Background
Teleconsultation is one of simple and accessible
telemedical technology for the help in acceptance of clinical decisions
when the physician collides with a complex and rare pathology.
Main goals
- terminology and classification
- indications
- choose of technology
Decisions
Terminology and Classification
Teleconsultation - remote discussion
of the concrete clinical case for the answer to precisely formulated questions
for the help in acceptance of the clinical decision.
Traditionally teleconsultations are classified
into: off-line; on-line.
Off-line teleconsultations comprise a type of
remote consultations not involving real time network communication (video,
chat etc.). Consulting and inquiring physicians exchange information via
email, FTP-servers, Internet forums. This type of teleconsultation is used
for elective medical care.
On-line teleconsultation is a type of remote
consultation involving real time network communication systems: video,
chat, ICQ etc. This type of teleconsultation is used for emergency (urgent)
medical care.
It should be pointed out that in routine clinical
practice these techniques are usually combined: a off-line teleconsultation
may be expanded through real time dialogue between the consulting and inquiring
physicians through the ICQ, chat or video conferencing, using applications
similar to NetMeeting; a real time video conference may be preceded by
exchange of medical information through email and so on. Thus, we believe
that this classification requires revision. It is practical to divide teleconsultations
into synchronous and asynchronous.
Asynchronous teleconsultation is a type of teleconsultation
implying consecutive use of certain Internet services by the consulting
and inquiring physicians with a time delay (email, Internet forums).
Synchronous teleconsultation is a type of teleconsultation
involving simultaneous use of a certain telemedical technique (video conference,
email, ICQ) by both physicians.
Also teleconsultations can be classified by
organization into:
- formal – two or more organizations are involved
under a previously signed contract (mostly under commercial agreements);
- informal – consultations based on a range
of Internet services (mailing lists, off-line forums).
- second opinion – teleconsultaions for patients
who address a medical organization via email or a special online form.
Indications for teleconsultation
We have elaborated the following list of indications
for teleconsultation:
- determination (confirmation) of diagnosis;
- determination (confirmation) of treatment;
- determination of diagnosis and treatment of
rare, severe diseases or diseases with a non-typical course;
- determination of complication prevention methods;
- need for a new and/or infrequent surgery (for
treatment or diagnosis) or procedure etc.;
- lack of immediate specialists in the necessary
or adjacent medical field or lack of sufficient experience for diagnosis
or treatment of the disease;
- the patient doubting diagnosis, treatment
and its results, complaint analysis;
- decrease of diagnostics and treatment cost
without impairment of quality and efficiency;
- search and selection of medical establishment
most suitable for urgent and planned treatment of the patient, coordination
of terms and conditions of hospitalization;
- medical care for patients located at considerable
distance from medical centers, when geographical distance between the patient
and health-care provider cannot be overcome.
- search for alternative solutions for clinical
tasks;
- obtaining of additional knowledge and skills
concerning a given medical problem.
Choose of technology
We propose an algorithm for choice of the telemedical
technique (fig.).
Synchronous teleconsultations are most suitable
in medical fields where dynamic types of medical information prevail: psychiatry
(direct communication between physician and the patient is of importance),
urgent surgery etc.
Non-synchronous teleconsultations are most suitable
in medical fields where static types of medical information prevail: trauma
surgery, orthopedics, dermatology, cytology, pathology etc.
Informal teleconsultation allows "to find" the
expert with personal experience in present clinical situation and “to receive”
his unique opinion. At formal teleconsultation is possible to solve organization
questions of the treatment - terms of hospitalization, methods of obligatory
clinical tests and investigations etc. With the help of second-opinion
is possible a pre-hospital revealing and diagnostics of various diseases,
active work on preventive maintenance of complications and a call of the
patient on treatment.
Contact
Anton Vladzymyrskyy,
M.D., Regional Telemedicine Director,
Head of Dep.of Informatics and Telemedicine,
R&D Institute of Traumatology and Orthophedics,
Deputy-editor of “Ukrainian Journal of Telemedicine
and Medical Telematics”
ul.Artema,106, 83048 Donetsk, Ukraine
E-mail: avv@telemed.org.ua
ICQ: 94280429