Telemedicine promises greater access to health care of higher quality, potentially at lower cost. The diverse applications of telemedicine technology developed to date have not been evaluated systematically in terms of their ability to achieve these goals. Furthermore, the great variety in telemedicine applications and the far-reaching consequences of new information systems for health care delivery pose challenges to traditional methods of technology assessment. Methods appropriate for mature technologies may not be suitable for emerging ones and, indeed, may risk stifling their development with premature negative conclusions. The staged approach to technology assessment proposed here matches the analysis to the technology's stage of development. It focuses on access, quality, and cost and considers the communication pathway employed in the telemedicine application. A staged approach to technology assessment can inform and foster the development of new telemedicine technology while allowing health care delivery systems to make rational decisions about adopting telemedicine.
A number of new diagnostic radiology services have emerged which use teleradiology. The main themes include: (1) stand-alone teleradiology practice; (2) the "Nighthawk"/on-call coverage; (3) solo radiologist practice; (4) expert/second-opinion teleradiology; (5) a global virtual radiology service based on workload sharing and reallocation. More applications of teleradiology can be expected due to the continuing shortages and uneven distribution of radiologists, and the increasing use of radiological imaging for diagnosis. In a large enterprise, such as the US army, teleradiology will allow the creation of a global diagnostic organization where diagnostic images are distributed according to the availability of radiologists. Eventually the distinction between picture archiving and communication systems and teleradiology will be blurred and radiology will be provided by virtual organizations with distributed capabilities. As teleradiology services claim a bigger share of radiology practice, various legal and regulatory issues will need to be solved. Ultimately the successful business model will depend on the ability to produce the highest-quality product at the lowest cost.
Teleradiology and telepathology form an integral part of the telemedicine concept. Teleradiology is becoming a mature technology because of advances in imaging technology, database design and communications infrastructure and capabilities. Telepathology has also made significant progress but more development is needed in the definition of required images, database design and standards. While the requirements of most clinical applications of teleradiology are well established, telemammography still presents some impediments. Technical difficulties in telemammography are presented in terms of the lack of a clinically accepted digital imaging system and large data volume required per image. Another important aspect in tele-imaging is the database question. Workstations constitute a window into database. Comprehensive database development is the most difficult and expensive technology for tele-imaging and operational features of such systems are discussed. Finally, we explore current examples of the use of telepathology and teleradiology in the global telemedicine context.
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