Telemedicine protocols and standards: development and implementation

A review of telematics in healthcare: evolution, challenges and caveats

Telemedicine is a fast-growing field, currently at the forefront of research in healthcare informatics. In this paper, we examine the challenges faced by the advent of telemedicine and the potential impacts on healthcare. We focus on the challenges of communication and collaboration in two areas: clinical applications, and education and training. Telematics its clinical applications, and education and training in healthcare telematics, are closely inter-linked. The provision of quality training and education, both as part of the clinical curriculum and also externally to practising clinicians, will play an important role in the success of telemedicine. Conversely, the development of new telemedicine applications, particularly those that provide information or decision support, is likely to change the role and skills required of clinical practitioners and thus affect the form and content of education programmes. Much work is still necessary to understand how this can best be achieved; small-scale practical studies together with formative multi-perspective evaluation studies are important steps towards realizing these benefits.

Telemedicine

Telemedicine began from the humble beginnings of the first telephone call from Alexander Graham Bell to his associate, Watson. These systems already have been used for educational programs, consultative care, image transfer, second opinions, and direct acute patient care. Most of the original programs failed because of several reasons, primarily because of lack of funding when a grant ended. The major lesson of these programs is that a solid business plan is needed initially for long-term survival. The reliability of telemedical examinations has been demonstrated superficially, but more conclusive work in this area is needed. Studies that evaluate clinical, financial, and satisfaction outcomes are required simultaneously. Further integration of medical informatics into telemedicine systems is needed before these systems can achieve more acceptance. Twenty years ago, few people predicted this technologic revolution. Innovations arise almost daily. The future seems promising for telemedical systems, but much work is required. Partnerships with industry must move beyond niche projects, and regulatory and medicolegal issues must be resolved. Anesthesiologists can expect their practice to be affected directly by technology, and should embrace it, evaluate it, and help lead its use in this millennium.

The experience of the Royal Children's Hospital Mental Health Service videoconferencing project

In April 1995 the Royal Children's Hospital Mental Health Service in Melbourne piloted the use of videoconferencing in providing access for rural service providers and their clients to specialist child and adolescent psychiatric input. What began as a pilot project has in two years become integrated into the service-delivery system for rural Victoria. The experience of the service in piloting and integrating the use of videoconferencing to rural Victoria has been an important development for child and adolescent mental health services in Australia.

Practical evaluation of telemedicine systems in the real world

There are six key questions that need to be asked before the evaluation of any telemedicine project. These are: who, why, what, when, where and how? Evaluation, and the subsequent communication of the results, is central to the development and implementation of any telemedicine system. As telemedicine technologies and processes gradually mature the extent and breadth of evaluations relevant to these technologies will undoubtedly improve and it is to be hoped that telemedicine systems will prove themselves as clinical tools.

Telemedicine; here to stay

Telemedicine is a technology of the future, available today. Here, we describe successful telemedicine systems used across Australia and review barriers to further implementation. Greater academic and multidisciplinary involvement, as well as adequate funding, is needed for the further development and evaluation of these systems.

Applications of the World Wide Web to neurosurgical practice

OBJECTIVE

The objectives of the New York University (NYU) neurosurgery Web resource are the following: 1) to educate patients and families of patients who have neurosurgical problems, 2) to provide a forum for communication among neurosurgeons and other physicians, 3) to educate neurosurgeons, and 4) to provide neurosurgeons with resources for enhancing their practices.

METHODS

The NYU neurosurgery Web resource resides on a Sun SparcStation 20, running Solaris 1.0 and National Center for Supercomputing Applications httpd 1.0. It is aimed at a broad audience that includes the general public as well as practicing neurosurgeons and other physicians. Accordingly, general information regarding a variety of neurosurgical problems is presented in easy-to-understand language. Material intended specifically for neurosurgeons, such as case discussions, is designed to stimulate discussion and encourage outside submissions. Interaction with the NYU faculty and residents may be accomplished by using electronic mail, file transfer protocol, and direct Web postings. Media in development include java applets and real-time video over the Internet. The uniform resource locator for the NYU neurosurgery Web site is "http:/(/)mcns10.med.nyu.edu/".

RESULTS

The Web site has averaged 1800 accesses per month, and 5 to 10 electronic mail messages are received daily. Several patients for whom our faculty have held consultations over the Web have undergone surgery at NYU. The most popular areas of the Web site are the spinal surgery section and the brain tumors section.

CONCLUSION

The ability to capitalize on the World Wide Web as a facile user is becoming an increasingly important skill for the modern neurosurgeon. In addition, Web sites published by neurosurgeons offer opportunities for communication and consultation that have previously been impossible.