A clinical evaluation of four alternative telemedicine systems.

A comparison was made of four alternative telecommunication systems used in delivering primary health care to remote populations. The media were color television, black and white television, still frame black and white television, and hands-free telephone. The patient population was that of a large organization in a Canadian province, a major component of a societal system. Over 1000 patients who came to a clinic seeking medical attention were examined remotely by one of the four systems. In addition, they were examined in the physical presence of a doctor at the clinic. The diagnoses, patient management programs, etc., of the clinic physician were used as the basis for comparison. We found no significant differences in diagnostic accuracy, proportion of supporting investigations requested, e.g., laboratory tests and X rays, time taken for the diagnostic consultations and the effectiveness of patient management across the four communication modes. On the contrary, in some instances it was found that behavior across the modes was significantly similar. Even patient attitudes showed only a slight preference for the more sensory rich modes of communication. It was concluded that there is little to distinguish the effectiveness of the four telecommunication modes when used for remote diagnostic consultations. Therefore, the cheapest mode is the most cost-effective. Phase four of the research program will compare the effects of the two least costly modes, still frame television and hands-free telephone, in an operational system in northern Ontario.