Telemedicine Consultations in Daily Clinical Practice: Systems, Organisation, Efficiency

Telemedicine Consultations in Daily Clinical Practice: Systems, Organisation, Efficiency

Anton V. Vladzymyrskyy (Association for Ukrainian Telemedicine and eHealth Development & Donetsk R&D Institute of Traumatology and Orthopedics, Ukraine)
DOI: 10.4018/978-1-60566-002-8.ch018
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This chapter introduces usage of telemedicine consultations in daily clinical practice. Author has describe process of teleconsultation, sample schemes of systems, parties of this process and its roles. Also, main steps of clinical teleconsultation (determination of necessity for teleconsultation, preparation of medical information, observance of ethics and law conditions, preparation of conclusion) are shown. Special part is dedicated to efficiency of teleconsultation – author has propose own complex method for estimation of it. Furthermore, the authors hope that understanding of teleconsultations’ process will make it more accessible and easy-to-use for medical practitioners.
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In this chapter the author describe approaches to usage of telemedicine consultation in daily clinical practice. First teleconsultations described at 1910s (published in JTT, 1997). Since that time telemedicine is use wide range of technologies – TV, satellite, Internet, cellular etc – for discussion of serious clinical cases at distance (Bashshur et al,1997, Kamaev et al, 2001, Nerlich et al,1999, Vladzymyrskyy,2004). Annually in the world are spent thousands teleconsultations. It is possible to say that this procedure is most wide spread telemedicine service.

Teleconsultation (telemedicine, remote consultation) – remote discussion of the clinical case via special computer information and telecommunication system to get answers to precisely formulated questions for the help in clinical decisions (Vladzymyrskyy,2003).

Author has propose classification of teleconsultation by 3 main classes: terms of teleconsultation leading, sort (kind) of organisation and technical platform.

  • 1.

    By term:

    • Synchronous: All parties use the same telemedicine system in the same time (in real time);

    • Asynchronous: All parties use the same telemedicine system with time delay (sequential use).

  • 2.

    By sort:

    • Formal: Two or more organizations were involved under a previously signed contract/protocol/agreement;

    • Informal: Free discussions of clinical cases in professional Internet societies (via mailing lists, Web-forums);

    • Second opinion: Teleconsultations for patients who contacted a medical organization by email or via a special online form/forum.

  • 3.

    By technical basis:

    • Systems at the base of Internet and its services (e-mails, Web-platforms, mailing lists, IP-phones, IP-videoconferences, chats, messengers etc);

    • Systems at the base of special links (satellite, ISDN, ftn-protocol, computer health networks etc);

Systems at the base of cellular phoniness and its services (mobile Internet, SMS, MMS, voice etc).


Systems Of Teleconsultation

As we can see in Figure 1, there are 4 main participants of teleconsultation process (Vladzymyrskyy,2003):

Figure 1.

Sample scheme of teleconsultation

Key Terms in this Chapter

CT: Abbreviation of computer tomography.

Coordinator: Physician/nurse, expert in the field of computer technologies and telemedical procedures, which provides uninterrupted work on realization of telemedical procedures.

Assistant: Technical expert serving telemedical system.

Adviser: Expert or group of the experts considering the clinical case which was presented for the teleconsultation.

Teleconsultation (Telemedicine, Remote Consultation): Remote discussion of the clinical case via special computer information and telecommunication system to get answers to precisely formulated questions for the help in clinical decisions.

ISDN: Abbreviation of Integrated Service Digital Network.

Inquirer: Legal or physical person representing a clinical case for the teleconsultation. Most frequently inquirer is the “face-to-face” physician/nurse, also - patient or relatives (in case of self-reference for teleconsultation, “second opinion”).

IP: Abbreviation of Internet Protocol.

Telemedicine Work Station (TWS): Complex of the hardware and software (multitask workplace) with opportunities of digitalization, input, processing, transformation, conclusion, classification and archiving of the any kinds of the medical information and realization of telemedical procedures (teleconsultation).

MRI: Abbreviation of magnetic resonance imaging.

TWS: Abbreviation of telemedicine work station.

Relevance of: Teleconsultation: Conformity of the distant adviser’s answer to information and medical needs of the attending physician (inquirer).

Telemedicine Deontology: Is a professional etiquette and a complex of moral requirements for the persons practising a telemedicine, principles of behaviour for medical, technical and support personnel.

MMS: Abbreviation of multimedia messaging system.

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