Pediatric Informatics: Computer Applications in Child Health (Health ...

20 Telemedicine Applications in Pediatrics 281
allowing for appropriate triage of patients to tertiary care facilities, especially in
disasters, to optimize resource utilization and reduce costs. 6
Telemedicine can also improve other aspects of health care. Discussion of
complex cases by remote experts can improve quality of care and educate local
providers, as well as integrate care delivery by guiding patients to centers of
expertise and excellence. Conversely centers may use telemedicine as part of business
strategies to improve market shares and to promote leading edge academic
endeavors, including research and data collection. 7
20.2 Essential Components of a Telemedicine System
A telemedicine network consists of four basic components: the computer tools
(including patient data/medical record, audio, video, and educational content), the
transmitter tools, the receiver tools and the connection between the sending and
receiving sites. Despite the obvious dependence on technology, the ultimate success
or failure of telemedicine is based on building collaborative relationships. People
with a variety of skills and backgrounds who may work in different countries
and cultures and who may speak different languages must be motivated to work
together to build a successful program. The most technically advanced project is a
failure if end users are not willing to take advantage of the technology.
Standard desktop, laptop, or handheld computers can be converted to functional
telemedicine systems by the addition of hardware and software that allows collection
of video and audio data from medical and nonmedical recording devices for transmission
via telephone/Internet connections or wireless for asynchronous or synchronous
use. Capacity for storing and forwarding files requires additional hardware, software,
and memory than videoconferencing, and many systems can be configured for both
functions. Costs vary: larger systems with “store and forward” capabilities can cost
over $50,000, while a desktop videoconferencing computer can cost less than $5,000.
A basic conferencing input system consists of a video camera and microphone
that can collect and transmit data simultaneously (“real-time”). Other telemedicinecompatible
medical inputs on the market include radiology scanners (less important
as PACS become more prevalent), high-quality dermatology video cameras, stethoscopes,
endoscopes, ophthalmoscopes, and otoscopes (costing between $1,000 and
$15,000). Input from echocardiography or ultrasound units (S-Video and RGB-
Video) can be connected into a standard telemedicine system for the additional cost
of a cable (under $10) to connect the unit to the computer, making echocardiography
and ultrasound ideal for telemedicine.
The output of a telemedicine transmission, from a local input device or a
remote source (desktop or laptop computer, hospital, or physician office network
or storage device), must be rendered from the digital form into an audio/video or
photographic format that can be used for interpretation and diagnosis. Quality of
output may be determined from the source (sufficient signal and information) and
at the reception point (sufficient resources to create visual or auditory presentation