Would you tell us about your new adventure?

I am involved in a number of projects at the present time. Perhaps the one that is attracting the most interest is the use of immersive virtual reality to demonstrate and describe the experience of psychosis. I am working with a number of researchers at the University of Queensland to use supercomputer powered visualization environments that allow you to literally walk into a room and be surrounded by visual and auditory hallucinations, as if you were psychotic and suffering from an illness like severe depression, schizophrenia or a drug related disorder.

Apart from this, I am also involved with a number of projects using high-powered search engines and neural network technologies for the diagnosis of a number of medical and psychiatric disorders. These technologies are used to analyze human facial expressions, languages and movement and then to classify diagnostically in an automated way. Ultimately these types of technologies will be able to be used at a distance so you will be able to sit down in front of your videoconferencing screen for example, and after a 10 or 15 minute interview, be sent an automated diagnosis, just as if you are sitting talking to a doctor.

The third area of interest for me, from a research perspective, concerns email consultation. I am involved with a number of groups working on this, looking at the clinical guidelines and requirements, and developing websites to support this type of approach. Email consultations can be seen to be a part of e-disease management, at a broader level, and I think this is one of the areas that telemedicine will move into very rapidly.

My final area of interest, in the commercial sector now, is in a company called Health Share (www.healthshare.com.au). Here we have developed some quite remarkably impressive software technology that allows doctors to videoconference with each other over broadband Internet, ideally using virtual private networks, but at the same time to share any applications, data or Internet access that is available at any of the networked computers at that time. I believe that Health Share's technology has the potential to really revolutionise the way we deliver health care and this technology is now being bought by quite a number of doctors here in Australia, and will hopefully become increasingly available globally in the not too distant future.

Where can we locate your site?

There are 2 sites of importance. The first is the University site at (www.coh.uq.edu.au), where a large amount of information on e-health is maintained as well as research and media reports from our research at the Centre for Online Health and a number of PowerPoint presentations that members of the Centre have given in recent times. The second site is the Health Share site at (www.healthshare.com.au), where in particular there is a 2-minute video that demonstrates the quite remarkable Health Share technology.

What are your target audiences?

I am basically interested in creating new and high quality approaches to care for both patients, particularly those with chronic illnesses, and health care providers. As a psychiatrist, I have a natural bias towards the psychiatric disorders, which of course have always been well supported in the telemedicine community. I have recently co-edited a book called Telepsychiatry and e-Mental Health which is published by the Royal Society of Medicine (www.rsm.ac.uk), and which I think is a good example of a state of the art publication looking at the many important clinical and research issues involved in that field.

Are these an extension of our telemedicine work?

That is certainly the case. I am still involved with providing consultations over the Queensland Telemedicine Network, for instance, and the Centre for Online Health manages a large telepaediatric project which has just completed its first 1,000 paediatric consultations. At a personal level, however, my interests have really moved on and I am focussing on the use of the Internet environment, high bandwidth networks and new computer technologies as I see e-health becoming a core long-term part of the health system in the next 20 or 30 years. I think that the work in conventional telemedicine that I have been involved in, since 1992, has been extremely useful and has led to me having a much greater understanding and interest in e-health generally, particularly in terms of change management and user adoption issues, but I do not see the use of the old big black boxes as being the way of the future.

What other interests have you developed?

One of the major areas I find fascinating is the whole concept of consumerism. I recently had a book published called Your Guide to e-Health - Third Millennium Medicine on the Internet by the University of Qld Press (www.uqp.uq.edu.au). This book is essentially a consumer guide or cookbook on the use of the Internet for e-health and I am pleased to say it is now in its second print run and has proved very popular. It has a comprehensive list of good websites for different medical and psychiatric disorders, but the issue that quite a number of patients have commented on that they have found very valuable has been the "how to" guide to performing searches for high quality health literature.

What is your prognosis for telemedicine?

My prognosis for telemedicine, as a term, is very poor in that I think it is unfortunately a rather outdated terminology that does not embrace the breadth that is e-health. I must say I tend to prefer the term "e-health," which was recently defined by Gunther Eysenbach, the editor of the Journal of Medical Internet Research 1 as follows:

"e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterises not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology."

Using this definition I think is much more sensible than the term "telemedicine" because it embraces attitudes and healthcare processes, rather than just technology, which tends to be how people view telemedicine. My view on the future of e-health is extremely bright. Australia in particular is now taking up this form of care quite widely, and there are a number of exciting e-health programs being introduced providing care at a distance. Naturally these are most effective when used for chronic conditions such as diabetes, asthma, depression, and for prevention or assessment in highly visual specialties such as dermatology and ophthalmology. So overall, I am very optimistic about the future and see e-health as an area of growing interest, but one that needs to be underpinned by high quality research and evaluation as occurs at the Centre for Online Health here in Australia.

Reference 1.
Eysenbach, G. What is e-health? Journal of Medical Internet Research, 2001; 3(2):e20