The continuing improvements in computer power, image resolution, data compression methods, audio and video communication and performance allow off the-shelf workstations to be used for the convenient and efficient manipulation of medical data, images, graphics, movies and voice annotation. The integration of multimodal clinical data for on-line processing and consultation follows naturally. These technological advances are now being harnessed to the benefit of medicine, health and social care, enabling the outreach of specialists'm edical expertiset o the primary-care environment. Using interactive technology, a specialist can conduct and control an examination carried out by the general practitioner (GP) via a two-way sound and picture connection. Numerous studies have shown that the diagnostic quality of such a system can beequal to that of a traditional hospital examination. In the field of cardiology, the incorporation of data, such as electrocardiogramse, chocardiogramsh, eart sounds and murmurs, vocal messagesa nd images, opens new possibilities for interactive computing and remote consultationa. Electrocardiography and echocardiography have emerged in the past decade as widely used, noninvasive, cardiovascular diagnostic tools which provide high-resolution realtime images of cardiac structure, function and intracardiac blood flow from portable equipment. They have become established as the standards for non-invasive cardiac assessment. Likewise, transtelephonic electrocardiography has been long established as a cost-effective tool for diagnosis, monitoring and rehabilitation of patients with paroxysmal arrhythmias and transient ischaemic changes. Transtelephonic exercise monitoring has also proved to be an effective alternative for hospital-based rehabilitation programmes. However, recent developments in transmission capability in echocardiography, such as the miniaturization of equipment components and improved image compression, offer further extension of remote cardiac diagnostics. An inexperienced doctor could perform investigations in a local hospital or primary-care environment and transfer ultrasound signals (M-mode, two-dimensional echo and Doppler data) to a referral hospital, where a cardiologist could serve as a consultant. The diagnostic precision is sufficient for the method to be applied clinically. Clinical assessment can incorporate cardiac transtelephonic auscultation through audio/video and data communication links using an electronic
stethoscopelr. The present study was part of the development of a comprehensive telecardiology consultation service. Its
aims were to assess telesupport for routine decision making of GPs in their daily practice based upon their requirements for specialist consultation in making management decisions, not merely electrocardiographic measurements. It also aimed to prioritize outpatient clinics' workloads, filter patients and identify the minoritv in need of instant attention.

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