Using e-mail in the management of tuberculosis patients, north-west Russia.

SETTING: Ten health care institutions in north-west Russia. OBJECTIVE: To improve the management of tuberculosis patients using e-mail. DESIGN: Over an 18-month period, all outgoing and incoming e-mails at the Arkhangelsk Regional Tuberculosis Centre were saved and categorised. All e-mails relating to distance learning were logged, and a consensus panel discussed and answered questionnaires regarding 47 e-mail-based second opinions. RESULTS: e-mail was found to speed up communication and increase the availability of specialist advice. Distance learning was positively received, but was used in moderation. For six of 47 consultations (13%), the consensus panel deemed that fast access to a second opinion saved lives. In 30 consultations (64%), the patient was saved a round trip to a specialist centre. In 24 consultations (51%), the panel considered that the patients had started correct treatment between 1 week and 1 month earlier than without e-mail access. In 11 of these consultations, 23% of the total, the patient was found to be infectious. The learning effects of second opinions were recognised. CONCLUSION: General e-mail use and the second opinion service in particular were found to be useful. Further studies are needed to investigate the advantages and disadvantages of using e-mail as a tool in the management of TB.

A mobile telemedicine unit for emergency and screening purposes: experience from north-west Russia.

A mobile telemedicine unit (MTU) was constructed for emergency and screening purposes in north-west Russia. The MTU included facilities for endoscopy, electrocardiography and digital photography. Data transmission was by ordinary telephone line. Between July and December 1999, the MTU was used in 48 incidents, involving 44 patients. The MTU was used to conduct 22 teleradiology examinations and 20 electrocardiograms were transmitted; in 10 cases still images of patients were transmitted and three consultations included tele-electroencephalography. Despite poor-quality analogue telephone lines, the MTU may prove useful in north-west Russia. Following the pilot study, the local Russian health administration stated that the MTU should always be included on emergency trips to the districts.

The North Norwegian Health Net.

The North Norwegian Health Net is a comprehensive scheme to connect all health-care institutions in the area to a national computer network. Services available include telemedicine, e-mail and Web access. A general practitioner has responsibility for ensuring that the clinical information is correct. Medical departments are responsible for the content of their own Web pages. All institutions require authorization before connection to ensure data protection and security. Changes in communication between primary- and secondary-care sectors are being monitored. To date the implementation of the network programme has gone smoothly.

A survey of Norwegian telemedicine.

To get an overview of Norwegian telemedicine, a questionnaire was sent to the contact persons of telemedicine programmes. There was an 83% response rate from 102 telemedicine programmes; there were 66 active research projects. Several larger networks had recently started operation, probably as a result of the Ministry of Health and Social Affairs' plan of action on information and communication technology in health care. Twenty-one programmes involved primary care or home care. Few programmes were using telemedicine to bridge established divisions of service responsibility or to make connections to institutions abroad. There were three large national research programmes in which telemedicine played an important role. Research projects were evaluating the economic, organizational and sociological aspects of telemedicine, as well as the medical. The oldest telemedicine activities were in northern Norway.

[Introduction of teleradiology]. / Oppstart av teleradiologi.

Against the background of Norwegian conditions, the authors outline the equipment needed to launch a teleradiology unit, and what the clinician using the unit might expect of such an imaging facility. They also discuss whether the unit should be organised with the needs of emergency care in mind or as an integrated part of everyday routine at the radiology department, how financing and judicial issues have been managed so far, and whether the introduction of teleradiology might effect relationships between health care personnel and patients.

Four years with teleradiology: a technical description.

Since September 1992, Troms Military Hospital (Norway) has been connected to the larger University Hospital of Tromsø by a teleradiology link transmitting about 6000 examinations annually. In the spring of 1995, the system was upgraded with a digital X-ray unit, thereby almost eliminating the scanning of analog radiographs. This article describes the technical development of the link. The discussion suggests ways of improving the teleradiology link, particularly in terms of integrating the radiology information system (RIS) and picture archiving and communication system (PACS).