The doctor

is on-line Telemedicine is cost-effective for off-island referral care

NEW communication technologies can be used for numerous cost-effective applications in medicine and health. Their role in networking health professionals was emphasised especial ly in the field of off-island referral care. The issue was raised on the second day of a regional conference on Telehealth in the Pacific in Noumea.

Victor Yano, President of the Pacific Basin Medical Association, outlined the need for better communication links between in-coun try practicians and overseas specialists. Before 1995, communica tion involved the use of long distance telephone, faxes and regular mail.

“Connecting to an (off-island) specialist required a long sequence of events before being connected to the right person”, he said. Things have changed with the use of new tools like still image phone systems. With this small device, freeze-images are captured at the sending end by a camcorder and transmitted to a remote receiver unit where they can be displayed and stored. A sep arate consultation form about the patient is submitted as a fax to specialists of the referral hospital.

“For the first time ever, colour patient images, patient data, and x-ray images could be transmitted with the submission of a written medical report”, Mr Yano said. Though highly sophisticated, telemedicine and telehealth activities are cost-effective, according to Dr Hedson from Federated States of Micronesia. “Pohnpei State, with 40,000 people, spends 10 per cent of the health budget in referring patients off-island for tertiary treatments, serving only one per cent of the total population”, he said. Before the Internet era, approximately US$l,5OO per month was spent on telephone bills for outside consultations, mainly with overseas specialists.

With the Internet connection, and the consult web page, particular ly at the Triplet Army Medical Center in Honolulu, Hawaii, where most of the referral patients are treated, the bill had decreased to below US$5OO per month for consultations, a saving of US$lOOO per month. Other Pacific countries and territories benefit from these communication tools that link in-country practicians to overseas colleagues. “In Majuro,-Marshall Islands, the telemedicine activi ties have been settled since seven and a half months, and mainly confined to referrals and teleconsultations”, Dr Gunawardane

explained.

Most of the health professionals attending the Pacific Telehealth Conference expressed their support to the development of e-mail and Internet applications in medicine and health. The main diffi culties so far are limitation of on-line access and computer illitera cy amongst most physicians. ■