OPINION Telemedicine Forum being established Wê are told that information is the cur- rency of the Nineties. Information couldsim- ply be regarded as any data which isuseful.A significant advantage of information in digital format is the ability to utilise that informa- tion at two or more differentlocations, mark- edly increasing its usefulness. Intrinsic to the information revolution over the preceding decades have been advancesin computer and telecommunications technology. The single overriding factor in the success of these infor- mation technology industries was the use of standardised hardware and software compo- nents, ensuring compatibility between a va- riety of manufacturers, permitting the indus- try's phenomenal growth. These standards include mechanical and electrical connec- tions, transmission media, electronic signal characteristics and sophisticated software protocols and applications. The ability to capture, process and store information in digital formathas already had a huge impact on Radiology. Just as in infor- mation technology the development cfmedi- cal and radiological standards at various strata has been a critical element in allowing the cohesive and productive evolution oftechni- cal advances in our profession. The same need for standards must apply to the rapidly germinating field of telemedicine, as a specialized hybrid branch of information technology and medicine. Again multiple layers of standards and protocols are required covering physical, electrical and software aspects, but beyond that are the medical and medicolegal con- siderations. There are atleastthree good practical rea- sons for developing locally accepted stand- ards - firstly, to protect the public and the medical profession; secondly, to allow inter- communication between systems; and thirdly, to avoid obsolescence.Already exam- ples of inferior performance ofteleradiology systems have raised the level of anxiety con- cerning medicolegal action. Standards may well differ according to individual circum- stances of specific telemedicine systems, with the various permutations of potential links between and within hospitals, prac- tices, clinics and homes. Should a set ofbasic SouthAfrican hard- ware and software standards addressing medical image transmission be pubhshed? Should these be verified and certification be implemented? One would envisage that DICOM 3 standards would be non-negoti- able.Digital image andmonitor specifications would probably be the next most important, requiring at least a 2CXXlby 2CXXlmatrix size and 12 bits of contrast resolution for diagnos- tic chest radiology (and possibly a 4000 by 4000 matrix size for mammography), ide- allywith high luminance, flicker-free screens. Compression isa more contentious issue, particularly whether it is permissible to al- Iow'lossy' compression with the attendant irreversible lossof data. Intercommunication between various systems andfuture upgrade potential would besharedconcems probably ultimately determined bymarketforces. Following a meeting of interested parties in CapeTown on 20January 1996,proposals 4 SAJOURNAL OF RADIOLOGY· September 1996 and discussion on these topics led to the for- mation of a steering committee on telemedicine which has as its objective the establishment of a National Forum on Telemedicine. This committee presently consists of Dr Jan Lo12 (chairman), Prof Steve Beningfield (UCf), Dr Pieter Se.rfontein (provincial ad- ministration Westem Cape), Dr Ashwin Hurribunce (SANDF), Dr Stuart Rutherfoord (Pathologist, University Stellenbosch) andDr Lennox Mathews (Ad- visor, Dept ofNational Health). Private prac- tice, state, provincial, military and academic groups are therefore represented and both radiology and pathology specialties are in- cluded.Any representatives from other in- terested groups or specialities would be warmly welcomed The intention of the pro- posed forum isto represent allinterested par- ties, acting as a conduit between users of telemedicine and central government. The Department of Health has already consti- tuted a committee evaluating the appropri- ateness and application of telemedicine in this country and has been informed of the planned development of the forum.This gov- ernmental committee would be the most likely avenue of communication with cen- tral structures, and many of these issues are pe.rhapsmore appropriately addressed atthat level. We hope that the proposed national telemedicine forum will serve to help culti- vate the discipline required to prevent the devaluation of our own unique currency, medical information. A South African National Telemedicine Forum homepage can be accessed on Internet at the follow- ing address: http://www.stm.ac.za! local/academic/ Anat Path! neuro_path!telemed.html JLotz SJBeningfield http://www.stm.ac.za!