CLINICAL EVALUATION OF 4 ALTERNATIVE TELEMEDICINE SYSTEMS

A comparison was made of 4 alternative telecommunication systems used in delivering primary health care to remote populations. The media were color television, black and white television, still frame black and white television and hands-free telephone. The patient population was that of a large organization in a Canadian province, a major component of a societal system. Over 1000 patients who came to a clinic seeking medical attention were examined remotely by 1 of the 4 systems. They were examined in the physical presence of a doctor at the clinic. The diagnoses, patient management programs, etc., of the clinic physician were used as the basis for comparison. No significant differences were found in diagnostic accuracy, proportion of supporting investigations requested, e.g., laboratory tests and X rays, time taken for the diagnostic consultations and the effectiveness of patient management across the 4 communication modes. In some instances the behavior across the modes was significantly similar. Even patient attitudes showed only a slight preference for the more sensory rich modes of communication. There is little to distinguish the effectiveness of the 4 telecommunication modes when used for remote diagnostic consultations. Phase 4 of the research program will compare the effects of the 2 least costly modes, still frame television and hands-free telephone, in an operational system in northern Ontario.