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Telemedicine use in Orthopaedics and Trauma PDF Print E-mail
Written by ChrisOliver   
Monday, 14 January 2021
Lucy Katharine Cogswell, MRCS
Senior House Officer Trauma and Orthopaedic Surgery

Christopher W. Oliver, DM, FRCS (Tr & Orth), FRCP
Consultant Trauma and Orthopaedic Surgeon

Edinburgh Orthopaedic Trauma Unit
Royal Infirmary of Edinburgh
Lauriston Place, Edinburgh
EH3 9YW Scotland


Telemedicine is a rapidly developing technology that is set to change the practice of medicine across all the specialties in a wide variety of ways. In the past decade the rapid development of computer technology in particular digital image processing, has meant that remote consultation using telemedicine has become available to a wide range of medical services at relatively low cost. Telemedicine in orthopaedics and especially trauma is rapidly developing and the technology will need to be carefully assessed. It is probable that the success, usefulness and practicability of telemedicine in orthopaedics and trauma will be dependent on positive cost-effective health impact for widespread usage to occur.

What is telemedicine?

For the uninitiated, the European Commission has defined telemedicine as “The investigation, monitoring and management of patients and the education of patients and staff using systems which allow ready access to expert advice and patient information, no matter where the patient or relevant information is located”. More simply, this is “medicine at a distance”. The technology has been in use since the early 20th century, when telephone and radio communication networks were set up between doctors and in fact; calling a colleague for advice is a simple form of telemedicine. However, recent rapid technological advances in telecommunications have allowed telemedicine to develop to an unprecedented scale, incorporating such diverse modalities as information websites offering education and advice, real-time videoconferences between doctors and patients and examination of patients in different continents.

Why use telemedicine?

There is no specific purpose for telemedicine; it is a tool for modern medicine and its applications are limited only by the extent of human ingenuity and imagination. Within current medical practice, there are three main roles for telemedicine; health information, education and training in healthcare. All of these areas are currently in use in the field of orthopaedics and trauma. The advantages of using telemedicine relate to ease of data storage, avoiding the need for travel and transporting patient information and theoretical cost and timesavings. The potential for wider dispersion of professional expertise via telemedicine links is potentially very useful in remote rural parts of the world.

More specifically, in the field of health information, current applications of telemedicine include electronic storage of patient data, medical e-mail, storage of and access to laboratory, radiology and other test results. In the future, we can expect improved facilities for data collection and assimilation for statistical analysis in audit and research and quite possibly global remote health information services.

In terms of teaching, once set up, a ‘telemedicine university’ is available to anyone with technology to reach it, education that is genuinely available to all. Many medical schools publish their curriculum and lectures on the Internet; distance-learning courses via the Internet are a reality for post-graduate studies (see http://www.informatics.rcsed.ac.uk). There are a wide range of Internet sites providing information on medical matters directed at the lay public and these services can be labeled as telemedicine services. There is scope for far more in terms of teaching medical staff such as multi-media and interactive services.

With regard to the provision of remote opinions, minor orthopaedic and trauma telemedicine systems have been successfully developed over the past few years and tele-triage systems are already under trial. Tele-image links for X-rays have transformed neurosurgical practice in particular in the UK. Tele-monitoring has a role in transmission of vital signs in trauma. Tele-videoconferencing is currently being assessed for provision of remote clinical conferences; it has also been suggested as a tool for communicating on-scene information in trauma, information that is often unavailable to hospital staff at present. This area of telemedicine, more than any other, is likely to radically change the practice and provision of trauma care worldwide in the future, as information networks are set up for exchange of information between fixed and mobile centres (e.g. ambulance to hospital) and across international geographical boundaries.

Technologies involved in Telemedicine

The types of technologies which telemedicine employs can be considered under the three categories of:

1.|Remote sensing technologies
2.|Diagnostic and teaching aids
3.|Collaborative techniques.

Remote sensing technologies allow information obtained from patients, such as ECGs, X-rays and temperature readings to be taken at a distance. This type of technology also includes; long - distance video recording, auscultation and otoscopy. Experimental ideas include remote endoscopy, and remote tactile systems. The data obtained may simply be stored for later review, or relayed to a remote location in real time in a remote consultation scenario.

Diagnostic and teaching aids are widespread, ranging from on-line algorithms and protocols for diagnosis and treatment, to databases, on-line medical journals, textbooks and lectures.

Collaborative techniques are rapidly becoming more sophisticated, with radio links and advanced digital telephones in use throughout the world, while real-time videoconferencing remains a largely experimental tool at present, though this is also moving rapidly into the mainstream as it becomes cheaper.

Infrastructure for Telemedicine

Transmission of medical information in a useful manner involves a number of stages:
·|Image capture and display
·|Storage of data
·|Data transmission
·|Processing information.

Another necessity when the technology is to be applied between mobile units is a portable energy system. Battery technology is now rapidly improving and stand-alone systems can now run in isolation for longer. One of the most significant limiting factors at present is provision of wide bandwidth transmission in order to send large files of multimedia information rapidly across a computer network.

Some Current Telemedicine Applications in Orthopaedics and Trauma:
·|Minor injuries algorithms
·|Collaboration networks for minor injury units staffed by nurses
·|Digital links for sending CT scans to neurosurgical units
·|Telematics Training for Surgeons
·|Trauma protocols - Internet

Potential Telemedicine Applications:
·|Long distance operating
·|Telelinks to ambulances/aircraft
·|Long distance referrals to specialists
·|Sending X-Rays to hyper-specialists
·|Advice by email - Doctor to Doctor or Doctor to patient
·|Internet patient support groups
·|Internet research questionnaires
·|Audit across international boundaries

Potential Telemedicine Problems:
·|Confidentiality of patient information (should not be an excuse to not deploy the technology)
·|Cost to set-up
·|Adequacy of telecommunications networks (bandwidth and security)
·|Legality when practicing across international boundaries
·|Smell and touch

Assessment of Telemedicine Projects

The assessment of telemedicine projects is multifactoral. One of the major problems after a telemedicine project is established is whether it is sustainable long term, particularly when the project has been funded from research funds. There should be consideration of “self sustainability” with minimal further pick-up costs by the health care provider. Telemedicine projects must give likely benefit of the money spent and the project must represent good value. Economic evaluation of telemedicine projects must be shown, as otherwise expensive technology will be wasted. Telemedicine projects in orthopaedics and trauma can help to address equity and access for health professionals disadvantaged by geography and can assist in support of evidence-based healthcare and clinical governance, however this must be assessed to show benefit. It must be asked of all telemedicine projects that usage is relevant to orthopaedic and trauma healthcare and not just an experiment for the sake of deploying the technology.


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Last Updated ( Tuesday, 19 July 2020 )
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