Preface

**Section 2 Telemedicine: Present and the Future 121**

**The Present and Future 123**

Heisler

**VI** Contents

Victoria Ramos

**Services 217**

Chapter 7 **Update on the Most Rural American Telemedicine Program —**

Chapter 8 **Short Range Technologies for Ambient Assisted Living Systems in Telemedicine: New Healthcare Environments 141** Silvia de Miguel-Bilbao, Jorge García, M. Dolores Marcos and

Chapter 9 **PITES: Telemedicine and e-Health Innovation Platform 163**

Chapter 10 **The Telemedicine Service Maturity Model: A Framework for the Measurement and Improvement of Telemedicine**

Liezl van Dyk and Cornelius S.L. Schutte

José Luis Monteagudo, Mario Pascual, Adolfo Muñoz, Pilar G. Sagredo, Ricardo Sánchez de Madariaga and Carlos H. Salvador

Edward T. Zawada Jr, Dana Buus, Don Kosiak, Pat Herr and Michael

Technological advances in Medicine has led to possibility of monitoring and caring for pa‐ tients remotely. The field of Telemedicine is spreading throughout the world in the different branches of Medicine. In this book, a collection of reviewed scholarly contributions written by different authors, recent developments in the different fields including Mental Health, Ophthalmology, Medicine, Obstetrics and Gynecology have been highlighted. Review arti‐ cles related to e-health care delivery platforms are discussed.

The target audience for this open access will be medical students, trainees, mid level provid‐ ers, physicians and health care administrators. The chapters will introduce the concepts of Telemedicine to the readers.

#### **Ramesh Madhavan M.D, D.M.**

Associate Chief Medical Officer Neurology Residency Program Director Director, Telemedicine Associate Professor, Wayne State University, USA

#### **Shahram Khalid, MD**

Vascular Neurology Fellow Wayne State University/Detroit Medical Center, USA

**Section 1**

**Telemedicine: Use in Different Scenarios**

**Telemedicine: Use in Different Scenarios**

**Chapter 1**

**Teleophthalmology: Eye Care in the Community**

The difficulties of sustaining care in hospitals are forcing health economies to deliver health care closer to the home in the community. The increased use of Vasoactive Endothelial Growth Factor (VEGF) antagonists to treat patients with wet age related macular degeneration has exponentially increased the need for additional clinic and treatment capacity. New National Institute of Clinical Excellence (NICE) guidelines for glaucoma (2009) have increased the number of referrals into secondary care. This chapter will explore how additional capacity may be created using digital imaging transfer techniques, to allow patients to be seen in virtual

The learning goal of this chapter is better understanding of novel ophthalmic technology for retinal disease management and glaucoma assessment deployed in the digital health environ‐ ment. This is a topic of considerable significance in retinal care given the explosion of relevant clinical imaging technology and the huge burden of certain retinal disease (age related macular degeneration, retinal vein occlusion and diabetic retinopathy) on National Health Service (NHS) services and which is set to expand even more with further new and welcome treat‐ ments for these conditions. It is also of importance in view of the increased glaucoma referrals into secondary care in the light of recent NICE guidance, increasing the need for more advanced imaging techniques in the diagnosis and investigation of these patients. Glaucoma patients are now more commonly undergoing Optical Coherence Tomography (OCT) scanning of the optic disc, or advanced disc imaging for follow up purposes and diagnosis. Smarter ways of working, using new technology, are required to cope with this clinical need and organisational burden. The need includes better use of IT infrastructure; innovation in primary care to secondary care referral management and enhanced productivity in secondary

care. The development of "Virtual Clinics" using this technology will be discussed.

© 2013 Dragnev et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Dragnev et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Daniel Dragnev, Usman Mahmood, Chris Williams and Manoj Kulshrestha

http://dx.doi.org/10.5772/55788

**1. Introduction**

Additional information is available at the end of the chapter

clinics, which may be located in either primary or secondary care.
