Remote management of haemodialysis patients: Design and implementation of a telemedicine network

Abstract

Summary. Telemedicine applications have been implemented in many clinical specialties. Some, like teleradiology, are now established applications with specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Project Phoenix, a National Library of Medicine funded project set up to look at the access, cost and quality implications of telemedicine in a renal dialysis setting, we are establishing such protocols and standards. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and Information Systems (ISIS) Center of the Department of Radiology, the Clinical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a remote outpatient dialysis clinic, and a nephrologist's home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. This paper shows that the first step in establishing standards and operational protocols for various clinical applications is to start with specific clinical needs assessment followed by an iterative process of reassessment and evaluation. This allows flexibility and a dynamic approach in the optimal system design.