Wj. Crump et al., A FIELD TRIAL OF THE NASA TELEMEDICINE INSTRUMENT PACK IN A FAMILY-PRACTICE, Aviation, space, and environmental medicine, 67(11), 1996, pp. 1080-1085
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.