Telemedicine: lessons remain unheeded

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Abstract
Enduring systems and new projects Some systems have endured, such as that in Newfoundland, which was based on the telephone network as the core technology supporting audioconferencing and the transmission of electrocephalograms.4 The telemedicine in north Norway project, centred on the University Hospital of Tromso, combines geographical inaccessibility with an advanced digital communications infrastructure. It has run successful pilot studies of remote diagnosis in dermatology, cardiology, pathology, radiology, and endoscopy of otorhinolaryngology patients, but the impact on the health of the population is still uncertain.5 There are other new European projects: the European Commission's research and development in advanced technologies in Europe (RACE) programme funded the telemed project from 1988 to 1992; this evaluated pilot studies of applications in remote radiology, reference database management, and psychiatry. The RGIT survival centre in Aberdeen has developed a system called Camnet which allows transmission of vital signs and video and audio pictures from a remote paramedic to a secondary care centre.6 View larger version: In this window In a new window The telephone is an effective and stable technology that is already in place in most health care systems—but its full potential has yet to be exploited There is much current interest in teleradiology and telepathology and a drive to develop systems that will transmit digitised images of radiographs and slides at higher and higher rates for remote examination. While there are obvious attractions for radiologists in systems that allow remote manipulation of real time images, the benefits to the patient and the impact on delivery of health care are less clear. Economies of scale and quality improvements may be gained by handling rare cases in centralised radiological and pathological services, but these have still to be formally evaluated and weighed against potential disadvantages such as the increased use of high cost diagnostic services, greater distance between the diagnostician and the patient, and job satisfaction. The advantages of service rationalisation should not be confused with advantages for advanced technology. Centralisation does not require expensive, high speed links—communication may take place by transmitting digitised images at lower speeds along the existing telephone network or even by sending conventional images by post.