Steinar Pedersen

Home telecare technologies for the elderly.

There are many home telecare technologies which have been developed specifically for chronic diseases and there are some more generic technologies that could be used as well. For home telecare, the equipment must be certified, the operational routines must be reformed, the infrastructure must be in place, the market must be prepared, the health authorities must be convinced that the system will work and the cost-effectiveness must be evaluated. Organizational and societal changes, such as cost reduction policies and an aging population, are the main driving forces for the development of home telecare, especially for elderly patients. At the moment there is no holistic model for scientific evaluation from different perspectives (e.g. clinical, legal, technical). We suggest that more research on home telecare and its effects needs to be conducted, in order to provide evidence for optimizing the use of this promising technique.

Prioritisation of telemedicine services for large scale implementation in Norway

In late 2005, the Northern Norway Regional Health Authority requested an evaluation of all tested telemedicine services in northern Norway to clarify which were suitable for large scale implementation. A total of 282 reports from the Norwegian Centre for Telemedicine, the University Hospital of North Norway and the University of Tromsø were included in the study. Projects not focusing on secondary health care were excluded and 46 studies representing 21 topics entered the final analysis. They were analysed with a self-developed scoring tool focusing on five items. Eleven topics were concluded as being candidates for large scale implementation and grouped according to priority. The first priority topics were teleradiology, digital communication/integration of patient records and education. The second priority topics were teledialysis, pre-hospital thrombolysis, telepsychiatry and teledermatology. The third priority topics were paediatrics, district medical centres, tele-ophthalmology and tele-otorhinolaryngology. No priority was suggested for the projects in cardiology, endocrinology, geriatrics, gynaecology/obstetrics, pathology and nursing/care. User support, training, research ability, financial incentives and interaction between clinicians and ICT-personnel were considered as important factors in motivating health-care personnel to use telemedicine.

Remote endoscopy of otorhinolaryngology patients

Present-day technology enables transmission of high quality images via telecommunication networks at an acceptable price. This enables the transfer of medical images. In our project we work on the development of a remote consultation service for diagnosis of otorhinolaryngology patients. This is done by integrating endoscopic equipment with a network of conference studios operated by Norwegian Telecom. Signals from a video camera attached to the endoscope are compressed and digitized by a video codec prior to transmission to a remote institution via a 2 Mbit/s circuit. The receiver can see the endoscopic examination on a monitor and influence the control and movement of the endoscope by communicating over two-way sound and picture connection with the person operating it. The challenge is to tailor a new service based upon two separate types of technology, i.e., endoscopic and telecommunication technology. Both these technical systems work well alone, but can they work together to solve a medical need? The development of remote consultation services is dependent on both technology and the ambient conditions. The article is based on our actual tests and has its focus on technology description and preliminary results from our experience with remote diagnosing and diagnostic reliability.

The potential of digital monochrome images versus colour slides in telescreening for diabetic retinopathy

Summary We explored the potential of digital monochrome images as an alternative to colour slides in screening for diabetic retinopathy. Twenty-eight patients with diabetes were recruited for the study and 20 actually participated. Using a fundus camera (Nikon 505AF) one set of three digital images and one set of three colour slides were taken per eye. Two independent ophthalmologists graded the colour slides and the digital images for diabetic retinopathy. The ophthalmologists spent about two minutes grading each set of images, suggesting that specialists could potentially screen a large number of patients. The agreement between the two screening methods was 0.95 and 0.89, with respect to disease or no disease. The agreement (κ) between the two ophthalmologists for grade of retinopathy was 0.47 when colour slides were employed and 0.61 when digital monochrome images were employed. The results indicate that digital red-free monochrome images represent a superior screening tool for diabetic retinopathy. Tele-screening may be beneficial when patients have to travel substantial distances to visit an ophthalmologist.