The impact of teleconsultations at a referential centre on the management of pulmonary patients.
Teleconsultation services at referential centres are an important area of telemedicine development. The implementation of such scenarios brings high-level competencies to peripheral hospitals through telecommunication links. Pulmonary teleconsultations were one of the key aspects of Krakow Centre of Telemedicine (KCT) activities conducted in 2002-2003. The role of the referential centre for respiratory medicine was played by the Division of Interventional Pulmonology, Jagiellonian University Medical College. Peripheral centres were pulmonary wards situated in local hospitals or policlinics located 20-80 km from Krakow. These hospitals were equipped with PC-based telemedical workstations and ISDN lines (256 kbps). Dedicated software (Telenegatoscope) was used for real-time discussions among physicians on medical images (X-rays, CTs) sent from peripheral centres to the referential centre. Images inserted in light boxes were cropped at peripheral centres with a high-resolution digital camera. During the pilot phase, about 40 pulmonary patients were referred via telemedical links to the University Hospital. The frequency of soliciting a second opinion at the referential centre was analyzed for each main type of disease. Top positions are currently occupied by diagnoses of lung cancer, pleural fluid of unknown origin, asbestosis and tuberculosis. About 70% of the patients referred for virtual consultation were admitted for further diagnostics and treatment in an ambulatory or inpatient mode at the Division of Interventional Pulmonology. The review of teleconsultations results indicates that teleconferencing contacts, even if conducted through relatively limited bandwidth, may bring considerable benefits to patients requiring complex diagnostic and sophisticated, procedures available at the referential university hospital.