Sept 21, 1999

Putting theory to practice

By ANITA MATTHEWS

 

TELEMEDICINE is no new buzzword as imagined by many. A quick tour online shows that it has been around and in practice for more than 30 years. However its practice is enhanced as technology improves.

The Malaysian government has essentially studied, reflected and borrowed elements of telemedicine practices from other parts of the world and incorporated its own flavour of medical practice.

What impresses proponents yet daunts sceptics is the inclusion of a lifelong health plan into the blueprint for telemedicine.

Here we share some of the telemedicine services practised elsewhere:

  • East Carolina University

    ONE of the early telemedicine sites in the world started at East Carolina University (ECU) in Greenville, North Carolina. ECU's School of Medicine introduced telemedicine consultation in late 1992 when the the state's largest maximum security prison contracted the school to provide telemedicine services.

    According to ECU's director of telemedicine, David C. Balch, that single step opened corridors to explore the practice and implementation of telemedicine.

    Over the years, the technical team at ECU has integrated advanced telecommunications technologies into a homogenous hybrid network of microwave, T1, ATM, ISDN, and Internet video which allows for the deployment of the most cost effective technology to each site.

    The microwave network provides full duplex connections statewide to 40 sites with three discrete channels of audio, video, and data. The ATM/SONET network, which is part of the North Carolina Information Highway, provides links to 200 distance learning sites and 11 telemedicine sites.

    The network is also connected to six rural hospitals and four medical centres in the region. These different networks are integrated into a large hybrid network called REACH-TV (Rural Eastern Carolina Health Television).

    REACH-TV and the ECU's Telemedicine Training Program are conducting courses and seminars, continuing medical education programmes, and managing a wide variety of video-conferences over each of these networks.

    Balch says that the large testbed enabled them to test and develop technology resources, network management skills, scheduling tools and the infrastructure for the next generation of telemedicine networks.

    ``Our telemedicine programme will continue the integration of patient information and management tools into its network,'' he says, adding that ECU will begin to test and implement Virtual Reality tools in the telemedicine environment.

    Its hybrid network of rural hospitals and medical centres will be expanded alongside plans to introduce telemedicine into homes under its new TeleHome Care programme.

    Balch also revealed that doctors at ECU had the honour of being the first to participate in a telemedicine program on demonstration at SIGGRAPH held in Los Angeles in 1995.

    ``Doctors had a chance to try out their bedside manner when experts linked Greenville, North Carolina, to Los Angeles for three full days of telemedicine consults,'' he said.

    A fibre-optic super pipe, stretching 3,000 miles across the country, provided a cyberspace portal connecting over 80 Los Angeles participants to ECU physician specialists.

    Crowds flocked to ECU's telemedicine presentation, aptly titled ``Doc In A Box'', where they were able to experience the world of telemedicine first-hand.

    SIGGRAPH's more adventurous attendees signed up for cross-country demonstration consultations. ECU offered 15 different medical specialities from which participants could choose. Sign-up was available over the Internet via ECU's telemedicine homepage or during the SIGGRAPH conference through PC desktop tele-conferencing with North Carolina telemedicine schedulers.

    At the time of the appointment, Los Angeles participants entered the telemedicine exam room where a telemedicine specialist presented the ``patient'' to a consulting physician ... three thousand fibre-optic miles away. Special telemedicine diagnostic tools allowed ECU physicians to enter the flesh and blood world of the participant.

    Working with the telemedicine presenter, the doctor could direct the use of water soakable cameras affixed with dermascope, otoscope and opthalmoscope adapters.

    As an added bonus, telemedicine participants experienced ``the waiting room of the future.'' This high-tech waiting room featured the latest in relaxation technology. Outside the telemedicine exam room, participants could sink into cocoon-like lounge environments and immerse themselves in full-body audio, light, and vibration therapy.

    ECU's demonstration also made telemedicine history as the first coast-to-coast telemedicine link using Asynchronous Transfer Mode (ATM) technology.

    Apart from ECU, other corporate partners on this team included Pitt County Memorial Hospital, Loma Linda University Medical Center, Sprint Midatlantic Telecom, FORE Systems, Andries Tek, Sun Microsystems, Parallax, Computer Innovations Consulting, InSoft, Quantitative Medicine Inc, and the North Carolina Health Care Information and Communications Alliance.

    For more information, go to Telemed.

  • Bangkok General Hospital

CLOSER to home, Bangkok General Hospital (BGH) has announced a major push into web-based telemedicine and consumer informatics services. Currently, patients address questions directly to BGH doctors via e-mail (Admin).

Hospital IT director Anucha Patipatkorkul said that a website would be developed to help patients obtain faster health information or answers to their questions.

The site will feature an electronic health consultant service with online doctors, a virtual hospital that will provide physical self-check questionnaires, and health tips. Other services will include an electronic message board and online pre-registration service for booking specialists.

The services will be provided free of charge.

The hospital is upgrading its existing ethernet network to gigabit ethernet technology. Intel switches and a hub have been installed to ease traffic for 310 computers connected via a fibre optic backbone.

The hospital also plans to upgrade its wide-area network, which links eight outside hospitals to BGH. The network is used for tele-conferencing and telemedicine applications, including sending X-rays between different hospitals.

  • Universiti Malaysia Sarawak

AT home, Universiti Malaysia Sarawak has introduced tele-conferencing for its medical students. According to Assoc Prof Dr Henry R. Gudum, the faculty offers desktop video-conferencing via ISDN lines at three sites.

The main campus in Kota Samarahan is connected to the Sarawak General Hospital (SGH) and the Serian Hospital.

``We use these facilities for undergraduate teaching in small groups,'' says Gudum via e-mail.

For instance, a lecturer can be at the main campus or at the SGH and conduct classes for a small group of students (about five or six) in Serian Hospital during their district hospital posting.

He adds that these facilities allow sharing of applications, exchange of images and questions and answers.

Note: It is understood that Sarawak General Hospital has succesfully implemented tele-consultation. Unfortunately, efforts to contact persons in charge proved futile.