Heikki Lamminen

A cost study of teleconsultation for primary-care ophthalmology and dermatology.

Teleconsultations were performed between a health centre in a small Finnish town and a university hospital 55 km away. Telemedicine consultations were carried out with a total of 42 patients suffering from various eye and skin disorders. We evaluated the costs of the teleconsultations in the health centre and the conventional alternative of the patient travelling to the hospital. The cost of conventional consultations, which was not affected by the patient workload, was EU126 per patient for ophthalmology and EU143 per patient for dermatology. The cost of the teleconsultations per patient decreased as the number of patients increased. There were cost savings in relation to teleconsultations when the annual numbers of patients were more than 110 in ophthalmology and 92 in dermatology. Benefits and savings achieved through teleconsultations mainly consisted of reduced transportation costs and reduced paperwork both at the health centre and at the university hospital, as well as time savings for the patient. Another important benefit was improved medical education. The present study shows that teleconsultations can be performed in a cost-effective way in a relatively small health centre.

A prospective study of teleconferencing for orthopaedic consultations.

We carried out a prospective study of teleconsulting in orthopaedics. A commercial videoconferencing system was connected by three ISDN lines between the Satakunta Central Hospital in Pori and the Orton Orthopaedic Hospital in Helsinki, 240 km away. A document camera was used to transfer radiographic images and paper documents. Twenty-nine patients who needed an orthopaedic consultation were studied over three months. They were examined by a surgeon in Pori with the aid of teleconferencing and again later in a traditional, face to-face appointment in Helsinki. Patients and doctors completed questionnaires after the consultations. Technically, the videoconferencing system functioned reliably and the quality of the video was judged to be good. Twenty patients 69 would not have needed to travel for a face-to-face appointment, because the teleconsultation afforded a definite treatment decision. The orthopaedic surgeons considered all the treatment decisions arising from the teleconsultation good, except in one case which was considered satisfactory. The quality of the radiographic images transferred with the document camera was good or very good in 17 cases and satisfactory in three cases. None of the patients had experienced videoconferencing before; 87 of them thought that teleconsultation was a good or very good method and the rest felt that it was satisfactory. All patients wanted to participate in teleconsultations again and most would have recommended it to other patients.

Teleconsultations between general practitioners and ophthalmologists in Finland

We carried out a study of the value of videoconferencing in consultations between general practitioners GPs and ophthalmologists in Finland. We used ISDN lines 128 kbit s between the Primary Health Care Centre in Ikaalinen and the ophthalmology clinic at the Tampere University Hospital TAUH. Questionnaires covering both clinical and technical matters were given to patients and doctors after the consultation. During the 10-month study, consultations were carried out successfully for 23 of 24 patients 96 . Most consultations 84 took less than 15 min. If we had not had this system, the GP would have made 21 referrals to an ophthalmologist. After teleconsultation, six patients were sent to the TAUH, so the system saved 15 referrals. Twenty-two patients 92 thought that videoconferencing was a reliable tool for GPs. Our system proved to be a valuable and reliable tool for the GPs in ophthalmology consultations and continuing education.

Preoperative leg-length inequality and hip osteoarthrosis: a radiographic study of 100 consecutive arthroplasty patients

ObjectiveTo assess the leg-length inequality in patients with hip osteoarthrosis (OA) and to evaluate a possible association between the length disparity and side of OA.Design and patientsWeight-bearing radiographs of 100 consecutive patients undergoing arthroplasty for primary OA were examined and measured for inequality of leg length, pelvic tilt and severity of OA.ResultsThe radiographic results showed that preoperatively OA occurred more frequently in the hip of the longer (84%) than the shorter (16%) leg. However, the development of OA did not show a linear relationship with the magnitude of leg-length inequality.ConclusionAs hip OA occurred more frequently in the longer leg the authors speculate whether leg-length inequality might predispose to OA in the hip of the longer leg.

Telemedical devices in diabetes management

This paper reviews telemedicine and its recent expansions within diabetes management. Diabetes mellitus continues to be one of the major chronic diseases with up to 11% of national health care expenditure, when all late complications are taken into account. Over and above this, the incidence of diabetes is increasing in pandemic fashion. Diabetes has been the focus of telemedicine and information technology over the past two decades. Useful applications supporting high quality treatment exist in clinical management, education, decision support and modelling. Development of high-speed networks enables transmission of good quality photographs making consultations from distant locations possible. Databases and data analysis are fundamental to diabetes outcome research. Less successful has been the development of electronic medical records although this is a dream of many. Evidence of improved clinical outcome using telemedical applications still awaits the breakthrough.

Experimental telemedicine in orthopaedics

There have so far been few telemedical applications in orthopaedics. This experiment involved clinicians in three different locations, two in Helsinki and the third in Tampere, consulting one another simultaneously. We used an ATM network to transfer X-ray pictures, digitized by a 12-bit CCD scanner and archived in a central image server. The consultations between the clinicians and the examination of the patient were transmitted by a videoconferencing system using the ISDN. We found that telemedicine offers new possibilities in orthopaedics, for clinical work, for training and for research.

Picture archiving and fundus imaging in a glaucoma clinic

Ophthalmological image archiving and distribution can be automated using a picture archiving and communication system (PACS). A fundus PACS has been in clinical use since February 2000 at the ophthalmology clinic of Tampere University Hospital. It consists of a digital fundus camera, an imaging workstation, from which new patients can be added to the archive, 10 viewing stations and an image archive server. In glaucoma imaging, the fundus images taken from a patient are transferred from the imaging workstation to the image archive server and are then immediately available from the physicians viewing workstation; the transfer time of an average image, of 350 kbit, is 0.0035 s, even though the archive is located 5 km away. After 18 months of operation there were over 16,000 images archived; these took 5.3 GByte of a total storage capacity of 41.9 GByte. The network and archive server achieved 99% reliability in use. Digital imaging makes it possible to shift ophthalmology clinics towards more patient-oriented treatment procedures.

Fundus imaging and the telemedical management of diabetes.

Diabetes is the major preventable form of blindness among people of working age in the Western world, despite the improvements in laser photocoagulation treatments. It is known that regular glycaemic control and annual retinal screening of people with diabetes can reduce its incidence. Effective treatment needs to be available but also screening methods which are simple to perform and cost-effective should be implemented. It will be important in future to integrate digital images of the fundus into the health records of diabetic patients. Screening programmes for the detection of diabetic retinopathy aided by image-processing software for processing fundus images will save manpower and increase quality. Before this can happen, we need more clinical studies of store-and-forward techniques, so that they can be standardized and their effectiveness established against that of traditional analogue screening.

Telemedicine framework and applications in dermatology and ophthalmology

Medicine has to balance between the advantages and costs of new technology. As the significance of technical aids has increased, medicine has become more tightly bound to technology. Telemedicine is one of the fastest developing fields, as its development is connected to the development of telecommunication and information technology. Technology sets the ultimate restrictions to telemedicine. However, most challenges are nontechnical. Fast development makes it difficult to perform generalizable studies on the field, and the lack of practical, applicable standardization hinders telemedical system design. The cost of technology is quickly falling compared with the cost of human labour. Because of these factors the efficient use of telemedicine requires strategic decisions at the level of the organization as well as more research concerning the effects of telemedicine on medical practice. This article describes the telemedical frame of reference by using dermatology and ophthalmology as examples.

Feasibility of personal prothrombin time measurement in anticoagulant treatment follow-up:

Sir, The number of patients on anticoagulant treatment with warfarin in Finland has increased by 50% in the past six years, according to drug sale statistics. Approximately 1% of the Finnish population is now on anticoagulant treatment. This trend results from an ageing population and from an increased knowledge of the benefits of anticoagulant treatment in various conditions1. It has been established that oral anticoagulant control can be reliably monitored by a general practioner2. However, a significant increase in the need for anticoagulant treatment calls for new methods of management. Portable prothrombin time meters can provide a telecare approach to treatment follow-up. We have conducted a preliminary study of the use of a personal prothrombin time meter in place of conventional laboratory testing. We investigated whether the prothrombin time results of a portable meter correspond to laboratory results. We also investigated how anticoagulant levels would behave during the long intervals between laboratory tests, to establish whether current laboratory follow-up testing can adequately track changes in anticoagulant levels.We wanted to compare the problems and benefits of the current centralized testing routine with those of a personal testing routine.