Integrating Telemedicine into a National Diabetes Footcare Network

Abstract

In a large country such as Australia, using telemedicine in management of diabetic foot disease may minimise unnecessary patient travel and also facilitate regular clinical monitoring. We tested a cost effective simple clinical system that accommodates routine and urgent consultations between an urban Diabetes Centre and rural sites. Routine consultations are organised by prior arrangement without the patient needing to be present. Process includes: (a) Digital images of foot e-mailed in advance to enable the Diabetes Centre foot team to review before phone linkup, (b) Images displayed on computer monitors during the phone linkup, (c) Patient management plan documented at both urban and local sites and implemented locally. Urgent consultations are booked on demand. The only limiting factor is the time taken for images to arrive at the Diabetes Centre. It is essential that at least one person from the Diabetes Centre foot team is available for immediate advice until further review can be arranged. We conclude that telemedicine is a useful adjunct to networking between rural and urban diabetic foot treatment services. It facilitates routine clinical care, allows for urgent consultations, research and ongoing training of this serious diabetic complication. This simple system is very portable relying on e-mail, and thus has the potential for use in very remote regions of Australia and in countries where diabetic foot services are limited. Copyright © 2000 John Wiley & Sons, Ltd.