Telemedicine

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Please see below forwarded for your info...

Ian

This information is to be published on the consultasap web site in the near

future please take a look there will be more for medics like you

www.consultasap.com <http://www.consultasap.com/> .

Introduction & History

The word telemedicine is derived from the Greek tele meaning at a distance and

medicine. Telemedicine has been practiced for many centuries; describing the

condition to the carer and following the advice given when the patient and carer

are physically separated is essentially telemedicine. In the last two decades,

it is a term associated with the application of technology to the practice of

medicine, the remoteness now can be global and beyond e.g. the space shuttle.

There have been times when the technology has frankly got in the way, just

because you can does not mean you should, there are few patients who would be

happy to have their appendix removed by a first aider with a head camera and a

scalpel even if such an operation is possible. The topic has now come of age and

we have a number of specialist practitioners and providers of equipment and

services. Despite the improvement in availability the complexity of the topic

remains and scares off many who may benefit from the application of

telemedicine.

Military

Some of my first experience of telemedicine was in the army. Sending casualty

reports in a standard format was taken to new heights in the SAS where a whole

medical coding system had been developed to permit the sending of quite detailed

medical information using Morse code (yes I'm that old!). With improved radio

communications this system was seen as clumsy and slow but it was an excellent

way of ensuring the critical information was sent. I have personally developed

systems in the military and more recently for the offshore oil industry which

follow the same principles of precise prioritised information. Think about it

how frequently do you seen casualty evacuation requests which start with the

patients name and not their location, a good principle to follow is give the

most essential information first.

The military continue developing in this area. Some very sophisticated systems

have been put in the field recently by the US. Personally I have a reticence

about some of the more elaborate systems as the triumph of technology over

common sense. See People paragraph later. The UK has trialled some very good

systems and QinetiQ QinetiQ - Information And Communications

<http://www.qinetiq.com/markets/health/information_and_communications/index.asp>

(formerly DERA) have a near patient management systems emedICS which Col Tim

Hodgetts has been helping them develop.

Offshore Oil - North Sea

A number of UK oil companies have run usability trials with various devices.

Historically Aberdeen had some telemedicine activity with researchers from the

Gordon Institute of Technology. This had been mainly about transferring

x-rays from outlying hospitals to Aberdeen Royal Infirmary for interpretation

and advice. There was a brief trial of the use of head-cameras and video

conference links but in the days before optic fibre the bandwidth restrictions

crippled it before it started and there was little added value in the system.

The ratio of useful information transferred to communications and technology

angst weighed heavily against the systems adoption.

Recently in BP I have been working with systems which will enhance the decision

making for the critically ill. It has been a challenging time as the

communication channels available often did not match up to the demands on them.

Some good lessons have been learnt and hopefully we will be in a position to

present an option paper to the senior management in the near future. The use of

thrombolytics had been a real challenge and much of the early work was based on

this. We have looked at Mobimed Ortivus www.ortivus.com/mobimed.asp

<http://www.ortivus.com/mobimed.asp> and Telemedics Vitallink www.telemedics.com

<http://www.telemedics.com/>.

Once I have written the review I will try and make the results available

meanwhile please contact me at james@.... The consultasap web site

will carry details and in due course we will be happy to provide a forum for

medics out there interested in telemedicine.

We learnt a major lesson after spending hours preparing a cost benefit analysis

based on the management of myocardial infarction learnt to obtain funding

(failed!); even given the major increase in the MI numbers with the ageing

workforce it still is not a high number. However one very important aspects of

telemedicine and especially the use of the devices mentioned above which does

add value: is by taking the virtual patient to the hospital clinician and then

enabling you to doing NOTHING but with confidence.

Consultasap is very active in this area and has some other technologies which we

hope to bring to market in the near future.

Remote Area Trials Prior to my own involvement with consultasap, Ande Salvin,

the company Director, organised some very useful trials of equipment and systems

in Georgia. These trials were on behalf of a major client. The trials helped all

parties to understand the vital importance of competent organisation and most

especially the difficulties associated with communications. In many remote

areas, even those boasting satellite links, it is simply not possible to make

the systems work without a considerable amount of blood sweat and tears. Ande's

tenacity was well employed and successful transmissions were achieved,

coordinating: Vitalink equipment, telemedicine data receivers - MedAire MedLink

in Phoenix, Arizona and the FMS clinic staff in Tbilisi. Providing this sort of

Health Management Solution is consultasap core competence.

People Before getting lost in technology we should not forget the people

involved. For a telemedical system to add value and facilitate better medical

practice it is essential the people in the system are considered.

Of course any one engaged in telemedicine must be qualified for the role but we

must not assume, just because they have an excellent reputation in their field,

that they have the skills to utilise telemedicine to the best advantage of their

patients.

Medics are at the cutting edge; my experience of telemedicine is that it very

much enhances the medics' role and definitely should not be seen as a threat.

Communications

The communication links in the telemedical systems are of course essential yet

often fragile. Although devices exist that will operate over GSM and other

networks and make very low demands on bandwidth it is often the case that

infrastructure is not in place in the emerging countries of the world. Remote

sites even in the developed world can experience the same problems. Often there

has been considerable investment in existing communication systems which are

fine for present use but cannot automatically cope with special demands of

telemedical systems. We live in an environment of real time television picture

from all over the globe but forget the enormous cost and organisational

resources required to deliver this to our homes.

Devices & Systems

There have been some exciting developments in the transmission of images; new

compression systems may further enhance fields of dentistry, ophthalmology and

dermatology. All areas where pre-hospital care is difficult now genuine

expertise can be brought to the patient reducing the need to evacuate for an

opinion. The system is coupled with a consultation management system which

permits audit and secure transmission of text in addition to the images.

www.ces.paisley.ac.uk/events/news/200201_cis.htm

<http://www.ces.paisley.ac.uk/events/news/200201_cis.htm>

Another experience of BP in the North Sea was the importance of an effective

triage system. We were greatly assisted by TSG (The Smart Group),

<http://www.smartmemos.co.uk/>, Colin Smart helped us to produce a new system

which meshed in with the receiving hospitals and very much improved the way

casualties were managed. This stuff is not rocket science but it is of great

value to the effective care of patients.

There is a host of systems and devices which come under the general heading of

telemedicine. To add value to your business and to be of real benefit to your

staff or patients it is essential that your needs are assessed and the best

solution for you selected. If systems are not fully integrated with your

operations the technology and devices will simply be an expensive white

elephant.

consultasap

We will review your needs and work closely with you to establish your real

requirements. We do not sell or promote particular systems; we are only

interested in ensuring you get the best solution. Our consultancy is charged

irrespective of the eventual installation decision. In the event that you choose

to install a system we will be happy to make the arrangements for a single

invoice and negotiate maintenance agreements for you.

We fervently believe there is a future in these systems but only in the right

circumstances

Dr Keech & Ande Salvin

m +44 7802 434410

t +44 1224 632034

e james@... <mailto:james@...>; ande@...

<mailto:ande@...>

__________________________________________

Ian Sharpe

International SOS Paramedic

AGIP Kco Marine Supply Base

Bautino, Republic of Kazakhstan

Tel: +31 70 313 3655 / 3690 (Clinic/ Accommodation)

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