Crump W J, Levy B J, Billica R D
University of Texas Medical Branch, Dept. of Family Medicine, Galveston 77555-0853, USA.
Aviat Space Environ Med. 1996 Nov;67(11):1080-5.
Previous studies of telemedicine applications have demonstrated that the technology is effective but inefficient. Little attention has been directed to the primary care portion of the connection, especially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to describe the effectiveness and efficiency of the NASA Telemedicine Instrument Pack, a small self-contained system of medical peripheral devices.
This study was an 8-week field trial of a suitcase-sized pack containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studied in specialty clinics and then was used in a family practice office connected to the consultant node by digital lines. Evaluations were obtained from technicians, patients, and consultants.
During 20 video clinic sessions, 59 patients with 38 different diagnoses were examined. The ear, nose, and throat portion of the exam was effective, with some decrement in color and clarity with compression of the signal. The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens did not meet the requirements for color or clarity prior to compression of the signal.
Subsequent design efforts for medical peripheral devices for telemedicine use will require significant modifications to "off the shelf" equipment to be effective and efficient. A family practice telemedicine testbed provides the appropriate environment for such field trials.
先前关于远程医疗应用的研究表明，该技术有效但效率低下。对于连接中的初级保健部分，尤其是医疗外围设备的使用，关注较少。本研究使用了一个模拟农村医疗环境的远程医疗试验台，以描述美国国家航空航天局远程医疗仪器包（一种小型独立医疗外围设备系统）的有效性和效率。
本研究是一项为期8周的实地试验，试验对象是一个手提箱大小的仪器包，其中包含眼底照相机、软性鼻咽镜、皮肤科大透镜、光源和视频监视器。该仪器包首先在专科诊所进行研究，然后在通过数字线路连接到咨询节点的家庭医疗办公室中使用。评估来自技术人员、患者和咨询人员。
在20次视频门诊期间，对59名患有38种不同诊断的患者进行了检查。检查的耳鼻喉部分有效，但信号压缩后颜色和清晰度有所下降。眼部检查效果一般，受视野过窄以及对技术人员要求严格的限制。皮肤检查在很大程度上不可接受，主要是因为大透镜在信号压缩前不符合颜色或清晰度要求。
后续用于远程医疗的医疗外围设备的设计工作将需要对“现成”设备进行重大修改，以提高有效性和效率。家庭医疗远程医疗试验台为此类实地试验提供了合适的环境。
