People considering telemedicine as a beautiful but unviable dream, were suddenly wide awake. Dr. Paul Garner confronted them, during his ITIS-conference talk, with the impressive video images of daily telemedical practices as developed at the British Telecommunications (BT) Laboratories, in the fields of teleconsultation, education, lifestyle monitoring and telecare. This UK experience shows the commercial and technical potential of relatively simple and inexpensive solutions, covering a wide range of useful home and hospital services, accessible for ordinary people like you and me.
Currently, six people are working in the BT Laboratories on projects, demonstrating that any communication by distance fits into telemedicine. There exists a narrow collaboration between BT Labs and a selection of English hospitals for the realisation of trials in tele-dermatology, a project based on videoconferencing for on-line consultation, and in tele-endoscopy. A third project, referred to as A&E Telepresence, involves distant consultation by means of a handsfree system between CamNet Paramedic, the East Anglian Ambulance Service and the related hospitals.
A truly simple and cheap system constitutes TraumaLink. An electronic camera is inserted into the port of an ambulance to shoot images of a car accident for instance. The images are sent over by mobile phone to the emergency department in the hospital, allowing doctors to figure out in advance the cause and origin of the victim's injuries. A very useful telemedical application is offered by Fetal Ultrasound, displaying an on-line referral method to remotely scan the unborn child. Expectant mothers need less travelling to get information on the baby's actual condition.
BT Labs equally has set up a tele-education service between Dublin and London for demonstrations of 3D video-imaging for remote surgery. Advanced visualisation facilities for general practitioners are currently being developed. Some of the projects, like the tele-dermatology trial and the remote fetal ultrasound method, already have amounted in a commercial success and are actively being purchased. Tele-monitoring initially started out as videoconferencing and real time interaction but now has led up to integrated clinical services, such as cardiac event monitoring.
Of course, Dr. Garner doesn't ignore the traditional Internet problems of congestion, quality of service and security but at the same time, he points out the existence of HealthNet in the UK, a private Internet for medicine and separated from the public Internet. Some of the HealthNet information services however, are available for the public Internet. Recent applications in telemedicine and information technology have generated the birth of telecare. Home health care implementation should complete the circle, beginning at the hospital and formerly ending at home. In the future, home will form a new starting point for remote electronic contact with the hospital.
At present, there are 7 million of disabled people in the UK. Lifestyle monitoring will provide a solution for the support of these people in their own homes. In a pilot project, sixteen flats have been interconnected by means of sensors, installed at crucial locations in the house and which are linked with a control unit and telephone. In case of emergency, immediate contact will be established between volunteering neighbours or family, the hospital unit, and the patient. Biomedical monitoring forms yet another approach. Implants and devices, like for instance a pulse oximetry, are carried on the body to control the major physical functions.
Dr. Garner believes in the empowering of the patient through information provision and validation. It might be necessary to address delicate issues and change the conventional working practice. Accessibility to innovative applications should be increased for the benefit of the people. Telecare may turn out to present a very human approach, if only we can imagine for example a home based palliative care. Do join this hopeful vision and have a look at the interesting site of the BT Laboratories.