The role of the Picasso phone system in distance consultation for remote Pacific Islands.

The U.S. affiliated Pacific Island nations spend an average of over 10% of total health budget on off-island referral care to tertiary centers. Tripler Army Regional Medical Center (TAMC) has been the major provider of this service for many years. Prior to 1995 communication to consultants at TAMC was by long distance telephone, fax and regular mail. Connecting to a specialist sometimes took hours and clearly a better communication link was needed. The AT&T Picasso phone, an instrument the size of a small briefcase was developed to reliably transmit still images over the regular phone. Freeze-frame images captured at the sending end by a cam recorder were transmitted to a remote receiver unit, where they were displayed and stored. A typical medical consultation involved about three images, with each transmission over the 28.8 Kbps modem taking about one minute. A separate consultation form submitted by fax to TAMC was attached to the transferred images. Four Picasso phones were used to test their usefulness in linking isolated Pacific islands to a metropolitan medical center. For the first time ever, coloured patient images, data, X-rays etc were transmitted with a faxed written medical report. The Picasso phone was the spark of the Telemedicine development in the US affiliated Pacific islands.