Abstract
Carried by the tide of increasing digitalization in the health care system, novel telemedical applications are continually being developed, presented, and hyped—before disappearing again in most cases. Many of these applications fail to become established in the market because they cannot easily be integrated into existing structures, neither in terms of technical aspects nor in terms of workflows. One hurdle is represented by the lack of an established framework for the telemedical infrastructure. Nevertheless, precisely this aspect provides good examples of how it would be possible to build upon established standards to work internally and externally without complex interfaces. The well-established DICOM standard for medical imaging data represents a good basis. As imaging data are required in many areas of medicine, discipline- and institution-wide communication of these data rapidly attains a level sufficient to justify implementation of systems for image exchange. With a monthly exchange of 50,000 examinations between 450 collaborators, the network of the Westdeutscher Teleradiologieverbund (West German Teleradiology Association) demonstrates the rationality of telemedical cooperation, which can be superior to traditional means involving creation and sending of CDs. Examining the individual process components, it is possible to elucidate which requirements patient electronic health records must fulfil in order to become established. In addition to financing, these include interoperability and an immediate improvement for the involved parties in terms of treatment quality and resource allocation.