TM can be school based [34] and can include services such as hospice [35], cancer [36], clinical, genetics [37], stroke and critical care. Research has even started exploring the use of mobile health, or mHealth, which is focused on providing medical care via mobile phones. Technologies using TM can be real time and interactive (synchronous), store and forward (asynchronous) or a combination

of both [33] using vendors to facilitate MAPK inhibitor videoconferencing or image storing. In its simplest form, the asynchronous technology transmits images or data that can be viewed by the physician at a later time (Fig. 1). Smaller bandwidth often suffices for asynchronous technologies that are most often used for radiology imaging, cytomorphology analysis, and for monitoring of blood Selleck SCH772984 pressure, blood sugar, weight and anticoagulation. Synchronous TM uses videoconferencing through a secure site that ensures patient confidentiality and may be supplemented by teledevices. Large bandwidths

are required for synchronous TM to achieve image clarity and simultaneous access by multiple persons, as may occur during a comprehensive visit. The Joint Commission (TJC), formerly The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), defines the location of the patient (clinic/hospital, rural

health centre, school) as the originating site and the location of the consultant as the distant site [38]. Regulatory impediments to the credentialing SPTBN5 of the consultant at the originating site have been eliminated by the Centres for Medicare and Medicaid Services (CMS). Table 1 outlines the requirements of setting up TM at distant and originating sites and Table 2 lists advantages and disadvantages of TM. Administrator Physician specialist Comprehensive (Comp) care team Nurse Social worker (SW) Physical therapist (PT) Dental hygienist Genetics Clinic staff Administrator Healthcare provider (HCP) Primary care physician, nurse practitioner, physician assistant, or nurse Some elements of Comp care team SW, PT, etc.