REMOTE MANAGEMENT OF HEMODIALYSIS-PATIENTS - DESIGN AND IMPLEMENTATION OF A TELEMEDICINE NETWORK

Telemedicine applications have been implemented in many clinical speci alties, Some, like teleradiology, are now estabilshed applications wit h specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Proje ct Phoenix, a National Library of Medicine funded project set up to lo ok at the access, cost and quality implications of telemedicine in a r enal dialysis setting, we are establishing such protocols and standard s. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and I nformation Systems (ISIS) Center of the Department of Radiology, the C linical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GU MC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a re mote outpatient dialysis clinic, and a nephrologist's home. The primar y functions of the network are to provide telemedicine services to ren al dialysis patients, to create, manage, transfer and use electronic h ealth data, and to provide decision support and information services f or physicians, nurses and health care workers. This paper shows that t he first step in establishing standards and operational protocols for various clinical applications is to start with specific clinical needs assessment followed by an iterative process of reassessment and evalu ation. This allows flexibility and a dynamic approach in the optimal s ystem design.