Ace Allen, M.D. with Glenn Wachter, Research Associate, Telemedicine Research Center, Portland, OR

INTRODUCTION

A key feature of telemedicine systems, which distinguishes them from simple videoconferencing systems, is the use of peripheral devices. These enable the clinician to better approximate an on-site physical examination, and include electronic versions of standard examination tools (stethoscopes, otoscopes, ophthalmoscopes) as well as other ‘sense extending’ implements that are almost exclusively electronic: close-up cameras and document stands, dermascopes, and microscopes. These are the tools that might be most useful in a multi-specialty telemedicine practice. There is as well a wide range of electronic tools specific to various specialties: cardiology (cf. vol. 4, no. 3), ophthalmology (vol. 4, no. 5), radiology (vol. 4, no. 6), etc.

To our knowledge, there has never been a survey soliciting observations from users about just which peripheral devices they’re using, which they aren’t using, and why. We thought it might also be interesting to fire a few questions at some prominent vendors to see what they’re up to. Keep your eyes open for the Peripheral Devices section of the 1997 Telemedicine Today Buyer’s Guide and Directory, coming out in March. This will be significantly expanded from the 9-page Medical Peripheral section in the 1996 Buyer’s Guide and Directory, and will include complete cost information on these products.

USER SURVEY (see Fig. 1)

This is a ‘convenience sampling’ of a wide variety telemedicine programs. All except one (New Hanover Regional Med. Ctr) are actively seeing patients; four of the programs (New England Med. Ctr, U. of KS, Georgia, and Dakota TeleMed) are among the most active in the country, according to our 3rd Annual Program Survey (vol. 4, no. 4). We were most interested in finding out about peripheral device usage in programs doing a wide range of specialty consultations, as opposed to single-specialty telemedicine clinics.

No firm conclusions can be drawn from this small survey that sampled less than 10% of interactive-video mediated telemedicine programs. We did notice some interesting trends, however, which may be quite useful to telemedicine program planners:

* electronic stethoscopes were the most used devices, followed by document stands and otoscopes
* document stands were the "Swiss Army Knife" of peripheral devices, used in a great variety of ways -- from imaging lesions to X-rays to EKGs.
* ophthalmoscopes did not appear to be used much; a note from one provider about difficulty of using their instrument may provide a clue as to why not.
* dermascopes were not noted to be used much. While no providers commented specifically on this, we understand from some of our teledermatology colleagues that these scopes may provide an image so magnified that it is outside the usual diagnostic reference frame of a practitioner. However, other dermatologists feel that the extremely magnified views can be quite useful, given adequate training.

Since peripheral devices can be quite expensive (none of the devices cited here sells for less than $1,000, and most cost much more than that), it behooves the buyer to carefully assess needs before committing to expensive equipment that may not find much use.

VENDOR SURVEY (see Fig. 2)

From what Telemedicine Today can piece together, two entities account for about 60% of diagnostic peripheral device sales in N. America. These are Andries Tek, Inc. and Welch-Allyn/American Medical Development. The latter work together for adapting devices to telemedicine applications and for product distribution.

Since a significant percentage of the cost of most peripheral imaging devices is for the camera and light source, most peripheral device manufacturers have developed, or are moving toward, a universal camera/light source with adapters for accommodating a range of tools (otoscope, ophthalmoscope, dermascope, etc.). Buyers should be aware of the extent to which their expensive peripheral devices can share a common camera and light source, so that redundancy is minimized.

JOURNAL ARTICLES AND NEW PUBLICATIONS

British Medical Journal
1996 - Vol. 313 (November)

Wootton R. Telemedicine: a cautious welcome. pp. 1375-1377

Harrison R, Clayton W, Wallace P. Can telemedicine be used to improve communication between primary and secondary care? pp. 1377-1380

Wyatt JC. Commentary: Telemedicine trials -- clinical pull or technology push? pp. 1380-1381

LaPorte RE. Commentary: Telepreventive medicine -- the autobahn to health. pp. 1383-1384

Journal of the American Geriatric Society (JAGS)
1996 - Vol. 44

Williams ME, Remmes WD, Thompson BG. Nine reasons why healthcare delivery using advanced communications technology should be reimbursed. pp. 1472-1475

BOOKS
Telemedicine: Theory and Practice

Bashshur RL, Sanders JH, Shannon GW (Eds). Charles C. Thomas, Springfield, IL, 1996. Hardbound, 435 pp. ISBN 0-398-06731-7

In 1975 Dr. Rashid Bashshur and his colleagues edited "Telemedicine: Explorations in the Use of Telecommunications in Health Care." It was the first hard-bound book on the emerging phenomenon of telemedicine, and provided an outstanding review of the state of the art, techniques, and pitfalls. This new book will be reviewed in an upcoming issue of the magazine.

Medical Surfari.
Gibbs SR, Sullivan-Fowler M, Rowe NW. Mosby-Year Book, St. Louis, MO, 1996. Paperback, 320 pp. Includes computer disc. $24.95

Subtitle: A Guide to Exploring the Internet and Discovering Top Health Care Resources. An excellent beginner’s guide to buying equipment, finding a service provider, nomenclature, software, and key web sites.