A FIELD TRIAL OF THE NASA TELEMEDICINE INSTRUMENT PACK IN A FAMILY-PRACTICE

Background: Previous studies of telemedicine applications have demonst rated that the technology is effective but inefficient. Little attenti on has been directed to the primary care portion of the connection, es pecially the use of the medical peripheral devices. This study used a telemedicine testbed that simulates a rural practice environment to de scribe the effectiveness and efficiency of the NASA Telemedicine Instr ument Pack, a small self-contained system of medical peripheral device s. Method: This study was an 8-week field trial of a suitcase-sized pa ck containing a fundus camera, flexible nasopharyngoscope, dermatology macrolens, light source, and video monitor. The pack was first studie d in specialty clinics and then was used in a family practice office c onnected to the consultant node by digital lines. Evaluations were obt ained from technicians, patients, and consultants. Results: During 20 video clinic sessions, 59 patients with 38 different diagnoses were ex amined. The ear, nose, and throat portion of the exam was effective, w ith some decrement in cole: and clarity with compression of the signal . The eye portion was marginally effective, limited by a field of view that was too narrow and also by rigorous technician requirements. The skin exam was largely unacceptable primarily because the macrolens di d not meet the requirements for color or clarity prior to compression of the signal. Conclusions: Subsequent design efforts for medical peri pheral devices for telemedicine use will require significant modificat ions to ''off the shelf'' equipment to be effective and efficient. A f amily practice telemedicine testbed provides the appropriate environme nt for such field trials.