Mara Boschetti

Computer-telephone integration and Internet development have allowed telemedicine and its application fields spreading; throughout research and systemic analysis of the sites that are present in the web about this matter, carried out between June and September 1999, it has been ascertained the presence of a high number of Web documents, a prove of an increasing interest towards telemedicine and its potentialities. 

They devote themselves to this field not only the big industries producing biomedical and telecommunication instruments but also the physicians and administrations; try and search "telemedicine" on the web: for example, by Altavista, and you will find far as 2035 web pages only among the Italian language sites.  

According to what is reported in this site, an important reason of growth of telemedicine is related to the need to serve comfortless areas where it's difficult or impossible to supply health services.  
Many innovations in telemedicine established indeed as a medical support on insulated oil rigs, artic expeditions, and other conditions alike; in a following moment, the most involved in telemedicine studies were just those States having troubles with their own territory morphology, as Norway with its fjords, and more in general archipelagos (the Azores and Canary Islands, for example).
Telemedicine development is remarkably fostered by the problem to supply health services to comfortless patients. 

This problem rises from the patient's inability to move from his own house and at the same time requiring medical service. 
By this viewpoint telemedicine can be employed with a twofold target: the patient direct monitoring from the medical practice and the support to the nurse's traditional work that this way can receive medical consultation. 

Another reason of the development is due to the improvement of the diagnostic activity by the means of the teleconsultation among specialists, increasing this way the possibility of professional update of physicians and freeing them from geographical restrictions. 

Finally one of the main reasons in employing telemedicine instruments has been since the beginning and it still goes on being this way, the control of health expenditures. 
To quote some examples, in Los Angeles during the weekend a sole radiologist from a hospital serves some other hospitals, reading radiographies by telecardiographers; the installation of telecardiographers at physician's on charge allows reducing the cases sent to the first aid for suspicious cardiac pathologies (reducing on the other hand the uneasiness of the patient). 

On the web many sites are available concerning projects started off already since some years ago as the one of the Centro di Ascolto Nazionale (National Centre of Listening) of Genoa, in the site "Telemedicine and informatics in medical and health world " and the one of Trentino Region: "Telemedicine in Trentino".      
Starting from January 1997 the Trentino Institute of Culture, in collaboration with the Health Councillorship of the Province of Trento, the Province Enterprise for Health Services and Telecom Italia, has fostered a project named "Oncologic Teleconsultation and Telecardiology over the territory ". 

The project, financed by the Ministry of Health, has a three-year duration. 

This experimentation aims to extend to the family doctors the cardiologic teleconsultation web in order to move out of the hospital structure the actions of assistance, monitoring and diagnosis. 
Another field where telemedicine has a great utility is that of the teleoncology: by addressing to a strong social impact pathology, telemedicine allows the teleconsultation with the referring centres and the patient monitoring, mainly in terminal phases; besides it is spreading the telepathology: the troubles in development in this field are due to the huge mass of images the anatomopatologist gets by observing a slide at several degrees of magnification. 

Currently they are on course several studies at this concern: in the site "HISTKOM Telepathology" is reported the experience of Stuttgart but also in Italy some experimentation are being carried out. 

In the site of the "University of Udine" it is described the pilot project for a web connecting all the services of pathologic anatomy that works over the regional territory in order to carry out consultations, updates and didactics.

A special and intensive development is surely devoted to teleradiology: by now the greater troubles are related to the transmission of images produced by techniques different by contents and methods (PET, RX, RM, Angiographies...) both static and dynamic and high resolution. This fact has limited the spread of applications in this field. Projects and experimentations do not lack both Italian and European level:

" Telemedicine experimentation on the Tuscany MAN ": that reports some examples of practical applications among which the possibility to integrate images produced in far places and by techniques different by contents and methods (PET, RX, RM, Angiographies, Echographies, Nuclear Medicine) in order to develop and apply quick clinic treatment process or to achieve consensual decisions (teleconsultation and telediagnosis) or the construction of archives reference images for the different pathologies, allowing the physician a quick and systemic access to documented information, not only for diagnostic consultation, but also for research and didactics purposes.
But there are also other telemedicine application fields, very large and in spread:

• Teledermatology: "Telemedicine", a site concerning the teledermatology experience in Norway.   

•

 Tele burn-centre: "Region Hospital Burn Centre", telemedicine in the cure of the patient seriously burned and not conveyable.

All the medical and surgery specialities can furthermore avail on the televideoconference throughout which it is possible to transmit images and sounds: this way it will be easier to keep the physician-patient relationship more like to the traditional one, to send data to the consultants for a more exact distance diagnosis (videoteleconsultation) and improve the update and the connection among physicians working in rural or comfortless areas and those working in the town great hospital centres. 
< This concern the site "V. Della Mea - Videoconferences for Telemedicine" is very exhaustive.

It describes the technical features and the practical aspects of the videoconference system.

Telemedicine, besides having strictly clinic functions, can contribute to an improvement in the health system management by the means of the wide applications, administrative kind. Indeed in many Italian and European regions application systems of a "Hospital INTRANET " are being planned, systems easing the access to the outpatient booking lists, beds availability, programmed admissions etc. allowing this way a more efficient management of the Hospital Enterprises. Furthermore it has been already started off experimental projects to equip every citizen with a magnetic card bringing all the information about his own case history. 

The site "Hospital INTRANET " is exhaustive in describing the applications and features of the proposed system. 

The heterogeneity of the Italian sites puts in light the lack of a common project and the need to coordinate the several activities, while in other European countries and mainly in the United States there are already coordination structures, regional and national level.
For example in Great Britain it has been established a "National Database of telemedicine" collecting the information got from all experiences of telemedicine and telemonitoring carried out in the United Kingdom.

In the United States the employ of telemedicine already belongs to the physician's daily practice. 

The insurance companies have started off economic studies to evaluate the reduction of the costs related to the early discharge from hospital. Just that gave the decisive push to the development of telemedicine for the homecare.  
On the web you may find sites offering information about this matter, by the links and search engines devoted only to this matter: very exhaustive is the site "ATSP" or "Telemedicine Links".  
The development of interest toward telemedicine goes hand in hand with the telecommunication and informatics technological development. 

The increase of the market demand of equipment able to transmit images, sounds and different kind data has fostered the establishment and development of companies and private enterprises able to offer equipment or whole services in telemedicine. 

Backed by these firms, any structure, both public and private, can benefit from the services as home tele-assistance, the access to outpatient services via Internet or the teleconsultation among specialists. It does not lack sites of this kind on the web, both Italian and foreign. 

In conclusion, from the analysis of the sites, it is possible to understand that telemedicine is surely an instrument able to improve the health service, the quality in services, the work condition of the personnel, by warranting at the same time cost cut. 

As already previously highlighted it is very sensed mainly in Italy the lack of a project unifying the several experiences and allowing the coordination of the studies on course.

 

Mara Boschetti

Ricercatrice
Istituto Scientifico
"Medicina Domani"