Real-time telemedicine involving video transmission has been used successfully in a number of specialties.
Telepsychiatry: Telepsychiatry is arguably the most successful real-time telemedicine application. It is not easily done in prerecorded mode, although psychotherapy by email has been reported. Real-time telepsychiatry, i.e., videoconferencing, is one of the few telemedicine applications for which there is some formal evidence of its efficacy and effectiveness. Much of the work in Australia was originally done at low bandwidths (128 Kbps) and much of the work in the U.S. began at much higher bandwidths (1.54 Mbps). Current preference in both countries seems to be for telepsychiatry at a bandwidth of about 384 Kbps.
Tele-ENT: Much of the published experience in ENT consultation by telemedicine concerns real-time interaction using video endoscopy. It is clear that the tele-ENT can be an effective method of consultation between a primary care practitioner and a specialist. Unnecessary referrals can be avoided and there may be early detection of serious pathology. Although the telemedicine equipment is likely to be relatively expensive, a high enough patient workload can achieve savings in comparison with patients’ travel to a specialist center. It is also possible to carry out ENT consultation based on prerecorded interaction, e.g., using still images or short video clips. There are not yet many studies that compare the two methods. In one study of 45 patients, 31 said there were no signiﬁcant differences between the real-time telemedicine diagnosis and the conventional face-to-face diagnosis. However, only 62% of the prerecorded cases were the video clips judged to provide sufficient information for a diagnosis.
Accident and emergency telemedicine: In contrast to some specialties (e.g., teledermatology), accident and emergency (A&E) telemedicine must be real-time because the delays in prerecorded mode are unacceptable. The technique offers the possibility of improving support for small-hospital emergency departments, especially out of normal working hours. Telemedicine has been very successful as a decision-support aid for nurse practitioners running minor injury services in the absence of on-the-spot medical cover. Regional minor injuries networks are beginning to evolve based on main A&E departments at tertiary hospitals.
Other: For similar reasons—providing access to medical services where there is no alternative—telemedicine has been used for decades at sea. Most of the major maritime nations established radio medical services for merchant ships in the early part of the 20th century. By the 1990s, for example, the Italian radio medical service had dealt with over 40,000 patients, mainly on ships, and more recently had assisted in the case of airline passengers becoming ill during a ﬂight (about 1% of the workload). Telemedicine for passenger aircraft is a particularly interesting area because of the high costs of diverting long-haul aircraft if a medical emergency occurs. The major airlines experience signiﬁcant numbers of such diversions and medical advice is normally provided from the ground via a radio link to the duty doctor. Transmission of vital signs in ﬂight may allow better decision making about whether a diversion is appropriate ii.