Burgess L P, Holtel M R, Syms M J, Birkmire-Peters D P, Peters L J, Mashima P A
Department of Surgery, Tripler Army Medical Center, Hawaii, HI 96859-5000, USA.
Laryngoscope. 1999 Sep;109(9):1433-7. doi: 10.1097/00005537-199909000-00014.
OBJECTIVE/HYPOTHESIS: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on-line.
Prospective.
The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in-house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral.
Video-otoscopy captures the image of an eardrum that can be sent from a remote site in a store-forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in-house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology.
These efforts performed in a stepwise approach will lead to an otolaryngology--head and neck surgery service that is on-line for the next millennium, with telemedicine advances normalized to the standard of care.
目的/假设：随着我们进入管理式医疗时代，远程医疗技术有助于提高整个医疗系统的效率。我们的业务围绕着一家联邦机构的住院医师培训项目展开。我们的目标是为整个在线服务奠定基础。
前瞻性研究。
逐步过程如下：进行需求评估，以确定业务的哪些部分适合部署远程医疗；开展可用性研究，以选择最佳设备；在内部进行研究，将技术与当前护理标准进行标准化，将对照组与实验组进行比较；部署远程单元，以研究远程转诊。
视频耳镜检查可获取鼓膜图像，并能以存储转发模式从远程站点发送。在将护理标准标准化后，诊断和治疗某些耳部疾病（如听力损失）的潜力显而易见。转诊的初级保健提供者进行的听力图、相关实验室数据以及病史和体格检查，将使患者能够接受虚拟诊疗和分诊。患者和耳鼻喉科医生都将节省时间。初步数据表明，与手持耳镜检查和双目显微镜检查的相关性超过90%。在言语科学领域，存在对无法获得言语治疗师的远程站点的患者进行评估和治疗的需求。使用实时视频电话会议在内部评估和治疗患者的初步结果表明，结果没有差异。作为我们的一项军事任务，研究对外科医生的远程监考也很有必要。初步数据表明，当住院医师由医院物理隔离的控制室中的主治医生进行监考时，结果没有差异。我们还参与了互联网肿瘤委员会，该委员会将四个远程站点与我们的医疗中心相连。不同站点浏览网站上列出的幻灯片，同时通过音频电话会议将每个站点连接起来。我们正在使用相同的技术启动互联网大查房。
以逐步方式开展的这些工作将促成一个在下个千年实现在线的耳鼻喉科——头颈外科服务，远程医疗进展将与护理标准实现标准化。
