Meeting summary: a Department of Defense agenda for development of the surgical suite of tomorrow--implications for telemedicine.
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Biomedical subjects
Publications and source records attributed to Charles R Doarn.
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Telemedicine education and application throughout Russia has its roots in Russia's space program. The concepts of telemedicine have evolved during the course of 40 years of space exploration. This paper reviews the evolution of telemedicine and the achievements of the Soviet/Russian Space Program.
The integration of telecommunications and information technologies in medicine, known as telemedicine, has traditionally been outside the operating room. However, with the advent of new technologies, smart systems, and advanced computing, adoption and adaptation of these technologies in the operating room has increased. The operating room has been a place of startling isolation. The operating room is an island within a health system that is only reached by a select few. The application of telemedicine in this inaccessible place offers a huge potential in a variety of ways. These include enhanced education for students, enhanced safety for the patient, enhanced knowledge of the events that occur-a sort of status monitoring of underlying infrastructures-and sharing of the operating environment for collaboration. The Operating Room of the Future will be linked to other islands of expertise by robust telemedicine capabilities, thereby eliminating the isolation. Telemedicine in tomorrow's operating room is a natural fit
The integration of telecommunications and information systems into health care delivery in human space flight operations is not new. It has been an integral tool for over 45 years. During these past decades, numerous efforts have been conducted to further develop and promulgate telemedicine. The National Aeronautics and Space Administration (NASA) established a commercial space center in 1997, known as the Medical Informatics and Technology Applications Consortium (MITAC). MITAC has developed and conducted a variety of test beds in several international settings, including Russia, Ecuador and other extreme and remote environments. These test beds have been designed to evaluate and validate technologies and techniques that have application in the delivery and support of health care in unique environments. The characteristics of these test beds are analogous to what might be observed or experienced in low earth orbit or on space-based platform. These include intermittent communications, low bandwidth, level of competency of the front line health worker, etc. These test beds have led to new approaches for the delivery of health care as well as enhanced education. These experiences have been beneficial in the promulgation of telemedicine as an effective tool and have provided new ideals for space exploration as well terrestrial medicine. This paper will highlight MITAC's test beds and their relationship to space exploration.
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BACKGROUND AND PURPOSE: The surgical theater has undergone a series of transformations from an open stadium-like environment to the closed environment of minimally invasive endoscopic surgery. Paradoxically, evolution from open surgery performed under direct vision to closed surgery performed through use of video images has been accompanied by improved viewing of the operative field by student observers. The objective of these experiments was to determine if a laparoscope mounted on the operating table during open surgery would provide students a better view of the operative field than that provided while standing behind the operating surgeon or via an optimally positioned hand-held video camera. MATERIALS AND METHODS: An endoscopic video camera and telescope were attached to an operating table by an Alpha Virtual Port, which facilitates use of the laparoscope in open surgery by fixing it to the operating table in the position of interest. Additional imaging systems were set up so as to simulate viewing of the surgical field by direct vision or a hand-held video camera. Common objects were placed on the operating table in mock surgical fields of various depth-to-aperture ratios. Images of these surgical fields were obtained by each of these systems and placed in a Web-based tool. Eleven people with a wide range of medical training evaluated the images and determined that the Alpha Port-mounted surgical telescope provided optimal visibility of the mock open surgical field. RESULTS AND CONCLUSION: The benefit of use of the mounted telescope was more pronounced as the depth-to-aperture ratio of the surgical field increased. Use of the Alpha Port-mounted laparoscope in open surgical procedures improves student viewing of the open surgical field.
Assessment of the logistics, economic feasibility, and accuracy of presurgical and postsurgical telemedicine consultations is reported. Virtual patient-surgeon consults were achieved through the use of desktop and laptop computers, digital video, and still cameras using two communications modalities. Patients were selected from rural clinics in the southern Oriente region and from communities located in the Andes Mountain range outside of Cuenca, Ecuador. Patients were evaluated preoperatively and postoperatively by general surgeons working with the Cinterandes Foundation, a not-for-profit organization providing surgical care in remote regions of Ecuador in cooperation with the Ministry of Health's primary care program. Preoperative and postoperative telemedicine consultations had a high measure of clinical accuracy and some economic value. Data were collected from several sites throughout the country during the course of the project. Formidable challenges were encountered and are reported here.
The main objectives of the G-8 Global Healthcare Applications Subproject-4 (G-8 GHAP-SP-4) were to establish an international concerted action on collaboration in telemedicine, telehealth, and health telematics (hereafter referred in this paper as telemedicine). In order to promote and facilitate the implementation of telemedicine or health telematics networks around the world, it was considered necessary to address certain key issues. Five thematic solution-seeking forums were held between May 1998 and December 1999. Each addressed a key issue, including interoperability of telemedicine and telehealth systems, impact of telemedicine on health care management, evaluation and cost effectiveness of telemedicine, clinical and technical quality and standards, and medico-legal aspects of national and international applications. The main objectives of these forums were to establish best practices and a thorough review of the issues and discussions among experts to determine the best solutions for the facilitation of global international telemedicine networks. More than 650 invited participants from 16 countries attended the five forums, which were of 2-3 days in duration. These forums provided a foundation for the exchange of ideas resulting in the initiation of collaborative activities. Based on these deliberations, a series of 21 recommendations were prepared by the national representatives of the G-8 GHAP SP-4. These recommendations propose to political leaders and health care managers of the G-8 and other countries roadmaps to follow in order to accelerate the achievement of a Global Society of Healthcare via Telemedicine, Telehealth, and Health Telematics. The 21 recommendations are presented in this report.
This report presents a series of recommendations derived from deliberations of the G8 countries Subproject 4 Group (SP4 Group) of the Global Health Care Applications Project entitled, A Teleconsultation Practice Guideline. The recommendations provide an initial step toward developing a general guideline platform for the practice of telemedicine/teleconsultation.