Images of skin diseases are only made if the general practitioner is unable to trace down the nature of the ailment. In an enclosed e-mail, the doctor provides additional medical information to the attached image. At the hospital, the dermatologist makes the diagnosis which is sent to the general practitioner by returning e-mail. This procedure is very efficient for patients living at remote locations or for people who have difficulties with walking. In this way, they can save themselves a long and straining trip to the hospital.
For every patient, three images are required. At present, there are only a few number of patients for each participating general practitioner. During a first six month pilot phase, the dermatologists have analysed per image about 80 skin affections. Additional consultation is also asked in the case of diverging birth-marks. The applied equipment is standard and consists of digital Sony Mavica cameras and ordinary PCs. The patient images are sent in the JPEG format and have a relatively low resolution of 480 x 640 pixels. The time for transmission of higher resolutions takes too long, according to the doctors. In any case, the image details in general are quite acceptable for diagnostic analysis, as stated by Dr. van den Akker.
Statistic material describing the number of cases in which the technology is insufficient for a responsible diagnosis is not yet available to this point. The four participating doctors in 94 percent of the cases experience telediagnosis as "useful", according to the Martini Hospital staff. An additional advantage constitutes the educational value for the general practitioner who receives immediate feedback from the dermatologist. From the patients' side, the service is highly valued as well.
Currently, three of the doctors' offices are situated in the city of Groningen while one practitioner is working on the island of Schiermonnikoog. From this location, about the same number of images was transmitted as from the three practices in town. During organised information meetings, another 8 general practitioners have shown vivid interest to participate in the project. The dermatologists consider this amount as sufficient for the time being. If too many images are being transmitted, a separate room in the hospital will be needed in order to analyse them.
Right now, it is still unclear whether the dermatologists will be reimbursed for the telediagnostic sessions. Discussions are being held with the health insurance companies. Indeed, a teledermatology consultation takes almost as much time as a live consultation. At present, the Martini Hospital is still paying for the equipment. In other countries, teledermatology already exists much longer. Images from British patients living on islands in the Irish Sea are being sent in digital form to the mainland.
Abroad, dermatologists tend to work on-line with digital cameras. This way of proceeding requires that both physicians are present simultaneously. The Dutch dermatologists however do not consider this to be very practical. For this article, the Automatisering Gids served as a news source. If you like to gain some more information on this discipline, you can also read the VMW article Teledermatology in Australia or a different sense of remoteness in the October 1999 issue.