At Georgetown University Medical Centre (GUMC), a three-year project is running, which studies the impact of telemedicine services on the condition of renal dialysis patients. The National Library of Medicine has offered a grant of $2.8 million to the Project Phoenix, that started off in October 1996 and will end in March 1999. The ultimate purpose is to prove that chronic illnesses are ideally manageable through electronic interactive communication between physicians and patients. The quality of care is being intensified to everyone's satisfaction, whereas the costs for permanent treatment are substantially being lowered. In addition, accessibility and security within Phoenix are superior to the paper-based system.
The project brings together experts from the Imaging Science and Information Systems (ISIS) Centre, the Department of Radiology, the Clinical Economics Research Unit (CERU), and the Division of Nephrology in the Department of Medicine at GUMC. They have collected the medical data of 400 patients and a control group, at three different sites, namely a dialysis clinic in Washington D.C., treating all GUMC patients; the GUMC office of Dr. James Winchester, who is clinical director for the Project Phoenix; and his home practice in McLean, Virginia. This network for renal care has been interconnected by means of T1 lines, each of them amounting to about $400 a month. The network further relies on the CareLink telemedicine system, consisting of a multimedia patient-folder package and a tailored interface for data transfer from each dialysis station to the central CareLink database.
In the United States, conventional hemodialysis makes up 70% to 80% of renal replacement therapy for final stage renal disease. Patients need to be continuously stimulated to carry on with the treatment since they tend to get tired of it. They easily miss the appointments because the doctor usually is absent. In rural areas, the physician's visits are limited to merely one every three months. The mortality rate for renal patients amounts to 22%, caused by lack of treatment motivation. In Japan, where the doctor is present for each single dialysis treatment, the percentage is situated between 14% and 16%. Therefore, the telemedical approach might be a stimulating factor, although the contact between patient and doctor is only virtual.
In order to optimally compare the results, the Project Phoenix includes a telemedicine patient group as well as a control group. For each patient, no matter to which group he belongs, the CareLink database contains all relevant information on clinical data, treatment costs, satisfaction and quality of life, while the electronic patient folder serves to collect images, audio, scanned medical history and progress data, next to specific dialysis parameters, and blood pressure and temperature. The most important factor of distinction between traditional and telemedical dialysis is the spent time. Live consultations take nearly twice as long as teleconsultations, due to physician travel. However, telemedical sessions require some additional time for the setting up and technical troubleshooting of the equipment.
Nevertheless, the research team has succeeded to save costs in those cases presenting complications due to the fact that the needle repeatedly was being introduced at the same site. If this occurs, the doctor is now able to compare the fistula image, stored in the patient folder with the real-time image. In general, the Project Phoenix has supported patients to continue their sessions till the end because they get the impression that the physician is more concerned with their health. For more details about the Project Phoenix, we refer to the Web site of the Georgetown University Medical Centre and the article of Kathy Kincade, published in the Telemedicine and Telehealth Networks magazine.