title: Review of 5.5 Years' Experience Using E-mail-Based Telemedicine to Deliver Orthopedic Care to Remote Communities.
abstract: The use of e-mail-based telemedicine has been demonstrated as an effective and low-cost way of delivering healthcare to patients in remote areas who have limited access to medical services. We established a novel teleorthopedic service for a catchment area encompassing 972,000 km2using a commercial off-the-shelf e-mail application. Before the implementation of this program, patients with acute orthopedic injuries were required to travel by air up to 1,900 km for evaluation by an orthopedic surgeon. In the present study, we examined the patient demographics and consultation characteristics and calculated the cost savings associated with patient travel for this teleorthopedic service.
  
  
  
  We retrospectively reviewed 1,000 consecutive e-mail-based consults and radiographic images received for new patients with acute orthopedic injuries from January 2008 to June 2013. Seventy-nine consults were excluded due to incomplete documentation, leaving 921 available for analysis. The service records were examined to identify patient demographics, orthopedic diagnosis, the percentage of patients managed locally, and the medical indications for patients requiring transfer. As the travel costs for patients requiring transport to the university hospital center are borne by governmental health agencies, the savings accrued from treating patients in their home communities were also calculated.
  
  
  
  For the 921 consultations, the mean age of patients was 27 years (range, 3 months-88 years), with 40.7% of all patients being younger than 18 years. The most common diagnoses were ankle fractures (15.2%), clavicle fractures (11.2%), distal radius fractures (11.2%), and fractures of the foot (10.2%). One hundred ninety patients (20.6%) required transfer, whereas 731 patients (79.4%) were treated in their home communities. Of the patients who were transferred, 123 (64.7%) required surgery, 55 (28.9%) required clinical evaluation by an orthopedic surgeon, and 12 (6.4%) required CT or MRI. Cost savings related to return trip travel expenses were calculated to be $5,538,120 Canadian (CAD) for the review period.
  
  
  
  Using an e-mail-based teleorthopedic service to manage acutely injured patients in remote communities allowed 79% of patients to be treated locally, with travel-related cost savings of $5,538,120 CAD.
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Adam
authors.initials: A
authors.lastname: Cota
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Magdalena
authors.initials: M
authors.lastname: Tarchala
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Caroline
authors.initials: C
authors.lastname: Parent-Harvey
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Victor
authors.initials: V
authors.lastname: Engel
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Greg
authors.initials: G
authors.lastname: Berry
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Rudy
authors.initials: R
authors.lastname: Reindl
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre , Montreal, Canada .
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Harvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D034742:Electronic Mail; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000191:economics* / Q000379:methods*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: emergency medicine/teletrauma; extreme environments; telehealth; telemedicine; telesurgery