FaceTime with Apple and Information Technology

Abstract

Sir:FigureFaceTime, an application found on the iPhone 4 and iPad from Apple, Inc. (Cupertino, Calif.), allows users to experience real-time video conferencing on their cellular device. With the click of one or two buttons, users are connected face-to-face in any location that has Internet service. As described in an article in Vein Therapy News, a surgeon at the University of Arizona's Southern Arizona Limb Salvage Alliance was able to instantly connect with the associate director of Valley Presbyterian Hospital Amputation Prevention Center in Los Angeles for a real-time wound consultation.1 Evaluation of more emergent issues with the assistance of video consultation has been shown to achieve higher diagnostic accuracy in other fields, including neurosurgery.2 This technology can profoundly impact the field of plastic surgery, increasing its outreach throughout medicine. The evaluation of a wound is one of the most frequent consultations received by any plastic surgery service or surgeon. Initial, over-the-phone recommendations are often held until the surgeon has physically “laid eyes” on the wound. Discrepancy between the initial description of the wound and the severity of the defect can handicap prioritization of consultations and diminishes efficiency. FaceTime and similar programs address these shortcomings by taking advantage of “newer, digital, dynamic, image-based learning” that can increase the dissemination of plastic surgery knowledge.3 Since the release of some of the first camera/mobile phone combined devices, text messaging of images has been used as a means of communicating photographs of wounds. Although we have found this to be of great benefit at our institution, photographs do not allow real-time manipulation of camera angles, nor do they allow for real-time conversation with the patient or consulting physician. Very little regarding functional status, such as range of motion or strength, can be ascertained from still images. As Plastic and Reconstructive Surgery releases applications to enhance its visual and auditory content beyond static text and pictures, we believe that the same technology will augment the practice of seeing wound consultations. A role for video consultation has already been identified in numerous Internet-based programs that facilitate direct physician-to-physician interaction. Such programs have been used in different settings, including real-time consultation between Level I trauma centers and rural community hospitals.4 Unfortunately, application of these systems has been limited by the need for transportable computers, cameras, and software. However, with FaceTime, the hardware and software infrastructure—the absence of which has been prohibitive in the past—is already in place. Using this technology, the plastic surgeon can visualize the important details necessary in evaluation and can thereby give initial recommendations without delay. The plastic surgeon is then more likely to effectively delegate responsibilities to different members of the wound care team. The evaluation of amputations, for example, could take place with wound-specific initial instructions to the patient and providers remotely. Mobilization of appropriate resources before patient arrival may increase efficiency while decreasing costs and optimizing patient outcomes. Indeed, nothing will replace being at the patient's bedside. The hope is that this technology equips plastic surgeons in ways that provide more time to be with those patients who need our specialty the most. Ajul Shah, M.D. Charles Tuggle, M.D. James E. Clune, M.D. Derek Steinbacher, M.D., D.M.D. Anup Patel, M.D., M.B.A. Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn.