Use of telemedicine will double in next decade, report predictsBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1634 (Published 23 March 2010) Cite this as: BMJ 2010;340:c1634
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Zarocostas indicates an ever-expanding area of healthcare services (1). Such new trends, however, should be considered seriously toward the needs of those in developing countries, as well as those countries that have developed them.
The utility and efficacy of telemedicine have been debated for years (2-7). Making telemedicine available to serve those with limited resources is a key global health concern (3). Taipei Medical University's medical mission provides an example of telemedicine linking one of the world's most remote locations with a team of experts.
In late December 2009, the medical mission began its work in the remote island country of Sao Tome & Principe. This former Portuguese colony is hundreds of miles from mainland West Africa. Medical resources in the host country are scarce, so most burn patients must recover without inpatient care if they survive infection. In early 2010 more than 10 patients with major burns were admitted to Sao Tome's central hospitals. Several of them died of infection and others faced problems later on.
Three children were brought to our mission in late March due to significant burns on the torsos, faces, limbs and inguinal regions suffered weeks earlier. Digital images of the children's burns were sent by e-mail to the University Hospital in Taipei. A follow-up Skype videoconference through rented satellite link in Taiwan's Sao Tome embassy provided a barely real-time but conventional telemedicine consultation to evaluate burn severity.
Due to inadequate bandwidth, the close-up images' resolution was not sufficient to determine hypertrophic scar thickness, but the plastic surgeon in Taiwan identified that contracture had resulted in limited limb range of motion (ROM).
The decision was made to transfer the patients to Taiwan for post-burn reconstruction before irreversible body disfigurement and permanent functional loss. Unfortunately, one patient died of infection before transfer. The other two boys did well on the flights and were with their family members. After transposition flap surgery, skin grafting and rehabilitation both children regained good function and movement.
Burn reconstruction requires long-term planning and years of follow-up to reach optimal outcomes, especially for growing pediatric patients, in the Wan Fang Hospital affiliated with the University. Functional evaluation after their return to Sao Tome is planned through web videoconferencing. The medical mission also seeks to reduce burn injuries by developing preventive programs for use in the islands later this year.
Telemedicine's capacities and utility in burn cases have been noted (8-10). In this case, telemedicine and subsequent transfer out of country were indispensable in saving the patients' lives. Despite limitations in the accuracy of triage done via virtual devices, the ROM assessment was close to the previous evaluation using telecommunication. This proves telemedicine can play a valuable role in triage and planning for burn treatment referrals.
Besides the medical professionals involved in the children's reconstruction therapy, the larger university community is campaigning for donations to cover the children's health costs. Telemedicine has brought together medical experts and concerned citizens across the globe to help two badly burned children recover and move freely again.
1. John Zarocostas, Use of telemedicine will double in next decade, report predicts BMJ 2010; 340:c1634.
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8. Saffle JR. Telemedicine for acute burn treatment: the time has come. Journal of Telemedicine and Telecare 2006; 12:1-3.
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Competing interests: None declared
Competing interests: No competing interests
J Zarocostas highlights an important obstacle to any potential
adoption of telemedical services in primary care. Namely, some general
practitioners “regard telemedicine as competition” (BMJ 2010;340:c1634).
There is, however, a growing body of evidence to the contrary. Referring
as an example to telecardiology (telemedicine that informs the diagnosis
and management of cardiac disease, in both the acute and chronic setting),
research suggests that telemedicine enables and empowers GPs to manage
more of their own patients than otherwise possible. This is principally
due to two factors:
1. Avoidance of unnecessary referrals to the secondary care level. In
an Italian study, a cohort of 200 GPs were provided with a telecardiology
service, resulting in the GPs managing their own chest pain patients in
74% of cases.
2. Development of GPs’ cardiac care expertise. It has been postulated
by some that bridging the gap between primary and specialist care via a
telecardiology service actually improves the GPs’ own knowledge-base, thus
improving the standard of cardiac care provided[2-3].
. Scalvini S, Zanelli E, Conti C, Volterrani M, Pollina R,
Giordano A, et al. Assessment of prehospital chest pain using
telecardiology. Journal of Telemedicine and Telecare 2002;8(4):231-6.
. Molinari G, Valbusa A, Terrizzano M, Bazzano M, Torelli L,
Girardi N, et al. Nine years' experience of telecardiology in primary
care. Journal of Telemedicine and Telecare 2004;10(5):249-53.
. Scalvini S, Glisenti F. Centenary of tele-electrocardiography
and telephonocardiography - where are we today? Journal of Telemedicine
and Telecare 2005;11(7):325-30.
Correspondence to: firstname.lastname@example.org
WB worked temporarily (summer 2009) in a clerical capacity for Broomwell Healthwatch telemedical services.
Competing interests: No competing interests