Skip to main content
SpringerLink
Log in

Telemedicine protocols and standards: Development and implementation

  • Position Papers
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

The nice thing about standards is that there are so many from which to choose. ... Anon

Abstract

Telemedicine is likely to adopt rather than create most of its protocols and standards as it becomes an integral part of medical practice. To optimize this process, it will be necessary to understand how to use existing protocols and standards, and influence the development, evaluation, and modification of new ones. We have identified key participants in standards setting activities under the titles of international government, United States government, professional certifying organizations, and independent institutes. We have reviewed their roles in establishing standards for identification of patients and providers, content and structure of patient records, terminology and codes of medical information and records, and transfer of messages and data. We have addressed requirements for storing and viewing images, the impact of image resolution on accuracy of clinical interpretation, the choice of communications protocols to satisfy transmission requirements, the need to link images and text data, and the evaluation of telemedicine systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rinde, E., Nordrum, I., and Nymo, B.J., Telemedicine in rural Norway.World Health Forum 14:71–77, 1993.

    Google Scholar 

  2. Houtchens, B.A., Clemmer, T.P., Holloway, H.C., Kesilev, A.A., Logan, J.S., Merrell, R.C., Nicogossian, A.E., Nikogossian, H.A., Rayman, R.B., Sarkisian, A.E., and Siegel, J.H., Telemedicine and international disaster response: Medical consultation to Armenia and Russia via a Telemedicine Spacebridge.Prehosp. Dis. Med. 8(1):57–66, 1993.

    Google Scholar 

  3. Ball, M.J., and Collen, M.R., (eds.),Aspects of the Computer-based Patient Record (2nd edition), Springer-Verlag, New York, 1993.

    Google Scholar 

  4. Dick, R.S., and Steen, E.B. (eds.),The Computer-based Patient Record: An Essential Technology for Health Care. Washington DC: National Academy Press, 1991.

    Google Scholar 

  5. Report of the Work Group on Computerization of Patient Records.Toward a National Health Information Infrastructure, Department of Health and Human Services, Washington DC, April 1993.

  6. Computer-based Patient Record Institute, Inc. Position paper: Computer-based patient record standards. American Health Information Management Association, Chicago, 1993.

    Google Scholar 

  7. Board of Directors of the American Medical Informatics Association. Position paper: Standards for medical identifiers, codes, and messages needed to create an efficient computer-stored medical record.J. Am. Med. Informatics Assoc. 1(1):1–7, 1994.

    Google Scholar 

  8. Reference 5, Appendix D; 1–16. Report of the Work Group on Computerization of Patient Records.Toward a National Health Information Infrastructure, Department of Health and Human Services, Washington DC, april 1993.

  9. Lindberg, D.A., and Humphreys, B.L., The Unified Medical Language System (UMLS) and computerbased patient records. (M.J. Ball, and M.R. Collen, eds.),Aspects of the Computer-based Patient Record, Springer-Verlag, New York, 165–175 (1992).

    Google Scholar 

  10. Kahn, M.G., The computer based patient record and Robert Fulghum's sixteen principles.M.D. Computing, 1995, in press.

  11. Kitanosono, T., Kurashita, Y., Honda, M., Hishida, T., Knoishi, H., Mizuma, M., and Anzai, M., The use of multimedia in patient care.Comput. Methods Programs Biomed. 37(4):259–63, 1992.

    Google Scholar 

  12. ACR Standard for Teleradiology (16pp). (E.O. Templeton, Chairman, ACR Board of Chancellors),ACR Standards. Council of the American College of Radiology, Reston, VA, 1994.

  13. Yamamoto, L.G., Scanned emergency department to emergency department image transfer (SEE-IT): Implementation and standardizing protocols to optimize tertiary referrals.Am. J. Emerg. Med. 11(1):70–76, 1993.

    Google Scholar 

  14. Baldwin, G.N.,CALL-RAD, PC Teleradiology, Salt Lake City, 1994.

    Google Scholar 

  15. Pedersen, S., Hartviksen, G., and Haga, D., Teleconsulation of patients with otorhinolaryngologic conditions: A telendoscopic pilot study.Arch. Otolaryngol. Head Neck Surg. 120(2):133–136, 1994.

    Google Scholar 

  16. DeSimone, D.N., Kundel, H.L., Arenson, R.L., Seshadri, S.B., Birkman, I.S., Khalsa, S.S., Davey, M.J., and Brisbon, N.E., Effect of a digital imaging network on physician behavior in an intensive care unit.Radiology 169(10):41–44, 1988.

    Google Scholar 

  17. Straub, W.H., and Gur, D., The hidden costs of delayed access to diagnostic imaging information: Impact on PACS implementation.AJR 155:613–616, 1990.

    Google Scholar 

  18. Goodman, L.R., Foley, W.D., Wilson, C.R., Rimm, A.A., and Lawson, T.L., Digital and conventional chest images: Observer performance with film and digital radiography systems.Radiology 158(1):27–33, 1986.

    Google Scholar 

  19. Kagetsu, N.J., Zulauf, D.R.P., and Ablow, R.C., Clinical trial of digital teleradiology in the practice of emergency room medicine.Radiology 165(11):551–554, 1987.

    Google Scholar 

  20. Franken, E.A. Jr., Driscoll, C.E., Berbaum, K.S., Smith, W.L., Sato, Y., Steinkraus, W., and Kao, S.C.S., Teleradiology for a family practice center.JAMA 261(20):3014–3015, 1989.

    Google Scholar 

  21. Metz, C.E., ROC methodology in radiology imaging,Invest. Radiol. 21:720–733, 1986.

    Google Scholar 

  22. Slasky, B.S., Gur, D., Good, W.F., Costa-Greco, M.A., Harris, K.M., Cooperstein, L.A., and Rockette, H.E., Receiver operating characteristic analysis of chest image interpretation with conventional, laser printed, and high resolution workstation images.Radiology 174:775–780, 1990.

    Google Scholar 

  23. Cox, G.G., Cook, L.T., McMillan, J.H., Rosenthal, S.J., and Dwyer, S.J., Chest radiography: Comparsion of high resolution digital displays with conventional and digital film.Radiology 176(9):771–776, 1990.

    Google Scholar 

  24. Ackerman, S.J., Gitlin, J.N., Gayler, R.W., Flagle, C.D., and Bryan, R.N., Receiver operating characteristic analysis of fracture and pneumonia detection: Comparison of laser-digitized workstation irnages and conventional analog radiographs.Radiology 186:263–268, 1993.

    Google Scholar 

  25. Hayrapetian, A., Aberle, D.R., Huang, H.K., Fiske, R., Morioka, C., Valentino, D., and Boechat, M.I., Comparison of 2048-line digital display formats and conventional radiographs: An ROC study.AJR 152(5):1113–1118, 1989.

    Google Scholar 

  26. MacMahon, H., Vyborny, C.J., Metz, C.E., Doi, K., Sabeti, V., and Solomon, S.L., Digital radiography of subtle pulmonary abnormalities: An ROC study of the effect of pixel size on observer performance.Radiology 158:21–26, 1986.

    Google Scholar 

  27. Balis, U.J., University of Utah Department of Pathology. Personal communication of pre publication data, November 1994.

  28. Best, D.E., Horii, S.C., Bennett, W., Thompson, B., and Snavely, D., Review of the American College of Radiology — National Electrical Manufacturers' Association standards activity.Comput. Methods Programs Biomed. 37(4):305–309, 1992.

    Google Scholar 

  29. Pedersen, S., Contemporary issues in telemedicine. Presented at the 2nd NASA/USUHS International Conference on Telemedicine, 8 Sep 1994; Bethesda, MD.

  30. Naegle, J.H., Testi, N., and Gossage, S.A., Developing an ATM network at Sandia National Laboratories.Telecommunications Feb:21–24, 1994.

    Google Scholar 

  31. Walker, F.L., and Thoma, G.R., Access to document images over the Internet. Proceedings, Ninth National Conference on Integrated Online Library Systems.Learned Information, Medford, NJ, 1994, pp. 185–197.

  32. Thoma, G.R., Long, L.R., and Berman, L.E., Design issues for a digital x-ray archive over Internet. (W. Niblack and R.C. Jain, eds.), Proceedings, SPIE: Storage and Retrieval for Image and Video Databases II. San Jose, CA, 1994, Vol. 2185, pp. 129–138.

  33. Stix, G., Habeas Corpus.Scientific American, 1993, Jan., pp. 146–147.

  34. Perednia, D.A., Telemedicine system evaluation and a collaborative model for multi-centered research. Proceedings, 1994 Annual HIMSS Health Care Communications Conference and Exhibition. Healthcare Information and Management Systems Society, Chicago, 1994, pp. 163–170.

    Google Scholar 

  35. Perednia, D.A., Evaluating the use of telemedicine for mental health applications.Telemed. Today 2(2): 10–11, 1994.

    Google Scholar 

  36. Grigsby, J., Survey of domestic telemedicine. Presented at the 2nd NASA/USUHS International Conference on Telemedicine, 8 Sep 1994; Bethesda, MD (Data provided by Allen A. Ed.,Telemedicine Today).

Download references

Author information

Authors and Affiliations

  1. From the University of Utah Departments of Surgery, Bioengineering, and Medical Informatics, and Sarcos Research Corporation, 360 Wakara Way, 84108, Salt Lake City, Utah

    Bruce A. Houtchens, Ace Allen, Terry P. Clemmer, Donald A. Lindberg & Steinar Pedersen

  2. Cancer Center, The University of Kansas Medical Center, 3901 Rainbow Boulevard, 66160, Kansas City, Kansas

    Bruce A. Houtchens, Ace Allen, Terry P. Clemmer, Donald A. Lindberg & Steinar Pedersen

  3. Department of Internal Medicine, LDS Hospital, and University of Utah, 8th Avenue and C Street, 84143, Salt Lake City, Utah

    Bruce A. Houtchens, Ace Allen, Terry P. Clemmer, Donald A. Lindberg & Steinar Pedersen

  4. High Performance Computing and Communications, National Library of Medicine, and National Coordination Office, 8600 Rockville Pike, Building 38A, Room B1N30, 20894, Bethesda, Maryland

    Bruce A. Houtchens, Ace Allen, Terry P. Clemmer, Donald A. Lindberg & Steinar Pedersen

  5. Department of Telemedicine, University Hospital of Tromso, Post Office Box 76, N-9038, Tromso, Norway

    Bruce A. Houtchens, Ace Allen, Terry P. Clemmer, Donald A. Lindberg & Steinar Pedersen

Authors
  1. Bruce A. Houtchens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ace Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Terry P. Clemmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald A. Lindberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steinar Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Houtchens, B.A., Allen, A., Clemmer, T.P. et al. Telemedicine protocols and standards: Development and implementation. J Med Syst 19, 93–119 (1995). https://doi.org/10.1007/BF02257060

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02257060

Keywords

Search

Navigation