PubMed · 10437489
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M Halls. Tax avoidance.. https://pubmed.ncbi.nlm.nih.gov/10437489/
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BACKGROUND: Distant diagnosing by two-way interactive motion video (videoconference) appeared in the 1980s, the last four years with weekly teleconsultations to Hammerfest and Kirkenes. MATERIAL AND METHODS: Patients are mostly referred from general practitioners. A physician with a 20% position is responsible for organising the videoconferences and participates in the consultation. A close-up camera is used for detailed examination of skin lesions. Photographs of skin areas may be transmitted directly to the specialist screen (still images). The studio physician writes prescriptions and sick leave notes. The specialist writes a reply to the referring physician. Referrals using still images are as yet at a pilot stage. RESULTS: Patients view early diagnosis, time saved, reduced costs, and less need for leave from work as important advantages with videoconferences. Patient satisfaction is high, although 10% are dissatisfied. Having a physician in the studio makes patients feel safer, and they understand the specialist better. This is a new role for the specialist; the doctor/patient relationship is often taken care of by the studio physician. Comparisons between videoconference and face-to-face consultations have shown up to 90% diagnostic agreement. A pilot study using still image referrals showed similar results. INTERPRETATION: Videoconferences are well suited in everyday dermatology, when follow-up by specialist is necessary, and for patients in regular treatment at local clinics for skin disease. Still image referral seems promising. The studio physician's diagnostic abilities are enhanced. Many patients are not suited for teleconsultation, but telemedical solutions will have a role in the years to come.
BACKGROUND: Our aim was to evaluate one year of operation of a newly established teleradiology service for people in Mid- and North Gudbrandsdalen (30,000 inhabitants). In Otta, one radiographer works with digital pictures (phosphorus plate technology). Pictures are sent to the local hospital in Lillehammer (115 kilometres away) by a broadband network (for health services only) for radiological evaluation. MATERIAL AND METHODS: We have measured the scope of the service, patient satisfaction, management stability and efficiency, and financial aspects (the latter are not included in this article). RESULTS: Over one year we have examined 3,081 persons (skeleton, thorax, sinuses). A majority of patients (90%) thought it was better for them to be examined at Otta. Waiting time was short, rarely more than one week. No re-examinations due to insufficient picture quality were required. Some expected and some unexpected problems occurred. Pictures from 37 patients were lost and could not be radiologically evaluated. The lead time from when pictures were taken to when the requisitioning doctor received the report, was too long (one to three weeks). The digital pictures are not easily available to hospital physicians. Copies must be made on film. INTERPRETATION: Our experience is positive. Most problems will be solved by storing copies at Otta, by better organisation of the radiologic service, and by establishing a digital picture archiving and communication system (PACS) at the hospital.
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