Internet And Telemedicine

In recent years, telemedicine, defined as the use of electronic information and communication technologies to provide and support health care from a distance, has become an important aspect in patient care. Advances in digital imaging, high-speed computer connections, and the widespread availability of the Internet have allowed a steady growth of telemedicine within urology (50). Digital images obtained from various sources such as a digital still or video camera, scanner, computed tomography, and magnetic resonance imaging can be exchanged over the Internet at high speed. Current transmission modalities includes the integrated services digital network transmitting 128 kilobits per second, T1 lines transmitting 1.54 megabits per second (Mbps), coaxial cable (up to 6 Mbps), asymmetric digital subscriber line (1 to 3 Mbps) (6,8,19).

Two types of telemedicine systems are currently available. One is the synchronous, real-time video conferencing. In general, real-time motion requires that images are generated at a speed of 30 frames per second (51).

The advantage of "live" video teleconferencing consists of real-time interaction between physicians and patients with full motion audiovisual images, allowing a true physician-patient relationship.

In addition, several medical centers can be linked with the teleconferencing facility to promote tele-education and teleconsultation. With proper equipment, digital images including endoscopic pictures, pathologic slides, and radiogic images can also be transmitted in real time. The high cost of real-time telemedicine systems and communication networks has currently prevented the widespread use of this technology. For example, a teleconferencing system can cost more than US$80,000 and that does not include the connection fee which can be as high as US$800 per month (52). Recent studies have demonstrated that one could provide high-quality high-definition television image-orientated telemedicine via integrated services digital network lines or communication satellites. However, the minimum set-up cost, greater than US$1,000,000, is still prohibitive (53).

Alternatively, telemedicine can also be accomplished using an asynchronous or "store and forward" system, whereby the information is transmitted via email or the Internet. The recipients can review and respond to the information transmitted at their convenience, as the data are stored in a locally accessible, computerized data storage and retrieval system. Many surgical disciplines, including urology, are increasingly utilizing this technology. Current store and forward technology are also progressively improving with better software development and secure transmission of encrypted data over the Internet (19). Despite lack of real-time interaction, these systems remain very effective and useful tools for medical care and endourologic training (8).

Standardization of input devices for image data exchange is essential for telemedicine. There is an urgent need for future standardization and integration of telemedicine hardware (53).

Although the digital imaging and communications in medicine standard exists for radiological images, there is no standard for other digital images such as endoscopic still pictures or video clips.

The upcoming challenge for telemedicine lies within the decisions made as regards physician licensing requirements, regulation of telemedicine, reimbursement of consultations, and protection of patient confidentiality.

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