A TELEMEDICINE CONSULTATIVE SERVICE FOR THE EVALUATION OF PATIENTS WITH UROLITHIASIS

Objectives. A 6-month pilot teleconsultative project linking Georgetow n University Medical Center (GUMC) in Washington, DC, and City Hospita l in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making pro cess for patients with urolithiasis. Methods, The telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patient's imaging studies were pe rformed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through a n Inverse Multiplexor (IMUX). Treatment options were recorded for the clinical trial group and a simulated study group by the consulting uro logist after the initial telephone consultation, after the telemedicin e consultation, and after examination of those patients transferred to GUMC. Results, A total of 32 telemedicine consultations were performe d: 14 in the clinical trial group and 18 in the simulated study group. The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultatio n compared with the recommended treatment after the initial telephone consultation. Conclusions. In the evaluation of patients with urolithi asis, this telemedicine application enhanced the clinical decision-mak ing process by allowing for improved quality of care through immediate access and effective transfer of information between the referring ur ologist, the patient, and the stone center specialist. (C) 1998, Elsev ier Science Inc. All rights reserved.