Information technology in medicine

Changing the way we practise

MJA 1997; 167: 574

In its enthusiastic embrace of information and communications technology in the health care sector, Australia is part of an accelerating universal phenomenon. While telemedicine today embraces very expensive robotic surgery and virtual reality, its current basis is the provision of simple, cost-effective methods of communicating and disseminating information for better medical practice. In this issue of the Journal, we find three articles dealing with means of sharing medical information. The simplest illustration is found in the article by Ian Charlton, in which printed material, videos and tapes in a practice library are made available to patients wanting more information about their disease management or about lifestyle issues.1 Next, Taylor and colleagues evaluate the use of well established technology -- the fax machine -- in informing family practitioners that patients from their practice have been admitted to hospital.2 Finally, Blackwell et al. report the use of "state of the art" diagnostic telemedicine, with real-time transmission of ophthalmological slit-lamp images from Mt Isa to specialists in Townsville.3 All three projects report significant success, and the last raises the possibility that telemedicine could result in cost savings for the community. The two major components necessary for successful telemedicine are the idea and the technology. Undoubtedly, ideas abound, as the number of technologies available for application in the health care sector is increasing rapidly. Meanwhile, current technologies are becoming cheaper and thus more widely applicable.4 Nevertheless, they are still costly and this, together with many unresolved issues such as State versus national licensure and charging structures for teleconsultation, currently limits the application of telemedicine largely to the public sector.5 Indeed, the Department of Defense in the United States remains a prime mover and funder of telemedicine in that country.6 Confined largely to the public sector, most telemedicine applications to date have been applied in giving rural communities better access to health care. The Mt Isa ophthalmology project reported in this issue of the Journal ( page 583 ) is a good example of this. Another is the South Australian Telepsychiatry Rural Service, which is the most established telemedicine service in this country,7 and an excellent example of the application of videoconferencing to provide real-time interaction between patients and doctors. Current activity in telemedicine applications in Australia -- at present predominantly rural -- leads to the conclusion by Yellowlees and Kennedy4 that telemedicine is here to stay. What of the future? Today's technologies will be further developed and refined, they will become cheaper, and new applications will be developed. Already we are witnessing the application of the personal computer and the Internet and other broadband mechanisms in "medical informatics" to transmit patient data in community-based care. Importantly, telemedicine will probably move from being used mostly in its current rural settings into more widespread use. By early in the next century, health care delivery will emphasise the importance of bringing care to patients rather than bringing patients to the health care system and tertiary hospitals, regardless of where patients live. "Multimedia e-mail" are current buzzwords in telemedicine. They refer to the development of store-and-forward electronic mail, allowing transmission of not just text, but also audio, still images and video. In the future we will have more sophisticated and affordable real-time videoconsultation, and the luxury of multimedia consultation, to be accessed when convenient. Concomitantly, if the vision of such projects as the APEC (Asia-Pacific Economic Cooperation Forum)-endorsed "Interactive Medical Curriculum" project of Health OnLine in South Australia becomes a reality (see the website at http://www.hol.com.au), the ongoing education of practitioners in the community (and of their patients) will be vastly different and delivered "online" to their homes. The implications of such changes inspired by information and communications technology are difficult to appreciate, but health care delivery in the 21st century will certainly apply such technology more effectively and, hopefully, less expensively. We will witness a significant change in the role of the tertiary teaching hospital, and increasingly empowered family practitioners with their better-informed patients will enforce a new role on the specialist practitioners. For better or for worse, communication in medicine will be different. Malcolm Mackinnon Professor of Telemedicine, Flinders University of South Australia and Director, Health OnLine Charlton I. Usefulness of a patient library in a suburban general practice. Med J Aust 1997; 167: 579-581. Taylor DMcD, Chappell-Lawrence J, Graham IS. Facsimile communication between emergency departments and GPs, and patient data confidentiality. Med J Aust 1997; 167: 575-578. Blackwell NAM, Kelly GJ, Lenton LM. Telemedicine ophthalmology consultation in remote Queensland. Med J Aust 1997; 167: 583-586. Yellowlees P, Kennedy C. Telemedicine: here to stay. Med J Aust 1997; 166: 262-265. House of Representatives Standing Committee on Family and Community Affairs, official Hansard Report, Health Information Management and Telemedicine. Canberra: The Parliament of the Commonwealth of Australia, 1997. In press. Edwards J, Motta C. Telemedicine and the military. In: Bashshur R, Sanders J, Shannon G, editors. Telemedicine, theory and practice. Springfield, Ill.: CC Thomas, 1997. Kavanagh S, Yellowlees P. Telemedicine -- clinical applications in mental health. Aust Fam Physician 1995; 24: 122-125.