The technical performance and clinical feasibility of telecolposcopy.
BACKGROUND
The purpose of our study was to demonstrate the technical performance and clinical feasibility of a telecolposcopic system through assessment of image transmission veracity, ease of office system implementation, and the patient's acceptance of the electronic image transmission.


METHODS
We used a telecolposcopic system incorporating a custom software package that integrated patient history, current gynecologic status, epidemiologic risk factors, and colposcopic images for local medical documentation and transmission. Satisfaction questionnaires were developed to measure ease of implementation at the remote sites and the patients' acceptance of telecolposcopy.


RESULTS
Seventy-nine women participated in our trial. From 3 to 20 images were captured for each woman, documenting cervical squamous intraepithelial lesions and vaginal and vulvar diseases. All images were received without distortions in color, size, or orientation. With complete visualization of the squamocolumnar junction there was an 86% agreement between the remote and review sites (kappa=.533, P=.019). The interobserver agreement for colposcopic impressions was 86% (kappa=.684, P <.001), and for colposcopic impressions with histology within one level of disease severity, 86% (kappa=.78, P <.001). Colposcopists' and patients' satisfaction with telecolposcopy was excellent. More than 95% of the women stated that they would rather have their colposcopy locally with electronic transmission if an experienced colposcopist were more than 25 miles away.


CONCLUSIONS
The telecolposcopic system described in our study is technically feasible, can be implemented in an office system with limited technical support, and is preferred by women who have to travel many miles to receive referral health care.
Department of Obstetrics and Gynecology, Dartmouth Medical School, Hanover, New Hampshire, USA. M.Harper@Dartmouth.edu
D M
DM
Harper
M M
MM
Moncur
W H
WH
Harper
G C
GC
Burke
C A
CA
Rasmussen
M C
MC
Mumford
D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009513:New Hampshire; D017060:Patient Satisfaction; D012423:Rural Health; D017216:Telemedicine / Q000458:organization & administration / Q000592:standards; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology