Telemedicine--future implications.

Abstract

Telemedicine, or “distance independent medicine”, offers today an opportunity to improve access to specialist medical care even in the most remote areas. It has the potential to significantly influence on the three main components of health care delivery, access and quality. There are well developed techniques for high quality transmission between health care institutions e.g. teleradiology and telepathology. In the prehospital setting there may be loss in the quality of transmission but promising introduction of ECG transmission is now in use. We have showed that telemedicine is possible with GSM for prehospital care. It has been very attractive in military medicine and since a few years the system is used and evaluated in different areas of the world by the US Army. The optimal situation for distance medicine is to send specialist competence to remote medical care centers and small hospitals, where there is sufficient facilities to perform qualified initial treatment. Based on the patients condition a decision could be made, whether the patient needs specialist care and to which hospital the patient should be transported. Such telemedicine links could be used for transmission of data and pictures of various kind. With ISDN or ATM technique the pictures will have high resolution and use the available network. If satellite transmission is necessary, there may be some loss of quality. In some parts of Sweden medical care centers are already linked to a telemedicine center at a local or a regional hospital, other county councils are in progress to gain that experience. We would like to report our experience of a telemedicine link to an UN-field hospital. In co-operation with the US Army Medical Research and the Walter Reed Army Medical Center (WRAMC), the Swedish Defence Force and Stockholm County Council have established the ”North Star project” in order to evaluate the value of telemedicine equipment in the UN-field hospital in Tuzla, Bosnia. A telemedical connection by satellite was established in March 1996 after a planning period of several moths between the Norwegian field hospital in Tuzla, The University Hospital of Linkoping, the Stockholm W e r Hospital and the Swedish Armed Forces Headquarter. At that time the political and military situation had changed to the better and the field hospital had a relatively low activity especially in the field of trauma. Since the start, the telemedical system in Tuzla has encountered a number of problems that have caused long periods of disrupted connection. Technical problems have been frequent and could be resumed by: unreliable satellite communication, problems with the computers, and “user unfriendly equipment”. Other important reasons for the low frequency of communication have been: reduced activity in the hospital, a large turn over of personnel and low priority of interest of the medical staff. The experience of the North Star project communication for medical consultation have been about 10 during a six month period. The Walter Reed experience of deployment telemedicine in hospitals in Somalia, Macedonia, Croatia and Haiti between February 1993 and March 1995 showed a number of 171 telemedicine consults but only 114 could be evaluated due to uncomplete or missing charts. Of these, only 17% were for emergency and trauma care patients. However, in spite of the problems mentioned above the system has a potential of becoming an important adjunct in remote hospitals dealing with trauma. In January 1996, at the time of installing the system in Tuzla, a tank hit a mine and several soldiers arrived to the hospital, some of them with severe injuries. It would have been a good example of how to use telemedicine. During the follow-up period, after that first examinations including x-rays were done and after resuscitation had been established, adequate consultations with different specialists could be achieved by sending rapid information with high resolution. Proper information including digital images of wounds and radiographic pictures could have been sent off to the University Hospital of Linkoping where the patients were evacuated next day. Digital still images and /or connection by interactive video teleconferencing. Although the staff were trained, a number of procedures could have been treated differently or discussed.