PRESENT AND FUTURE

nun
he bases for making a Medical diagnosis in the development of diagnostic and

T diagnosis today, as for

20 years
history-taking and
ago are:
medical
internet age
therapeutic competence
medicine will require a m o r e
specialised hospital structure
in

examination; test results from Lise Balteskard, Eivind Rinde in which different centres
different laboratories such as will have to collaborate on
clinical chemistry, radiography, microbiology, histology, individual patients. Information and communication
and others; collaboration and discussion with colleagues in technology will be the key to the success of this new model.
house or nationally and even abroad in the case of rare Medical centres and hospital departments will find
diseases; and medical information retrieval. themselves organised differently, with specialised hospitals
T h e technical evolution in the field of therapeutic spread over a wide geographical area, possibly linked via
medicine has been impressive. M u c h of this is based on telecommunication to form a virtual general hospital.
technological development in Experiments with tele-
information and communi- medicine for remote diagnosis
cation technology, which has have resulted in its regular use
been extremely swift over the in sparsely populated areas.
past decades. The computer Remote real-time consultations
has undergone an evolution such as laparascopy, dermat-
process from its existence as a ology, and ear, nose and
tool enjoyed exclusively by throat examination, require
specialised personnel to an the simultaneous presence of
invaluable piece of equipment medical staff at both the
found not only on almost diagnosis and the expert sites.
everybody's desktop but also in This presents a logistical
many people's pockets. challenge, and the services
One of the major challenges require more medical resources
faced by the medical profession than ordinary consultations.
today is to put together all However, technical solutions
the medical information that are already available. When
already exists in such a way as Telemedicine: the future of diagnosis the diagnosis and the expert
to render it an effective tool for sites can be asynchronous,
reaching diagnoses. T o d a y a large amount of diagnostic as in the case of teleradiology, telemedicine is easier to
equipment generates electronic output, and the vision is to organise and may not be more costly than in-house
include this as digital data in the medical record. diagnosis.
T h r o u g h the internet we have become accustomed to Medical information is already to a large degree available
linking information from different sources. T h e same on the internet today. In the future we will have access to
method of accessing information has become reality in all necessary information in our hand-held computers,
some medical-record systems. In the future, all information which will be fitted with a cordless connection to the
on a patient (ie, medical record, radiographs, audiotapes, internet. T o sift the large volume of information
images and videos from different imaging devices, real-time on the internet, intelligent search mechanisms will be
sensor data) may be presented in a web-browser user developed. Such mechanisms will collect relevant
interface. T h e medical information on one patient will be information for the problem in question and improve
made available anywhere in the world provided the right differential diagnosis.
security identification is presented. T o access the patient's Computer-aided diagnosis has become a reality
complete medical history from anywhere in the world, in areas such as m a m m o -
there must be a unique key for each patient recognised by graphy, bone densiometry,
all. T h e information may be located in one computer, or and electrocardiography. In
may be stored at its source of origin. In the latter case, the furore, these methods
specialised search programmes would collect the patient's will be used to screen the
medical history. Very strict access control must be used to healthy population, relieving
prevent unauthorised access to medical information. As an the physician to oversee
example: the patient may bring a smart card with his access suspect cases. Computer-
key, or the iris or fingerprints of the patient may be used as aided diagnosis will be
a basis for the access key. available for other diseases
Today, department meetings and telephone discussions and will be an essential tool
with colleagues located elsewhere are held to diagnose to meet increasing demand
unusual cases. This method of communication may for screening progran~mes.
become computer-based in real time, or may become Despite the technological
e-mail and web-based. Expert panels may be set up on advancements, the key to
national or worldwide levels to give advice on different a successful diagnosis will
diseases or groups of symptoms. still mainly depend on
T h e need for rapid exchange of medical information will the physician's judgment,
become more important in the future as a result of the based on experience and
increased mobility and travel of the general public. T h e diagnostic imagination.

The Lancet • 2000 • 354 • December • 1999 sty 14