The teledermatology consultation programme in which a selection of rural general practitioners remotely collaborates with specialists, situated in metropolitan areas, is an initiative organised by the Austin & Repatriation Medical Centre and the Centre for Rural Health at Monash University. Store-and-forward technologies are used to perform a range of distant dermatology services, that include the drawing up of a clinical history and examination of the patient, diagnosis, consultation, treatment planning, and supervision. In fact, the dermatology speciality is mainly lacking in the rural areas which are located around the cities. The remote expertise is therefore highly valued by the general practitioners.
One should clearly realize that in Australia only five to six cities are situated around the coast with a relatively low population of at the most a few million people each. The Australian inland consists of desert, wetlands and tropical wood. On average, there are living some 27.000 people per 100 km². The telecommunication infrastructure can be compared with that of Eastern Europe or Canada. The telephone connections are established through radio concentrators which are often struck by lightning during the rainy season. The local copper loop is too long, too old and too noisy for data transmission. Satellite use is asynchronous and has latency. ISDN connections are limited to the rural areas whereas mobile phones barely cover a distance of 175 km. The satellite mobiles are too expensive and cable television facilities are only present in the cities.
In the teledermatology trial, real time interaction is performed by telephone or videoconferencing. Store-and-forward techniques consist of mail and fax traffic, as well as of e-mail with attachments for images and patient history, and Web transmissions. The mobile phone is also utilized for collaboration between medical colleagues. The electronic means of consultancy however imply the establishment of technical as well as clinical standards. The most important limitations are the costs of both time and money, since expensive equipment is required. So far, the legal standards have not been tested yet, neither has there been any funding from the government. Nevertheless, the teleconsultation service is welcomed with great enthusiasm.
In the future, the remote health care providers in Australia will dispose of more satellite communication tools with asynchronous connection through the use of Low Earth Orbit (LEO) satellites. Also microwave and radiowave networks will be installed. For more details concerning the teledermatology project, you can visit the Web site of the Centre for Rural Health at Monash University.