评估一个远程医疗系统以协助皮肤科转诊管理。

Evaluating a telemedicine system to assist in the management of dermatology referrals.

作者信息

Taylor P, Goldsmith P, Murray K, Harris D, Barkley A

机构信息

Centre for Health Informatics and Multiprofessional Education, Royal Free and University College London Medical School, Archway Campus, Highgate Hill, London, N19 3AU, UK.

出版信息

Br J Dermatol. 2001 Feb;144(2):328-33. doi: 10.1046/j.1365-2133.2001.04023.x.

DOI:10.1046/j.1365-2133.2001.04023.x

PMID:11251567

Abstract

BACKGROUND

Teledermatology systems fall into two categories: live video or store-and-forward. In the former, video-conferencing equipment is used to connect a patient with a remote consultant. This method has been evaluated as an aid to dermatology, but it is expensive both in terms of capital and running costs. Video consultations are generally longer than conventional ones and harder to schedule. Some authors have considered store-and-forward as an alternative to live video: instead of a consultation, specialists could make a rapid inspection of a transmitted still image.

OBJECTIVES

A study was conducted to evaluate the role of telemedicine in the dermatology outpatients department of a district general hospital (Whittington Hospital NHS Trust, London, U.K.).

METHODS

One hundred and ninety-four patients were seen by one of two consultant dermatologists. A nurse used a video camera to store digital images of each patient's problem and compiled a history from the GP's referral letter. The images were reviewed 13 months later by both dermatologists; they recorded a provisional diagnosis and an assessment of how urgent an appointment would have been made given the information provided by the system. A third consultant graded the level of agreement between the telemedicine diagnoses and the face-to-face consultations.

RESULTS

High levels of agreement were found between the diagnoses of the dermatologists using the system to inspect images and those of the dermatologist who saw the patients (77%). Consultants using the system recommended fewer urgent appointments (32% compared with 64%) and felt that in 31% of cases the patient did not need to be seen. In 15% of these cases (5% of the total), however, their diagnosis differed significantly from that of the consultant who saw the patient. Had the system been in use, 14% of patients conventionally assigned a non-urgent appointment would have been seen urgently.

CONCLUSIONS

The images allowed a reasonably accurate diagnosis. The software was not reliable (six cases could not be viewed), or easy to use (it took approximately an hour to view 20 cases) but an improved version could be used in triaging outpatient appointments.

摘要

背景

远程皮肤病学系统分为两类：实时视频或存储转发。在前者中，视频会议设备用于将患者与远程会诊医生连接起来。这种方法已被评估为对皮肤科有帮助，但在资本和运营成本方面都很昂贵。视频会诊通常比传统会诊时间更长，且更难安排。一些作者认为存储转发可作为实时视频的替代方案：专家可以快速检查传输的静态图像，而不是进行会诊。

目的

进行一项研究以评估远程医疗在一家地区综合医院（英国伦敦惠廷顿医院国民保健服务信托基金）皮肤科门诊中的作用。

方法

194名患者由两位皮肤科会诊医生之一进行诊治。一名护士使用摄像机存储每位患者问题的数字图像，并根据全科医生的转诊信编写病史。13个月后，两位皮肤科医生对图像进行复查；他们记录了初步诊断以及根据系统提供的信息对预约紧急程度的评估。第三位会诊医生对远程医疗诊断与面对面会诊之间的一致程度进行评分。

结果

使用该系统检查图像的皮肤科医生的诊断与看过患者的皮肤科医生的诊断之间存在高度一致性（77%）。使用该系统的会诊医生建议的紧急预约较少（32%，而面对面会诊为64%），并认为在31%的病例中患者无需就诊。然而，在这些病例中的15%（占总数的5%），他们的诊断与看过患者的会诊医生有显著差异。如果该系统投入使用，14%通常被安排非紧急预约的患者将被紧急就诊。