A field trial of the NASA Telemedicine Instrument Pack in a family practice.
BACKGROUND
Previous studies of telemedicine applications have demonstrated that the technology is effective but inefficient. Little attention has been directed to the primary care portion of the connection, especially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to describe the effectiveness and efficiency of the NASA Telemedicine Instrument Pack, a small self-contained system of medical peripheral devices.


METHODS
This study was an 8-week field trial of a suitcase-sized pack containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studied in specialty clinics and then was used in a family practice office connected to the consultant node by digital lines. Evaluations were obtained from technicians, patients, and consultants.


RESULTS
During 20 video clinic sessions, 59 patients with 38 different diagnoses were examined. The ear, nose, and throat portion of the exam was effective, with some decrement in color and clarity with compression of the signal. The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens did not meet the requirements for color or clarity prior to compression of the signal.


CONCLUSIONS
Subsequent design efforts for medical peripheral devices for telemedicine use will require significant modifications to "off the shelf" equipment to be effective and efficient. A family practice telemedicine testbed provides the appropriate environment for such field trials.
University of Texas Medical Branch, Dept. of Family Medicine, Galveston 77555-0853, USA.
W J
WJ
Crump
B J
BJ
Levy
R D
RD
Billica
D001291:Attitude of Health Personnel; D016287:Computer Peripherals / Q000592:standards*; D003880:Dermatology / Q000295:instrumentation / Q000592:standards; D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D005194:Family Practice / Q000295:instrumentation* / Q000592:standards; D006801:Humans; D009885:Ophthalmology / Q000295:instrumentation / Q000592:standards; D010036:Otolaryngology / Q000295:instrumentation / Q000592:standards; D010342:Patient Acceptance of Health Care; D010808:Physical Examination / Q000295:instrumentation* / Q000592:standards; D019114:Remote Consultation / Q000295:instrumentation* / Q000592:standards; D019035:Rural Health Services; D014741:Video Recording / Q000295:instrumentation* / Q000592:standards