Telemedicine kept simple

Abstract

Telemedicine ("medicine from a distance") is about bringing specialist knowledge to a patient from afar, by the use of communication technology. This article is based on personal experience in helping set up a simple, versatile, cheap and effective store-and-forward telemedicine system for the British Defence Medical Services. This system uses readily available still digital cameras to record clinical, radiographic and microscopic images, which are then sent by electronic mail to an organised network of specialists for secondary or tertiary opinion. The system is in use in various countries throughout the world, and has also proven to have civilian and humanitarian uses. The system is now being emulated in civilian practice in the United Kingdom, the United States, and in previously isolated hospitals in the Third World. I also describe the active role played by a telemedicine charity and by medical students on elective in the Third World in setting up telemedicine links using this system. Readers are invited to co-operate in the setting up of a global outreach telemedicine programme, linking elective students, isolated Third World hospitals, and University Teaching Hospitals.

Keywords: Defence medical services; Digital cameras; Medical students; Telemedicine; email.

Figure 1

Mosaic of a doctor contemplating an ill patient from the Medical School, Emory University, Atlanta, Georgia USA. This is purported to depict the American physician Benjamin Rush

Figure 2

Two specialists discussing a patient, from a wall mosaic in Emory University, purporting to show Semmelweiss and Holmes, of puerperal fever fame

Figure 3

DMS Telemedicine System, Kosovo, 1999

Figure 4

Chest Xray photographed with Olympus C2500 digital camera, Bosnia Dec 1999

Figure 5

ECG showing inferior myocardial infarction, photographed in Bosnia, December 1999

Figure 6

Attempted resuscitation on a fourteen year old boy who sustained massive trauma from a bomb explosion

Figure 7

The author, using a satellite telephone, Bosnia, January 1998

Figure 8

tmed med GIB053, referral letter

Figure 9

One of several photos of an ECG sent from RNH Gibraltar on 15 June 2000

Figure 10

tmed orth SGE001 – South Georgia, November 1998

Figure 11

The Three Georgias Telemedicine link

Figure 12

lesions on inner thigh, tmed derm BEL010, November 1999, prior to treatment

Figure 13

healing lesions on thigh, tmed derm BEL010, during treatment

Figure 14

Olympus C2500 camera with microscope adaptor, Kosovo, April 2000

Figure 15

Plasmodium falciparum, photographed using microscope adaptor