الفهرس 
TELEMEDICINEOnly 14 pages are availabe for public view
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Abstract
Telemedicine is a rapidly developing application of clinical medicine
in which medical information is transferred via the Internet or another
communication network for the purpose of consultations, and sometimes
also for remote medical procedures or examinations. A telemedicine
system can also be applied to medical education.
There is no doubt that telecommunication saves a great deal of time
and expense when exchanging information, and recent technological
advances have increased its popularity in business and educational
applications. Many doctors and medical students could benefit from telementoring
and tele-education based on videoconferencing systems.
However, telemedicine in general has not yet become popular in clinical
practice or medical education.
TD is essentially “dermatology a distance” dermatology is
particularly suited for Telemedicine, as it is visual in nature TD has been
adopted more for use in the developed world, most often in specific
situations where the medical care delivery systems find it fills a gap in
specialty care and is cost-effective. However, TD offers even more
potential benefits to those in the developing world that lack even basic
health care access.
TD can be broken in to 4 main categories:
1-Synchronus (video-conference)TD .
2-Asynchronus (Store and forward)TD .
3-Combined (Hybird Model).
4-Mobile TD.
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While the concordance of TD and in-person dermatology care for
diagnosis and management of skin conditions was generally acceptable.
Data from some studies assessing diagnostic accuracy of TD which refers
to whether or not a diagnosis is correct found that SAF is inferior to inperson
dermatology care, especially for skin malignancies, an important
and common condition in the veteran population. While several studies
have found diagnostic accuracy of SAF TD to be comparable to in-person
consultations, only one study have found that in-person consultation
provides a significantly greater diagnostic accuracy than SAF TD.
Little information exists on the impact of TD on clinical outcomes.
studies found similar clinical outcomes of SAF TD compared to
conventional care. Patient and provider satisfaction with TD were relatively
high though there were individuals who have strong beliefs for a particular
approach. Cost analysis studies were limited in number and relevance to
current United States practice. Studies are needed to compare TD with
primary care to better understand the most effective way to deliver
dermatology care in areas without reliable access to in-person dermatology
(e.g., rural areas).
Given the results of this review, the potential benefits of TD (e.g.,
decreased patient travel, shorter time to intervention, primary care provider
education) need to be evaluated in the context of its limitations including
inferior diagnostic accuracy and management accuracy, especially for
malignant skin neoplasms.
Additional research is needed to determine the long-term
effectiveness, feasibility, satisfaction, and cost-effectiveness of TD,
especially store and forward methodology. Standardized reporting of
diagnostic, management, and outcome accuracy and concordance are
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important. Research evaluating clinical outcomes and patient management
are especially needed. Studies that blind the assessor (s) to the
patient/lesion/care method are preferred to reduce bias in outcome
assessment. Additional outcomes could assess the impact of TD on primary
care practitioners’ practice, satisfaction, and follow-up patterns. Barriers to
successful implementation need to be identified that incorporate differences
in patient populations, skin condition severity, distance traveled,
availability of on-site dermatologists, and other clinical setting issues in
order to determine the relative feasibility and effectiveness of different TD
strategies. Research priorities include comparing TD with dermatologic
care by a Veterans Affairs (VA) primary care provider or a dermatology
trained nurse practitioner (rather than a dermatologist), assessing patient
and primary care provider (as well as dermatologist) satisfaction with TD,
and conducting high quality cost effectiveness studies relevant to VA
populations and care settings.
It is fairly obvious that TD would be a wonderful tool in the context
of management of dermatological problems in remote parts of the world.
However, as of now, we have come across a number of practical problems
which need to be addressed before TD can produce a really significant
impact. In fact, the effectiveness of TD as a primary health care tool at
present is questionable, though it is definitely possible that it may help to
prioritize referrals from remote areas.
It might be quite a while before TD becomes a common and accepted
tool for primary care dermatology. A number of practical issues have to be
addressed, especially regarding the standardization of telemedicine
equipment and procedures. May be a combination of the store-and-forward
system with real-time consultation would be the most effective means of
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TD consultation. Along with the development of telemedicine tools, it
would be important to expand the investigative and pharmaceutical
facilities in the remote hospitals.