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Telemedicine

Remote clinical encounters with live diagnostic imaging — and, fifteen years earlier and under a different name, diagnostic studies delivered to radiologists at home over dial-up.

Left to right is time. Each row is one of the 3 disciplines this one worked alongside, ordered so kindred disciplines sit next to each other rather than alphabetically — a landscape only means anything if neighboring rows belong together. Height is the work running in that domain in that year, weighted by what failure would have cost — life-safety ×3, a statutory obligation ×2.2, the estate itself ×1.5, an evaluation ×1. Every project declares which of those it was, so each ridge traces to an entry you can open and disagree with. Only the work that used this technology is counted, so what shows here is the company it kept rather than the record around it. Height and color are on the record-wide scale rather than this page’s own, so a modest estate draws a modest landscape and any two of these pages can be read against each other.

It was built once already, under another name

The teleradiology platform designed at StorComm from 1997 delivered diagnostic imaging to radiologists reading from home over ISDN and dial-up, on a platform operating under Food and Drug Administration clearance.

Telemedicine is the same proposition with the clinician and the patient both moved. A remote physician has to be able to trust what they are seeing well enough to make a care decision on it, and everything else in the design follows from that one requirement. The fifteen years between the two changed the transport, the codecs and the vocabulary. They did not change the problem.

The municipal program

Built out a telemedicine program with local hospital partners, piloted over multiple years, serving two populations the city had a duty to and limited means to reach: indigent residents for whom travel to a clinician was itself the barrier to care, and the incarcerated population in the Sheriff’s Office corrections system.

Multiple video systems were integrated with diagnostic imaging modalities including ultrasound and X-ray, so a remote clinician could conduct the encounter and read live imaging in the same session rather than working from a description. The design problem was clinical rather than technical at heart: the physician has to trust what they are seeing well enough to make a care decision on it, which sets the bar for image fidelity, latency and synchronization far above an ordinary video call.

The corrections use case was designed around staff safety as well as access to care. Examining injuries on incarcerated people remotely protects the physician and attending staff, and removes a transport movement that carries its own risk. Inmate medical records sit at the intersection of HIPAA and CJIS with different access, retention and disclosure rules on the same record, which made the compliance boundary as much of the architecture as the video path.

Applied in

  • Telemedicine Program with Hospital PartnersMay 2014 – August 2015Duval County Jail to UF Health — fifteen months from vendor presentation to completed pilot, opened with a business case rather than with equipment.
  • StorComm PACS Platform1997–1999Chief system designer of a clinical picture archiving and communication platform for hospital customers.
  • StorComm Teleradiology Platform1997–1999Diagnostic imaging delivered to radiologists at home over ISDN and dial-up — telemedicine fifteen years before the market used the word.

Career

See also

Also searched as

  • telehealth
  • virtual care
  • remote clinical
  • corrections healthcare