Dr. Gudrun Zahlmann works at the National Research Centre for Environment and Health in Germany. At the ITIS Conference, she presented a short survey of the current telemedical applications, technical tools, global projects and patient related services. Telemedicine as a concept includes remote health care services, patient data management, and medical expertise. The general patient care is being supported by the transfer of patient specific data, knowledge exchange, and overall improvement in communications. Telemedicine involves items such as teleconsultation, diagnosis, education, management, and therapy. Throughout this vast definition, one major priority has to be kept in mind at all times: the physician has a responsibility to explain to the patient what is going to happen.
If we decide to go telemedical, we technically can't do without videoconferencing tools, ISDN, and direct communication. We can build in security, using point-to-point connections. Office teleconsultation only provides limited image quality whereas e-mail based teleconsultation offers a higher image quality. There exists a large potential market for telemedical services. Dr. Zahlmann refers to space missions, antartic expeditions, battle field, disaster and emergency experiences, isolated regions, undesirable patient transport, urban areas with many options, and plain convenience.
On a worldwide scale, projects are being set up. In Europe for instance, Mermaid constitutes a telemedical service delivered to ships. In Australia, the Tardis project has been organised. Both in North and South America, telemedicine is being applied in Canada as well as in Chile. In the United States, the telemedical practice is particularly concentrated at the different universities, the Department of Defense, and the Nasa. Nearly all medical specialities by now have been integrated into the telemedical universe. Today, we effortlessly talk about telepathology, teledermatology, tele-ophtalmology, telepresence, teleradiology, telehomecare for the elderly and underserved people, prenatal telecare, and telemonitoring for emergency cases.
Some country governments have not limited themselves to separate projects but have introduced telemedicine into daily life. Since 1988, Norway disposes of a complete telemedical infrastructure, managed by legal regulations. In Australia, health care in rural areas has been organised in telemedical structures. In general, there is a growing tendency to move from hospital to home care by the year 2000. Various communications patterns are being established between patient and nurse, patient and general practitioner, patient and patient, and patient and insurance company. The ideal telecommunications tools consist of satellite, telephone and e-mail. In reality however, this is often limited to the telephone and the TV cable. Since the equipment is very expensive, urgent funding is needed at regional levels as well as at national government level.