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PubMed1997

An architecture for naval telemedicine.

Navy fleets have a defined overall objective for mission readiness impacted by the health of personnel aboard the ships. Medical treatment facilities on the ships determines the degree of mission readiness. This paper describes the concepts and technologies necessary to establish a Naval telemedicine system, which can drastically improve health care delivery. It consists of various combinations of the following components: Fleet Naval Medical Consultation and Diagnostic Centers, Shipboard Naval Medical Consultation and Diagnostic Centers (hospital ship or combatant ships with medical specialists on board), and Remote Medical Referring Centers such as a ship, a small Naval station annex, or a field hospital. This Naval telemedicine architecture delivers clinical medicine and continuing medical education (CME) by means of computers, video-conferencing systems, or telephony to enhance the quality of care through improved access to research, medical and nonmedical imaging, remote consultations, patient clinical data, and multimedia medical education programs. It integrates the informatics infrastructure and provides a medical telepresence among participants.

Computer Systems↗
PubMed2004

Internet consultations from a remote Pacific island: impact of digitized radiologic images on referral decisions.

A study was carried out to determine whether digitized radiologic images added valuable information to Internet consultations from a remote Pacific Island. Chuuk State Hospital (Federated States of Micronesia) has limited film screen radiology, minimal ultrasound capability, and no radiologist. Providers initiate Web-based referrals for consultation or patient transfer. Digitized images (via low-cost digital camera or flatbed scanner) were uploaded to a Web site. Images were assessed for impact on referral decisions. A radiologist scored image quality and confidence (scale: 1-7). Of 97 referrals with images that were reviewed, 74 (76%) image sets were abnormal, 20 (20%) were normal, and 3 (4%) were indeterminate. Median scores were 4 for image quality and 5 for diagnostic confidence. In most cases with abnormal radiology (52/74, 70%), images were considered valuable. Radiologic images digitized with a low-cost camera or flatbed scanner provided valuable information for decision making in an Internet-based consultation and referral process from a remote, impoverished Pacific Island jurisdiction, despite relatively low image quality.

Humans↗
PubMed2002

Tele-3-dimensional computer-assisted functional endoscopic sinus surgery: new dimension in the surgery of the nose and paranasal sinuses.

One of the main objectives of our 3-dimensional (3D) computer-assisted functional endoscopic sinus surgery was to design a computer-assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high-speed, wide-bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele-flythrough or tele-virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele-3D computer-assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.

Adult↗
PubMed2003

A clinical and educational telemedicine link between Bulgaria and Greece.

During its transition to a market economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports: an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities; electronic design and publishing activities; Web hosting and mail server activities; and satellite communications. Communications are via ISDN. The main clinical experience has been remote consultations in immunology. This experience (admittedly limited) demonstrates that telemedicine can be used to provide assistance to remote colleagues. In addition, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers in cases where the patient cannot communicate with the attending physician because of a language barrier.

Bulgaria↗
PubMed2004

A clinical and educational telemedicine link between Bulgaria and Greece.

During its transition to a free economy, Bulgaria benefited from foreign aid provided by Greece. One of the projects was the clinical and educational telemedicine link between the Medical University of Varna in Bulgaria and the Faculty of Medicine of Aristotle University of Thessaloniki in Greece. This began in 1997. In terms of the educational activities, the Bulgarian side of the network supports (a) electronic design and publishing activities, (b) web hosting and mail server activities and (c) satellite communications. In addition it supports an electronic classroom equipped with personal workstations, multimedia projectors and videoconference facilities. Communications are via the ISDN network. In terms of its telemedicine activities, the network provides remote medical assistance to "language handicapped" travellers and to migrant workers in both countries. The main clinical experience is remote consultations in immunology. This admittedly limited experience demonstrates that telemedicine can be used to provide assistance to remote colleagues. In cases where the patient cannot communicate with the attending physician, the use of telemedicine can greatly improve the quality of care available to travellers and migrant workers.

Bulgaria↗
PubMed1994

Teleconsultation of patients with otorhinolaryngologic conditions. A telendoscopic pilot study.

OBJECTIVE: We have integrated endoscopic equipment with a network of video conference studios to develop a remote consultation service for diagnoses of patients with otorhinolaryngologic conditions. DESIGN: The study was performed as a diagnostic test in three phases. During the first phase, a general practitioner was instructed in otorhinolaryngologic examination techniques. In the second phase, remote endoscopic examinations were simulated and the diagnostic results were compared with results from a standard examination. In the third phase, the general practitioner made real telendoscopic examinations. SETTING: Signals from a video camera attached to the endoscope are transmitted from the primary care center to the otorhinolaryngologist who is 180 km away via a 2-million-bits-per-second circuit. The specialist observes the endoscopic examination on a monitor and influences the control and movement of the endoscope by communicating over a two-way sound-and-picture connection with the general practitioner. PATIENTS: A convenience sample of 24 patients was examined in the last two phases. RESULTS: Although the video image is compressed before transmission over the telecommunications network, our results show that the quality of the transmitted images was equivalent to the quality of the images from a standard endoscopic examination. CONCLUSIONS: Our study has shown that this method of consultation may be used in the clinic with the same degree of reproducibility as in a conventional consultation situation. This enables us to give patients in remote locations better service at a lower cost.

Adolescent↗
PubMed2002

The image pyramid system--an unbiased, inexpensive and broadly accessible method of telepathology.

Although computerised information technology, including the Internet is broadly used and globally accessible it is still not a significant form of professional communications in diagnostic histopathology. The high cost of interactive dynamic telepathology systems makes their use limited outside the richest economies. In contrast static telepathology systems are relatively cheap but in practice their information content can be heavily biased by the choice of images sent by the consulting pathologist. The degree of this bias may be regarded simply as the amount of information transferred to a remote location expressed as a percentage of the total information present in the histological sample. We refer to this as the percentage of explicit versus implicit information. Another major source of bias may be found in the information transmitted in written or verbal discussion with a remote consultant. We have developed a system of static telepathology, the image pyramid, which attempts to minimise bias by transferring all of the information in a section to the consultant. It is inexpensive and should prove to be widely accessible.

Data Display↗
PubMed2006

Computer-assisted surgery and computer-assisted telesurgery in otorhinolaryngology.

Surgical preparation is enhanced by the availability of computer-generated three-dimensional models that allow surgeons to explore the surgical field in various projections prior to an actual operation. In fact, with adequate computed tomography images, an entire operation can be simulated beforehand so that surgeons can plan the safest and most effective approach and be prepared to avoid or overcome obstacles during the actual procedure. Also, computer technology allows surgeons to conduct remote consultations and to even perform telesurgery--that is, to operate on a patient from a great distance. In this article, we describe our experience with computer-assisted local and remote endoscopic sinus surgery in Croatia.

Computer Communication Networks↗
PubMed1998

WWW-based access to object-oriented clinical databases: the KHOSPAD project.

KHOSPAD is a project aiming at improving the quality of the process of patient care concerning general practitioner-patient-hospital relationships, using current information and networking technologies. The studied application field is a cardiology division, with hemodynamic laboratory and the population of PTCA patients. Data related to PTCA patients are managed by ARCADIA, an object-oriented database management system developed for the considered clinical setting. We defined a remotely accessible view of ARCADIA medical record, suitable for general practitioners (GPs) caring patients after PTCA, during the follow-up period. Using a PC, a modem and Internet, an authorized GP can consult remotely the medical records of his PTCA patients. Main features of the application are related to the management and display of complex data, specifically characterized by multimedia and temporal features, based on an object-oriented temporal data model.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Distance diagnosis of skin diseases].

During a period of eight weeks in late 1989, doctors in general practice in Kirkenes brought 27 dermatological patients to a studio at the local hospital. Video images were transmitted via a two-way telephone and video network, which enabled the patient and the doctor in Kirkenes to consult a specialist in dermatology in Tromsø. All the patients received written information before the consultation. Anamnestic information and clinical manifestations were presented from the studio at Kirkenes sykehus. The dermatologist diagnosed the disease and prescribed treatment from the studio at the hospital in Tromsø. The technical equipment satisfied our demands for remote diagnostics in dermatology. All the patients were positive to remote consultations.

Computer Communication Networks↗
PubMed1997

Expert pathology consultation through the Internet: melanoma versus benign melanocytic tumours.

Twenty consecutive cases of melanocytic lesions were chosen from the archives of the archives of the institute of Anatomic Pathology at Santa Chiara Hospital, Trento. Representative images were acquired at a spatial resolution of 512 x 512 pixels, saved in IPEG format and delivered to the remote pathologist by multimedia internet electronic mail. Six cases were diagnosed as benign melanocytic lesions by the local pathologist. Of the 20 cases transmitted, each with an average of 5.3 images, the remote pathologist suggested a diagnosis of malignancy in nine cases while 10 cases were thought to be benign. In one case the images were not considered sufficient for diagnosis. Overall, the diagnostic agreement between local and remote pathologist was 79% (kappa = 0.58, P = 0.002). This preliminary study suggest that telepathology by internet electronic mail can be a valuable tool for remote consultation in dematopathology, as well as for other diagnostic fields where expert consultation is necessary.

Computer Communication Networks↗
PubMed1996

Fetal telemedicine: six month pilot of real-time ultrasound and video consultation between the Isle of Wight and London.

DESIGN: Prospective audit of first six months. SETTING: Referral from a district general hospital on the Isle of Wight to a comprehensive tertiary referral service, the Centre for Fetal Care at Queen Charlotte's Hospital 120 km away in London. PARTICIPANTS: Women whose pregnancy was suspected, or at risk, of fetal abnormality. INTERVENTIONS: Remote consultation by transmitting ultrasound and video in real-time over ISDN 30 telephone lines. Contemporaneous questionnaire to referring practitioner and patient. MAIN OUTCOME MEASURES: Frequency, indication, technical success and duration of consultation. Qualitative and semi-quantitative image quality. Effect of teleconsultation on need for physical referral. RESULTS: Twenty-nine women underwent 39 teleconsultations, and image quality was sufficient for diagnosis in all but one. Fetal abnormalities were present in 76%. Referral in person was required for only four women, significantly fewer than the 13 the referring hospital indicated would have been physically referred in the absence of this service (P < 0.001). Most mothers were counselled by the specialist "face-to-face' over the link, and 80% felt teleconsultation reduced their anxiety. CONCLUSIONS: A fetal telemedicine service is technically and clinically feasible. This demonstration suggests that such a service reduces the need for physical referral while increasing the rate of consultation, allowing better selection of patients who might benefit from referral. Further evaluation in a variety of clinical settings is now indicated, along with cost-benefit analysis.

England↗
PubMed1998

Digital wireless radiology consultations with a portable computer.

A wireless system for radiological subspecialist consultation based on a portable personal computer and a GSM cellular phone was tested. A link with secure access to the hospital image network was built. A total of 68 emergency computerized tomography (CT) examinations were transmitted. Transmission time via GSM for a single CT image was 1 min and for a complete head scan was 18 min. The transmitted images were acceptable for final diagnosis in 72% of the cases, the rest being acceptable for preliminary diagnosis. The diagnosis from the transmitted images did not change after a later review of the original images in 97% of cases. The wireless link saved a hospital visit by the senior radiologist in 24% of cases. The results show that a remote consultation link can be built with readily available technology and that the technique is useful in radiological subspecialist consultations for CT images.

Adolescent↗
PubMedDate not supplied

The electronic house call. Consequences of telemedicine consultations for physicians, patients, and society.

Within the next 10 years, telemedicine technology is likely to become widely available in physicians' offices and patients' homes. Rather than describing the technology of telemedicine, we discuss the implications of its widespread use among physicians, patients, and society as a whole, focusing on that mainstay of communication between physician and patient, the "electronic house call." After exploring the new relationship that is likely to develop between patients and physicians as a consequence of the use of telemedicine, we discuss the broader economic, legal, and political consequences of the widespread use of this technology.

Communication↗
PubMedDate not supplied

Profile of users of real-time interactive teleconference clinical consultations.

BACKGROUND: Real-time interactive teleconference clinical consultations are envisioned for increasing accessibility to medical care by patients whose demographics restrict care. There are no published studies, however, describing referrals and the referring practitioners, patients, and specialists participating in these consultations. OBJECTIVE: To assess characteristics of participants of interactive teleconference clinical consultations. DESIGN: Descriptive study, February 1, 1996, through April 30, 1999. SETTING: Eastern North Carolina: Brody School of Medicine at East Carolina University and 7 rural hospitals and clinics in its telemedicine network. SUBJECTS: Rural practitioners requesting consultations (n = 76), consulting physicians (n = 40), and patients completing evaluations following consultations (n = 495). MAIN OUTCOME MEASURES: Demographic and descriptive variables for referring providers, patients, and consulting physicians relative to the population in the region and to patients and physicians at the East Carolina University School of Medicine clinics. RESULTS: The largest number of referrals (65.2%) were made to obtain a second opinion or recommend a management plan in dermatology (33.5%), allergy (21.0%), or cardiology (17.8%). Significant patient characteristics were race (56.8% minorities), age (19.6% < or = 10 years old and 26.0% > or = 59.0 years old), sex (59% females), and insurance status (10.7% no insurance, 33.7% Medicaid, 15.4% Medicare). In addition, 38.0% had household incomes below the poverty level. Only 5.2% of the patients would have been treated by the referral practitioner, making travel necessary for consultation. Demographic characteristics of the practitioners were not statistically different. CONCLUSIONS: Participants of interactive teleconference clinical consultations are patients whose access to medical care might otherwise be limited. Use of telemedicine by practitioners is not related to age or sex. Arch Fam Med. 2000;9:1036-1040

Adolescent↗
PubMed2004

[Interdisciplinary surgery and telemedicine].

Surgical therapy is becoming increasingly complex. Besides new surgical techniques, sophisticated diagnostic methods and innovative interventional procedures must be integrated into the therapeutic concept to increase the efficacy of surgery. Accurate application of these techniques requires close cooperation between surgeons, other medical specialists, and technicians. Consequently, there is a significant need for structures promoting efficient communication, organization, and interaction in surgical departments. New techniques developed from telecommunication and information technology enable the transferal of complex medical data at any time to any place and are therefore the basis for telemedical applications. Telemedicine and other new techniques such as virtual operation planning, simulation, and intraoperative navigation promise to increase the efficacy of surgical therapy in the future. This paper provides an overview of the applications of telesurgery and currently available techniques.

Computer Communication Networks↗
PubMed2005

[Teledermatology versus consultations--a comparative study of 120 consultations].

Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

Adolescent↗
PubMedDate not supplied

Update on digital image management and PACS.

Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. The major benefit of PACS resides in its ability to communicate images and reports to referring physicians in a timely and reliable fashion. With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.

Costs and Cost Analysis↗