ICSL E-Medicine Project

Introduction Traditionally, telemedicine systems have been designed to improve access to care by allowing physicians to consult a specialist about a case without sending the patient to another location, which may be difficult or time-consuming to reach. The cost of the equipment and network bandwidth needed for this consultation has restricted telemedicine use to contact between physicians instead of between patients and physicians. Recently, however, the wide availability of Internet connectivity and client and server software for e-mail, world wide web, and conferencing has made low-cost telemedicine applications feasible. With the Department of Orthopaedics and Sports Medicine, we have developed a web-based system, called E-Medicine, for asynchronous multimedia messaging between shoulder replacement surgery patients at home and their surgeons. A web browser plug-in was developed to simplify the process of capturing video and transferring it to a web site. The video capture plug-in can be used as a template to construct a plug-in that captures and transfers any type of data to a web server. For example, readings from home biosensor instruments (e.g., blood glucose meters and spirometers) that can be connected to a computing platform can be transferred to a home telemedicine web site. Both patients and doctors can access this web site to monitor progress longitudinally. This technology will be used as one of the building blocks for future Distributed Diagnosis and Home Healthcare (D2H2) systems. The system is currently being tested with patients at the University of Washington Medical Center. Characteristics of E-Medicine Some of the characteristics of E-Medicine that set it apart from the typical real-time videoconferencing type of telemedicine are: Convenience of asynchronicity: Patients and physicians can access each other from any site at any time. Information can be accessed or added at anytime, not only when prior arrangements have been made for a telemedicine contact. Convenience of re-access: Patients, families, and physicians can go back to the information as often as they need, enabling consultation and recall. Economy and geographic neutrality: Patients can access providers and vice versa without waste of precious energy, time, or money. E-Medicine provides equal access for patients in Barrow, Alaska as for patients in Seattle, Washington. Medical recording and service documentation: An examination today can be compared to an examination obtained last year, and records can be searched electronically. It is easy to document interactions for insurance purposes. Application in Shoulder Replacement Arthroplasty Shoulder replacement arthroplasty is a surgical procedure used to help restore comfort and function to shoulders damaged by degenerative joint disease, osteoarthritis, or rheumatoid arthritis. Patients learn to do their own physical therapy and are discharged about three days after surgery when they are comfortable and have a good range of passive motion. The first application of our E-Medicine system is in following patients after their surgeries. Patients can use E-Medicine to: Review treatment plans (medications, physical therapy with video demonstrations, and any additional instructions) Send status reports to doctors with video showing how they are performing their assigned exercises Send free-form questions to doctors, optionally with video File SF-36 and Simple Shoulder Test self-assessment surveys to track how the shoulder surgery is affecting everyday activities Usage Scenario Consider a patient leaves for Hawaii shortly after his shoulder replacement. He forgets how to do his exercises, so he dials into his E-Medicine account to review them. While he is away, he sends an updated video progress note. The doctor recognizes that he is making good progress and wants to progress his exercises. He returns home and finds the new exercises are now enabled on his E- Medicine home page. The analogous scenario would pertain if the doctor has to leave town to attend a meeting, but is very anxious about the daily progress of his patient. Screenshots Patients' self-assessment form Patients report on their general health status through this SF-36 survey. The survey is scored and the results displayed as a graph on the doctors' interface. Patients' main page Patients can review messages from their doctors, their current medications, and the physical therapy exercises they should be doing, complete with video demonstrations. If patients are logging in from their home where our software package has been installed, the videos play from the local hard disk. Otherwise, they are streamed over the Internet. Patients' video recording page Our video capture browser plug-in interfaces with any PC camera with a Video for Windows driver. The plug-in captures the video, compresses it, and sends it via an encrypted connection directly to our server all with only a few mouse clicks. Doctors' status report review page Doctors can view patients' self-assessment scores, videos patients recorded, and any other questions they may have typed in. They can respond to patients by typing in a message that will be displayed at the top of each patient's home page (see the second screenshot). Doctors' treatment reminders page In addition to writing messages back to patients, doctors can also post treatment reminders that are displayed on patients' home pages. They can list medications and physical therapy exercises, including links to demonstration videos. Publications C. Lau, S. Churchill, J. Kim, F. A. Matsen III, and Y. Kim, "Web-based Home Telemedicine System for Orthopaedics," Proceedings of SPIE Medical Imaging 2001, vol. 4319, pp. 693-698 (2001). [ PDF ] C. Lau, S. Churchill, J. Kim, F. A. Matsen III, and Y. Kim, "Asynchronous Web-Based Patient-Centered Home Telemedicine System," IEEE Transactions on Biomedical Engineering, vol. 49, pp. 1452-1462 (2002). [ PDF ] Back to ICSL Home Page