addressed. Simultaneously, there is a range of areas where telemedicine
practices are being newly applied. Some of these areas include, but are
notlimitedto,ophthalmology,surgery,dentistry,dermatology,pathology,
and public health. The success of public–private partnership programs
offering telescreening services to rural and semiurban premature infants,
viz., Karnataka Internet Assisted Diagnosis of Retinopathy of Pre-maturity
(KIDROP) in India, stands testimony to the emergent trend. In this
government-funded program, the health care industry provides medical
expertise and helps in skills development, whereas technology
companies provide the customized communications, storage, and
computing services along with innovative features that improve
diagnosticvalueoftheinformationbeingcommunicated[7].
Another novel application of the telemedicine solutions has been
found in continuing medical education (CME). CME that is vital for
professional development is also a mandatory requirement for
extending license practice in many countries. CME helps those in the
medical field to maintain competency and learn about new and
developing areas of their field. Currently, a significant portion of CME
activities takes place as live events such as conferences, publications,
and e-learning or online CME, which is a convenient, cost-effective
alternative with the potential to reach a wider audience, and is
expected to seize the majority market share in the near future [8].
(Input from: Hrushikesh Garud, Texas Instruments, India.)
Teleradiologyis
graduallybeing
adoptedthroughout
theworldtomeetthe
growinggapbetween
thedemandforand
supplyoftrained
radiologists.
(continued on page 47)](https://image.slidesharecdn.com/06955904-150317133539-conversion-gate01/85/Making-Health-Care-Universally-Accessible-2-320.jpg)
![NOVEMBER/DECEMBER 2014 ▼ ieee pulse 47
The closer our relationships, the more we
favor those individuals; the farther apart
we are, the more we recognize the differ-
ences. We treat diversities as excuses to
direct our positive attitudes elsewhere,
especially if we consider dissimilar indi-
viduals as competing for limited finan-
cial, physical, or emotional resources.
One troubling form of discrimination
is racism. Racism exists in many forms
and many places; it is especially noted
whenever different races come in close
contact with each other. Fortunately,
I have observed over the course of my
lifetime that racism in the United States
has diminished somewhat, although no
one dares to say that racism is even close
to being eradicated in our country. Hav-
ing lived through the time of the civil
rights marches 50 years ago, listened to
and taken to heart the words of Martin
Luther King, Jr., and admired the cour-
age and resolution of Rosa Parks, I am
very happy with this trend. And it seems
that the acceptance of other races is
being led by the younger generations,
who seem to be much more tolerant
than their parents.
Discrimination may be a natural con-
sequence of our genomes, but discrimina-
tion does not have to turn into racism.
To keep that from happening, we should
become more familiar with the other
people so that the differences become
less important compared to the similari-
ties we discover. If we no longer consider
relationships as competitive, then we
can act in a more generous and tolerant
way. Engineering success, which should
be based on merit and cooperation, can
become a model of the way that we wish
society in general to behave. In this case,
we can exercise another deeply ingrained
biological attribute—that of fairness and
altruism—also embedded in our genomes
[2], [11]. That should make it easier to
move beyond the extremes of discrimina-
tion originating with our genes.
References
[1] J. Ackerman, “Dragonflies strange love,”
Nat. Geogr., vol. 209, no. 4, pp. 105–119,
Apr. 2006.
[2] S. F. Brosnan and F. B. DeWaal, “Mon-
keys reject unequal pay,” Nature, vol. 425,
no. 6955, pp. 297–299, Sept. 2003.
[3] R. Dawkins, The Selfish Gene, 2nd ed. Cam-
bridge, U.K.: Oxford Univ. Press, 1989.
[4] B. W. Domingue, J. Fletcher, D. Conley,
and J. D. Boardman, “Genetic and edu-
cational assortive mating among U.S.
adults,” PNAS, vol. 111, no. 22, pp. 7996–
8000, 2014.
[5] B. Ganetsky, “Tracking down a cheat-
ing gene,” Amer. Sci., vol. 88, no. 2, pp.
128–135, Mar.–Apr. 2000.
[6] W. D. Hamilton, “The genetical evolu-
tion of behaviour,” J. Theor. Biol., vol. 7,
no. 1, pp. 1–16, July 1964.
[7] W. D. Hamilton, “The genetical evo-
lution of behaviour II,” J. Theor. Biol.,
vol. 7, no. 1, pp. 17–52, July 1964.
[8] A. T. Johnson, Biology for Engineers.
Boca Raton, FL: CRC Press, 2011.
[9] A. T. Johnson, “The fallacy of genetic
selection,” IEEE Pulse, vol. 5, no. 2,
p. 66, Mar.–Apr. 2014.
[10] J. Purdy, “Love is the answer,” UGA Res.
Mag., vol. 34, no. 1, pp. 32–43, summer
2005.
[11] F. Range, L. Horn, Z. Viranyi, and L. Hu-
ber, “The absence of reward induces in-
equity aversion in dogs,” PNAS, vol. 106,
no. 2, pp. 340–345, Jan. 2009.
virtually extend the services of the tertiary
hospital to urban homes and remote rural
health care centers, there is a sea of chal-
lenges—both technical and human factor
related—that needs to be surmounted
before we develop a truly intelligent sys-
tem that connects the teeming millions
across geographical boundaries.
Niharika Midha received her M.Sc. degree in
biomedical engineering with a focus on medical
physics from Imperial College London. She is a
medical devices analyst based in GlobalData’s
Singapore office. Before joining GlobalData,
she was a health care journalist for BioPharm
Insight, which is part of the Financial Times
Group, and a research assistant at Imperial
College London. Subhamoy Mandal is cur-
rently a DAAD Ph.D. scholar with the Institute
of Biological and Medical Imaging at the Tech-
nical University of München and Helmholtz
Zentrum München. He was the recipient of the
IEEE Education Society Student Leadership
Award in 2013 and the IEEE Computer Society
Richard E. Merwin Scholarship in 2014.
References
[1] National Leadership and Innovation
Agency for Healthcare. (2014, Aug. 14).
FAQs. Telemedicine/telehealth. [Online].
Available: http://www.wales.nhs.uk/
technologymls
[2] P. Eric, C. Cusack, J. Hook, A. Vincent, D.
C. Kaelber, D. W. Bates, and B. Middleton,
“The value of provider-to-provider tele-
health,” Telemed. e-Health, vol. 14, no. 5,
pp. 446–453, 2008.
[3] D. Lalmalsawma. (2014, June 4). Tele-
medicine in India might be just what the
doctor ordered. India Insights. [Online].
Available:http://blogs.reuters.com/india/
2014/06/04/telemedicine-in-india-might-
be-just-what-the-doctor-ordered/
[4] S. Mandal, K. Basak, K. M. Mandana, A. K.
Ray, J. Chatterjee, and M. Mahadevappa,
“Developmentofcardiacprescreeningdevice
for rural population using ultralow-power
embedded system,” IEEE Trans. Biomed. Eng.,
vol. 58, no. 3, pp. 745–749, Mar. 2011.
[5] H. Garud, A. K. Ray, S. Mandal, D. Sheet,
M. Mahadevappa, and J. Chatterjee,
“Volume visualization approach for
depth-of-field extension in digital pathol-
ogy,” in Proc. 2011 4th Int. Congr. Image and
Signal Processing (CISP), Oct. 15–17, 2011,
vol. 1, pp. 335–339.
[6] S. S. Gustke, D. C. Balch, V. L. West, and
L. O. Rogers. “Patient satisfaction with
telemedicine,” Telemed. J., vol. 6, no. 1 pp.
5–13, 2000.
[7] A. Vinekar, C. Gilbert, M. Dogra, M. Ku-
rian, G. Shainesh, B.Shetty, et al., “The
KIDROP model of combining strategies
for providing retinopathy of prematurity
screening in underserved areas in India
using wide-field imaging, tele-medicine,
non-physician graders and smart phone
reporting,” Indian J. Ophthalmol., vol. 62,
pp. 41–49, 2014.
[8] J. M. Harris, B. M. Sklar, R. W. Amend,
and C. Novalis-Marine, “The growth,
characteristics, and future of online
CME,” J. Contin. Educ. Health Prof., vol. 30,
pp. 3–10, 2010.
STUDENT’S CORNER (continued from page 6)](https://image.slidesharecdn.com/06955904-150317133539-conversion-gate01/85/Making-Health-Care-Universally-Accessible-3-320.jpg)
Making Health Care Universally Accessible
- 1. STUDENT’S CORNER 4 ieee pulse ▼ NOVEMBER/DECEMBER 2014 C an a case of the flu be diagnosed over Skype? Is it possible to learn the re- sults of your computed tomography scan after midnight? Can a young mother receive care where a trained pediatrician can’t visit? The answer to all of these ques- tions is yes. With the latest revolution in information technology and the availability of advanced computer systems worldwide, telemedicine has made all of this possible. In the past few decades, hospitals have become smarter, safer, and more sophisti- cated, which has accentuated health care costs and generated a rural-urban health care divide. Telemedicine has stepped in as an instrument to bridge the gaps and pro- vides the ability to exchange medical in- formation, such as patient health records, using telecommunication technology, including video calls, smartphones, and wireless tools [1]. The use of telemedicine offers huge potential in disease diagno- sis, consultation, monitoring, treatment, education, and management; thus, it makes the emergent intelligent health care infrastructure universal and more ac- cessible to the common masses (Figure 1). As most economies steer in the direc- tion of unsustainable health care costs, telemedicine offers significant promise as an efficient health care delivery and management tool. Limited access to ad- equate medical care, especially in remote settings, the growing pressure of aging patient populations, increasing life ex- pectancies, the increasing prevalence of chronic conditions, and the shortage of medical professionals continue to burden health care systems worldwide. There is growing evidence to support the cost-effectiveness of implementing telehealth technologies. For example, a research article published by the Center for Information Technology Leadership in November 2007 observed that the savings MakingHealthCare UniversallyAccessible Theemergenceoftelemedicineasacorenecessity NiharikaMidhaandSubhamoyMandal Digital Object Identifier 10.1109/MPUL.2014.2355316 Date of publication: 14 November 2014 FIGURE1 A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have been relentless and still continue today.The years after 1976 are the period of maturation and rapid growth of telehealth technologies. First Exposition on Telehealth Care 1924 Photophone 1880 Transatlantic Wireless Transmission 1901 Electric Telegraph 1844 1840 1900 1940 Digital (Binary) Transmission 1949 Telephone 1875 Television 1884 (First Patent) First ECG Transmission 1906 The Internet ISRO (India) Telemedicine Project 2001 First Internet Transmission 1969 TCP/IP Goes Global 1989 1980 2000196019201880 Telerobotic Remote Surgery Service 2003 NASA (U.S.) ATS-6 Satellite 1974
- 2. 6 ieee pulse ▼ NOVEMBER/DECEMBER 2014 generated by eliminating the transfer of patients between emergency departments could fund the installation of hybrid tele- health technologies across all emergency departments in the United States. The au- thors reported that 2.2 million patients are transported each year between emer- gency departments at a cost of US$1.39 billion and that telehealth technologies can avoid 850,000 transports at a cost savings of US$537 million annually [2]. Recent re- ports from HealthCursor Consulting Group observe that remote health care and E-health can give hospitals an easy return on investment with a lucra- tive profit margin in a short period of time. Health care operators such as Apollo and Fortis in India are lured by the pan-India reach, and lower operating costs have escalated their entry into the vast untapped domain of telemedicine. Moreover, newer and smarter health devices have provided an impetus to the industry’s growth. Heart and blood pres- sure monitors can now wirelessly trans- mit the patient’s data to mobile phones or to a central online database accessed by telemedicine centers [3]. This has encour- aged more academic research on point- of-care devices [4], and more companies are coming out with devices with mobile health care capabilities [5]. The consumer demand (see “Indus- try Outlook”) for high-quality health care has also played a fundamental role in the overall acceptance, as well as in- tegration, of these technologies. In ad- dition, patient satisfaction has gained vital importance in this expanding era of personalized medicine. Some studies suggest that telemedicine has been able to achieve high levels of patient satisfac- tion as it allows for easy and rapid ac- cess to health care. A study by Gustke et al. concluded that 98.3% of patients (n = 495) were satisfied with interactive telemedicine clinical con- sultations [6]. According to Global- Data’s estimates, the tele- health and telemedicine market will increase at a compound annual growth rate of 14% to be worth an estimated US$32.5 bil- lion by 2018. Telehealth pilot programs and regu- latory and standardiza- tion initiatives to attract investment by private organizations have been adopted by governments in several regions of the world. One sector where telemedicine has been accepted rapidly is disease diagnosis. For example, teleradiol- ogy has witnessed considerable growth in recent years. Teleradiology encompasses medical im- aging information systems that improve theeaseofcapturing,storing,andexchang- ing medical images between providers, including remotely located medical prac- titioners and patients, through integrated electronic health records. Picture archiving and management systems equipped with clinical decision support systems enable the efficient management of remote di- agnosis and faster clinical management. Teleradiology is gradually being adopted throughout the world to meet the growing gap between the demand for and supply of trained radiologists. Furthermore, it has also opened avenues for making specialists available around the clock. For example, if an emergency occurs at a time when Eu- ropean radiologists are not available, their counterparts in Asia can evaluate the pa- tient to provide immediate assistance. However, as with most new technolo- gies, data security and privacy concerns have been raised and are key impedi- ments to the adoption of telehealth so- lutions and services. Inadequate data security and transmission could lead to inaccurate diagnosis and erroneous prog- nosis. These issues negatively impact the overall utilization of telemedicine. In ad- dition, the penetration of telemedicine solutions and services in the emerging markets is currently limited by the sparse availability of broadband technologies. As most of these developing countries have a significantly larger rural population, the low penetration levels and the asso- ciated higher up-front costs substantially limit the deployment of telehealth mod- els. Thus, we can conservatively opine that, while the information technology- enabled approach to health care can Industry Outlook Modern computing, communications, medical devices, and health informatics technologies, when integrated in a holistic manner to create telemedicine and e-health services with skill development and business model, have the potential to solve the health care delivery problems that the large population of the world faces. Today, teleradiology can be considered as an established telemedicine model where technology, cost, quality, convenience, and information safety aspects have been addressed. Simultaneously, there is a range of areas where telemedicine practices are being newly applied. Some of these areas include, but are notlimitedto,ophthalmology,surgery,dentistry,dermatology,pathology, and public health. The success of public–private partnership programs offering telescreening services to rural and semiurban premature infants, viz., Karnataka Internet Assisted Diagnosis of Retinopathy of Pre-maturity (KIDROP) in India, stands testimony to the emergent trend. In this government-funded program, the health care industry provides medical expertise and helps in skills development, whereas technology companies provide the customized communications, storage, and computing services along with innovative features that improve diagnosticvalueoftheinformationbeingcommunicated[7]. Another novel application of the telemedicine solutions has been found in continuing medical education (CME). CME that is vital for professional development is also a mandatory requirement for extending license practice in many countries. CME helps those in the medical field to maintain competency and learn about new and developing areas of their field. Currently, a significant portion of CME activities takes place as live events such as conferences, publications, and e-learning or online CME, which is a convenient, cost-effective alternative with the potential to reach a wider audience, and is expected to seize the majority market share in the near future [8]. (Input from: Hrushikesh Garud, Texas Instruments, India.) Teleradiologyis graduallybeing adoptedthroughout theworldtomeetthe growinggapbetween thedemandforand supplyoftrained radiologists. (continued on page 47)
- 3. NOVEMBER/DECEMBER 2014 ▼ ieee pulse 47 The closer our relationships, the more we favor those individuals; the farther apart we are, the more we recognize the differ- ences. We treat diversities as excuses to direct our positive attitudes elsewhere, especially if we consider dissimilar indi- viduals as competing for limited finan- cial, physical, or emotional resources. One troubling form of discrimination is racism. Racism exists in many forms and many places; it is especially noted whenever different races come in close contact with each other. Fortunately, I have observed over the course of my lifetime that racism in the United States has diminished somewhat, although no one dares to say that racism is even close to being eradicated in our country. Hav- ing lived through the time of the civil rights marches 50 years ago, listened to and taken to heart the words of Martin Luther King, Jr., and admired the cour- age and resolution of Rosa Parks, I am very happy with this trend. And it seems that the acceptance of other races is being led by the younger generations, who seem to be much more tolerant than their parents. Discrimination may be a natural con- sequence of our genomes, but discrimina- tion does not have to turn into racism. To keep that from happening, we should become more familiar with the other people so that the differences become less important compared to the similari- ties we discover. If we no longer consider relationships as competitive, then we can act in a more generous and tolerant way. Engineering success, which should be based on merit and cooperation, can become a model of the way that we wish society in general to behave. In this case, we can exercise another deeply ingrained biological attribute—that of fairness and altruism—also embedded in our genomes [2], [11]. That should make it easier to move beyond the extremes of discrimina- tion originating with our genes. References [1] J. Ackerman, “Dragonflies strange love,” Nat. Geogr., vol. 209, no. 4, pp. 105–119, Apr. 2006. [2] S. F. Brosnan and F. B. DeWaal, “Mon- keys reject unequal pay,” Nature, vol. 425, no. 6955, pp. 297–299, Sept. 2003. [3] R. Dawkins, The Selfish Gene, 2nd ed. Cam- bridge, U.K.: Oxford Univ. Press, 1989. [4] B. W. Domingue, J. Fletcher, D. Conley, and J. D. Boardman, “Genetic and edu- cational assortive mating among U.S. adults,” PNAS, vol. 111, no. 22, pp. 7996– 8000, 2014. [5] B. Ganetsky, “Tracking down a cheat- ing gene,” Amer. Sci., vol. 88, no. 2, pp. 128–135, Mar.–Apr. 2000. [6] W. D. Hamilton, “The genetical evolu- tion of behaviour,” J. Theor. Biol., vol. 7, no. 1, pp. 1–16, July 1964. [7] W. D. Hamilton, “The genetical evo- lution of behaviour II,” J. Theor. Biol., vol. 7, no. 1, pp. 17–52, July 1964. [8] A. T. Johnson, Biology for Engineers. Boca Raton, FL: CRC Press, 2011. [9] A. T. Johnson, “The fallacy of genetic selection,” IEEE Pulse, vol. 5, no. 2, p. 66, Mar.–Apr. 2014. [10] J. Purdy, “Love is the answer,” UGA Res. Mag., vol. 34, no. 1, pp. 32–43, summer 2005. [11] F. Range, L. Horn, Z. Viranyi, and L. Hu- ber, “The absence of reward induces in- equity aversion in dogs,” PNAS, vol. 106, no. 2, pp. 340–345, Jan. 2009. virtually extend the services of the tertiary hospital to urban homes and remote rural health care centers, there is a sea of chal- lenges—both technical and human factor related—that needs to be surmounted before we develop a truly intelligent sys- tem that connects the teeming millions across geographical boundaries. Niharika Midha received her M.Sc. degree in biomedical engineering with a focus on medical physics from Imperial College London. She is a medical devices analyst based in GlobalData’s Singapore office. Before joining GlobalData, she was a health care journalist for BioPharm Insight, which is part of the Financial Times Group, and a research assistant at Imperial College London. Subhamoy Mandal is cur- rently a DAAD Ph.D. scholar with the Institute of Biological and Medical Imaging at the Tech- nical University of München and Helmholtz Zentrum München. He was the recipient of the IEEE Education Society Student Leadership Award in 2013 and the IEEE Computer Society Richard E. Merwin Scholarship in 2014. References [1] National Leadership and Innovation Agency for Healthcare. (2014, Aug. 14). FAQs. Telemedicine/telehealth. [Online]. Available: http://www.wales.nhs.uk/ technologymls [2] P. Eric, C. Cusack, J. Hook, A. Vincent, D. C. Kaelber, D. W. Bates, and B. Middleton, “The value of provider-to-provider tele- health,” Telemed. e-Health, vol. 14, no. 5, pp. 446–453, 2008. [3] D. Lalmalsawma. (2014, June 4). Tele- medicine in India might be just what the doctor ordered. India Insights. [Online]. Available:http://blogs.reuters.com/india/ 2014/06/04/telemedicine-in-india-might- be-just-what-the-doctor-ordered/ [4] S. Mandal, K. Basak, K. M. Mandana, A. K. Ray, J. Chatterjee, and M. Mahadevappa, “Developmentofcardiacprescreeningdevice for rural population using ultralow-power embedded system,” IEEE Trans. Biomed. Eng., vol. 58, no. 3, pp. 745–749, Mar. 2011. [5] H. Garud, A. K. Ray, S. Mandal, D. Sheet, M. Mahadevappa, and J. Chatterjee, “Volume visualization approach for depth-of-field extension in digital pathol- ogy,” in Proc. 2011 4th Int. Congr. Image and Signal Processing (CISP), Oct. 15–17, 2011, vol. 1, pp. 335–339. [6] S. S. Gustke, D. C. Balch, V. L. West, and L. O. Rogers. “Patient satisfaction with telemedicine,” Telemed. J., vol. 6, no. 1 pp. 5–13, 2000. [7] A. Vinekar, C. Gilbert, M. Dogra, M. Ku- rian, G. Shainesh, B.Shetty, et al., “The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting,” Indian J. Ophthalmol., vol. 62, pp. 41–49, 2014. [8] J. M. Harris, B. M. Sklar, R. W. Amend, and C. Novalis-Marine, “The growth, characteristics, and future of online CME,” J. Contin. Educ. Health Prof., vol. 30, pp. 3–10, 2010. STUDENT’S CORNER (continued from page 6)