Norway's Telenor adds new 'tele' applications

Norway is one of the first countries where telemedicine has moved beyond the trial stage. A sparse population of only 4.4 million and a population density in the north of fewer than two persons per square kilometer has encouraged Telenor (Oslo, Norway), the national telephone company, to develop a multitude of applications bearing the "tele" prefix, including telecardiology, teledermatology and tele-psychiatry.

Two hospitals in Oslo and London are testing Telenor's PathSight advanced telepathology system, which uses advanced digital camera technology to capture high-definition images at high speed with the consultant at the receiving end being able to control the microscope remotely. According to Angela Myhre, market development manager at Telenor, "One of the driving factors has been the need to ensure that all people in Norway have easy access to health care. More than 30 million biopsies are performed in Europe each year and many would benefit from a second opinion."

Telenor also has developed InterMed, a satellite-based internet designed specifically for the health community, with PathSight being one of several applications and information services offered. InterMed uses the same low-cost technologies as the Internet, but access is restricted to subscribing health institutions. Myhre said Telenor hopes to have 50 hospitals connected within the next 12 months.

Ultrasound image transfer

The Center for Industrial and Medical Information (CIMI; Nottingham, England), which has been set up by the University of Nottingham, has developed a remote ultrasound system for obstetrics. An estimated 10% of pregnancies show anomalies in their fetal ultrasound images, though worries usually are groundless. "The CIMI system allows such images to be quickly referred to a remote specialist for a second opinion," said Tim White, a consultant with CIMI.

"It is based on pioneering work in Australia, where the nearest consultant obstetrician may be several hundred miles from the worried expectant mother." The system is interactive and an audio link enables the consultant to guide remotely the technician operating the ultrasound scanner. The CIMI system uses Digital Equipment (Maynard, Massachusetts) Alpha workstations and a combination of Ethernet and fiber optic links to connect the workstations to the ultrasound scanner.

White said the heavy bandwidth requirement has limited commercial development of the system, but Internet technologies are developing rapidly. Perception Ultrasound recently launched in the U.S. a Net-based ultrasound image transfer system.

Less-expensive teleradiography

AT&T Healthcare (London), a division of AT&T (New York), recently demonstrated a PACS (Picture Archiving and Communication System) for X-ray images with a price tag of around $16,000, compared to earlier PACS prices in excess of $1.5 million. The system uses compression techniques to enable the X-ray images to be stored on hard disks and sent over the Internet.

Ray Heath, business development manager at AT&T Healthcare, agreed that compression resulted in poorer image quality than a proprietary PACS system, but, he said, "for diagnostic purposes, the loss of quality is acceptable in the majority of cases."

Remote ophthalmoloy grows

The Bristol Eye Hospital (Bristol, England) is helping to install in Malaysia the ENAA (Electro-diagnostic Neurophysiological Automated Analysis) system. That system was developed more than five years ago by Demetrius and Sophia Papakosta-paulos and Yuri Gogolitsyn at the Bristol institution.

The ENAA system which is being installed in the Tun Hussein Onn National Eye Hospital (Kuala Lumpur, Malaysia) uses a simple apparatus that the patient can use to carry out self-examination of the eye. That information then is transmitted by telephone to the ophthalmology department in Kuala Lumpur for consultant evaluation.

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