Desktop telemedicine in vascular surgery: Some preliminary findings

Objective: Surgical specialists have generally underutilized telemedicine t echnologies. This report describes the use of real-time interactive-video t elemedicine to augment the care of vascular surgical patients in underserve d rural areas within our region. Materials and Methods: The telemedicine system at Fletcher-Alien Health Car e (FAHC) and the University of Vermont in Burlington utilizes desktop video conferencing technology with terrestrial transmission at 384 kbps. The cur rent system was initiated in January 1996, and there are at present 18 exte rnal sites and multiple locations at FAHC, including the vascular laborator y, angiography suites, operating rooms, and the home of one vascular surgeo n. During the first 12 months of operation, the vascular surgeons were aske d to complete a questionnaire to evaluate the technology and its usefulness in clinical care. The use of the telemedicine system by the vascular surge ons was monitored by the questionnaires, phone bills, and a special "no cha rge" billing code. Telemedicine events were classified as clinical or educa tional. Results: In the 26 months since implementation, 107 events have taken place , including both clinical and educational uses. There were 103 clinical use s by three vascular surgeons, including five emergency uses. A joint Vermon t-Maine vascular educational conference has taken place four times. Overall , use by vascular surgery represented 14.2% of all telemedicine events in t he first year or 30.9% of all clinical events during that time period. Use of telemedicine was reported to have improved patient care in 96% of the ca ses. Eighty percent of the telemedicine uses in the first year saved patien t travel. There were no diagnostic errors, as determined by in-person clini cal follow-up, attributable to the telemedicine system use. Conclusions: Use of a real-time video telemedicine has great potential for vascular surgeons, but cost-effectiveness studies may be needed prior to it s widespread adoption.