Occupational Health - Public Health Poster Session
It is very important to support availability of medical services in the field of occupational medicine at adequate level; otherwise health care authorities cannot provide proper revealing and treatment of occupational pathology in the workers of industrial enterprises.
POSSIBLE USE OF TELEMEDICINE
Telemedicine, or "remote communication of information to facilitate clinical care" , allows improving medical service for the population of remote regions, where the direct consultation of some medical specialist happens to be complicated or impossible. The availability of telephone communication, computer and devices for input of medical information makes possible to perform telemedical consultations with any expert, located practically in any point of the world. The introduction of new telemedical technologies will often allow lowering the charges on qualified medical service at the remote territories [2, 5]. The telemedical technologies are widely used now in Northern America, in Scandinavian countries, in Southeast Asia.
USE OF TELEMEDICINE IN OCCUPATIONAL DERMATOLOGY
According to the present situation, the use of telemedicine in Nizhny Novgorod region can be especially actual for occupational dermatology.Telemedical consultations on occupational dermatology can diminish the need to trip to regional center of occupational pathology for most of patients. Now Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology actively introduces Internet technologies, that will allow organizing regional (and later - interregional) network of telemedical diagnostics of occupational skin diseases. Certainly, this structure can be used also for consultations of the patients with complicated cases of general skin diseases. The patients from Nizhny Novgorod and from the whole region can also be consulted with leading Moscow dermatologists (in Dermatovenereology Chair of Moscow Medical and Stomatological Institute).
Nowadays Research Institute of Hygiene and Occupational Pathology has got the first experience in telemedical examinations of patients with presumed occupational skin diseases. The connection was established between dermatological department of Bor District Hospital (about 10 km from Nizhny Novgorod) and the clinic of Institute in Nizhny Novgorod. The images of affected skin were obtained using digital camera Sony Mavica FD-71(resolution 640x480 pixels, 24-bit color). The sample image is shown below (mycotic eczema):
The JPEG files (about 100 kB) can be transferred using email, or Microsoft NetMeeting can be used to transfer images along with text documents.
Due to financial crisis, prices for Internet connection in Russia (usually rated in US dollars) became comparable with tariffs for long distance telephone calls (rated in rubles). For example, the lowest tariffs for telephone calls from Bor District Hospital to Nizhny Novgorod are from 0.6 to 1.2 rubles per minute (36-72 rubles per hour), while Internet connection tariffs in Bor can be as high as 4-5 USD per hour (64-80 rubles). Thus, it can expected that even Internet connection at 28.8 kbps would be too expensive for health care organizations and mainly direct connections via long-distance telephone lines will be used to transfer medical information.
Unfortunately, modern law system in Russia does not allow using electronic documents in cases concerning questions of financial compensation etc. So it is needed to confirm all the electronic data with hard copies of the same documents. But there is a hope that situation will be changed soon, because technologies of authorization and encryption of electronic documents become more and more perfect. Good example of use of these technologies can be found in sphere of banking.
According to the available information concerning the experience of foreign dermatologists, telemedical diagnostics does have some restrictions. In 25-30 % of cases remote diagnosis had appeared to be inexact or incorrect [3, 4]. Therefore, the final diagnosis of occupational skin diseases will certainly be made only at face-to-face examination. Moreover, at the first stage of introduction of a telemedical system each case diagnosed remotely should be verified through direct contact of the doctor and the patient. Nevertheless, even at the first stage of introduction of the system it will be possible to fasten the delivery of the necessary documents from district hospitals to the occupational dermatologist to Nizhny Novgorod via email instead of simple mail, used now.
Being implemented, the system of medical data transfer in the field of occupational pathology may also be used to evaluate the risk of occupational skin diseases in individual workers. A computer expert system "Predict" was elaborated in the Institute for such evaluation. Now only desktop version of the system is available, which can help evaluating the risk of allergic contact dermatitis in workers handling chemical allergens (e.g. epoxy resins) . The on-line version of the system will be available at website of the Institute soon.
THE QUALITY OF IMAGES TO BE USED IN TELEDERMATOLOGY
The quality of images obtained with Mavica FD-71 was generally acceptable, but resolution of the images perhaps should be higher (not less than 1 mln. pixels totally). Some instability in reproduction of standard color test was found. For example, the level of red was constantly and significantly (about 80%) lower, which made images tinged with blue. This tinge was stable and could be corrected using proper software (The colors of above shown image was corrected). But the proportion of green component was unpredictable and could vary ± 30-40%. Obviously it was impossible to improve the level of green using software. The level of blue was rather stable and it needed no correction. The comparison of color test images, obtained with calibrated scanner and Sony Mavica, as well as color-corrected Sony Mavica image can be seen below.
It was concluded that for the best performance the images used for teledermatological purposes should have resolution not less than 1 mln. pixels totally with 24-bit color, and the color fidelity of the equipment should be thouroghly tested. Now digital cameras with even better characteristics are available at reasonable prices (e.g. modern Olympus, AGFA and Kodak models).
In accessible literary sources the authors could not managed to find out the information on telemedical application for diagnostics and treatment of occupational skin diseases. The authors consider that key characteristics of the implemented system of telemedicine should be the following:
1. Coiera E Guide to medical informatics, the Internet and telemedicine. Chapman & Hall Medical, London (1997)
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|Tikhomirov, IuP.; Matveev, NV.; Somov, BA.; (1998). APPROACHES TO THE IMPLEMENTATION OF TELEMEDICAL SERVICE IN SIX REGIONS OF RUSSIA IN THE FIELD OF OCCUPATIONAL DERMATOLOGY. Presented at INABIS '98 - 5th Internet World Congress on Biomedical Sciences at McMaster University, Canada, Dec 7-16th. Available at URL http://www.mcmaster.ca/inabis98/occupational/tikhomirov0639/index.html|
|© 1998 Author(s) Hold Copyright|