Tele diagnostic and treatment services  :

Telediagnostic involves consulting a specialist in the same or a different field or a general practitioner or even healthcare staff with a specialist doctor at a specialist center to help diagnose the patient  .

Tele Diagnosis  :
In this type of counseling, according to the definition provided above, the physician of the specialized center is assisted to achieve the correct diagnosis. At this stage, despite the treatment, the disease is still not cured and the diagnosis is questioned, or the decision to send the patient is made, and due to doubts about the diagnosis or the number of lesions and doubts about the priority of treatment, the service is unclear. Therefore, after performing the consultation, the initial diagnosis is made and the patient is sent to the relevant service in the covered hospital. During this consultation, treatment recommendations are sometimes provided by a specialist physician to create a stable condition in the patient, which must be implemented .

Counselors: In this type of counseling, a specialist or specialist in the same or different field, a general practitioner or medical staff who decides to send or refer a patient can request counseling .

Topics to be consulted :

This type of counseling is usually requested in cases where : -
A specialist or general practitioner or medical staff has doubts about the initial diagnosis and therefore can not begin the necessary treatment .
- After treatment, the symptoms of the disease have not yet resolved and the initial diagnosis is questionable .
- They decide to send or refer the patient to other centers and there is still doubt in the initial diagnosis and therefore the referred service .
- In some cases, due to the multiplicity of lesions, there is a doubt in the urgency of one of them .
For example, in cases where the patient has suffered multiple trauma due to an accident, and in addition to head trauma, which is suspected of intracerebral hemorrhage, there is also trauma to the abdomen, and the possibility of acute surgical abdomen is also raised. In addition, this patient has multiple trauma to the limbs and fractures of one or more limbs. In such a case, the decision to send the patient to an orthopedic center or a center with neurosurgery and general surgery is sometimes questioned. In such a case, due to the urgency of the patient's condition, the right decision can save the patient's life. Therefore, by consulting with a specialized center, initial treatment recommendations are made and a decision is made to send the patient to the desired center .
Another example of this type of consultation can be done in non-emergency cases where a specialist or general practitioner or medical staff has doubts about the correct diagnosis of the disease or after the necessary treatment the disease has not yet improved and therefore non-emergency with one of the specialists with Diseases are related to consult. In this case, either the diagnosis is registered and treatment recommendations are made, or according to the diagnosis of the specialist, the patient's specialized center needs to consult with another specialist, in which case the consulting physician decides to consult the other specialist again about the patient. Or refer the patient to a specialist. In this type of counseling, the goal is to reach a diagnosis, and although the doctor of the specialized center can make treatment recommendations, he is not required to do so, and the physician requesting counseling decides on the necessity of implementing the treatment instructions provided by him. . Information required for consultation: In order to perform any consultation, the consultation request form and the patient's background information must first be completed. Required information includes demographic information, medical history, test and examination results, and diagnostic and treatment measures performed so far. Depending on the electronic facilities available in the information center, this information can be accompanied by a live image or photo of the patient, radiological images, ECG, echocardiography, sonography, peripheral blood smear image or pathology. It is also helpful to send patients heart and lung sounds if possible. In centers where these facilities do not exist, reporting the type of sounds by the center physician or experienced staff can be a substitute for direct voice transmission. Depending on the electronic facilities available in the information center, this information can be accompanied by a live image or photo of the patient, radiological images, ECG, echocardiography, sonography, peripheral blood smear image or pathology. It is also helpful to send patients heart and lung sounds if possible. In centers where these facilities do not exist, reporting the type of sounds by the center physician or experienced staff can be a substitute for direct voice transmission. Depending on the electronic facilities available in the information center, this information can be accompanied by a live image or photo of the patient, radiological images, ECG, echocardiography, sonography, peripheral blood smear image or pathology. It is also helpful to send patients heart and lung sounds if possible. In centers where these facilities do not exist, reporting the type of sounds by the center physician or experienced staff can be a substitute for direct voice transmission..

Type of consultation :

Counseling can be done urgently or non-urgently. In the emergency type, communication with the consulting physician is established directly and sounds and images are sent directly and the answer is received simultaneously. In the non-emergency type, the information is sent to a specialized center and is answered within 24 hours by the consulting physician, or in case of a request from the consulting physician  (real time)  , this consultation is done simultaneously. In this type of counseling, it is possible for the patient to be present at the counseling center and perform additional examinations and establish direct contact with him.

Information submission process: At the beginning of each consultation, the necessary forms and information are collected, a copy of it is registered in the center of origin and then sent. A copy of all the information is also stored in the specialized center. Any response to counseling, whether simultaneous or asynchronous, is recorded by a specialist center and then sent to the counseling center. Obviously, the counseling response will also be recorded by the counseling center. In this way, in both centers, all information will be recorded and available for future use .

Non-emergency counseling: In each counseling center, in each work shift, a nurse in charge of the shift (supervisor) is responsible for setting up the system and ensuring proper communication with the specialized center .
The need for counseling in the covered centers is determined by the opinion of the general practitioner (or requesting specialist) in charge of the shift in the ward or emergency room. In centers without a general practitioner, this responsibility has been assumed by the highest shift therapist, such as a supervisor or a trained nurse .

In the specialized center, in each work shift, a nurse in charge of the intensive care unit is responsible for setting up, using and receiving consultations (due to the location of the equipment in this department). Due to the non-emergency nature of this type of consultation, the responsible nurse, after ensuring that the submitted information is complete, delivers it as soon as possible to the coordinating physician, who is usually present in the morning work shift. The relevant physician, after checking the information and making sure that it is complete, according to the request made or the content of the consultation, presents it to the relevant specialist and receives the answer. The response to the consultation is sent to the requesting center with the opinion of the coordinating physician and the nurse in charge of the shift. Other consultations and follow-up of patients will be the responsibility of the coordinating physician .

(Real time)  Emergency counseling :  In this type of counseling, communication must be established simultaneously and live. Dr. Masih Daneshvari is in charge of communicating as in the above case with a trained nurse and the person responsible for responding to the advice of a specialist physician residing in the intensive care unit of the hospital. In this type of counseling, in order to complete the patients' files, it is necessary to fill in information forms and the steps of sending and receiving information similar to non-emergency counseling are done.

Consulting process :
First, the patients are visited by the responsible physician (or in the absence of the physician, the highest therapist in each shift). . Test results, ECGs, radiographs, and other paraclinical images are transferable. Non-emergency consultations are first saved as a completed file and then sent to a specialized center. In the specialized center, while recording a copy of the patient information, a written response to the consultation is prepared, a copy is recorded in the records and then sent to the counseling center. If there is a need for a direct visit of the patient by a specialist, such as direct observation of the lesions or the appearance of the patient, an appointment will be made with the counseling center. Emergency counseling cases are requested in writing first and the above steps are completed in full. In cases where there are no conditions for written communication, in order to address the patient's condition as soon as possible, the communication is established only in the form of a direct image and the face-to-face consultation video is saved in two copies at the origin and destination. It should be noted that after the consultation and receiving the final answer, a copy of the consultation sheet stamped by the physician requesting the consultation and the respondent to the consultation should be kept in both centers for administrative and financial matters. The time of exchanging forms between the two centers will vary from a minimum of once a month to a maximum of once every six months, based on the number of consultations. It should be noted that after the consultation and receiving the final answer, a copy of the consultation sheet stamped by the physician requesting the consultation and the respondent to the consultation should be kept in both centers for administrative and financial matters. The time of exchanging forms between the two centers will vary from a minimum of once a month to a maximum of once every six months, based on the number of consultations. It should be noted that after the consultation and receiving the final answer, a copy of the consultation sheet stamped by the physician requesting the consultation and the respondent to the consultation should be kept in both centers for administrative and financial matters. The time of exchanging forms between the two centers will vary from a minimum of once a month to a maximum of once every six months, based on the number of consultations..