Overview of telemedicine applications for otolaryngology

Objective/Hypothesis: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care sy stem. Our practice is centered around a residency training program in a fed eral facility. Our goal was to lay the groundwork for an entire service bei ng on-line. Study Design: Prospective. Methods: The stepwise process is as follows: needs assessment to examine what part of the practice would lend i tself to telemedicine deployment; usability studies to select the best equi pment; study in-house to normalize the technology to the current standard o f care comparing control subjects with experimental subjects; and deploying remote units to study remote referral. Results: Video-otoscopy captures th e image of an eardrum that can be sent from a remote site in a store-forwar d mode. After normalizing the standard of care, the potential for diagnosin g and treating certain ear conditions such as hearing loss is readily appar ent. An audiogram, pertinent laboratory data, and history and physical perf ormed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngo logist would be gained. Initial data indicate a greater than 90% correlatio n with handheld otoscopy and binocular microscopy, In speech sciences, a ne ed existed to evaluate and treat patients from remote sites where speech th erapists are unavailable. The use of live video teleconferencing to evaluat e and treat patients in-house has preliminary results that show no differen ce in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcome s when residents are proctored by attending physicians from a physically se parated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Differ ent sites scroll through the slides that are listed on a Web site while lin king each site with audio teleconferencing. We are initiating Internet Gran d Rounds using the same technology. Conclusion: These efforts performed in a stepwise approach will lead to an otolaryngology-head and neck surgery se rvice that is on-line for the next millennium, with telemedicine advances n ormalized to the standard of care.