[Teleconsultation network for ophthalmology--experiences and results]

[Electronic patient records and teleophthalmology. Part 2: concrete projects in ophthalmology]

Electronic storage of patient-related data will replace paper-based patient records in the near future. Because of the high visualization needed in ophthalmology integrated electronic data storage and usage will be very useful. Chronic diseases like glaucoma, macular degeneration and diabetic retinopathy would benefit from long-term data storage and analysis. Unfortunately there are nearly no widely accepted systems available providing these options. Another important point is the simplification of existing diagnostic procedures and nomenclature on an international level. Increasing mobility of patients requires a better portability of existing medical examination data between different physicians. This is the only way to provide continuously high levels of quality in patient care and to simultaneously reduce costs and prevent unnecessary secondary examinations.

[Electronic patient records and teleophthalmology : part 1: introduction to the various systems and standards]

Electronic storage of patient-related data will replace paper-based patient records in the near future. Some steps in medical practice can even now not be achieved without electronic data processing. Both systems, conventional paper-based and electronic-based records, have advantages and disadvantages which have to be taken into consideration. The advantages of electronic-based records are e.g. good availability of data, structured storage of data, scientific analysis of long-term data and possible data exchange with colleagues in the context of teleconsultation systems. Problems have to be solved in the field of data security, initial high investment costs and time consumption in learning to use the system as well as in incompatibility of existing IT systems.

Telemedicine framework and applications in dermatology and ophthalmology

Medicine has to balance between the advantages and costs of new technology. As the significance of technical aids has increased, medicine has become more tightly bound to technology. Telemedicine is one of the fastest developing fields, as its development is connected to the development of telecommunication and information technology. Technology sets the ultimate restrictions to telemedicine. However, most challenges are nontechnical. Fast development makes it difficult to perform generalizable studies on the field, and the lack of practical, applicable standardization hinders telemedical system design. The cost of technology is quickly falling compared with the cost of human labour. Because of these factors the efficient use of telemedicine requires strategic decisions at the level of the organization as well as more research concerning the effects of telemedicine on medical practice. This article describes the telemedical frame of reference by using dermatology and ophthalmology as examples.

Ocular manifestations of diabetes mellitus

The ocular complications of diabetes mellitus are numerous and include retinopathy, cataract, uveitis, and neurophthalmic disorders. A review of the current literature shows that the emphasis has changed from the laser and surgical management of pre-existent retinopathy to the development of cohesive multidisciplinary screening and education programs, and to a better understanding of the cellular and molecular mechanisms that underlie disease. The role of associated and potentially modifiable systemic factors is also now recognized. Early intervention with systemic and local therapies may soon provide hope for the better management of diabetic eye disease.

Telemedicine and ophthalmology

Technology to create and move multimedia medical information is creating alternatives to physically transporting patients and health care professionals. Teletechnology is a physician extender, both supplementing and reinventing traditional health care delivery systems. The potential of comprehensive teleophthalmology is compelling. This article provides a historical perspective of telemedicine, describes various teleophthalmology systems, and surveys teleophthalmology in clinical consultation, research, and education programs around the world. It also discusses basic issues in applying teleophthalmology to public health.

Evaluation of telemedical services

With the rapidly increasing development of telemedicine technology, the evaluation of telemedical services becomes more and more important. However, professional views of the aims and methods of evaluation are different from the perspective of computer science and engineering or from medicine and health policy. We propose that a continuous evaluation strategy should be chosen which guides the development and implementation of telemedicine technologies and applications. The evaluation strategy is divided into four phases in which the focus of evaluation is shifted from technical performance of the system in the early phases to medical outcome criteria and economical aspects in later phases. We review the study design methodology established for clinical trials assessing therapeutic effectiveness and diagnostic accuracy and discuss how it can be adapted to evaluation studies in telemedicine. As an example, we describe our approach to evaluation in a teleconsultation network in ophthalmology.