Telemedicine as an Aid to Clinical Practice, Research and Education in Plastic Surgery

Abstract

Telemedicine has the potential to expedite and improve the delivery of high-quality, costeffective care by extending the reach of health care practitioners (or patients themselves) beyond their local setting, using advanced information technologies. Plastic Surgery relies to a significant degree on visual modes of telemedicine to transfer medical information for diagnostic, physical examination, and outcome measure purposes; therefore, this specialty in particular, derives major benefits from telemedicine. At the same time, telemedicine benefits from Plastic Surgery by providing an opportune model for research and for testing new developments in this technology. The two basic modes of telemedicine applications: store and forward (asynchronous transfer) and real time transmission (synchronous transfer, e.g., videoconference) are both utilized in the plastic surgery setting. Intense reliance on both static and dynamic images distinguishes this specialty to an even greater degree than dermatology as a model for telemedicine research and development as well as for an educational tool (Meyer & Friedman, 2010). Both physicians and patients have been surveyed for their perspectives on the introduction of telemedicine in plastic surgery, and their acceptance for the technology is high. Both parties assign telemedicine positive ratings in satisfaction surveys, although some potential problems with practical solutions have been noted and will be presented below. Objectives of early studies included assessing the accuracy and usefulness of telemedicine consults in aesthetic surgery, reconstructive surgery, and problem wound care. Comparisons were made between consultations provided via telemedicine to those provided by a direct or face-to-face consultation. The specificity, sensitivity, and positive predictive values of equivalent (or different) diagnosis and potential treatment plan were calculated. We made the assumption that a correct diagnosis and indication (or lack thereof) for surgical intervention was established during direct consultation. Agreement levels between the two assessments (telemedicine and face-to-face) were judged by an independent surgeon. Typically, agreement rates were categorized as follows: total agreement, trivial disagreement (error not changing the overall management plan), and clinically important disagreement (error requiring change of approach after face-to-face consultation). Many studies show evidence of adequate overall accuracy of telemedicine as a tool in research, education and clinical practice in plastic surgery (Dobke MK et al., 2006; Dobke MK et al., 2007; Dobke MK et al., 2008; Dobke MK & Gosman A, 2009; Gosman A et al, 2009).