being explored.4 The committee's site visits turned up two image evaluation studies in dermatology. A project at the Oregon Health Sciences University (with assistance from the Telemedicine Research Center and funding from the National Library of Medicine) is intended (a) to verify that electronic images can be used to make accurate diagnoses and (b) to determine the minimum technical specifications required for the capture of diagnostically relevant information (Perednia and Brown, 1995). Clinical photographs with proven diagnoses will serve as the "gold standard" against digital images acquired, transmitted, or stored under varying conditions (e.g., different video formats, different color resolution). In another project, Stanford researchers will compare image quality for three groups of patients: one involving real-time video consults; a second using store-and-forward video technology using technicians to acquire the images; and the third relying on face-to-face examinations (Barnard, 1995).

Evaluations of Automated, Telephone-Based Services

As noted in Chapter 2, nonvideo applications of telemedicine are common in the form of telephone calls initiated by patients or clinicians. A variety of telephone-based computer-assisted services have also been developed over more than two decades (see, e.g., Greenlick et al., 1973; Muller et al., 1977; Alemi and Stephens, in press). These include automated systems that call to remind people of scheduled appointments, programs that provide recorded health information, and others that monitor patient status and record voice answers or touch-tone telephone responses.

Alemi and colleagues at Cleveland State University have reported on a number of attempts to use quasi-experimental research designs to evaluate the effectiveness of these kinds of services. One study


The problem of color fidelity is familiar to amateur photographers and television viewers. The committee heard anecdotes about physicians worried about the pale color of patients seen in video consultations who discovered the problem was with their color monitor. In a study reported in 1977 that compared on-site physician diagnoses with remote physician diagnoses using telephone, still-frame black-and-white television, black-and-white television, and color television, few differences were found among the telemedicine options (Dunn et al., 1977). For dermatology diagnoses, however, telephone did worse (as expected) but so did color television because of color inaccuracies.

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