Walid G. Tohme

Teleradiology/telepathology requirements and implementation

Teleradiology and telepathology form an integral part of the telemedicine concept. Teleradiology is becoming a mature technology because of advances in imaging technology, database design and communications infrastructure and capabilities. Telepathology has also made significant progress but more development is needed in the definition of required images, database design and standards. While the requirements of most clinical applications of teleradiology are well established, telemammography still presents some impediments. Technical difficulties in telemammography are presented in terms of the lack of a clinically accepted digital imaging system and large data volume required per image. Another important aspect in tele-imaging is the database question. Workstations constitute a window into database. Comprehensive database development is the most difficult and expensive technology for tele-imaging and operational features of such systems are discussed. Finally, we explore current examples of the use of telepathology and teleradiology in the global telemedicine context.

Teleradiology and emerging business models.

A number of new diagnostic radiology services have emerged which use teleradiology. The main themes include: (1) stand-alone teleradiology practice; (2) the Nighthawk/on-call coverage; (3) solo radiologist practice; (4) expert/second-opinion teleradiology; (5) a global virtual radiology service based on workload sharing and reallocation. More applications of teleradiology can be expected due to the continuing shortages and uneven distribution of radiologists, and the increasing use of radiological imaging for diagnosis. In a large enterprise, such as the US army, teleradiology will allow the creation of a global diagnostic organization where diagnostic images are distributed according to the availability of radiologists. Eventually the distinction between picture archiving and communication systems and teleradiology will be blurred and radiology will be provided by virtual organizations with distributed capabilities. As teleradiology services claim a bigger share of radiology practice, various legal and regulatory issues will need to be solved. Ultimately the successful business model will depend on the ability to produce the highest-quality product at the lowest cost.

A Telemedicine Consultative Service for the Evaluation of Patients With Urolithiasis

OBJECTIVESnA 6-month pilot teleconsultative project linking Georgetown University Medical Center (GUMC) in Washington, DC, and City Hospital in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis.nnnMETHODSnThe telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patients imaging studies were performed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through an Inverse Multiplexor (IMUX). Treatment options were recorded for the clinical trial group and a simulated study group by the consulting urologist after the initial telephone consultation, after the telemedicine consultation, and after examination of those patients transferred to GUMC.nnnRESULTSnA total of 32 telemedicine consultations were performed: 14 in the clinical trial group and 18 in the simulated study group. The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultation compared with the recommended treatment after the initial telephone consultation.nnnCONCLUSIONSnIn the evaluation of patients with urolithiasis, this telemedicine application enhanced the clinical decision-making process by allowing for improved quality of care through immediate access and effective transfer of information between the referring urologist, the patient, and the stone center specialist.

Hemodialysis Patient Management by Telemedicine: Design and Implementation

The authors describe the design and implementation of a personal computer based telemedicine system for managing patients by telemedicine. With three identical systems connected by high speed T1 lines, the physician (or allied healthcare giver) can interact, by videoconferencing, and by using multimedia files, with patients at two remote hemodialysis sites. The physician is able to visualize specifically the patients fistula/graft, and auscultate fistula, heart and lung sounds, and incorporate still pictures or audio sounds in the patients multimedia database folder, which also contains an electronic and paperless medical record. In addition there is the capability of downloading into this database all the machine parameters during dialysis. ASAIO Journal 1997; 43:M763-M766.

Telemedicine in neurosurgery: peri-operative management

Despite the growing interest and use of telemedicine, few studies have examined the clinical efficacy and reliability of telemedicine, and none have looked specifically at the role of telemedicine in neurosurgery. This prospective, observational study evaluates the effectiveness of telemedicine in the management of perioperative neurosurgical patients. A PC based compressed video media-conferencing system with high-resolution image transmission and retrieval is used. All transmissions are via point-to-point integrated services data network (ISDN 3) at 384kbps. Patients are examined by an on-site physician and remotely by a second physician using telemedicine. Examination data, assessment and recommendations are recorded on a standardized data collection form. The results of a pilot study of ten patients are presented. Correlation between the on-site and remote examiner was 100% for the following parameters: mental status, cranial nerves, sensory examination and wound evaluation. Correlation between observers was 89% for reflexes and 80% for speech, motor, and gait abnormalities. Sensitivity for detection of neurological abnormalities using telemedicine was 86%. Assessment and management decisions were identical for the on-site and remote physicians. Telemedicine provides an effective means to evaluate and manage neurosurgical patients in the peri-operative period.

The executive summary of the National Forum on the Future of Defense Health Information Systems.

The Department of Defense (DoD) has been engaged in the development and deployment of the longitudinal health record (LHR). It has achieved remarkable technological success by handling vast amounts of patient data coming from clinical sites around the globe. Interoperability between DoD and VA has improved and this information sharing capability is expected to continue to expand as the defense health information system becomes an integral part of the national network. On the other hand, significant challenges remain in terms of user acceptance, ability to incorporate innovations, software acquisition methodology, and overall systems architecture.

Telemedicine and dialysis

More than 280,000 patients are treated by hemodialysis in the USA. The first-year annual adjusted mortality is very high and, in part, relates to the dose of the delivered dialysis (Kt/V). Using multimedia telemedicine, we have been following dialysis patients for over one year with a weekly telemedicine visit in addition to weekly physician visits, in an attempt to maintain compliance with the dialysis schedule, in addition to comprehensive medical consultation. Transmission is achieved with T1 lines from the clinic to the physicians office or home. The telemedicine session uses electronic patient folders containing relevant medical details, digitized X-rays, lab values, etc. We are able to achieve high-quality videoconferencing, capture still or video images, record remote stethoscope sounds, capture local or remote data and modify the medical record. Our goal is to increase the quantity of delivered dialysis and thereby improve quality of life and patient satisfaction, and reduce the costs of medical care, at the same time maintaining patient confidentiality. Appropriate measures to ensure data integrity and patient confidentiality have been integrated into the study. Questionnaires are also utilized to measure, on an ongoing basis, quality of life and patient satisfaction, while a weekly questionnaire captures any medical event taking place. The project is nearing completion, with subsequent data analysis to take place in the following six months. The system and procedures we have employed are accepted enthusiastically by patients and staff alike, and have aided in patient management.

Remote management of haemodialysis patients: Design and implementation of a telemedicine network

Summary. Telemedicine applications have been implemented in many clinical specialties. Some, like teleradiology, are now established applications with specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Project Phoenix, a National Library of Medicine funded project set up to look at the access, cost and quality implications of telemedicine in a renal dialysis setting, we are establishing such protocols and standards. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and Information Systems (ISIS) Center of the Department of Radiology, the Clinical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a remote outpatient dialysis clinic, and a nephrologists home. The primary functions of the network are ...

Health Information Sharing System for Refugees and Immigrants in Five States

Resettled immigrants and refugees in the US do not get appropriate healthcare attention because of organizational barriers, cultural differences, poor explanation of health problems and their geographical distribution in the country. These problems often lead to inappropriate diagnoses and inappropriate treatment. Healthcare providers also face significant challenges partly due to the diversity of languages, cultures, and protocols of immigrants and refugees, and partly due to their inexperience in handling diseases not found among the American population. In response to these issues, we have developed the Refugee Health Information Network (RHINtrade) a Web-based information management system that can improve access to medical and public health information related to refugees and immigrants and to facilitate the exchange of this information between distributed health departments, health professionals and service providers in five states