1. What is Telemedicine?
2. Is there a charge for Telemedicine consultation?
3. Why should I send my cases to the AFIP?
4. What type of equipment do I need?
5. What telemedicine systems does the AFIP have?
6. Do I need to send slides?
7. What is the turn-around time?
8. What is the cost of a consultation?

 

What is Telemedicine?
Telemedicine is essentially the practice of pathology (consultation, education and research) using telecommunications to transmit data and images between 2 or more sites remotely located from each other.

Telemedicine allows a pathologist practicing in a geographically distant site to consult another pathologist for a second opinion, or to consult other pathologists who are experts on particular disease processes. The consultation process is an educational tool for both the referring and the consultant pathologist.

Consultations may be transmitted using "static" or digitized still images. Some institutions use real-time systems, where one or both pathologists can control the mechanical stage and move the slide. Audio and/or video conferencing may also be available with these systems.  

Is there a charge for Telemedicine consultation?
Telemedicine consultation is available on a fee-for-service basis to the AFIP’s civilian customers. Telemedicine consultation is covered under CPT code 88321 The same fee applies to static-image, real-time, or virtual slide cases. If the AFIP consultant requests slides or blocks on a telemedicine case, and they are submitted, the fee for the teleconsult will not be applied to that particular case.

 

Why should I send my cases to the AFIP?
The Armed Forces Institute of Pathology (AFIP) is a tri-service agency of the Department of Defense specializing in pathology consultation, education and research. AFIP maintains 22 subspecialty departments with a combined workforce of over 820 personnel, including over 120 pathologists and other scientists.

In 2001 AFIP consulted on over 92,000 cases, including 55,000 sent to the AFIP for an expert "second opinion." 90% are tumor pathology cases -revealing difficult, unusual or rare entities not typically seen in the military or civilian medical communities. AFIP experts also conducted 27,000 cytology cases for the U.S. Air Force in 2001, and another 10,000 cases for quality assurance and risk management. The AFIP plays a vital role in assisting the international medical community in diagnosing the most difficult and challenging cases.

AFIP is also home to unique pathology resources such as the Department of Veterinary Pathology, the Department of Legal Medicine, the Office of the Armed Forces Medical Examiner, and the Department of Environmental and Toxicologic Pathology. Initiated in 1991, the AFIP Telemedicine program became fully operational in 1993. An evaluation of the pilot program confirmed a high degree of agreement between diagnoses made on transmitted images and glass slides. The Telemedicine Department completed 275 consultations in 1997 from 60 contributors around the world.

 

What type of equipment do I need?
The basic telemedicine setup consists of a microscope, a high resolution camera (1024x768 minimum, 1600x1200 ideal), and a connection to the Internet.

The system must have a mechanism for transfer of images to the AFIP. Most contributors now use a local-area network to transmit cases across the Internet; however some institutions use a modem and telephone service to send images directly to the Department of Telemedicine. Commercial telemedicine systems are available. Since these systems are proprietary, both parties have to have the same system to send and receive consultation cases. However, if a commercial system has the capability to transmit images across the Internet via email or file transfer protocol, then these sytems may also be used for electronic consultation with the AFIP.

 

What telemedicine systems does the AFIP have?
While 90% of our 2002 caseload involved static images, we also support a wide range of more specialized systems. The AFIP has an "open system" which allows contributions by any pathologist with a digital camera and an internet connection. Submitted images must be saved in standard formats - (.bmp, .jpg., .gif, .tif, etc.) - for transmission to AFIP.

We also support a number of proprietary static image, real-time, and virtual slide systems, including: ISSA/Pharos, TrestleCorp, Apollo Imaging, Bacus Laboratories BLISS system, and Aperio Inc. Scanscope system.

Our primary means of receipt is through our secure WWW server at https://www3.afip.org , although we can also receive cases by email attachment at telepath@afip.osd.mil submission of cases through the secure server will ensure the most prompt handling of your case. If images are submitted by email attachement, please fill out and complete a Contributor's Consultation Request Form and fax it to 202-782-9010.

 

Do I need to send slides?
While glass slides are not required, AFIP consultants request glass slides and/or additional material in approximately 80% of cases. This material enables us to perform additional specific tests (such as immunohistochemisty, molecular procedures, etc.), to perform continuing quality assurance on our telemedicine service, and specific feasibility studies. Glass slides and paraffin blocks are routinely requested in all cases in which a malignancy is diagnosed, all cytology cases, and in cases where the AFIP telemedicine diagnosis differs significantly with the contibutor's diagnosis.

 

What is the turn-around time?
The AFIP Telemedicine Department strives to provide a four-hour turnaround time for cases arriving from within the seven times zones across North America (received between 0800 and 1500 Eastern Time), and a 24-hour turnaround time from any originating point around the world. The median turnaround time for ALL Telemedicine cases in 2002 was 3.2 hours.

 

What is the cost of a consultation?
There is no charge for consultations from VA and uniformed services medical treatment facilities. Fees are waived for research or educational cases of interest to the AFIP, for all veterinary cases and for those foreign contributors enrolled in military, WHO or other AFIP cooperative programs, and in cases for which no source of funds is available.