DISCUSIÓN

"Telemedicine in maxillofacial surgery"

"Telemedicina en cirugía maxilofacial"

L.M. Junquera Gutiérrez

Servicio de Cirugía Oral y Maxilofacial. Hospital Central de Asturias. Oviedo, España

The word "telemedicine" comes from the Greek "Τελε " (tele), meaning "distance," and "medicine." Etymologically, it is medicine practiced at a distance. Initially, it arose from a simple circumstance: that of a doctor located near a telephone. However, with time and technological advances, telemedicine has become a social, professional, educational, economic, and health care management tool. The World Health Organization defines telemedicine as "the provision of health care services in cases in which distance is a critical factor by health care professionals using information technologies and communication to exchange information valid for the diagnosis, prevention, and treatment of diseases, as well as their continuing education and research and evaluation activities designed to improve the health of people and communities".¹

As currently understood, telemedicine services include applications for providing care, administering and managing patients, and offering remote information and training for users and professionals. The main telemedicine applications for health care include teleconsultation/telediagnosis with a variety of applications for different specialties, including radiology, surgery (visualization of interventions), dermatology (diagnosis and remote treatment of dermatology pathology), cardiology, otorhinolaryngology, psychiatry, and many others.²

On the other hand, since the 1990s, health systems have been seeking new organizational formulas and alternatives to traditional management practices. Information and communication technology has been shown to be an important tool that can make organizational models viable, improving the continuity of care and bringing care closer to patients. As a result, the idea of telemedicine as a tool simply for overcoming geographic barriers has lost weight. Telemedicine now can be viewed not merely as a technological tool, but as a new way to conduct and organize health care services. Due to their relative newness, telemedical practices are not definitively established or integrated in the routine procedures of health organizations. Some applications have reached maturity and demonstrated their usefulness, while others are emerging. Many aspects related to telemedicine, however, are still uncertain or still awaiting definitive evaluation. These considerations include evaluating the effectiveness and efficiency of telemedicine practices compared with traditional practices, the acceptance of patients and professionals, every aspect of the cost of introducing these services and payment formulas to professionals, and legal aspects related to security, confidentiality, accreditation, etc.

In Europe, the first country to introduce teledermatology techniques was Norway. A real-time teledermatology service was set up in 1989 between the Hospital of Tromso and the primary care center of Kirkenes, 800 km away. In a pilot study published by these centers, 100% diagnostic coincidence was found between face-to-face and teledermatology consultations.³ The results of other authors also reflect more than acceptable levels of agreement in the diagnosis and degrees of patient satisfaction^.4,5 Four years later, the Kirkenes center was equipped with surgical material so that patients wouldn’t have to travel to Tromso. This example constitutes the model known as deferred, or asynchronous, telemedicine (store-and-forward).

In 1995, the Mayo Clinic (EE.UU.) set up a permanent connection with the Royal Hospital of Amman in Jordan. Daily consultations between a local physician and physicians in the United States were held. The Jordanian doctor presented the patients successively, as if in a hospital clinical session. The American doctors could interrogate the patients about their illness, either directly or through the native doctor. Years later, Jordanian doctors no longer needed this technology due to their degree of training. This is an example of a real-time telemedicine model (online).

The authors of this interesting article describe a deferred telemedicine project targeting temporomandibular joint (TMJ) pathology as a useful tool for public health services. They propose the store-and-forward system due to its simplicity and lower cost. Although telemedicine is well-known and used satisfactorily by different work groups in private practice in our specialty, its potential contribution to public health services may be of broader interest. The authors more than justify the merits of their project on the basis of the social, economic, and administrative benefits of diagnosing nonsurgical MTJ pathology in primary care health centers. Oral and maxillofacial surgery departments in our country often have to evaluate a large number of patients with nonsurgical MTJ pathology. One of the most interesting points for developing this process is the questionnaire, which is «the physical substrate by which the odontologist/stomatologist transmits the patient’s clinical information to the specialist.» However, it may be necessary to develop more consensus about the content of this report (Table 1. Consultation Request Form). Still, it is curious that dentists have the training to manage the diagnosis and nonsurgical treatment of this pathology, but a large volume (almost 70% of cases) of patients requiring no more than an occlusal device are referred to oral and maxillofacial surgery departments for care. The reasons for this are unknown. The project that the authors present here may help to resolve this question.

References

1. Palau E. Telemedicina: Un intento de aproximación desde la gestión sanitaria. Revista de Administración Sanitaria 2001;19:45.        [ Links ]

2. Eedy DJ, Wootton R. Teledermatology. A review. Br J Dermatol 2001; 144:696-707.        [ Links ]

3. Bergmo T. A cost-minimization analysis of a realtime teledermatology service in northen Norway. J Telemed Telecare 2000;6:273-7.        [ Links ]

4. High WA, Houston MS, Calobrisi SD, Drage LA, McEvoy MT. Assessment of the accuracy of low-cost store-and-forward teledermatology consultation. J Am Acad Dermatol 2000;42:776-83.        [ Links ]

5. Weinstock MA, Nguyen FQ, Risica PM. Patient and referring provider satisfaction with teledermatology. J Am Acad Dermatol 2002;47:68-72.        [ Links ]