1. Telemedicine in practice: Examples and experiences from Northern Norway Eli ARILD

2. Outline of presentation Why TM in Northern Norway? Overview of telemedicine routine services in Northern Norway VC – online S&F – offline

3. OSLO TROMSØ Artic- circle Why Telemedicine in Northern Norway?

4. Long distance Unstable weather and long winters Scattered population Equal access to medical services Exellent telecommunication network

5. Model for telemedicine applications Telemedicine Workstations Telemedicine program modules Standard software and hardware computer products Telecommunication services Telemedicine Services Telemedicine Application Requester Provider Network ATM X.400 PSDN ISDN BOS Mira Vida Rekvisisjon Organisational level Healthcare service level Technology level Telemedicine Network Rekvisisjon

6. Routine TM services Dermatology Pathology Otorhinolaryngology Radiology Cardiology Psychiatry Endoscopic surgery Ophthalmology Dialysis Distant teaching Requests & Reports

7. VIDEOCONFERENCE Started in 1989 GP and a patient in remote studio Communication patient-specialist, patient-Gp and specialist-GP GP; the specialist’s ” prolonged arm”

8. VC - Patients experience Less waiting time Make a diagnosis early Reduced stress Saving of time Reduced costs Reduced needs for sick leave => satisfied patients A comparative study of teleconsultations versus face to face consultations – EJ Nordal, D Moseng JTT,2001

9. VC - advantages –Less travelling –Reduced waiting time –Save time and money –Better access to expertise –The patients ”meet” the specialist Standard equipment available

10. Patient unsuitability for VC Ca. 20% unsuitable (Dermatology)

11. VC - disadvantages VC require management and planning The specialist and the GP have to be present at the same time Expensive equipment - studios

13. Offline Based on web or e-mail service - available ”everywhere” and “everytime” Low bandwidth demand Reduced equipment demand - reduced costs?

14. Offline – in Norway: DORIS

15. Offline The specialist ”disappears” The patient ”disappears” Reduced medical skills? System error? Selection

17. Conclusion Telemedicine is a tool for more efficient communication and co-workingTelemedicine is a tool for more efficient communication and co-working Reques ter Rekvisisjon Provider Network