Mobile remote-presence devices for point-of-care health care delivery

It is likely that dedicated devices (i.e., devices designed and used solely for telemedicine) will be required if remote-presence medical technology is to be relied on to inform decision-making that results in immediate clinical action by health professionals in clinical situations. The US Food and Drag Administration (FDA) has issued a rale regarding medical device data systems that clearly differentiates the handling of devices for medical display or documentation purposes from active patient monitoring.6 The next step in the evolution of mobile telemedicine is the development of portable, dedicated medical communication devices capable of providing real-time remote presence and transmission of diagnosticquality medical data from a range of peripheral diagnostic devices that will allow point-of-care therapeutic intervention. These devices must incorporate security, reliability and stable connectivity, and be able to pass stringent regulations. In contrast to smartphone applications, dedicated remote-presence medical devices have encryption protocols for secure communication, as well as high-resolution cameras and ports for the attachment of peripheral diagnostic devices such as portable ultrasound machines or digital stethoscopes (Figure 1). Although production of these devices is in its early stages, and each type of medical mobile device may be slightly different, the device that we are familiar with is the RPXpress (InTouch Health). This device is currently the only mobile remote-presence device designated by the FDA as a class II device, meaning it fulfills the FDA's requirements for active patient monitoring in clinical situations in which immediate clinical action may be required. The device is encased in a rugged protective shell that has a solid handle for easy manoeuvrability (Figure 2). It is the size of a regular laptop, weighs 7 lb and is equipped with 2 screens and 2 cameras. Connectivity is provided by a standard wireless network and 3G cellphone signals with a minimum bandwidth of 300 Kbps (kilobits per second). Box 1 summarizes our experience with this mobile remotepresence device. Mobile remote-presence devices for telemedicine have the potential to change the way health care is delivered in developed and developing nations. The availability of cellular network signals around the globe and rapidly increasing bandwidth will provide the telecommunication platform for a wide range of mobile telemedicine applications. The use of low-cost, de