(Ipoh, Monday):"Telemedicine" refers to the use of electronic communication and information technologies to provide or support clinical care at a distance.
Telemedicine, in one form or another, has been practised for over thirty years. At the simplest level, a consultation over the telephone for a second opinion is telemedicine. Today, however, we think of telemedicine applications that employ advanced image as well as audio capabilities. These technologies can range from high resolution still images (e.g., x-rays) to sophisticated interactive teleconferencing systems.
I have been reading some materials on telemedicine in the United States. It has been described as having the potential to make a difference in the lives of many Americans. For example, telemedicine can improve the delivery of health care in Amercia by bringing a wider range of services such as radiology, mental health services and dermatology to communities and individuals in underserved urban and rural areas. In remote rural areas, where the distance between a patient and a health professional can be hundreds of miles, telemedicine can mean access to health care where little had been available before. In emergency cases, this access can mean the difference between life and death. In particular, in those cases where fast medical response time and specialty care are needed, telemedicine availability could be critical.
I believe a similar case for telemedicine can be made for Malaysia. However, there is a need for a nation-wide debate as to whether telemedicine is a viable health care delivery option for Malaysia at this stage of our development and whether it can provide cost-effective medical services within the reach of ordinary Malaysians.
Apart from the various technical, legal and medical issues of telemedicine including those of patient safety, quality of services and malpractice liability, which have to be addressed by all countries practising telemedicine, Malaysia has our own specific problems which must be dealt with first.
For instance, there is the question of trade-off between potential health benefits in terms of access, efficiency, speed of information transfer and the cost of infrastructure.
Simple "store and forward" equipment to transmit recorded images for later review by a specialist might require only standard telephone lines at normal transmission rates. The transmission of chest x-rays using digitized uncompressed images (2 new films, plus 2 old films for comparison) requires approximately 7 hours over a 14.4 kbps modem, 3.5 hours over a 28.8 kbps modem and only 40 minutes over a more costly ISDN line, but only 4 minutes over a T1 (at 1.5 mbps) line. Of course, Asynchronous Transfer Mode (ATM) using 155 mbps transmissions can provide very high resolution imaging together with rapid transfer of information suitable for applications that need very accurate and detailed imaging.
However, there is a major difference between the US and Malaysia in determining whether telemedicine is a viable health care delivery option, as in the United States, even in the most remotest rural areas, there are good telecommunications infrastructure where telephone services are quite ubiquitous. This is however not the case with Malaysia. In fact, there are 1,273 schools in the country without electricity supply or with only limited power supply. Furthermore, there is no steady quality electricity supply by Tenaga Nasional - which registers over 100,000 power interruptions in a good year!
Furthermore, the biggest healthcare problem in Malaysia is still on very elementary questions of basic medical and health services, with many hospitals without the minimum of beds, staff, hospitals or infrastructure - including telecommunications infrastructure which excludes the possibility of telemedicine as a viable option.
In these circumstances, there should be a nation-wide debate whether Malaysia should take to telemedicine in a big way or whether the country should be focussing on ensuring that all Malaysians, including those in the remotest rural areas, can have access to the most basic health and medical needs.
DAP will propose at least two amendments to the Computer Crimes Bill, one a "Spiderman" clause and another to empower the court to order payment of compensation for the offence of unauthorised access, which is provided in many national legislation on computer crimes.
The Computer Crimes Bill is providing the toughest penalties in the world where a person who is guilty of unauthorised access to computer material would be punishable to a maximum fine of RM50,000 or five years� jail or both.
However, there is no saving clause to exempt hackers who gain access to computers with no criminal or malicious intent, as in the case of the two TMnet hackings last month - which were to highlight public unhappiness with the poor TMnet services and to point out its poor security system.
In fact, under the Computer Crimes Bill, the two TMnet hackers would be regarded as criminals liable to the more serious charge of unauthorised modification of the contents of any computer under section 5 of the Bill, where the maximum penalties are RM100,000 fine, seven years� jail or both.
Recently, the "French Spiderman", Alain Robert was arrested by the police for trying to scale one of the Petronas Twin Towers, the world�s tallest building on March 20 - after climbing 60 floors of the 88-storey building.
However, the Attorney-General�s Chambers decided not to prefer any charges against him for trespassing.
The Computer Crimes Bill should have a "French Spiderman" provision to exempt hackers with no criminal or malicious intent and which result in better computer security systems from prosecution.
The computer crime law should make a distinction between "hacking" and "cracking", the latter connoting malicious computer meddling, while in its original technological sense, the word "hacker", coined at the Massachusetts Institute of Technology (MIT) in the 1960s, simply connoted a computer virtuoso. The 1994 edition of the New Hacker�s Dictionary defined such a person as someone "who enjoys epxloring the details of programmable systems and how to stretch their capabilities; one who programs enthusiastically, even obsessively".
The ethics of "responsible hacking" included the following ideals:
The finest software pioneers in the United States were proud to be called hackers. The government should enlist the support of the computer whizz-kids who breach computer security defences for sport and could tell the experts how they do it, so as to improve on the information security systems.
The second amendment being considered by the DAP Parliamentary Working Group on the Cyberbills is present in the Singapore legislation on computer crimes. Section 10 of the Singapore Computer Misuse Act 1993 provides that the court may order a person convicted of a computer crime to make a payment of a sum to be fixed by the court by way of compensation to any person for any damage caused to his computer, program or data.
This Singapore section on "Order for payment of compensation" further provides:
"10 (3) An order of compensation under this section shall be recoverable as a civil debt.""10 (2) Any claim by a person for damages sustained by reason of the offence shall be deemed to have been satisfied to the extent of any amount which has been paid to him under an order for compensation, but the order shall not prejudice any right to a civil remedy for the recovery of damages beyond the amount of compensation paid under the order.
As computer crimes of unauthorised access and unauthorised modification can cause astronomical financial losses, such a provision on compensation for damages caused would be most apt and pertinent.
(21/4/97)