The building and assessing of a regional telemedicine testbed at the University of Washington has proven that the American experience is not so far apart from the European situation as we might imagine. In her talk at the ITIS Conference, Professor Sherrilynne Fuller gave a vivid account on what telemedicine involves in geographically separated and isolated areas, in order to define the regional needs and testbed components. She briefly but explicitly mentioned the policy and technical hurdles before entering into the interesting details of the research and evaluation of a project, which is trying to reconcile the perpetual fog and traditional way of living in Alaska with the wonders of telemedicine.
The University of Washington hosts six medical schools and two large hospitals. This health care infrastructure serves five states in the USA, including Alaska. Obviously, telemedical initiatives in such an extended and diversified region imply more than real time video consultations. In fact, there exists a tremendous need for information and teaching resources, decision support tools, as well as remote control of instruments and monitoring devices. The purpose involves improved access to medical care for underserved groups. In rural areas, health professionals are frequently faced with farmers, suffering from life-threatening injuries. These people expect timely, expert input and definitely want to avoid unnecessary referrals to remote hospitals. The overall aim of the project is therefore to increase health care quality while at the same time reducing costs. This indeed sounds pretty familiar...
In the north-west of the States, there are few or no communication switches and people only dispose of a system of party-lines which have to be shared among many. The general lack of digital services and ISDN calls for urgent funding to improve the connectivity. To complete the picture, this region only has small clinics and some rare hospitals, and in many areas, even a physician is hard to find. Access to libraries simply doesn't exist. To better serve the population, local health care providers are aiming for a single device, a single interface and the appearance of a single database. They search for strategy consistency and want to do useful things instead of obnoxious tasks.
The team of Professor Fuller wants to fill the gaps by optimising the general infrastructure, security, tele-consultation means, and public health linkages. The researchers are generating an integrated Web interface for single log-on to all services. Focus areas include facilities such as authentication, encryption, authorisation, and physical linkages. Logically, the user has to be who he claims to be, so no unauthorised access may be permitted and encryption mechanisms have to be identified. The idea is to elaborate a full 24h/24h service for the user. A second goal consists in building a scaleable, extensible imaging infrastructure with Digital Imaging and Communications in Medicine (DICOM) standards, sufficient compression and storage capacity, as well as indexing and archiving possibilities. The testbed equally has to provide a wide range of teaching tools.
In order to realise a telemedicine environment for efficient workflow, the research team is trying both to develop standardisation requirements for vendors, and equitable compensation for services performed by specialists and general practitioners. In the meanwhile, the University of Washington also explores in-home use for patients. Professor Fuller indicates the integrated workstation as a gold standard. Physicians particularly express their need for secure clinical e-mail, digital libraries and distributed access to electronic medical patient records.
The technical problems to overcome are situated in the fields of image-retrieval from 2D and 3D data-sets, security, bandwidth and high speed networking, virtual linkages to distributed databases, and force feedback. From the political point of view, the cost/benefit analysis is an issue of major importance to make consistent decisions about funding. This study involves an adequate number of clinical trials and similar cases which is impossible to offer for a three-year project. In this regard, telemedicine clearly constitutes a research domain that is not too different from other application areas, after all. Here as well as everywhere, only cooperative relationships can lead to final success.