A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.

Two pilot telemedicine trials were established, one using basic-rate ISDN (minor injuries service) and one using primary-rate ISDN (remote fetal scanning). Preliminary results were most encouraging. In the first 10 months of operation, 49 patients with minor injuries were managed successfully using telemedicine. Preliminary calculations suggest that the use of a low-cost telemedicine link was extremely cost-effective in comparison with the cost of providing conventional medical cover. In the first six months of operation the fetal scanning link was used for 39 consultations in 29 patients. In 25 cases (86%) a definitive diagnosis was made using the telemedicine link and physical referral was avoided. However, the current cost of the required hardware (approximately £35,000 per end) is likely to militate against the widespread introduction of the technique, especially since the principal savings are intangible from the perspective of any hospital considering purchase. From the point of view of its use as an information transport system for telemedicine, the ISDN proved reliable (only one failure to establish a connection on demand). Picture quality was acceptable in most cases.