Diagnoses at a distance

PUBLISHED : Wednesday, 10 July, 1996, 12:00am
UPDATED : Wednesday, 10 July, 1996, 12:00am

Chinese University professor Frank Tong was worried: 'I hope I don't need to take my clothes off.' Professor Tong, 'the patient', was sitting in his university office being examined by Professor Magnus Hjelm, chairman of the department of chemical pathology at Prince of Wales Hospital. The difference from a regular consultation was that Professor Hjelm was six kilometres away.

The two professors were taking part in a demonstration of one of the latest technological marvels on the health scene: telemedicine or long-distance consultation, which the Chinese University plans to bring to Hong Kong and China.

Two sets of US$5,000 (about HK$38,500) video-cameras and radios linked up the two men, beaming the image of Professor Tong (of the university's department of information engineering) as he opened his mouth wide, to Professor Hjelm's Sha Tin office.

But what if something more drastic than sticking one's tongue out had been required? What if somebody else is watching? Patient confidentiality and privacy are two of the many areas the university's task force for telemedicine will need to address before the technology can be used to save lives and money in Hong Kong and China.

The basic idea of telemedicine, or satellite conferencing, is to link doctors and patients, using modern communications technology, sometimes via satellite, so that expertise can be made instantly available, regardless of distance.

It is being hailed as the best way to provide safeguards as well as save patient and specialist time, and consequently money. It is ideal for doctors wanting a second opinion and patients suffering diseases which make travelling difficult. In the United States, this method of providing health care has already been tested. In Texas, it is used in the prison system, where patients are examined by doctors and specialists located at urban hospitals.

One surgeon in an urban hospital in the US watched an operation via video, and guided a rural physician through his first amputation. The operation was a success.

Radiologists at large centres have been asked to interpret MRI (magnetic resonance imaging) or questionable X-rays transmitted from small, rural hospitals. Dermatologists who specialise in rare skin conditions have been asked to review images of patients' skin conditions from distant out-patient clinics.

A surgeon at Yale University has used telemedicine to guide a physician on a US naval carrier during a hernia operation.

In the past 18 months, a number of trial projects have been started in Britain to discover whether telemedicine could live up to the hype in the US.

Locally, a trial link-up between the Chinese University and a dermatologist in Belfast was organised last year. In November, the university is planning to link up Hong Kong, Beijing and London to mark the inauguration of a communications centre for surface and satellite links.

But medicine is a private business, and the doctor-patient relationship requires a personal touch. Do doctors lose anything by not being in physical contact? Do patients find it strange describing their symptoms to a TV screen? In the US, doctors point out that the concern for misappropriation of health care information is real. A market already exists for the sale of personal information from public and private sources. Through unauthorised interception, they warn, fundamentally private information may be disseminated into the public arena with devastating consequences.

There are also potential legal medical problems such as who should be held responsible should anything go wrong in treatment.

Professor Hjelm admits all these should be addressed and a code of practice drawn up. He is, however, optimistic of telemedicine's development.

The system can also help improve health care in China.

'It can be used to transfer what you see in a microscope to a centre of expertise for a second opinion,' Professor Hjelm said. 'The system will benefit expats working in China as well as Chinese nationals in remote areas.' Professor Hjelm said he thought it would also mean that 'long term you need less staff because you are doing things in a more centralised fashion'.

'One of our aims is to look at whether this way of delivering health care is more or less effective,' he said. 'And whether it is more or less expensive.'