Medecine without frontiers

Even in the Antarctic, your doctor is just a phone call away.

Britain's first tele-dentists are poised to begin work. Four consultants at the University Dental Hospital, Cardiff, will examine the teeth of patients in clinics up to 60 miles away and make treatment decisions based on what they see on a screen in front of them.

Patients will have their dental problem filmed with a camcorder, the doctors will view the live images as they are transmitted down telephone lines and recommend what treatment should be carried out by local practitioners. The project, due to get off the ground later this year, will be the 18th telemedicine scheme in Britain with dermatologists, psychiatrists, ophthalmologists, obstetricians, and casualty doctors already involved in similar schemes.

Oil rig workers off the Scottish coast, scientists in remote Antarctica, dermatology patients in rural Wales, expectant mothers on the Isle of Wight, and people with eye problems in a Greek village are already benefiting from telemedicine projects based in Britain.

For some doctors, telemedicine is the brave new frontier in the delivery of health care, where specialist services can be more widely shared and more swiftly available, and where emergency medical help can be given to patients hundreds of miles from a doctor.

For others, the cost effectiveness of the technology has yet to be proven, and there are those who still have lurking doubts over safety and fear that the technology linking the patient and the doctor may go disastrously wrong. There are a few, too, who are yet to be persuaded that telemedicine is little more than a high-tech toy that has been over-promoted by a handful of enthusiasts.

Telemedicine has been slowly evolving since the late 1960s, but was given a big push in the 1970s when research backed by the US National Aeronautical and Space Administration (Nasa) found that the quality of care provided at a telemedicine centre staffed by paramedics with cameras was no worse than that provided in a conventional clinic staffed by doctors.

Since then telemedicine has developed apace, especially in the US, where intense competition between large telecommunication companies has stimulated a rapid spread of projects, ranging from the remote medical examination of prisoners in a North Carolina high security jail, to a DIY obstetrics care system in Brooklyn where patients take home a computer-based kit linked to the hospital.

The main aims of telemedicine, regarded by enthusiasts as one of the most innovative areas in the delivery of health care, is to use interactive telecommunications for the diagnosis and, in some cases, treatment of patients.

At the technical level it is a marriage of fibre optics, fast computers, high resolution monitors and advanced telephone lines. At the patient end it usually involves he or she being filmed with a camcorder by a nurse or a GP and having a consultant many miles away look at the problem and talk to the patient and their doctor at the same time.

It can, however, also be a fast-track way of processing data. Some big hospitals, such as the Hammersmith in London, have been looking at processing X-rays, for instance, and shipping them back to GPs in rural areas over telephones lines, giving a much faster return than at present.

For most professionals, the principle attraction of telemedicine is that it makes better use of scarce resources, and in most cases this is the expertise of a consultant. By using video links a consultant can see many more patients.

According to a review of telemedicine by Dr Bill Maton-Howarth of the Department of Health, there are 17 active projects in the UK, with many more in the pipeline. Ten centres are working on various ideas, he says, but warns that there have been few attempts at examining the cost effectiveness of telemedicine.

Dr Richard Wootton, Britain's only professor of telemedicine, based at Queens University, Belfast, has costed one of the longest running projects, which links the city's Royal Victoria Hospital with a health centre in Westminster.

Professor Wootton says the annual cost of the project was pounds 7,250 a year, compared to the alternative costs of having medical staff on site at the centre, which would have been pounds 50,000 a year - a net saving of pounds 42,000.

"The Westminster centre, which is staffed by nurse practitioners, faced one of the classic paradoxes in staffing healthcare facilities: it was adequately staffed to treat 98 per cent of the cases presented to it, yet needed to consider employing more highly skilled staff to cope with only two per cent of the case load," he says.

As well as saving money, as in Westminster, telemedicine widens access to expertise. In Wales, the dental hospital is a regional unit and some patients with problems that cannot be dealt with locally currently have to travel to Cardiff to be examined. Once the project begins, they can be examined locally.

Professor Malcolm Jones, who is setting up the teledentistry project, says: "Essentially, the dental hospital will be the hub of the service, and various clinics will be the spokes. We will provide consultant diagnosis and treatment support services along the spokes.

"As a first step we will be providing services to community clinics in the South Wales Valleys and from there we plan to expand into rural Wales to other clinics and eventually to practices. Initially, we will be looking at orthodontics and then move into paediatrics."

He adds: "As consultants we are very thinly spread and this is a way of providing a consultant service to rural Wales without anyone having to travel."

The removal of the need to travel may be one of the main attractions for patients, but ironically, it is not taken into account in costings, as Professor Wootton points out: "Some of the main savings are in the intangibles like patients not having to spend time getting from, say, the isle of Wight to a London hospital."

He is convinced that the secret to further expansion of telemedicine in the UK is providing proof that it saves money. "It is my belief that until you have studies which show that telemedicine in a specific circumstance is economic to the health service it simply won't happen on any scale. We might not like it but unless you can show a new technique is cost effective on the NHS, it is not going to get introduced. It is crucial to find evidence of cost effectiveness."

Dr Bill Maton-Howarth at the Department of Health says there needs to be further research too, into issues like the confidentiality of patient information, patient consent, and the duty of care that doctors and the health service have.

Both in the UK and the US telemedicine has already spread across international boundaries with specialists in New York performing diagnostic work on a patient in Saudi Arabia, and Bristol-based eye specialist Dr Demetrios Papakostopoulos providing a diagnostic service for the population of a poor Greek village.

Telemedicine has found a role in the more glamorous side of health care too - accidents and emergencies - by giving camcorders with telemedicine links to paramedics in remote situations like oil rigs and Antarctic expeditions.

An EC-funded telemedicine project - Mermaid - is poised to take the technology one step further and revolutionise health services to merchant ships. It's hoped that by equipping ships with cameras and data links to a multi- lingual, 24-hour medical centre, all sick seamen will get instant access to medical treatment.

And similar work is also under way to find ways of providing remote health care to future space explorers, the vision that Nasa researchers had nearly 30 years ago which gave the original impetus for telemedicine and which is now finally much closer to becoming reality.

News
peopleFrankie Boyle responds to referendum result in characteristically offensive style
News
news
Life and Style
Couples have been having sex less in 2014, according to a new survey
life
New Articles
i100... with this review
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Voices
Holly's review of Peterborough's Pizza Express quickly went viral on social media
Sport
footballTim Sherwood: This might be th match to wake up Manchester City
Arts and Entertainment
musicHow female vocalists are now writing their own hits
New Articles
i100
News
news
Arts and Entertainment
musicBiographer Hunter Davies has collected nearly a hundred original manuscripts
News
Blahnik says: 'I think I understand the English more than they do themselves'
people
Arts and Entertainment
Michelle Dockery as Lady Mary Crawley in Downton Abbey
TVInside Downton Abbey series 5
Life and Style
The term 'normcore' was given the oxygen of publicity by New York magazine during the autumn/winter shows in Paris in February
fashionWhen is a trend a non-trend? When it's Normcore, since you ask
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Marketing Manager - Leicestershire - £35,000

    £30000 - £35000 per annum: Ashdown Group: Marketing Manager (CIM, B2B, MS Offi...

    Marketing Executive (B2B and B2C) - Rugby, Warwickshire

    £22000 - £25000 per annum: Ashdown Group: A highly successful organisation wit...

    SEN Coordinator + Teacher (SENCO)

    £1 per day: Randstad Education Leeds: Job Purpose To work closely with the he...

    Research Manager - Quantitative/Qualitative

    £32000 - £42000 Per Annum: Clearwater People Solutions Ltd: Our client is curr...

    Day In a Page

    Scottish referendum: The Yes vote was the love that dared speak its name, but it was not to be

    Despite the result, this is the end of the status quo

    Boyd Tonkin on the fall-out from the Scottish referendum
    Manolo Blahnik: The high priest of heels talks flats, Englishness, and why he loves Mary Beard

    Manolo Blahnik: Flats, Englishness, and Mary Beard

    The shoe designer who has been dubbed 'the patron saint of the stiletto'
    The Beatles biographer reveals exclusive original manuscripts of some of the best pop songs ever written

    Scrambled eggs and LSD

    Behind The Beatles' lyrics - thanks to Hunter Davis's original manuscript copies
    'Normcore' fashion: Blending in is the new standing out in latest catwalk non-trend

    'Normcore': Blending in is the new standing out

    Just when fashion was in grave danger of running out of trends, it only went and invented the non-trend. Rebecca Gonsalves investigates
    Dance’s new leading ladies fight back: How female vocalists are now writing their own hits

    New leading ladies of dance fight back

    How female vocalists are now writing their own hits
    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam