Balearic Islands connect to joint network

“All public hospitals and around 80 connected Primary Health Centers in the Balearic Islands are now connected to a joint network, where the use of a master patient index is enabling Balearic doctors to access patient data and medical findings anytime.”
Article
eHealth Europe, 5 May 2008

10 years teledermatology in The Netherlands

The Netherlands are one of the European front runners on teledermatology. 70% of dermatology teleconsults do not have to visit clinic but can be dealt with by GP, being a time benefit for both patient and dermatologist.

Article (Dutch)
Huisarts Vandaag, 14 April 2008

Mobile teledermatology: a feasibility study of 58 subjects using mobile phones

“Abstract:
We investigated the diagnostic agreement between teledermatology based on images from a mobile phone camera and face-to-face (FTF) dermatology. Diagnostic agreement was assessed for two teledermatologists (TD) in comparison with FTF consultations in 58 subjects. In almost three-quarters of the cases (TD1: 71%; TD2: 76%), the telediagnosis was fully concordant with the FTF diagnosis. Furthermore, the diagnosed diseases were almost all in the same diagnostic category (TD1: 97%; TD2: 90%). If mobile teledermatology had been used for remote triage, TD1 could have treated 53% subjects remotely and 47% subjects would have had to consult a dermatologist FTF. TD2 could have treated 59% subjects remotely, whereas 41% subjects would have had to consult a dermatologist FTF. Forty-eight subjects responded to a questionnaire, of whom only 10 had any concerns regarding teledermatology. Thirty-one subjects stated that they would be willing to pay to use a similar service in future and suggested an amount ranging from €5 to €50 per consultation (mean €22) (€ = £0.7, US $1.4). These results are encouraging as patient acceptance and reimbursement represent potential obstacles to the implementation of telemedicine services.”
Abstract
Ebner, Christoph; Wurm, Elisabeth M.T.; Binder, Barbara; Kittler, Harald; Lozzi, Gian Piero; Massone, Cesare; Gabler, Gerald; Hofmann-Wellenhof, Rainer; Soyer, H Peter, Journal of Telemedicine and Telecare, Volume 14, Number 1, January 2008 , pp. 2-7(6)

Distribution of Telemedicine in Japan

“Of 1,006 telemedicine projects initiated between 1997 and 2004, 348 were active in 2004, representing a two-fold increase in active programs. There was a four-fold increase in home health and telepathology. Telemedicine is widely distributed in Japan with most serving rural populations, but 30% of the projects in urban areas.
This paper reports the situation of telemedicine in Japan. A comprehensive database search showed that a total of 1,006 telemedicine projects had been implemented from 1997 to 2004. Teleradiology accounted for the largest proportion (37%) of these projects and home-care telemedicine (home telecare) accounted for one third of the total number of projects. The subsequent questionnaire-based survey revealed that 348 projects were active in 2004, indicating a more than twofold increase in the number of ongoing projects from the 151 projects reported in 1997. In particular, the use of home telecare and telepathology has exhibited an approximately fourfold increase since 1997. Telemedicine was most common in remote areas, although approximately 30% of the projects were implemented within urban areas. The number of telemedicine projects peaked twice: in municipalities with populations ranging from 10,000 to 30,000 and in municipalities with populations ranging from 100,000 to 300,000. However, with regard to the population density, there was no characteristic distribution of implementation. The present data suggest that in Japan, there are various population sizes and densities for which telemedicine may be valuable.”
Abstract
Takashi Hasegawa, Sumio Murase. Telemedicine and e-Health. 2007, 13(6): 695-702. doi:10.1089/tmj.2007.0013

Teledermatología ‘web’: más eficaz y más barata

Teledermatology “web”, much more efficient and much cheaper.

“Realizar consultas de teledermatología en tiempo real a través de videoconferencia puede ser más rápido y vistoso, pero resulta menos eficaz y más caro que enviar las imágenes a través de un entorno web.”
Article
Mercedes M. Rubio, Diario Medico, 2 October 2007

VisualDxHealth: Visual Diagnosis Made Easy

“VisualDxHealth is a new Health 2.0 site specializing in easy to understand visual aids to guide clinical decision making, combined with experts’ opinions.”
Article
MedGadget, 19 September 2007

iPath – a Telemedicine Platform to Support Health Providers in Low Resource Settings

K Brauchli*, D O’Mahony**, L Banach*** and M Oberholzer*
*Department of Pathology, University Hospital Basel, Switzerland
**Family Practitioner, Port St Johns, South Africa
***Telemedicine Unit, University of Transkei, South Africa

Abstract:

In many developing countries there is an acute shortage of medical specialists. The specialists and services that are available are usually concentrated in cities and health workers in rural health care, who serve most of the population, are isolated from specialist support. Besides, the few remaining specialist are often isolated from colleagues. With the recent development in information and communication technologies, new option for telemedicine and generally for sharing knowledge at a distance are becoming increasingly accessible to health workers also in developing countries. Since 2001 the Department of Pathology in Basel, Switzerland is operating an Internet based telemedicine platform to assist health workers in developing countries. Over 1800 consultation have been performed since. This paper will give an introduction to iPath - the telemedicine platform developed for this project – and analyse two case studies: a teledermatology project from South Africa and a telepathology project from Solomon Islands.

Woundhealing analysis and measurement by means of colour segmentation (WHAT 2005)

Thomas Wild(1), Michael Prinz(1), Annita Budzanowski(1), Stefan Stremitzer(1), Finn Gottrup(3), Luc Téot(4),Thomas Hölzenbein(2)

1. University of Vienna, Department of General Surgery, Austria
2. University of Vienna, Department of Vascular Surgery, Austria
3. Odense University Hospital, Department of Plast. Reconstr. Surgery, Denmark
4. Montpellier University, Department of Surgery, France

Abstract:

Consolation of skin wounds costs the European Health Service, many millions of Euro every year which makes it important to choose the best method of treatment for a given wound. In order to assess whether a treatment being used on a wound is working effectively, the clinician, often a nurse, requires quantitative feedback on the healing progress of the given wound. Moreover it would be important to get such feedback on weather a pharmaceutical, or different forms of treatment are better than the others.
But the assessment of a healing wound is today a subjective process, depending on the inspecting clinician. It is a common problem that because of the lag of time in daily clinical routine, the wound observation is made without any kind of measurement tool, not even a ruler. But wound size is only half the part of a descriptive wound documentation, the often more important part is its composition from granulation tissue, fibrine exudation and necrotic tissue. Since these three types of tissue have distinct colouring the healing status could be indicated by measuring their proportions. Unfortunately the human eye is hardly able to quantify the amount of a given colour within a region.

Methods
One possible solution to this problem of subjective wound-analysis is the use of digital image processing. Taking a picture of the woundside stores all the given colour values in the pictures smallest unit of measurement, the pixel. Analysing these pixel values with a special algorithm, sorts and counts them according to red granulation tissue, yellow fibrin and black necrotic tissue. In our study we took photographs with a Sony power shoot digital camera and stored the picture in jpeg-graphic files with a resolution of 1024×768 Pixel on a personal computer running under Microsoft Windows 2000. At the next step, the picture of the wound was analysed by the image processing software WHAT, standing for Wound Healing Analysation Tool (WHAT) The following proportions can be assessed by the user: Wound area, wound perimeter and elective distances, measured on the computer screen in pixels, millimetres and square millimetres, plus automatic tissue segmentation module’s results, area of granulation, fibrin and necrosis, which are presented in pixels, square millimetres and in percentage of the wound area. The analysing algorithm was set up after the statistically evaluation of colour histograms of about 100 typical wound photographs. To verify the right segmentation into the wound components, biopsies from the wound side where taken in 45 cases of different wounds and histologically examined. 10.400 cases were analysed till 11/2004.

Results
Morphological analysis of the take biopsies showed that there is similarity to digital wound processing results, on whether tissue is granulation, fibrin or necrosis. Granulation tissue was separated correct in almost any cases, with acceptation of some circumstances where blood couldn’t be split up of Granulation tissue due the same colouring. Automatic recognition of fibrin functioned at high rate if its thickness exceeds a certain amount and its yellow and white colouring covers the underlay. There is now known way to separate fibrin from colliquation or fat necrosis, moreover tendons and fascias must be detached manually before or after automatic wound processing. Necrosis presenting at a dark hue, showed that hit rate was most accurate within well lighted photograph. Shadows or week light resulted in incorporation of granulation tissue in percentage of necrosis.
Over all exactness can be set up at 80-95 %, depending on some basic rules during picture taking. The acceptation are some complicated wounds where manual correction is needed to be done, because of non typical structures mixing up with the colour separating algorithms.
We could reduced infection rate in our department less 30% and reduce the length of stay in patients with wound infection at 3,4 day shorther than 1 year ago.

Conclusion
Photographs taken during normal wound care routines, present a simple but effective way of clinical data storage and moreover comprise the option of objective wound assessment. It could be said that in comparison with today’s situation of subjective and verbal wound assessment, an image analysing system like WHAT, offers sufficient accuracy to be used as an objective diagnostic instrument in daily clinical workflow. There are different settings of wound healing disorders, like them induced from diabetic angio- and neuropathy, which could be studied and maybe optimised in therapy by means of colour segmentation. We assume that in times of consumer electronic mass production the equipment needed is affordable to any clinical department and larger scaled studies may demonstrate the efficiency of such wound evaluation system. Bridging the gap between electronic engineering and patient care will shortening therapy time, save up resources of staff and money to the health care system. This new tool for wound healing measurement can objective proof the effect of different treatment options. Over all it should be mentioned that especially the time of the patients impairment could be reduced by further studies on this topic.