What is happening is a change in the way that Dermatology is now practiced. Dermatology is becoming an electronic medium and the thing that has really enabled this to happen are two things. First of all, is the ability to access images in a high resolution format electronically. We are fortunate to make some of the cameras that do that, you can take the slides and scan them into an electronic form so that now you can work with images in a very powerful manner on a desktop computer. You don't need a high end workstation to pull this off. We are running a standard Windows workstation or a Macintosh workstation, so the level of high-end publishing is now on the desktop. The second thing that has enabled this electronic Deramtology as I'll call it is the advances that have occurred in the telecommunications infractructure. In addition to having the images available, it is very easy to take that information in a store-and-forward manner and send it from one location to another. The Internet enables the sharing of that data, and we're in a position now where the electronic image transfer becomes electronic knowledge transfer because of all the medical specialties, dermatology is a very visually sensitive specialty.

There has been a lot of discussion tonight about using these images for educational purposes: CME credit, Grand Rounds, the Electronic Textbook of Dermatology and training applications. These all are important uses for digital imaging, but perhaps the most essential use is in the dermatology clinic where this technology can have a direct impact on your daily patient care. You can work in live video conferencing or store and forward technique and be in consultation and referral mode to improve your local dermatological care.

However, it is much more than just imaging which is necessary. Images can be used to document procedures and as comparison with previous patients with similar findings. Fortunately, all of this technology is already available. We have cameras that can acquire images with 6 million pixels (18MB file) so that you get the same resolution as with a 35mm camera. The higher resolution allows for magnification of images and printing with photo quality. With Kodak Photo CD, you can store the images for same storage.

Where is all of this technology going?

Those technologies available today to acquire digital images and transfer them will be getting faster and better tomorrow. The feature sets are going to become enhanced in terms of the quality of the image produced. They are going to become less expensive, the price performance of these cameras is going to improve. The resolution is going to go up, the color is going to be more accurate. You will be able to guarantee the color change from one step to the next as you acquire an image. Compression algorithms will improve. You can compress images and make them available on a remote site without losing any of the resolution.

The other thing which will change the way that these images are transferred is enabling software. You will be able to use software like what we call PhotoCD on the Web which is a Java applet that really solves the problem of how to share a high resolution image. It sends the receiver pieces of the image. In woking in an enabling software mode, you can retain the image at your location.

All these pieces put together are turning into "Teledermatology". They are giving you the ability now to capture and render images with the quality that is sufficient to perform examination directly off the electronic data set. People are now being able to collaborate interactively using high speed data transmission. We arenow starting to move information instead of moving patients or physicians between locations. There are several ways that you can do this. One way is through real-time teleconferencing, real-time telemedicine where the visual conference takes place in an interactive mode. There are definitely problems with this model including scheduling concerns. It takes an average of twenty telephone calls to get physicians together to accomplish a single video teleconference. The other mode for telemedicine is store and forward transfer of images and text. These are both available currently. So what is new? Well, the fact that these applications are going to become routinely available. Issues of bandwidth and resolution will be resolved. The challenges of using the electronic media today are going to become fewer. The lawyers will come to agree on what is to be done with teledermatology and the ramification of multi-state care in terms of the licensing, etc. With the standardization of case presentations, dermatologists will be able to share cases with all other physicians connected to the network. Now, there are two parts to the cost issue. One part is the cost of the equipment and making sure that it is available and making sure that the level of resolution is uniform at your site. The other cost is making sure that this venue is profitable to you.