Overview and status of the AKAMAI Telemedicine Evaluation Initiative

Project AKAMAI is a Federally funded program designed to augment health care delivery to DoD and beneficiaries in the Pacific Basin using telecommunications technology. The AKAMAI Evaluation Initiative is a systematic evaluation of the potential contribution of telemedicine technologies and processes in a health care delivery system. In this prospective study, patients are randomly allocated to usual care (UC) or telemedicine (TC) for routine dermatology or orthopedic consultations between a primary care outpatient clinic and a tertiary care center. To assess the impact of this change in health care, measures of structure, process and clinical outcome are performed over a 90 day period from the date of consultation. Data analysis will include descriptive and analytical statistics, and construction of medical models based on individual patient trajectories. The automation infrastructure for the study employs a thin client-server design and integrates existing hospital legacy systems and image servers on a secure network. Health care providers access the AKAMAI server using Web browser software and use predefined clinical protocols that define required Hx, PE, labs, and images for problem oriented consultation. The evaluation project background, status, and anticipated applications are discussed