Evaluation of the effectiveness of portable low-bandwidth telemedical applications for postoperative followup: Initial results

Background: The idea of using telemedical applications to evaluate patients remotely is several decades old. It has already been established that x-ra y images (and magnetic resonance images) can be transferred using a persona l computer and a modem, and many other such applications have been implemen ted. Over the past 50 years the expense and technical demands of the equipm ent involved in telemedicine have hindered its widespread deployment. The p urpose of this study is to evaluate the ability of a mobile, low-bandwidth telemedicine platform to achieve real-time postoperative visits in the home . Study Design: This evaluation was designed to evaluate the feasibility of p erforming a real-time clinical visit with computer and telecommunications h ardware and software. A nurse and medical student (for information gatherin g only) made postoperative visits at patients' homes while the physician st ayed at the office. Clinical evaluations were performed by using low-resolu tion and frame-rate video, high-resolution still images, and simultaneous t elephony over a standard telephone line. These remote visits were followed by a standard visit in the office. Eleven patients were included, all of wh om had undergone various laparoscopic procedures. They lived 5 to 240 miles from their surgeon. Efficiency was measured by recording the time required to capture and send data required by the physician to make a clinical deci sion. The time expense was measured at both the patients' and physician's l ocations. Technical issues were evaluated and patient satisfaction was asse ssed by standardized objective questionnaires. The accuracy of the evaluati on at the remote visit was determined with a standard office visit. Results: No technical problems were observed. The mean total time of the ho usecall at the remote site was 86 minutes (range 60 to 160 minutes) and at the base station site was 41 minutes (range 21 to 71 minutes). After person nel became familiar with the system, the last three visits averaged 61 and 25 minutes at the two sites, respectively. This corresponds favorably with current time requirements for visiting nurses and office visits. The patien ts were highly satisfied with the home visit and, on average, rated the exp erience as 4.8 out of a maximum of 5. Conclusions: Followup visits in patients' homes after laparoscopic procedur es can be accomplished by transmitting simultaneous voice, low-resolution v ideo, and high-resolution still images to accurately perform postoperative evaluations over standard telephone lines, with time requirements and clini cal accuracy similar to those of standard visits. (J Am Coll Surg 2000;191: 196-203. (C) 2000 by the American College of Surgeons).