A client/server approach to telemedicine.

This paper describes the Medical College of Ohio's efforts in developing a client/server telemedicine system. Telemedicine vastly improves the ability of a medical center physician or specialist to interactively consult with a physician at a remote health care facility. The patient receives attention more quickly, he and his family do not need to travel long distances to obtain specialists' services, and the primary care physician can be involved in diagnosis and developing a treatment program [1, 2]. Telemedicine consultations are designed to improve access to health services in underserved urban and rural communities and reduce isolation of rural practitioners [3].

Implementation of COSTAR in an academic group practice of general pediatrics.

High-quality medical care requires a medical record that is complete, legible, and readily available. Information storage and retrieval are often more difficult in academic group practices than in private offices because of the complexity of the delivery system. We implemented a computerized medical record (COSTAR) in our academic group practice in pediatrics, and recorded data on 14,486 visits for preventive health care or illness over an 18-month period. Except when follow-up visits were made within 48 hours of an encounter, a complete medical record was available at all times. The attending staff physicians were enthusiastic about the computer-based record, and after a period of adaptation, the residents were as well. The nurses and clerical staff agreed that it improved office efficiency and thus patient care. Yet the system was abandoned in the face of medical college politics and problems in other practices at our institution.