Teledermatology - the Cardiff experience.

This paper describes the development and on-going management of an email-based teledermatology service, providing General Practitioners in the metropolitan area of Cardiff, UK, with rapid access to a hospital-based Consultant Dermatologist. The paper describes the ethos behind the establishment of the service, details the equipment and methods used to deliver it, and presents results from the first four years of operation. It also discusses the lessons learnt in moving from an initial pilot to a supported service.

The National Programme for Information Technology--an overview.

The National Health Service (NHS) in England is in the middle of an Information and Communications (ICT) revolution. The NHS National Programme for IT (NPfIT) has been described as one of the world's biggest IT projects, costing pound6.2bn. 'Over the next ten years, state-of-the-art computer systems will be installed across the NHS. Once the work is complete, those systems will, for the first time, connect more than 117,000 doctors, 397,000 nurses and 128,900 other healthcare professions in England'. The improvement of services through the application of ICT surrounds our everyday life, whether at the bank, in supermarkets or in the entertainment industry. Whilst major technological advances have taken place in medical imaging, diagnosis, treatment and surgery, the same level of advancement in information and communication management, across the whole organization, has proved far more elusive. The concept of the Electronic Patient Record (EPR) in the NHS was first introduced to readers of this journal in 2000. The idea of using information management and technology to ease the burden on NHS staff had been developing for years, with some success in what Brennan described as 'pockets of excellence', but on the whole these initiatives had not achieved the revolutionary change sought and were regarded as a 'frustrating failure'. The Department of Health (DH) therefore seconded Frank Burns from one of the successful EPR sites, Wirral NHS Trust, to develop a strategy to take the NHS towards the vision of an integrated, computer-savvy health service. Three years later, Brennan was back in these pages with an update. The vision of Information for Health and its spin-offs had led to disappointment, missed targets and, ultimately a major re-think. Apart from the failings of Information for Health, the DH was also having to respond to a number of other influential publications; Building the Information Core: Implementing the NHS Plan, Jan 2001; Delivering the NHS Plan; and Securing Our Future Health: Taking a Long-Term View, April 2002 (commonly known as the Wanless Report).

Digital imaging in the forensic post-mortem room.

This paper describes the development of a specialist forensic post-mortem room, complete with digital imaging facilities, by the Institute of Forensic Medicine at the University Hospital of Wales, Cardiff. It gives the background to the development of the facility, and briefly details the specifications before discussing the use of digital imaging in evidence and the need for a full-time specialist forensic medical photographer.

Modernizing medical photography, part 2.

Part 1 of this paper explored the origins of process activity mapping, one of the major tools currently being used to modernize patient pathways in the National Health Service in Great Britain. Within medical photography the current notion of modernization is inextricably linked to the development of digital technology. Whilst the core principle of capturing light on a sensitive medium remains as clear and relevant as ever, the mechanisms by which the image is processed and presented to the client have changed profoundly. Part 2 shows how the principles of lean thinking and process activity mapping can be utilized to harness the advantages of digital technology to provide a modern and appropriate medical photography service in a large disparate teaching hospital.

Modernizing medical photography, part 1.

Government, media and public focus on waiting times in the National Health Service in the United Kingdom has forced the organization to look closely at the process by which a patient progresses through an increasingly complex and ever changing system. In an effort to streamline the patient journey or care pathway, modernizers have turned to business and manufacturing for solutions. Whilst medical photographers need to recognize their role in this context, they are also facing major technological modernization through the development of digital photography. Part 1 of this paper looks at the origins of some of the techniques presently being used to modernize the patient journey. Part 2 shows how these tools of modernization can be utilized to harness the advantages of digital technology to provide a modern and appropriate medical photography service in a large, disparate teaching hospital.