The Evaluation of the Effectiveness of Mobile Low-Bandwidth Telemedical Applications for Postoperative Follow-up: An Initial Impression

James C. Rosser, Jr., MD, FACS; Ruediger L. Prosst, MD; Edgar B. Rodas, MD; Ludie E. Rosser, BS; Michinori Murayama, MD, PhD; and Harold Brem, MD

Department of Surgery, Yale University, New Haven, CT

Corresponding author:
James C. Rosser Jr., MD
Department of Surgery, Yale Endo-Laparoscopic Center
40 Temple Street, Suite 3A
New Haven, CT 06510-8062
Telephone # 203-764-9060
FAX # 203-764-9066

No competing interests declared.

ABSTRACT

Background
The idea of using telemedical applications to remotely evaluate patients is several decades old. It has already been established that x-ray images (and magnetic resonance images) can be transferred using a personal computer and a modem, and many other such applications have been implemented. However, over the past 50 years, the expense and technically demanding equipment involved in telemedicine has hindered its widespread deployment. The purpose of this study is to evaluate a mobile, low bandwidth telemedicine platform to achieve real time post-operative visits in the home.


Study Design
This evaluation was designed to evaluate the feasibility of performing a real time clinical visit utilizing computer and telecommunication hardware and software. A nurse and medical student (for information gathering only) made postoperative visits at patients’ homes, while the physician stayed at his office. Clinical evaluations were performed by utilizing low resolution and frame rate video, high-resolution still images, and simultaneous telephony over a standard telephone line. These remote visits were followed up by a standard visit to the office for standard clinical corelation. Eleven patients were included, all of whom had undergone various laparoscopic procedures. They lived from five to two hundred and forty miles from their surgeon. Efficiency was measured by recording time utilized to capture and send data required by the physician to make a clinical decision. The time expense was measured at both patients' and physician's location. Technical issues were evaluated. Patient satisfaction was assessed by standardized objective questionnaires, and the evaluation accuracy of the remote visit was determined with a standard office visit.

Results
No technical problems were observed. The mean total time of the housecall at the remote site was 86 min (range 60-160) and 41 min (range 21-71) at the base station site. After familiarization with the system the last three visits were 60 and 21 minutes respectively. This corresponds favorably with current visiting nurse and office visit time requirements. The patients were highly satisfied with the home visits and on average rated the experience as a 4.8 out of a maximum of 5.


Conclusions
Follow up visits in patient's homes after laparoscopic procedures can be accomplished by transmitting simultaneous voice, low resolution video and high resolution still images to accurately perform post-operative evaluations over standard phone lines with similar time and clinical accuracy to standard visits.