Telemedicine for the Diabetic Foot: A Model for Improving Medical Care, Developing Decision Support Systems, and Reducing Medical Cost

Abstract

The main purpose of this chapter is to discuss the place of telemedicinein the modern medicine, its present and future application in theclinical medicine. It covers aspects of clinical telemedicine practice,technical advances, principles and practices, health policy andregulation, and health services research dealing with clinicaleffectiveness, efficacy, and safety of telemedicine and its effects onquality, cost, and accessibility of care. The diabetic foot problem waschosen as a suitable model to examine whether the use of telemedicinetechnology will improve the quality of medicine and reduce medicalcosts.According to the American Telemedicine Association, telemedicine is theexchange of medical information from one site to another usingelectronic communication such Lis telephone, Internet or videoconferenceto improve patients' health status {[}1]. Related with telemedicine isthe term ``telehealth,{''} which covers a quite broader definition ofremote healthcare, being more focused on other health-related servicesthat do not always involve direct patient clinical services.Telemedicine practices allow for specialist consultation, direct patientconsultation, patient monitoring, and medical education.Although the term telemedicine is a relatively recent one, since 1970s,medicine has long made use of various communication technologies datingback to 1906. Wilhelm Einthoven, inventor of the electrocardiograph,created the ``telecardiogram,{''} which transmitted electrocardiogramsvia telephone from the clinic to his office, enabling him to monitor hispatients' condition at a distance {[}2]. In the early 1990s,telemedicine experienced a considerable progress due to rapidadvancements in information and telecommunications technologies anddigital data transmission. Since then, the interest in the use oftelemedicine procedure:; and the number of related publications hadrapidly increased. A A search of MEDLINE in 1990 found six publicationson telemedicine; while by February 2009 there were more than 10,700entries under the search term telemedicine.{''}