Telemedicine isn't widely used outside of the West,
despite its evident utility for the developing world. This
is due, in large part, to its technological requirements:
telemedicine has come to rely upon high-bandwidth network
links for the transmission of medical data and
high-resolution images. As a result, the developing world
telemedicine focus is often on
bringing in high-end hardware. But that may soon change.
Research at the University Hospital of Geneva,
Switzerland,
published in the current issue of Archives of Dermatology,
tested the
usability of camera phones as an approach for visualizing
leg ulcerations. The researchers compared face-to-face
evaluations of leg wounds to evaluations made via mobile
phone pictures, under normal lighting, and sent via email.
The three physicians separately
evaluated the 61 leg ulcers for nine variables. "The
image quality was judged to be good in 36 cases (59
percent) and very good in 12 (20 percent). The
participants felt comfortable making a diagnosis based
on the pictures in 50 cases (82 percent)," the authors
state. To compare the results, the researchers used a
statistical analysis which measures agreement between
two raters when both rate the same object. The value
range is one to zero, where one is perfect agreement and
zero is no agreement between the two raters. "Overall,
the agreement between the remote and face-to-face
evaluations was very good, with values of up to 0.94,"
the authors state.
While this was a narrow test, it is suggestive. A wide
array of telemedical applications relying on visual
examination and diagnosis may be able to take advantage of
the mobility and connectivity of cameraphones. Cameras in
mobile phones are rapidly improving in quality, and cameras
with the ability to record video are now on the market.
While 3G networks aren't yet widely available, they should
(in principle) also allow real-time video over the phone
connection, making interactive telemedicine calls possible.
Using digital images and email for telemedicine is not
new. The Australia-based
Swinfen Charitable
Trust provides free telemedicine services around the
world using little more than digital cameras and email.
While they technically don't provide emergency services,
they are sometimes called upon to provide
rapid assistance to remote health care workers. This
brief 2002 article (PDF) by the project's founders,
Roger and Pat Swinfen, gives an overview of the Swinfen
project.
The SCT is run from home, by the two
authors. New referrals are allocated to a panel of
medical consultants, who give their advice free of
charge. We have consultants in 23 specialties, who are
located in Europe, Australia and the USA. Referrals are
coordinated, and records kept of each referral and
reply. Email messages are checked three to four times
daily, seven days a week. Should a referral not receive
a reply, we are able to intervene and seek another
specialists advice.
The Internet infrastructure in remote parts of the
developing world is often non-existent, while mobile phone
networks
cover more than 80% of the planet's population.
Cameraphone photographs and phone network email have the
potential to improve both the scope and reliability of the
Swinfen and related low-cost telemedicine projects.
The Markle Foundation,
as part of its
telemedicine clinic project in Ratanakiri Province, Camobia,
provides an example (PDF) of another pathway to
telemedicine in areas without network access: "Motomen."
Within
Ratanakiri Province, poor roads and distance isolate
villages. Many of these villages have no phones, TV,
electricity, water, transportation system, or much
contact with the rest of the province or country.
Fourteen of them do have AAfC [American Assistance for
Cambodia]-built schools, each with a solar-panel fueled
computer. While it would be prohibitively costly to
dedicate satellite dishes to individual villages in this
area, or to create a wirebased network among them, they
are now being linked to each other and to the Internet
wirelessly via a mobile send-and-receive system. Twice a
day one of a small fleet of motorcycles is driven past
each of 14 computer equipped schools and the satellite
hub, the Markle Telemedicine Clinic.
Each motorcycle is outfitted with
a wireless antenna and a data storage box (see photo,
above). As it drives past a school, the motorcycle can
transmit e-mails and information from web sites. This
mechanism allows people to send e-mail and effectively
surf the web in a time-delayed fashion. The schools, in
addition to the clinic, are becoming community hubs from
which villagers can send and receive questions and
information about their personal health, regardless of
whether they are able to travel to the Markle clinic, as
well as communication on other topics. This so called
Motoman initiative was designed by the Cambridge,
Massachusetts-based firm First Mile Solutions in
association with AAfC.
Within Telemedicine can be of great value in the developing
world, bringing global medical expertise to regions
suffering from
limited resources and "brain drain." It just needs the
components to be in place. Fortunately, the convergence of
efforts to bring Internet access to remote areas, the growth
of low-cost mobile phones, and the increased medical utility
of images sent by digital camera could soon lead to a
telemedicine revolution.