Telemedicine: An Educational and Healthcare Tool

Abstract

Accessible online at: www.karger.com/journals/mpp Telemedicine literally means ‘medicine at a distance’. It is about bringing specialist knowledge to the patient and doctor from afar by use of communications technology. Using telecommunication networks to communicate information, it provides health care consultation and education. Physicians, hospitals and medical schools have been exploring the uses of telemedicine since 1964, however, it was only in the late 1980s and the 1990s that its practical applications were recognised and started being evaluated. There is increasing interest in the use of telemedicine as a means of health care delivery and to its increasing relevance as an educational tool at both the undergraduate and postgraduate level. This is partly because technological advances have made the equipment less expensive and simple to use. Indeed, in the United States of America, telehealth is a major growth area. A 1997 survey reported 139 active programmes, conducting over 40,000 non-teleradiology consultations in 35 specialties, primarily mental health, cardiology, ophthalmology, orthopaedics and dermatology. About 75% of these utilised video conferencing; the others used store-and-forward formats. About 20% of consultations were carried out in prisons. In the same year, there were about 250,000 diagnostic teleradiology readings, with teleradiology becoming a significant commercial activity. In August 1996, Norway became the first country to implement an official telehealth fee schedule, making all telehealth services reimbursable by the national health insurer. Although telephone consultation falls within the broad definition of telemedicine, the term is usually taken to refer to more sophisticated applications such as video conferencing and the transmission of medical images. Modern digital cameras can reproduce diagnostic quality images of clinical features, of ECGs, and of microscopic films; they can also reproduce high quality images of most radiographs. This system has been successfully used by British Forces in the war zones of Bosnia and Kosovo and is now being emulated in civilian practice in the UK, USA and in previously isolated hospitals in the Third World. Indeed, the US armed forces in Kuwait carried out a study to determine the relative ease with which an offthe-shelf ophthalmic telemedicine package could be successfully applied from within a remote theatre of operations and found that it could be successfully used from a remote deployed site. Indeed, telemedicine has proved itself both from the technical and clinical aspects. Telemedicine has been used for undergraduate, graduate and continuing medical education (CME). Video conferencing has been used for meetings, tutorials, presentations and training events. It has made it possible for medical, pharmacy and nursing students to receive part of their education at distant sites. INSURRECT is a programme which provides interactive on-line teaching in surgical procedures for medical undergraduates in hospitals in Cambridge, London, Newcastle, Manchester, Bristol and Edinburgh. Indeed, this educational tool is also being applied in other specialities.