Diabetes and Telemedicine

Is the technology sound, effective, cost-effective, and practical?I n this issue of Diabetes Care, Chase et al. ( 1) have very nicely demonstrated how modem technology can be a useful tool for providing effective management of type 1 diabetes when used in lieu of a clinic visit.This study represents an example of telemedicine, a technology that can be defined as the use of telecommunications to support health care.Was their Colorado program sufficiently successful in becoming a model for other programs that will provide modem transmission of glucose values?I believe it was.An analysis of the technology utilized by this telematic program for type 1 diabetes demonstrates that the method appears to provide effective tools for health care providers to deliver a valuable experience for patients, with decreased costs for payers.The value of a new application of technology to medicine can be judged by four criteria, each of which may be expressed as a question.First, is the technology sound?That is, did the technology fulfill its purpose?Second, was the program effective?That is, was the new program successful compared with base care?Third was the program cost-effective?That is, did it provide sufficient benefit for the cost to be economically viable?Fourth is the program practical?That is, did the program create new significant problems that we do not currently have to deal with in the absence of the program?Applying these criteria, the Colorado program can be evaluated as to whether it was successful.A set of criteria for assessing whether a telemedicine program is technologically sound was proposed recently by Ronald C. Merrell, MD, director of the NASA Telemedicine program.He stated that the elements of a successful telemedicine program include: 1) accurate collection of data in digital format; 2) incorporation of those data into an electronic record that may be transmitted with fidelity; 3) protocols for distant analysis; and 4) communication tools to permit effective dialogue among primary managers, patients, and consultants (2).I would add that the analysis and communications system