WO2003053232A1

WO2003053232A1 - Telemedicine system, use thereof and telemedicine patient care

Info

Publication number: WO2003053232A1
Application number: PCT/EP2002/014003
Authority: WO
Inventors: Peter Hunfnagl; Martin Schultz; Trong-Nghia Nguyen-Dobinsky
Original assignee: Ghc Global Health Care Gmbh
Priority date: 2001-12-20
Filing date: 2002-12-10
Publication date: 2003-07-03
Also published as: DE10163095A1; DE10163095B4; AU2002366731A1

Abstract

The invention relates to a telemedicine system (10) which comprises a consultation center (12) located on the side of the doctor; at least one telemedicine device (30), located on the side of the patient, for recording medical data (Dmed) and/or communications data (Dkom) and for transmitting the data to the consultation center (12); a communications system (28) for the wireless and/or wire-bound data transmission between the consultation center (12) and the at least one telemedicine device (30); a data base (18) with digital patient files (20) that comprise patient data (DPA); and means for allocating a patient file (20) of the data base (18) to a patient (32) and for accessing the pertaining patient file (20) and for the visual and/or audio representation on the side of the doctor of the patient data (DPA) contained in the allocated patient file (20) and of the transmitted medical data (Dmed) and/or communications data (Dkom).

Description

Telemedicine system, its use and procedures for telemedical patient care

The invention relates to a telemedicine system with a doctor-side consultation center and at least one patient-side telemedicine device.

The use of systems for telemedical diagnosis and / or treatment of patients is potentially desirable in places or in situations in which no medical specialists, in particular no doctor, are available. Typical examples are planes or ships or remote, sparsely populated areas. Since a quick diagnosis and therapy is particularly necessary in a medical emergency, there is usually not enough time at such locations to bring together an experienced doctor and the patient concerned. To remedy this, diagnostic devices can therefore be stationed at such medically underserved locations, for example in airplanes, with which individual diagnostic functions, such as blood pressure measurements, can be carried out. These devices must be designed so that they can be used by laypeople or, if necessary, trained personnel. Conventionally, the person providing assistance then has to contact a doctor by telephone or radio connection or the like Establish a connection that must derive a diagnosis from the information available to him in order to instruct therapy or first aid measures. The doctor is completely dependent on the information communicated to him. It is obvious that with conventional communication the device diagnostic possibilities, the reliability of the diagnosis and of course the quality of the treatment measures fall far short of the standard for direct doctor-patient contact.

Mobile telemedicine devices are known from recent developments, in which the diagnostic data are sometimes transmitted to a doctor himself. EP 1 051 945 A2 describes a mobile telemedicine device which combines various diagnostic functional elements and transmits the recorded data as well as voice and image information to a ground station over narrow frequency band ranges. The disadvantage is • here, on the one hand, the coherent

Construction of the device, in which the individual diagnostic instruments are connected to a central computer via a cable. This severely limits the flexibility of the device, since the use requires the entire device to be transported to the patient. Furthermore, only low data transfer rates are possible in the known device, so that real-time image transfers (video) or the transfer of extensive diagnostic data are not possible. The applicant's older patent application DE 101 54 908.3 also describes a patient-side telemedicine device which communicates with a doctor-side consultation center and which has a modular structure with a large number of diagnostic, communication and / or therapy modules. These function modules, which are preferably connected wirelessly to a base unit of the telemedicine device, permit simple handling of the device, flexible equipment and / or retrofitting and, above all, high data transmission rates, which also allow transmission of image and audio data in real time.

The object of the present invention is to provide a telemedicine system which is further improved compared to the prior art and which enables even faster and more reliable remote diagnoses and thus improves the overall telemedical patient care.

This object is achieved by a telemedicine system with the features of claim 1, a method according to claim 20 and by uses according to claim 22.

The inventive telemedicine system comprises

(a) a medical consultation center,

(b) at least one patient-side telemedicine device for patient-side recording of medical data and / or communication data and to transmit this data to the consultation center,

(c) a communication system for wireless and / or wired data transmission between the

Consultation center and the at least one telemedicine device,

(d) a database with digital patient files, which include patient-specific data (patient data), and

(e) Means for assigning a patient file of the database to a patient and for calling up the assigned patient file and means for the physician's visual and / or auditory representation of the patient data contained in the assigned file, the transmitted medical data and / or communication data.

The invention therefore aims essentially at the integration of a database with digital patient files, whereby after an emergency patient has been identified, the patient file associated therewith is called up and the patient data stored therein are automatically made available to a medical specialist of the consultation center. Of course, this concept requires prior registration of the patient and storage of his medically relevant data. For reasons of data protection is readily possible to the database with the ^'anonymous patient records to be managed In addition, the system can also be used - albeit less advantageously - for remote medical care for patients who are not registered and therefore do not have a digital patient file.

Immediately after a medical emergency has been reported, the medical specialists, for example a doctor or a team of doctors, receive important diagnosis-relevant information which, together with the current medical data and / or communication data transmitted, make it easier to make a quick and reliable diagnosis. The otherwise cumbersome exchange of information with the patient or a service provider, which is often not possible at all in terms of the level of detail provided, in order to determine, for example, the patient's medical findings, is eliminated. As a result, therapeutic measures or first aid measures on the patient side can be instructed and initiated more quickly, thus ensuring better and more effective patient care. In addition, preparatory actions, for example in a receiving clinic, can be initiated more quickly. Of course, it is also conceivable to also present the data contained in the patient file to the auxiliary person on the patient side, preferably by means of the telemedicine device, so that the person providing assistance can also benefit from this.

The patient data stored in the digital patient files can contain all medically relevant data of the patient, which are also included in conventional patient files. In particular, this can be age, gender, weight, blood group, blood values, allergies, medical findings, medical history data, family dispositions, medication data and / or the like. In addition, the patient data can also contain digital image data that can be called up by the doctor, for example X-ray images, ultrasound images, magnetic resonance imaging, electrocardiograms or the like. This gives the doctor a comprehensive overview of the patient's health and general condition. In individual cases, a direct comparison can even be made with image data currently acquired and transmitted by means of the telemedicine device, for example an electrocardiogram. This further improves the diagnostic certainty. Particularly in the case of permanently supervised patients, the patient file can also include information about medical equipment, for example with an electrocardiograph, and / or about medication of the patient. This makes it easier for the doctor to make individual decisions regarding further diagnostics or therapy.

The database comprising the digital patient files can be assigned to the telemedicine device on the patient side. However, since such an execution requires a large number of copies of the database and can also cause a certain time delay due to the transmission of the relevant content to the consultation center, it is preferably provided that the Database is assigned to the doctor's consultation center. However, it is also conceivable for the patient to carry an appropriate identification card on which the patient data mentioned are stored. In this case, the database is constituted by the large number of individual identification cards.

According to a simple embodiment of the invention, the assignment of the patient file can be carried out by the aid provider simply by entering the patient's name or identification number, for example using a keyboard or the like. According to a preferred embodiment, however, the telemedicine system comprises an automatic identification system for recording and recognizing identification data of the emergency patient. The identification system comprises in particular a reading device on the patient side, preferably assigned to the telemedicine device, for recording the identification data of the patient.

In particular, this can be a reading device (scanner) for recording a fingerprint, the iris, the face or the voice of the patient or for reading an identification card of the patient. The identification system also includes a recognition system for recognizing the recorded identification data of the patient in order to enable an automatic assignment of the associated patient file. Programs that use image or pattern recognition methods known per se are particularly suitable here. The currently recorded identification data of the patient are included compared to a reference database that contains the corresponding stored identification data of the registered patients. Of course, each of these methods requires a previous one-time recording and storage of the corresponding identification feature of the patient, for example his fingerprint. The reference database can exist separately and can be linked to the database with the patient files or can also be integrated in the latter. The automatic identification system results in a further time advantage.

A particularly advantageous embodiment of the invention provides that the doctor-side consultation center also has diagnostic aids for automatic and / or interactive diagnostic support that can be influenced by the doctor. These diagnostic tools preferably include stored algorithms or forward depending on the by the "telemedicine ^{device""transmitted} ^'medical data and / or communication data and / of the patient information of the associated patient record diagnostic and / or therapeutic proposals. This can in particular also be provided to present the corresponding suggestions together with weightings, which, for example, represent a measure of the reliability of the diagnosis proposal or the urgency of a therapy proposal, such aids significantly contribute to increasing the reliability of the diagnosis and to accelerating the diagnosis. According to a further advantageous embodiment of the invention, the patient-side telemedicine device comprises at least one diagnostic device which is operated, for example, by the person providing help and which enables medical data to be recorded at the emergency location and transmitted to the consultation center. Such a diagnostic device can be, for example, an electrocardiograph, a pulse oximeter, a spirometer, a blood pressure monitor, a thermometer, a sonograph, a double sonograph, a cardiotocograph, a mini laboratory unit and / or the like. The modular configuration of the telemedicine device with a large number of different mobile diagnostic devices is particularly advantageous.

Further, the telemedicine system may patient-side control devices (so-called Event Recorder) feature, said at least one vital sign -Monitor preferably in patients at risk automatically and permanently, acute about - to detect cardiac rhythm ^■ disorders and to signal a medical emergency. The use of monitoring devices enables the automatic and immediate notification of the emergency both at the emergency location itself and at the doctor's consultation center. One or more of such monitoring devices can also be assigned to the telemedicine device.

According to a further particularly advantageous embodiment of the invention, the telemedicine system comprises at least one communication on the patient side, preferably also associated with the telemedicine device. kationseinheit for recording and transmission of audio data and / or visual data of the patient and / or the helper. In particular, a microphone and loudspeaker device for the mutual transmission of voice data and a camera for the transmission of video data, preferably in real time, are suitable as the communication unit.

In a further advantageous embodiment of the invention, a location system for determining a position of the telemedicine device is provided, which can be based, for example, on a satellite-based method. In particular, the telemedicine device can have a GPS device (Global Positioning System) for this purpose. This enables a quick coordination of any necessary transports of the patient to a clinic or a doctor to the patient.

^• The data transmission ^■ between the patient sideή

The telemedicine device and the doctor's consultation center are preferably - in some applications (for example in airplanes or on ships) necessarily - wireless, with particularly advantageous broadband data transmission technologies, in particular using Internet protocols (TCP / IP), being used. In principle, all known data transmission systems can be used, in particular fixed network, mobile radio, preferably UMTS mobile radio, satellite,

Local Area Network (LAN), Wide Area Network (WAN) and / or Wireless Local Area Network (WLAN) transmission conditions. Several of these systems can also be used in combination. The communication module has appropriate facilities and interfaces for this. In this way, the system according to the invention enables very large amounts of data to be transmitted in the shortest possible time. Thus, video data can also be transmitted in real time (live mode), which, for example in a video conference circuit, transmits a direct visual impression of the patient to a doctor connected via the communication system and allows him to monitor, comment on, and approve therapeutic measures conduct.

15 The invention further relates to a method for telemedical patient care with the features of claim 20.

The telemedicine system of the invention can be carried ^• 20 ~ Sonder advantageous for telemedizinischen- care "and care of patients, especially in aircraft or ships to use. Furthermore, addition is the use in patient care in sparsely populated and remote or difficult to reach 25 areas also conceivable.

Further advantageous embodiments of the invention are the subject of the remaining subclaims.

30 The invention is explained in more detail in an exemplary embodiment with reference to the accompanying drawings. Show it: Figure 1 schematically shows an overview of a structure of the telemedicine system according to the invention according to an advantageous embodiment of the invention and

FIG. 2 schematically shows a more detailed structure of the telemedicine device and the database with the digital patient files of the telemedicine system from FIG. 1.

According to FIGS. 1 and 2, the telemedicine system, designated as a whole by 10, comprises, as the first essential component, a physician-side (stationary) consultation center 12 which has medical staff, in particular at least one doctor 14, and a central data processing system 16.

The data processing system 16 includes in addition to usual "Chen ^* peripherals; 'e ^~ r ± egerät" s ";" ^~ such as one or more screens, a keyboard and / or other input means, a specially designed computer that the usual components not shown here, such as system board, processor, read-only memory, memory, etc. The data processing system 16 also has access to a database 18 which contains a multiplicity of digital patient files 20 (FIG. 2) The patient files 20 comprise stored, medically relevant patient data D _PA registered Patients, such as age, gender, weight, blood group, blood values, allergies, medical findings, medical history data, family dispositions, Medication data and the like. In addition, the patient files 20 can also include digital image data of the patients, for example of X-ray images, as well as a possible device medical and / or medication of the patient.

The data processing system 16 also has access to diagnostic aids 22 in the form of at least one stored algorithm that supports a diagnosis of the doctor 14 that can be influenced automatically and / or interactively. Both the database 18 with the digital patient files 20 and the diagnostic aids 22 can be stored on a permanent memory of the computer of the data processing system 16 or on external systems connected via a data transmission network.

The consultation center 12 may also, if necessary, for example, via live conference ^calls' üngeή ^'' with wei'teren ^'' ^'medical' ^'experts'' 24 'and / or clinics 26 may be connected.

The consultation center 12 is connected to at least one (mobile) telemedicine device 30 via a communication system 28. A large number of telemedicine devices 30, which are stationed in different locations, for example in airplanes, on ships or in other locations that are difficult to reach, are usually connected to the consultation center 12. The communication system 28 particularly advantageously uses broadband data transmission techniques, in particular using Internet protocols (TCP / IP), in order to ensure the highest possible data transmission rates. For example, the transmission can take place via a satellite system. Both the data processing system 16 of the consultation center 12 and a central computer, not shown here, of the telemedicine device 30 have the required protocols, connections and interfaces for this purpose.

On the side of an emergency patient 32, the telemedicine device 30 is usually operated by an assisting person 34 who at the same time communicates with the doctor 14 of the consultation center 12.

A ^" device""""described in the earlier mentioned patent application DE 101 54-908.3 can be used particularly advantageously as the telemedicine device 30. The more precise structure of such a telemedicine device 30 and its interaction with the consultation center 12, in particular with the database 18, can be seen in FIG.

The telemedicine device 30 has a modular structure. At its heart is a basic module 36, which essentially includes a specially designed PC. The telemedicine device 30 also includes a communication unit 38 for connection to the communication system 28. In addition, the telemedicine device 30 has a number of different functional modules, which can preferably be completely separated from the base module 36 and thus enable mobile, autonomous use. For this purpose, the function modules have their own power supply, in particular batteries, and a wireless data transmission system, which enables them to exchange data with the base module 36. First of all, according to the example shown, a communication module 40 is provided as a first function module, which typically comprises a microphone and / or a video camera and thus enables the transmission of voice and video data both by the helper 34 and by the patient 32. The telemedicine device 30 is also equipped with a large number of diagnostic devices 42, of which only two are shown as examples here for the sake of clarity, for the acquisition and transmission of medical data D _med ι, Dmed2. This ^"could ^'eh for example, ^a' Elekfrokardiogräph; ^'a blood pressure measuring device, an ultrasonograph, or the like In addition, also referred to as an event recorder monitoring device 44 is provided which certain vital signs (heart rate, blood pressure, etc.) in particular continuously monitored at-risk patients and one at abnormalities. medical emergency signals, in particular event recorders for the detection of cardiological rhythm disorders are known.

In addition, a therapy module 46 is provided for carrying out therapeutic or emergency measures. seen that can be, for example, a defillibrator that can be operated independently or according to instructions from the doctor 14 by the assistant 34.

Finally, the telemedicine device 30 has a reading device 48 with which certain identification data D _{ID of} the patient 32 can be recorded. According to the example shown, the reading device 48 is a fingerprint scanner that records and digitizes the fingerprint of the patient 32. For the automatic identification of the patient 32, a recognition system 50 is also provided, which is preferably integrated in the data processing system 16 of the consultation center 12. This is preferably a suitable pattern recognition system known _{per se which} reads in the recorded and transmitted identification data D _ΪD and _{compares it} with a reference database which comprises the corresponding identification data (here fingerprints) of all registered patients. In the present example, this reference database is an integral part of the database 18 with the digital patient files 20, each patient file 20 comprising the identification data Dm of the corresponding patient. The recognition system 50 thus enables the patient file 20 associated with the emergency patient 32 to be assigned, so that this file 20 is loaded into a working memory of the data processing system 16 and the patient data D _PA contained therein

Doctor 14 in the consultation center 12 can be visually displayed on a monitor, for example. The typical course of the procedure will be illustrated below using the example of an emergency. Of course, different applications of the telemedicine system 10 according to the invention are also conceivable and useful, for example for simple doctor consultations or for monitoring the chronically ill.

The beginning of the sequence is the acute medical situation, for example an acute cardiac arrhythmia of a patient 32 on board an aircraft. The cardiac rhythm disturbances are detected by the event recorder 44 and reported to the flight crew. At the same time, the telemedicine device 30 sends an alarm signal S _AL to the consultation center 12 in order to automatically establish contact with the consultation center 12. If the telemedicine system 10 does not have a monitoring device 44, alternatively, of course, the ^'flight attendants or ^"a passenger directly pay attention to the medical emergency or are informed by the affected patients 32 itself. In this case, the contact with the Consultation Center 12 is a trained auxiliary person 34 of the flight personnel.

In the consultation center 12, the call is automatically accepted and a new electronic case is created in the database 20. If the telemedicine system 10 has an automatic identification system, the assistant 34 takes the identification data immediately after the emergency is recognized D _{1D of} the patient 32 with the aid of the reading device 48, which preferably transmits the identification _data D _ΪD to the base module 36 via a wireless connection. From here, the identification data _{D D are sent} to the consultation center 12 with the aid of the communication unit 38 via the communication system 28. Here, the recognition system 50 automatically begins to compare the transmitted identification data _{D D} with the identification data contained in the patient file 20. For this purpose, pattern recognition methods are used which are known per se and are therefore not explained in more detail here. In the event that no identification system 48, 50 is provided, the corresponding patient file 20 is selected and loaded by transmitting the name of the patient 32 or an ID number or the like. If a patient file 20 is available for the patient 32 concerned, the currently occurring medical care case is automatically electronically entered into the patient file 20. If, on the other hand, the patient 32 is not registered so far, a new digital patient file 20 with the corresponding entry is automatically added - puts. The patient data D _PA available in the patient file 20 belonging to the patient 32 are displayed to the doctor 14 of the consultation center 12, for example on a screen.

In addition, the auxiliary person 34 begins the primary diagnosis, possibly under the instruction of the doctor 14, by using the diagnostic devices 42 to interest rate data D _med . For example, an electrocardiograph (D _med i) can be recorded and transmitted to the consultation center 12 and / or an ultrasound image (D _me d2) can be recorded and transmitted using a Doppler sonograph. At the same time, the communication module 40 enables the transmission of voice and image data, so that the doctor 14 can communicate with the assistant 34 and instruct them. The image data, which are preferably transmitted in real time, help the doctor 14 to _obtain a comprehensive overall impression of the patient 32. These communication data D _com are also transmitted to the consultation center and are _presented acoustically and visually together with the medical data D _me di, D _med2 . At the same time, the data D _rae dι, D _mβd2 and possibly D _{com are} automatically stored in the patient _file 20 in order to support permanent documentation and updating of the database 18. ^'

The doctor 14 creates a diagnosis on the basis of the data D _{PA i} D _om , D _me i Dmed2 available to him and instructs the auxiliary person 34 on appropriate auxiliary and therapeutic measures. For example, he can instruct the use of a therapy module 46 or the like or the administration of medication or initiate further diagnostic examinations.

The diagnosis of the doctor 14 is also supported by the diagnostic aids 20 which, based on the available data D _PA , D _kora , D _me di / D _{me 2,} weighted or unweighted diagnosis suggestions and given if submit therapeutic measures. The continuous monitoring of the recognized passenger 32 and the continuous transmission of medical data and communication data enable the doctor 14 in the consultation center 12 to assess the effectiveness of the therapy and to make a decision about the further procedure.

LIST OF REFERENCE NUMBERS

10 telemedicine system

12 consultation center

14 doctor

16 data processing system (PC)

18 database with digital patient files 20 digital patient files

22 Diagnostic tools

24 experts

26 clinic

28 communication system 30 telemedicine device

32 patient

34 helpers

36 basic module

38 communication unit 40 auditory-visual communication module

42 Diagnostic device

44 monitoring device (event recorder)

46 Therapy module 48 Reading device 50 Recognition system

D _ID identification data

Dkom communication data

D _m ed medical data D _PA patient data

S _A ι alarm signal

Claims

claims

1. Telemedicine system (10) with

(a) a medical consultation center (12),

(b) at least one patient-side telemedicine device (30) for receiving medical data (D _rae d) and / or communication data (D _kom ) and for transmitting the data to the consultation center (12),

(c) a communication system (28) for wireless and / or wired data transmission between the consultation center (12) and the at least one telemedicine device (30),

(d) a database (18) with digital patient files (20) comprising patient data (D _PA ), and

(e) means for assigning a patient file (20) of the database (18) to a patient (32) and for calling up the assigned patient file (20) and means for. medical visual and / or auditory. Representation of the patient data contained in the assigned patient file (20)

(D _PA ), the transmitted medical data (D _med ) and / or communication data (D _ko ) •

2. Telemedicine system (10) according to claim 1, characterized in that the patient data (D _PA ) of the digital patient files (20) medically relevant 5 data, such as age, gender, weight, blood group, blood values, allergies, medical findings, medical history data, familial Dispositions, medication data and the like include.

10 3. Telemedicine system (10) according to claim 1 or 2, characterized in that the patient data (D _PA ) of the digital patient files (20) include image data such as X-ray images, ultrasound images, magnetic resonance imaging, electrocardiograms and the like.

15

4. Telemedicine system (10) according to one of the preceding claims, characterized in that the patient data (D _PA ) of the digital patient files (20) information about a device medical and / or

^'20 include medication for the patient ^' (32).

5. Telemedicine system (10) according to one of the preceding claims, characterized in that the data

25 database (18) with the digital patient files (20) is assigned to the doctor-side consultation center (12) and / or the patient-side telemedicine device (30) and / or by a large number of individual patient files stored on the patient side

30 (20) is embodied.

6. Telemedicine system (10) according to one of the preceding claims, characterized by an identification system (48, 50) for receiving and recognizing identification data (D _ID ) of the patient (32).

7. Telemedicine system (10) according to claim 6, characterized in that the identification system (48, 50) has a patient-side reading device (48) for receiving the identification data (D _ID ) of the patient (32), in particular for receiving a fingerprint, the iris, of the patient's face or voice (32) or for reading an identification card of the patient (32).

8. telemedicine system (10) according to claim 7, characterized in that the patient-side reading device (48) is integrated in the telemedicine device (30).

9. "Telemedicine system (10) according to claim 6, characterized in that the identification system (48, 50) comprises a recognition system (50) for recognizing the identification data (D _ID ) of the patient (32).

10. Telemedicine system (10) according to one of the preceding claims, characterized in that the doctor-side consultation center (12) comprises diagnostic aids (22) for automatic and / or interactively influenceable diagnostic support.

11. Telemedicine system (10) according to claim 10, characterized in that the diagnostic aids (22) comprise at least one stored algorithm which, depending on the medical data (D _me d) and / or communication data (D _om ) transmitted by the telemedicine device (30) and / or on the 5 patient data (D _PA ) of the assigned patient file (20) Proposed diagnoses and / or therapies.

12. Telemedicine system (10) according to one of the preceding 10 claims, characterized in that the

Telemedicine device (30) comprises at least one diagnostic device (42) for recording the medical data (D _med ), in particular an electrocardiograph, a pulse oximeter, a spirometer, a blood pressure monitor, a thermometer, a sonograph, a Doppler sonograph, a cardiotocograph, a mini laboratory unit and / or the like.

13. Telemedicine system (10) according to one of the preceding ^■ 20 claims, ^{■ •} characterized by at least one "patient-side monitoring device (44), in particular assigned to the telemedicine device (30), for automatically monitoring at least one vital function of the patient (32) and for signaling 25 a medical emergency depending on the monitored function.

14. Telemedicine system (10) according to one of the preceding claims, characterized by at least

30 a communication unit (40) on the patient side, in particular associated with the telemedicine device (30), for recording and transmitting audio data and / or of visual data of the patient (32) and / or an auxiliary person (34), in particular of voice and video data.

5 15. Telemedicine system (10) according to one of the preceding claims, characterized by at least one patient-side, in particular associated with the telemedicine device (30), therapy device (46) for carrying out therapeutic measures on the patient 10 (32).

16. Telemedicine system (10) according to one of the preceding claims, characterized by one, in particular associated with the telemedicine device (30),

15 location system for determining a position of the telemedicine device (30).

17. Telemedicine system (10) according to one of the preceding claims, characterized in that the

^• 20 communication system - (28) ^• for wireless'"ndOdef wired data exchange between the telemedicine device (30) and the consultation center (12) includes a broadband data transmission, in particular using Internet protocols.

25

18. Telemedicine system (10) according to claim 17, characterized in that the communication system (28) for wireless and / or wired data exchange is a landline, cellular, in particular UMTS.

30 mobile radio, satellite, local area network (LAN), wide area network (WAN) and / or WLAN transmission ^' includes.

19. Telemedicine system (10) according to one of the preceding claims, characterized in that the doctor-side consultation center (12) can be connected to further consultation centers, clinics (26) and / or the like.

20. Procedure for telemedical patient care, whereby

(a) a medical care case is detected on the patient side and reported to a doctor-side consultation center (12),

(b) medical data (D _med ) and / or communication data (D _kom ) are recorded on the patient side and transmitted to the consultation center (12),

(c) the patient (32) is assigned and called up a digital patient file (20) - contained in a database (18) - with patient data (D _PA ) of the patient (32) and

(d) the transmitted medical data (D _me d) and / or communication data (D _kom ) and / or the patient data (D _PA ) of the assigned patient file (20) are displayed visually and / or audibly on the doctor's side.

21. The method according to claim 20, characterized in that the medical care case is an emergency case or is a chronic or routine care case.

22. Use of a telemedicine system (10) according to one of claims 1 to 19 for the telemedical care of patients, in particular in airplanes or on ships or in other medically underserved regions.