2002

Ultrasound and cardiotocogram in a telemedicine service. A pilot installation

Ultrasound and cardiotocogram in a telemedicine. A pilot installation

Heidi Jacobsen, Norwegian Centre for Telemedicine Jan Norum, Norwegian Centre for Telemedicine Trine Bergmo, Norwegian Centre for Telemedicine Elisabeth Sjaaeng, Norwegian Centre for Telemedicine IN Vold, Lofoten hospital, Norway MV Johansen, Lofoten hospital, Norway B. Holdø, Nordland Central Hospital, Norway N. Jamissen, Nordland Central Hospital, Norway

Abstract

Background: Lofoten Hospital is a local hospital in a rural area, serving a population of 24.000 people. Midwifes administer the delivery unit at the hospital. The midwifes cooperate with Central Hospital of Bodø (NSS) in the obstetric aid service. The midwifes are also responsible for the obstetric aid in four neighbouring municipalities. They provide services to some 300 pregnant women annually, and about 100 of them give birth at NSS. The midwife at Lofoten Hospital may consult an obstetrician or a midwife on duty at the NSS for support to interpret a cardiotocogram (CTG) or an ultrasound. Health institutions in northern Norway have recently been connected through a broadband network. The network offers possibilities for new telemedicine services between obstetricians at the hospitals and midwifes at the delivery units in remote areas. The main aim of establishing a telemedicine service was that the pregnant woman can be controlled and followed-up locally during the whole pregnancy, even if she gives birth at the central hospital.

Objectives: The three main objectives were; 1) to establish an online telemedicine demonstrator for transmitting ultrasound and CTG from Lofoten Hospital to Central Hospital of Bodø, 2) to specify the telemedicine service and document the quality of the transmitted medical information, 3) to evaluate the pregnant women's and midwifes' experiences with telemedicine service and 4) to carry out a cost-effectiveness analysis.

Material and methods: In November 2001, the teleobstetric service was installed between the delivery unit at Lofoten Hospital and the Department of Obstetrics, Central Hospital of Bodø. The teleobstetric pilot installation was a server to store CTG at Lofoten Hospital and a client to read the data at NSS. A videoconferencing unit is connected to the ultrasound equipment for transferring the ultrasound. The videoconferencing system may be operated either in a synchronous (online) or asynchronous setting between the two hospitals. When employing the asynchronous alternative, the ultrasound examination performed by the midwife in Lofoten was taped on a digital video-recorder at NSS. The line capacity was 10 Mbps, and the security was obtained by a Virtual Private Network (VPN). The aim of the study was to clarify whether this technology may be of help when midwifes at a local delivery unit asks for advice and support from an obstetrician or a midwife at a distance. A log was registering the activity on the net and a questionnaire measuring the pregnant women's experiences were developed for the survey. A total number of about 100 questionnaires were expected to be answered.

Results: So far, technical difficulties have been the major concern. In the process of upgrading the network from existing bandwidth to broadband, there were problems. The main problems were related to the firewall at the local hospital, and a delay from the network provider. We also experienced some scepticism among the clinicians. However, the installation is now running and preliminary results will be available in October 2002. The result may form the basis for further expansion of this telemedicine service. This service may also stimulate learning and skill development for the health care personnel in rural areas.

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