Feature Story

SUCCESS OF TELE-MEDICAL TECHNOLOGY IN THREE DIAGNOSTIC CATEGORIES AND TREATMENT IS NEXT STEP

During the recent International Cardiology Conference that was held in Cairo at the end of last February, a major part of the activities of this conference focused completely on lectures and surgical operations transmitted live from the USA to conference halls in two of the biggest hotels in Cairo. Tens of cardiology physicians and professors watched one American lecturer after another demonstrating his information over a wide screen while the audience interacted with him live and exchanged questions and answers. The conference participants also witnessed a live surgical operation that was performed in real-time at Washington University in St. Louis.

Behind this live transmission was an international expert in telemedicine technology managing the communication network and executing the live transmission between Cairo and St. Louis. That expert is Dr. Keith W. Vrbicky, M.D., the Director of the Board and Chief Executive Officer of American Egyptian Telecommunications (AET), which specializes in telemedicine and is a subsidiary of American Educational Telecommunications, which is considered the largest telemedicine company in the United States and the world. AET recently opened a regional office in Cairo.

In a brief meeting with Dr. Keith for this article, I asked him about his current assessment of telemedicine technology. He commented: "What has really been accomplished so far in tel-medicine technology can be divided into three categories: (1) routine services for sending patient information electronically from any place via I*NET for a physician to analyze it and report back the result within 24 to 48 hours; (2) scheduled consultations arranged in advance for real-time interaction between the patient, the patient's current physician, and a specialist based in the United States or anywhere else in the world who has received the patient's information in advance; (3) emergency consultations providing real-time interaction between the patient, the patient's current physician, and a physician specialist based somewhere else with most of the patient's information being exchanged at the time of consultation."

Dr. Keith added, "There is another dimension to this technology which is tele-medical education via live transmission of classes, lectures, and curriculums for obtaining special degrees. For example, the students may be in Egypt, Pakistan, China and Australia while the lecturer is in the United States. In addition, the technology is used in distributing and participating in pre-recorded health programs; live televised health programs to more than one location during the recording session at the original location; holding live medical conferences involving several locations around the world similar to the Cairo conference; and interactive tele-training on medical hardware and software."

I commented on what Dr. Keith saying: "It seems that your response is based more on the theoretical aspects of this technology rather than the practical. Is there an actual tele-medical program under implementation?"

He replied: "We actually have a program for providing tele-medical services to ships sailing the oceans. Many of these ships have now access via I*NET to the best specialists, advanced diagnostic tools and medical data from around the world. Any subscriber ship can contact any of the Network's centers to meet the needs of the elderly passengers or those who need emergency treatment. The network supplements the capabilities available on the ship by providing access to the patient's data and diagnostic systems. For example, if a patient had a heart attack and the patient is a member of I*NET, this patient's complete medical records can be transmitted to the ship's physician to utilize this vital information in treating the patient, especially if the patient was unconscious or incoherent. We have another program that linked distant hospitals, such as linking Cairo University Medical Hospital and King Hussein Medical Center and others in Jordan, Kuwait, Qatar, S! outh Africa, South America, Hong Kong, and tens of hospitals and medical centers in the United States that currently employ tele-medical services."

"These types of medical services were introduced also in numerous 5- star hotels around the world. In fact, a program was implemented to provide tele-medical services in many international hotel chains. Another program targets remote rural, desert, and mountainous communities and coal mining and oil excavation communities located in remote locations."

I asked Dr. Keith to explain briefly how telemedicine services work. He replied: "tele-medicine services take place between branch centers specializing in this service and interconnected by one network. There is usually one main center in the city or in a location where one can find experienced physicians in the areas of diagnostics and treatment that are not available in the branch centers. The branch offices should be equipped with certain systems, especially ones that can convert patient's radiology images generated by various diagnostic systems, be it CT scans or MRI, into a suitable format that can be stored, analyzed and transmitted via computer systems. These images can either be received directly on radiology equipment without the need for printing them on film and stored in computers or can be received as printed films in a format that can be stored."

"Naturally, telephone lines of some kind, wired or wireless, should be available at the branch center. If the branch center capabilities were limited only to the availability of the equipment, then the medical services will depend on the information and diagnostic images available in the patient's file that are transmitted to the main office. A skilled professional physician will then analyze the data and issue his final recommendation for treating the patient."

"If the required technical capabilities are available at the center, the branch office can be equipped with digital cameras and special microphones not only to transmit the images and recorded data available in the file, but also the patient's picture and voice to the physician responsible for the diagnosis. In this case, a new service can be added which is known as video teleconferencing. This is a highly advanced technology that allows a physician in Cairo, for example, to discuss a medical case with another physician in Aswan or any other city. Both physicians can see each other and exchange question and answers regarding the patient. A third physician can join the discussion to provide another opinion about the patient, and so on. Also, this capability allows examining pathological samples for various diseases by allowing taking pictures of a microscopic section and transmitting it to a specialty lab in another city. The two physicians can also discuss t! he case while both seeing the sample under the microscope."

Dr. Keith confirmed that these networks are sometimes closed and are not connected with open information networks as the Internet for maximum security and privacy. Utilizing high-speed connectivity allows live video/audio links and exchanges between two places or more. This feature is not available through the Internet so far.

I suggested to Dr. Keith that this puts restrictions on expanding this service to areas that do not have fast and strong communications or human resources capable of utilizing these technologies. These two factors are widespread in many areas of the world, especially in developing countries where this can clearly be seen in rural areas in Egypt.

Dr. Keith said: "Companies developing telemedicine technology fully understand this point and are working on finding a solution to it. For example, AET has provided a series of special products used in building networks based on copper cables used in regular telephone lines found in homes, villages and remote areas and used to access the Internet with speeds up to 512 Kbs or 384 Kbs. It is easy to use by any employee at a clinic or rural health unit after little training. This means that there are services ready for implementation on regular telephone lines in remote health care units at a reduced cost."

Regarding the future of telemedicine technology, Dr. Keith said: "telemedicine has entered the realm of telesurgery. This may sound strange to some because surgery requires direct intervention by the surgeon. In reality, however, several surgeries took place via telephone lines. Many engineering teams are working on developing micro surgical systems with the assist of robots which will become available at the end of this decade."

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