The legal and risk management conundrum of telemedicine.

A store-and-forward teledermatology service was established between two general practices and the department of plastic surgery at Derriford Hospital in Plymouth. An academic lawyer and an expert in risk management made an assessment of the service. They looked at the following issues: medicolegal problems; security; confidentiality; and risk. None of them was considered insoluble and there is no reason why such issues should prevent the National Health Service from developing telemedicine services. All organizations considering telemedicine need to ensure that the proposed telemedicine service satisfies the issues raised in this study.

The virtual mole clinic: preliminary results from the Plymouth skin cancer screening study using telemedicine.

This study evaluated a skin cancer screening service between primary and secondary care in Plymouth using a store and forward telemedicine system. The primary objective was to minimize the time from a patient presenting to a GP with a suspicious lesion to the lesion being assessed and diagnosed by a plastic surgeon. This study retrospectively assessed the practical, technical and operational aspects of incorporating telemedicine into everyday practice and patient satisfaction. Both the GP practice and plastic surgeons were equipped with the appropriate technology for creating, transmitting and accessing an electronic telemedicine record (ETR) via an ISDN 2 line. Patients with suspicious lesions accessed the GP via Mole Check Clinics. The GP captured and transmitted an ETR consisting of digital images and relevant clinical data. In a virtual mole clinic, the plastic surgeon accessed and reviewed the ETR. The expert opinion was entered directly into the ETR and transmitted to the GP within 48 hours. All patients were offered a face-to-face consultation at a real mole clinic within 7 days. Outcomes demonstrated patient and clinician satisfaction and the ability to deliver high quality diagnostic images and resulting expert opinion. This study informed a larger study for future applications of telemedicine.

An evaluation of telemedical support for a minor treatment centre.

A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.