We have performed a feasibility study of telemedicine as an alternative to conventional outpatient appointments for the making of diagnostic and management decisions for patients referred for vascular surgery. Twenty-two sequential patients referred by a single general practice to a vascular centre were offered a telemedicine clinic appointment as an alternative to a conventional hospital outpatient appointment. A referral pro forma and digital photograph (where appropriate) were transmitted in advance of the videoconference. The videoconference involved patient, practice nurse and vascular consultant. All patients opted for the teleconsultation. The majority had leg ulceration or leg pain. Six patients required only the initial teleconsultation and were managed thereafter in the community. Thirteen were referred to the vascular laboratory for investigation. Three proceeded to angioplasty and four to surgery. Two patients had a conventional outpatient appointment for follow-up but all others were followed up via telemedicine. Overall 27 conventional outpatient appointments were replaced by a teleconsultation.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.