The purpose of the University of Hawaii Telemedicine Project (UHTP) is to assess and establish an effective telemedicine curriculum uniquely tailored for the training of military healthcare personnel...
.... To accomplish this task, a clinical telemedicine service was established such that a hub of physician specialists in Honolulu is available to primary care providers and patients in rural and/or remote clinics...
The purpose of the University of Hawaii Telemedicine Curriculum Research Project is to develop an effective web-based curriculum for training military health care personnel in the use of contemporary...
Burgess, Lawrence P; Birkmire-Peters, Deborah P
The purpose of the University of Hawaii Telemedicine Curriculum Research Project is to develop an effective web-based curriculum for training military healthcare personnel in the use of contemporary...
institutions in Hawaii and include specialists such as pharmacists to them. Initially, interest was limited in utilizing the technology and nutritionists, as...the physician infections ( UTI ). for inclusion in the telemedicine program. Before Treating patients at home is one alternative that can considering...infection.’ 5 Patients with UTI are excluded if they have uncomplicated pyelonephritis or if they have an obstructed ureter or sepsis syndrome. Patients with
Telemedicine began from the humble beginnings of the first telephone call from Alexander Graham Bell to his associate, Watson. These systems already have been used for educational programs, consultative care, image transfer, second opinions, and direct acute patient care. Most of the original programs failed because of several reasons, primarily because of lack of funding when a grant ended. The major lesson of these programs is that a solid business plan is needed initially for long-term survival. The reliability of telemedical examinations has been demonstrated superficially, but more conclusive work in this area is needed. Studies that evaluate clinical, financial, and satisfaction outcomes are required simultaneously. Further integration of medical informatics into telemedicine systems is needed before these systems can achieve more acceptance. Twenty years ago, few people predicted this technologic revolution. Innovations arise almost daily. The future seems promising for telemedical systems, but much work is required. Partnerships with industry must move beyond niche projects, and regulatory and medicolegal issues must be resolved. Anesthesiologists can expect their practice to be affected directly by technology, and should embrace it, evaluate it, and help lead its use in this millennium.
Wootton, Richard; Vladzymyrskyy, Anton; Zolfo, Maria; Bonnardot, Laurent
Background Telemedicine has been used for many years to support doctors in the developing world. Several networks provide services in different settings and in different ways. However, to draw conclusions about which telemedicine networks are successful requires a method of evaluating them. No general consensus or validated framework exists for this purpose. Objective To define a basic method of performance measurement that can be used to improve and compare teleconsultation networks; to employ the proposed framework in an evaluation of three existing networks; to make recommendations about the future implementation and follow-up of such networks. Methods Analysis based on the experience of three telemedicine networks (in operation for 7–10 years) that provide services to doctors in low-resource settings and which employ the same basic design. Findings Although there are many possible indicators and metrics that might be relevant, five measures for each of the three user groups appear to be sufficient for the proposed framework. In addition, from the societal perspective, information about clinical- and cost-effectiveness is also required. The proposed performance measurement framework was applied to three mature telemedicine networks. Despite their differences in terms of activity, size and objectives, their performance in certain respects is very similar. For example, the time to first reply from an expert is about 24 hours for each network. Although all three networks had systems in place to collect data from the user perspective, none of them collected information about the coordinator's time required or about ease of system usage. They had only limited information about quality and cost. Conclusion Measuring the performance of a telemedicine network is essential in understanding whether the network is working as intended and what effect it is having. Based on long-term field experience, the suggested framework is a practical tool that will permit
Full Text Available Telemedicine has been used for many years to support doctors in the developing world. Several networks provide services in different settings and in different ways. However, to draw conclusions about which telemedicine networks are successful requires a method of evaluating them. No general consensus or validated framework exists for this purpose.To define a basic method of performance measurement that can be used to improve and compare teleconsultation networks; to employ the proposed framework in an evaluation of three existing networks; to make recommendations about the future implementation and follow-up of such networks.Analysis based on the experience of three telemedicine networks (in operation for 7–10 years that provide services to doctors in low-resource settings and which employ the same basic design.Although there are many possible indicators and metrics that might be relevant, five measures for each of the three user groups appear to be sufficient for the proposed framework. In addition, from the societal perspective, information about clinical- and cost-effectiveness is also required. The proposed performance measurement framework was applied to three mature telemedicine networks. Despite their differences in terms of activity, size and objectives, their performance in certain respects is very similar. For example, the time to first reply from an expert is about 24 hours for each network. Although all three networks had systems in place to collect data from the user perspective, none of them collected information about the coordinator's time required or about ease of system usage. They had only limited information about quality and cost.Measuring the performance of a telemedicine network is essential in understanding whether the network is working as intended and what effect it is having. Based on long-term field experience, the suggested framework is a practical tool that will permit organisations to assess the performance of
Combi, Carlo; Pozzani, Gabriele
Summary Background Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries. Objective We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems. Methods We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects. Results We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area. Conclusions We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries. PMID:27803948
Full Text Available Abstract Background A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. Method The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Discussion Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients. The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25% when real-time telemedicine was employed was significant (P = 0.014. Service planners can use this information to weigh up the costs and benefits of the two approaches.
Wootton, Richard; Bahaadinbeigy, Kambiz; Hailey, David
A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.
Piga, Matteo; Cangemi, Ignazio; Mathieu, Alessandro; Cauli, Alberto
To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction. PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration's tool for assessing risk of bias and a modified version of CONSORT 2010 Statement. A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools. Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are needed. Copyright © 2017 Elsevier Inc. All rights reserved.
Luo Deli; Liu Xiaoya; Jiang Gang; Meng Daqiao; Zhu Zhenghe
Density functional (B3LYP) method with Relativistic Effective Core Potential (RECP) have been used to optimize the structures and to calculate the potential energy function both for the ground and excited states of UH and UH 2 molecules. Results show that the ground state of UH and UH 2 molecules are X 4 II and X 3 A 2 , which belongs to C2v symmetry, and the disassociation energies are 2.886 eV and 5.249 ev respectively, and the spectral data of UH and UH 2 have also been derived both for the ground and excited state. The potential energy function of UH and UH 2 have been derived based on normal equation fitting method and the many-body expansion theory. The information is useful to mechanism analysis of the aging effect of the hydrogen storage material
Selected Acquisition Report (SAR) RCS: DD-A&T(Q&A)823-341 UH-60M Black Hawk Helicopter (UH-60M Black Hawk ) As of FY 2017 President’s Budget Defense...Acquisition Management Information Retrieval (DAMIR) March 21, 2016 18:25:45 UNCLASSIFIED UH-60M Black Hawk December 2015 SAR March 21, 2016 18...Operational Requirements Document OSD - Office of the Secretary of Defense O&S - Operating and Support PAUC - Program Acquisition Unit Cost UH-60M Black Hawk
Craft, Richard Layne, II
For telemedicine to realize the vision of anywhere, anytime access to care, the question of how to create a fully interoperable technical infrastructure must be addressed. After briefly discussing how 'technical interoperability' compares with other types of interoperability being addressed in the telemedicine community today, this paper describes reasons for pursuing technical interoperability, presents a proposed framework for realizing technical interoperability, identifies key issues that will need to be addressed if technical interoperability is to be achieved, and suggests a course of action that the telemedicine community might follow to accomplish this goal.
Nielsen, Lasse Overballe; Krebs, Hans Jørgen; Albert, Nancy M.
BACKGROUND: Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine......: Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements...
Since the 1970s, NASA has been involved in the research and demonstration of telemedicine for its potential in the care of astronauts in flight and Earth-bound applications. A combination of NASA funding, expertise and off-the-shelf computer and networking systems made telemedicine possible for a medically underserved hospital in Texas. Through two-way audio/video relay, the program links pediatric oncology specialists at the University of Texas Health Science Center in San Antonio to South Texas Hospital in Harlingen, providing easier access and better care to children with cancer. Additionally, the hospital is receiving teleclinics on pediatric oncology nursing, family counseling and tuberculosis treatment. VTEL Corporation, Sprint, and the Healthcare Open Systems and Trials Consortium also contributed staff and hardware.
Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.
ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894
Arizona Univ., Tucson. Coll. of Medicine.
Designed to provide health services for American Indians living on rurally isolated reservations, the Arizona TeleMedicine Project proposes to link Phoenix and Tucson medical centers, via a statewide telecommunications system, with the Hopi, San Carlos Apache, Papago, Navajo, and White Mountain Apache reservations. Advisory boards are being…
Codell, R.; Nuttle, W.K.
1 - Description of program or function: Three programs model performance of an ultimate heat sink cooling pond. National Weather Service data is read and analyzed to predict periods of lowest cooling performance and highest evaporative loss. The data is compared to local site data for significant differences. Then the maximum pond temperature is predicted. Five programs model performance of an ultimate heat sink spray pond. The cooling performance, evaporative water loss, and drift water loss as a function of wind speed are estimated for a spray field. These estimates are used in conjunction with National Weather Service data to predict periods of lowest cooling performance and highest evaporative loss. This data is compared to local site data for significant differences. Then the maximum pond temperature is predicted. 2 - Method of solution: The transfer of heat and water vapor is modeled using an equilibrium temperature procedure for an UHS cooling pond. The UHS spray pond model considers heat, mass, and momentum transfer from a single water drop with the surrounding air, and modification of the surrounding air resulting from the heat, mass, and momentum transfer from many drops in different parts of a spray field. 3 - Restrictions on the complexity of the problem: The program SPRCO uses RANF, a uniform random number generator which is an intrinsic function on the CDC. All programs except COMET use the NAMELIST statement, which is non standard. Otherwise these programs conform to the ANSI Fortran 77 standard. The meteorological data scanning procedure requires tens of years of recorded data to be effective. The models and methods, provided as useful tool for UHS analyses of cooling ponds and spray ponds, are intended as guidelines only. Use of these methods does not automatically assure NRC approval, nor are they required procedures for nuclear-power-plant licensing
Conclusions: The framework we proposed serves as a useful tool to obtain more insights into the future development of telemedicine. The cost of operating a telemedicine service system is currently not low. The practitioner could reduce the cost through modifying value proposition, service process or allying with more experienced partner.
Combi, Carlo; Pozzani, Gabriele; Pozzi, Giuseppe
Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries. We consider all the major projects in telemedicine, devoted to developing countries, as described by the proper scientific literature. On the basis of such literature, we want to define a specific taxonomy that allows a proper classification and a fast overview of telemedicine projects in developing countries. Moreover, by considering both the literature and some recent direct experiences, we want to complete such overview by discussing some design issues to be taken into consideration when developing telemedicine software systems. We considered and reviewed the major conferences and journals in depth, and looked for reports on the telemedicine projects. We provide the reader with a survey of the main projects and systems, from which we derived a taxonomy of features of telemedicine systems for developing countries. We also propose and discuss some classification criteria for design issues, based on the lessons learned in this research area. We highlight some challenges and recommendations to be considered when designing a telemedicine system for developing countries.
are being utilized? What medical disciplines are being addressed using telemedicine systems? Methods: All data was surveyed from the "Telemedicinsk Landkort", a newly created database designed to provide a comprehensive and systematic overview of all telemedicine technologies in Denmark. Results......Objectives: The aim of this study is to survey telemedicine services currently in operation across Denmark. The study specifically seeks to answer the following questions: What initiatives are deployed within the different regions? What are the motivations behind the projects? What technologies......: The results of this study suggest that a growing number of telemedicine initiatives are currently in operation across Denmark but that considerable variations existed in terms of regional efforts as the number of operational telemedicine projects varied from region to region. Conclusions: The results...
Kottapalli, Sesi; Malki, Heidar A.; Langari, Reza
Adaptive neuro-fuzzy relationships have been developed to model the UH-60A Black Hawk pilot floor vertical vibration. A 200 point database that approximates the entire UH-60A helicopter flight envelope is used for training and testing purposes. The NASA/Army Airloads Program flight test database was the source of the 200 point database. The present study is conducted in two parts. The first part involves level flight conditions and the second part involves the entire (200 point) database including maneuver conditions. The results show that a neuro-fuzzy model can successfully predict the pilot vibration. Also, it is found that the training phase of this neuro-fuzzy model takes only two or three iterations to converge for most cases. Thus, the proposed approach produces a potentially viable model for real-time implementation.
Burke, Bryan L.; Hall, R. W.
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits. PMID:26122813
A Directive of the European Union was first published in 2000, which dealt with telemedicine as part of its provisions. This E-Commerce Directive, as it became known, was subjected to further study which revealed some problems relative to the practice of telemedicine. Among the subjects discussed in this paper are those of privacy, data protection, free movement of services, the impact of electronic communication and ethical issues.
Zhang, G H; Poon, Carmen C Y; Li, Ye; Zhang, Y T
Security and privacy are among the most crucial issues for data transmission in telemedicine systems. This paper proposes a solution for securing wireless data transmission in telemedicine systems, i.e. within a body sensor network (BSN), between the BSN and server as well as between the server and professionals who have assess to the server. A unique feature of this solution is the generation of random keys by physiological data (i.e. a biometric approach) for securing communication at all 3 levels. In the performance analysis, inter-pulse interval of photoplethysmogram is used as an example to generate these biometric keys to protect wireless data transmission. The results of statistical analysis and computational complexity suggest that this type of key is random enough to make telemedicine systems resistant to attacks.
Pilloy, W.J.; Lewalle, L.; Pilloy, S.
Full text: Aim: To identify the legal and ethical obstacles to the development of tele (nuclear) medicine, and to propose solutions. Material and method: Lessons have been drawn from 4 years practice of telemedicine between Luxemburg and 5 European centres. Problems so raised have been confronted with the US and EU literature. Results: Academic applications (web sites, teaching, hospital networks) are yet functional and are not dealt with here. Difficulties arise in case of 1st reading (e.g. 24 hour service), 2nd reading (expert advice) or distant reading (locum, service in remote places). In most applications, the relation is doctor to doctor; patient issues like quality of content, freedom of choice are minor. A body of laws, rules and directives apply to other issues. Confidentiality is ruled by the EU Directives on the Protection of Individuals and on Data Protection. Data are commonly encrypted/anonymized. Consent and free choice are ruled by the law of medicine. A doctor requiring 2nd advice stays in charge of the patient (no need to consent). Remote reading or 1st reading is usually based on prior agreement between doctors (like after hours service), and information or consent is recommended. Registration and accreditation are ruled by the Directives of the European Internal Market for Services. No obstacle to the delivery of services across the EU would remain if it is perceived that a tele-patient consults abroad rather than a tele-doctor practices abroad. (author)
Mohr, Nicholas M; Vakkalanka, J Priyanka; Harland, Karisa K; Bell, Amanda; Skow, Brian; Shane, Dan M; Ward, Marcia M
Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.
Moncrief, Jack W
The use of interactive video has been recognized as a means of delivering medical support to isolated areas since the 1950s. The Department of Defense recognized early the capacity of telemedicine to deliver medical care and support to front-line military personnel. In 1989, the Texas Telemedicine Project received grants and support from the then American Telephone and Telegraph Company (now AT&T) and the Meadows Foundation of Dallas, Texas, to establish and evaluate telemedicine delivery in central Texas. That project had 6 connected telemedicine sites: 3 in Austin, Texas, and 3 in Giddings, Texas (a small community 55 miles to the southeast of Austin). The sites in Giddings included a chronic outpatient dialysis facility, an inpatient psychiatric hospital, and the emergency department at Giddings Hospital. Patient contact began in April 1991 and continued through March 1993. During that period, data on the 1500 patient contacts made were recorded. After termination of the Texas Telemedicine Project, AT&T continued to provide the transmission lines, and between 1993 and 1996, another 12,000 patient contacts were made. Approximately 80% were dialysis evaluations and 20% were non-dialysis primary care contacts. The original cost of materials and equipment in the Texas Telemedicine Project exceeded $50,000 per site. Today, a secure Internet connection with full-motion video and wireless data transfer to almost any location in the world is achievable with an iPad. Multiple inexpensive applications with connections for electrocardiogram, otoscope, and stethoscope, among others, make this technology extremely inexpensive and user-friendly. The revolution now is rapidly moving forward, with Medicare reimbursing telemedicine contacts in medically underserved areas. Multiple bills are before Congress to expand Medicare and therefore private insurance payment for this service.
Hakika, Kisti; TS, Hendra Yunianto; Afriyanti, Liza
Telemedicine atau pelayanan kesehatan jarak jauh bukan hal yang baru lagi dalam dunia kesehatan.Penggunaan teknologi sangat membantu dalam mengimplementasikan telemedicine. Namun perkembangantelemedicine mengalami kemajuan seiring dengan perkembangan teknologi informasi. Salah satu perkembanganteknologi adalah robot. Secara umum kegunaan robot adalah untuk menggantikan tugas manusia. Padamakalah ini, akan dibuat simulasi telemedicine berupa konsultasi antara dokter dan pasien menggunakansebua...
Havir, Thomas J; Durbin, David B; Frederick, Lorraine J; Hicks, Jamison S
The utility helicopter (UH)-60M Product Manager requested the U.S. Army Research Laboratory's Human Research and Engineering Directorate to participate in the Limited User Test for the UH-60M Black Hawk...
Zanaboni, Paolo; Lettieri, Emanuele
During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.
Nielsen, Lasse O; Krebs, Hans J; Albert, Nancy M; Anderson, Nick; Catz, Sheryl; Hale, Timothy M; Hansen, John; Hounsgaard, Lise; Kim, Tae Youn; Lindeman, David; Spindler, Helle; Marcin, James P; Nesbitt, Thomas; Young, Heather M; Dinesen, Birthe
Telemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine. The aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life. Case study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements. Data collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile. Greenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system.
required to fully service two engines during engine change. 3. One quart of hydr aulic fluid , MIL 5606. Used to replace spillage while disconnecting...Maryland , dated 24 January 1963. 7. Report Nr. 1, Final Report, Climatic Laboratory Environ- mental Test of the Model UH- 2A Helicopter , by US
Holtel, Michael R; Burgess, Lawrence P A
More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt  points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific
Christensen, Jannie Kristine Bang; Nielsen, Jeppe Agger; Gustafsson, Jeppe
through negotiating, mobilizing coalitions, and legitimacy building. To illustrate and further develop this conceptualization, we build on insights from a longitudinal case study (2008-2014) and provide a rich empirical account of how a Danish telemedicine pilot was transformed into a large......-scale telemedicine project through simultaneous translation and theorization efforts in a cross-sectorial, politicized social context. Although we focus on upscaling as a bottom up process (from pilot to large scale), we argue that translation and theorization, and associated political behavior occurs in a broader...
Lilly, Craig M; Motzkus, Christine; Rincon, Teresa; Cody, Shawn E; Landry, Karen; Irwin, Richard S
ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Craft, Richard Layne, II
In order for telemedicine to realize the vision of anywhere, anytime access to care, it must address the question of how to create a fully interoperable infrastructure. This paper describes the reasons for pursuing interoperability, outlines operational requirements that any interoperability approach needs to consider, proposes an abstract architecture for meeting these needs, identifies candidate technologies that might be used for rendering this architecture, and suggests a path forward that the telemedicine community might follow.
Whitten, Pamela; Sypher, Beverly Davenport
Telemedicine, the use of telecommunication technologies to provide health services over some distance, has a history that spans more than five decades. Technological development and deployment have been interrelated with shifting paradigmatic views. This paper proposes that telemedicine has evolved through three generations that began with telemedicine as a communication medium to complement traditional services to a technology of automation and decision tools that expands the scope and range of health services and creates a unique health communication context. This paper provides a literature review and overviews three proposed evolutionary stages for telemedicine to date, namely synchronous versus asynchronous modalities, data transfer and storage, and automating decision making and robotics. Finally, we conclude with a discussion of the barriers for telemedicine and a call for engineers to join with social scientists and medical professionals to set an agenda for future telemedicine development.
Ravi K Chittoria
Full Text Available The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer and real-time transmission (synchronous transfer, e.g. video conference, are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.
Telemedicine, the ability to examine patients while physically removed from them by using high-tech virtual treatment, is used increasingly to diagnose and prescribe treatment for patients in nontraditional settings. In Los Angeles (California), Charles R. Drew University of Medicine and King-Drew Medical Center communicate in real time with…
Hung, K.; Zhang, Y.T.
Telemedicine refers to the utilization of telecommunication technology for medical diagnosis, treatment, and patient care. Its aim is to provide expert-based health care to remote sites through telecommunication and information technologies. The significant advances in technologies have enabled the introduction of a broad range of telemedicine applications, which are supported by computer networks, wireless communication, and information superhighway. For example, some hospitals are using tele-radiology for remote consultation. Such a system includes medical imaging devices networked with computers and databases. Another growing area is patient monitoring, in which sensors are used to acquire biomedical signals, such as electrocardiogram (ECG), blood pressure, and body temperature, from a remote patient, who could be in bed or moving freely. The signals are then relayed to remote systems for viewing and analysis. Telemedicine can be divided into two basic modes of operations: real-time mode, in which the patient data can be accessed remotely in real-time, and store-and-forward mode, in which the acquired data does not have to be accessed immediately. In the recent years, many parties have demonstrated various telemedicine applications based on the Internet and cellular phone as these two fields have been developing rapidly. A current, recognizable trend in telecommunication is the convergence of wireless communication and computer network technologies. This has been reflected in recently developed telemedicine systems. For example, in 1998 J. Reponen, et al. have demonstrated transmission and display of computerized tomography (CT) examinations using a remote portable computer wirelessly connected to a computer network through TCP/IP on a GSM cellular phone. Two years later, they carried out the same tests with a GSM-based wireless personal digital assistant (PDA). The WAP (Wireless Application Protocol) Forum was founded in 1997 to create a global protocol
Full Text Available A typical telemedicine system involves a small set of hospitals providing remote healthcare services to a small section of the society using dedicated nodal centers. However, in developing nations like India where majority live in rural areas that lack specialist care, we envision the need for much larger Internet-based telemedicine systems that would enable a large pool of doctors and hospitals to collectively provide healthcare services to entire populations. We propose a scalable, Internet-based P2P architecture for telemedicine integrating multiple hospitals, mobile medical specialists, and rural mobile units. This system, based on the store and forward model, features a distributed context-aware scheduler for providing timely and location-aware telemedicine services. Other features like zone-based overlay structure and persistent object space abstraction make the system efficient and easy to use. Lastly, the system uses the existing internet infrastructure and supports mobility at doctor and patient ends.
.... This report reviews military and civilian models for evaluating telemedicine systems in order to determine future directions for Navy telemedicine research within the current funding environment...
Full Text Available The viability of a telemedicine system is the strength of its business continuity. Business continuity can only stand if the telemedicine system remains continuously feasible. This article studies telemedicine risk in terms of its feasibility on all its five components: economical, technical, social, operational, and legal/ethical. Any deficiencies in one or more of the feasibility components will affect the system business continuity risk and can lead to infeasibility and possible dissolution. The telemedicine computing environment is full of uncertainties and ambiguities and it just involves too much background knowledge that Bayesian theory cannot accommodate. Decision theory however offers a basic evidence-based multi-criteria decision mechanism that can tackle those decision problems treating both quantitative and qualitative criteria under various uncertainties including ignorance and randomness. We propose an evidential reasoning model to assess a telemedicine business continuity risk based on infeasibility. This business continuity risk is modelled using Dempster and Shafer Theory as the plausibility of infeasibility of the telemedicine system. A numerical example is provided to demonstrate the working of the proposed risk assessment model.
Yun, Eun Kyoung; Chun, Kee Moon
Telemedicine generally refers to the use of communications and information technologies for the delivery of health care. owever, telemedicine is not merely a simple combination of health care and technology. The researchers propose a systematic approach for assessing needs of telemedicine customers, called critical-to-quality (CTQ) in Six Sigma, with a purpose of continuous quality improvement. The combination approach using DFSS (Design for Six Sigma) and SERVQUAL (Service Quality Framework) was applied to define the critical quality attributes of telemedicine service management and to match them with the current telemedicine process. With a step-by-step procedure, telemedicine service process was reviewed and all the important CTQ candidates identified via a case study. The findings suggest that nurses need further understanding and research methods that will improve and manage the quality of health care service in various medical fields.
Kim, Yun Il; Woo, Tae Ho
Following the Fukushima accident, it is proposed to find a better safety system, which has a pool-type cooling system without coolant injections. Since the conventional piping-based injection systems have failed in treating the three major severe accidents, the artificial pool could be constructed to cover the failed reactor core systems in which the pool-like structure is constructed. Regarding this study, there were some previous studies about the ultimate heat sink (UHS). In this study, the system dynamics (SD) modeling is performed in the case of Fukushima Unit 1 accident. The basic events are obtained by the Boolean values as 0 and 1. The quantifications are obtained by the SD algorithm incorporated with the Vensim software. In the simulations work, there is a plateau region between the 25th and 45th years in the interested period. The nonlinear algorithm is applied for the UHS analysis which was not installed for the commercial use yet. (author)
Full Text Available Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article.
Chatrath, Veena; Attri, Joginder Pal; Chatrath, Raman
Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article.
Cao, Minh Duc; Minh, Cao Duc; Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
Minh, Cao Duc [National Agency for Science and Technology Information, Hanoi (Viet Nam); Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao [Kyushu University Hospital, Fukuoka (Japan)
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
Minh, Cao Duc; Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao
This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.
Lamaster, H.; Meylor, J.; Meylor, F.
Internet technologies are briefly introduced and those applicable for telemedicine are reviewed. Multicast internet technologies are described. The National Aeronautics and Space Administration (NASA) 'Telemedicine Space-bridge to Russia' project is described and used to derive requirements for internet telemedicine. Telemedicine privacy and Quality of Service (QoS) requirements are described.
Konge Nielsen, Marie; Johannessen, Helle
Basic ideas of empowerment and user involvement in relation to telemedicine are presented, as is a case implying user resistance to telemedicine. Four logics of empowerment are employed to identify the underlying rationale of specific cases of telemedicine. The article concludes, that although...... telemedicine is acknowledged as relevant, the approach to it is often too mechanical to imply empowerment of the patient. Some patient groups may not feel safe by using telemedicine, and user involvement and empowerment will not be possible....
Bayer, Steffen; Gonçalves, Luís; Barlow, James
Abstract Alentejo covers a third of Portugal, yet it is home to only 5% of the population. Residents of the region are poorer, older, and less educated than the rest of the country. There is a shortage of physicians in several specialties. The low population density, a concentration of specialized services, and a poor public transportation network all create barriers to access. Telemedicine was introduced in 1998 to help address these challenges. In this article, we provide an overview of the program and its current status, focusing on infrastructure, services, and activity volume. We also discuss the impact the program has had from the perspectives of patients and healthcare professionals. From 1998 to 2011, there were 132,546 episodes of service using telemedicine, including real-time teleconsultations, teleradiology, teleultrasound, and telepathology. At present, the network includes 20 primary care units and five hospitals, covering almost 30,000 km2 and 500,000 people. Units have high-resolution videoconferencing equipment, access to patients' clinical records, an image archive, and peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are available in 15 medical specialties and areas, ranging from neurology to pediatric surgery. In 2008, regional health authorities started a tele-education program, and by the end of 2011, 876 healthcare professionals, across 52 locations, had participated in remote learning sessions. More than a decade since telemedicine was introduced in Alentejo, it is now an integral part of everyday service provision. A comprehensive assessment of the costs and consequences of the program is currently underway. PMID:24180419
Full Text Available With the support of Tianjin Municipal People’s Government and the People’s Government of Binhai New Area, the “First China (Tianjin International Telemedicine Technology Exhibition” hosted by the American Telemedicine Association (ATA, will be held October 28- 30, 2014 at the Tianjin Binhai International Convention and Exhibition Center. The three day event will feature keynote sessions, concurrent discussion forums, exhibits (e.g., telemedicine, information technology, mHealth, a venture summit, meet-and-greet sessions for international and domestic companies for potential business collaboration, and policy discussions on China healthcare. For registration information: http://www.atacn.org/en/
Chen, Chang W.; Jiang, Jianfei; Zheng, Zhiyong; Wu, Xue G.; Yu, Lun
In this paper, we present the performance evaluation of wavelet-based coding techniques as applied to the compression of pathological images for application in an Internet-based telemedicine system. We first study how well suited the wavelet-based coding is as it applies to the compression of pathological images, since these images often contain fine textures that are often critical to the diagnosis of potential diseases. We compare the wavelet-based compression with the DCT-based JPEG compression in the DICOM standard for medical imaging applications. Both objective and subjective measures have been studied in the evaluation of compression performance. These studies are performed in close collaboration with expert pathologists who have conducted the evaluation of the compressed pathological images and communication engineers and information scientists who designed the proposed telemedicine system. These performance evaluations have shown that the wavelet-based coding is suitable for the compression of various pathological images and can be integrated well with the Internet-based telemedicine systems. A prototype of the proposed telemedicine system has been developed in which the wavelet-based coding is adopted for the compression to achieve bandwidth efficient transmission and therefore speed up the communications between the remote terminal and the central server of the telemedicine system.
Chanussot-Deprez, Caroline; Contreras-Ruiz, José
Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
Problem. Due to the rapid progress in the fields of information technology and data networks, telemedicine applications are growing in number. Besides curative telemedicine, the electronic exchange of medical data and the integration of health information systems between health care providers is gaining importance. Through the improved accessibility of electronic patient record information, considerable risks arise.Methods. A project for the interconnection of medical picture archiving and communication systems (PACS) between several hospitals is presented and the possibilities for further developing such networking systems utilizing new software technologies for transparent data access between different locations (GRID) and for decision support (software agents) are considered.Results. The availability of the electronic patient record via the data network and the perspective of semi intelligent software systems automatically preparing the data bears great potential for a boost in treatment quality and efficiency. Systems for unique electronic patient identification and for secure digital signature are a prerequisite, but per se not enough to ensure the protection of data against illegitimate access.Conclusion. Despite quality and efficiency benefits, challenges in the protection of sensible data and in the change of the physicians role result. (orig.) [de
Danis, Judit; Forczek, Erzsébet; Bari, Ferenc
Technological advances in the fields of information and telecommunication technologies have affected the health care system in the last decades, and lead to the emergence of a new discipline: telemedicine. The appearance and rise of internet and smart phones induced a rapid progression in telemedicine. Several new applications and mobile devices are published every hour even for medical purposes. Parallel to these changes in the technical fields, medical literature about telemedicine has grown rapidly. Due to its visual nature, dermatology is ideally suited to benefit from this new technology and teledermatology became one of the most dynamically evolving fields of telemedicine by now. Teledermatology is not routinely practiced in Hungary yet, however, it promises the health care system to become better, cheaper and faster, but we have to take notice on the experience and problems faced in teledermatologic applications so far, summarized in this review.
.... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...
Latifi, Rifat; Dasho, Erion; Shatri, Zhaneta; Tilley, Elizabeth; Osmani, Kalterina L; Doarn, Charles R; Dogjani, Agron; Olldashi, Fatos; Koçiraj, Agim; Merrell, Ronald C
The U.S. Government and other developed nations provide billions of dollars annually in relief assistance to countries around the world. The long-term benefits of this aid, however, are often difficult to elucidate. The aim of this article is to present a model of a multipartnership collaboration among U.S. governmental, nongovernmental organizations, and academia to rebuild medical systems using telemedicine as a sustainable model of foreign aid. The International Virtual e-Hospital implemented the "initiate-build-operate-transfer" strategy to establish an effective telemedicine system in Albania that includes the National Telemedicine Center and 12 regional telemedicine centers. This nationwide telemedicine network has active clinical programs, virtual educational programs, and an electronic library that has substantially improved the access to care while advancing medical education. We propose that telemedicine is an optimal, sustainable, low-cost model for rebuilding medical systems of developing countries when implemented through a multipartnership approach.
Jia, Judy; Gildersleeve, Kasey; Ankrom, Christy; Cai, Chunyan; Rahbar, Mohammad; Savitz, Sean I.; Wu, Tzu-Ching
During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences incorporating telestroke into the vascular neurology fellowship curriculum and propose recommendations on integrating formal telemedicine training into the Accreditation Council for Graduate Medical Education vascular neurology fellowship. PMID:27016522
Terreros, D A; Martinez, R
A multimedia telemedicine network is proposed for a VISN-19 test bed and it will include picture archiving and communication systems (PACS). Initial tests have been performed, and the technical feasibility of the basic plan has been demonstrated.
Full Text Available UH3 based hydrides with modified structure and composition can be prepared using high H2 pressures from precursors in the form of rapidly cooled uranium alloys. While the alloys with α-U structure lead to the β-UH3 type of hydrides, γ-U alloys (bcc lead either to α-UH3 hydride type or nanocrystalline β-UH3. The nanocrystalline β-UH3 structure, appearing for Mo alloying, can accommodate in addition numerous other d-metal components, as Ti, Zr, Fe, Nb. The pure Mo alloyed hydrides (UH31−xMox exhibit increasing Curie temperature TC with maximum exceeding 200 K for x = 0.12–0.15. Other components added reduce the TC increment with respect to pure UH3 (170 K. Also alloying by Zr gives a weaker enhancement. Seen globally, the TC variations are rather modest, which reflects the prominence of interaction of U with H. It is suggested that important ingredient is a charge transfer, depopulating the U-6d and 7s states, while the 5f band stays at the Fermi level.
Miller, Adam; Rhee, Eugene; Gettman, Matthew; Spitz, Aaron
Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields. Copyright © 2017 Elsevier Inc. All rights reserved.
Le Goff-Pronost, Myriam; Sicotte, Claude
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.
Cavaro-Ménard, Christine; Lu, Zhang Ge; Le Callet, Patrick
Telemedicine that involves sharing of digital data (i.e. physiological signals, 2D/3D images and videos) should meet the same standards of traditional healthcare in terms of usability, accessibility, efficiency, effectiveness and quality of clinical processes. All these requirements can be seen as elementary components that participate to the quality of experience (QoE) in an ad hoc medical application scenario. Although, the quality of service (QoS) in telemedicine has been quite investigated, QoE is still lacking clear definition in this context. This later should not be assimilated to QoS as it refers clearly to the experience by the user while QoS focuses mostly on the system. QoE has a potential relevancy to optimize and understand the technical transmission chain from the final task point viewpoint which one of the most important factor for adoption of telemedicine. Towards this goal, QoE studies should be conducted with an appropriate methodology incorporating user involvement and digital data and their relation with QoS. As one of the first effort in this field, this paper proposes a survey of some key issues and solutions associated to QoE in telemedicine. We first present the services offered by telemedicine and underline the significance of QoE for tele-diagnosis and tele-surgery. Next, we identify and analyze the influencing factors such as application area, application purpose (emergency care, acquisition assistance, second opinion, education...), content type (data specificities depending on acquisition modality), context of use (offline/real time, interactivity...), and user's state (stress, expertise...), that have to be considered for a relevant QoE assessment in telemedicine.
Ling, Li; Dezhong, Yao; Jianqing, Li; Bin, Li; Ling, Wang
A multimedia telemedicine system (MTS) using Transfer Control Protocol and Internet Protocol (TCP/IP) over the Internet is developed. Doctor with patient and doctor can communicate each other using this system. Real-time data, including audio, video and instant message (IM), and non-real-time data, including vital sign signals, radiological images with DICOM 3.0, file, bio-signal, bio-data and so on, can be exchanged on the system. This system's architecture is client/server mode. All data are encoded/compressed before transferring through Internet/Intranet. The real-time audio is encoded and decoded by MPEG (Moving Picture Experts Group) audio layer 3 algorithm and real-time video is encoded and decoded by MPEG-4. The software implementation of needed functionality without any externally attached hardware CODEC (Coder/Decoder) units enables the compact design with low cost. The real-time video has 25 frames per second at Local Area Network (LAN) and more than 20 frames per second at ADSL.
LeRouge, Cynthia; Tulu, Bengisu; Forducey, Pamela
There is some tacit understanding that telemedicine can provide cost efficiency along with increased access and equality of care for the geographically disadvantaged. However, concrete strategic guidance for healthcare organizations to attain these benefits is fragmented and limited in existing literature. Telemedicine programs need to move from a grant-funded to a profit-centered status to sustain their existence. This article extends work presented at a recent American Telemedicine Association Business and Finance Special Interest Group course to provide a conceptual framework for strategic planning and for effectively implementing telemedicine programs. An expert panel of telemedicine coordinators provides insight and recommendations.
Jacobson, P D; Selvin, E
The expansion of information technology has shattered geographic boundaries, allowing for extraordinarily increased access to health information and expanded opportunities for telemedicine practice across state boundaries. But despite its recent growth, telemedicine technology remains embedded in a state-based licensure system that places severe limits on its expansion. The current system of medical licensure is based primarily on statutes written at the turn of the 20th century. This system is inadequate to address the emerging medical practices and future uses of medical technology in the telecommunications age. To respond to the changes offered by the telecommunications revolution, we need to design a new regulatory structure for the 21st century. The purpose of this article is to propose a policy of national telemedicine licensure. The primary goal here is not to simply develop a policy proposal, but to discuss the rationale for national licensure and place it on the policy agenda. A national licensure system will expand the market for telemedicine, promote both the use and development of new technologies, and simultaneously eliminate many of the legal and regulatory ambiguities that plague and constrain the present system.
The Processing and Properties Branch of the U.S. Army Research Laboratory's (ARL) Weapons and Materials Research Directorate examined the shot-peened surfaces of three UH-60 Blackhawk utility helicopter servolinks...
Manikas, Konstantinos; Hansen, Klaus Marius
and interoperability issues, silo solutions, and lack of guidelines and standards. In this paper, we characterise the ecosystem evolved around the telemedicine services in Denmark and study the actors involved in this ecosystem. We establish a method for this study, where we define two actor roles and ways...... of characterizing actor contributions, and apply the method to the largest healthcare region of Denmark. Our findings reveal an ecosystem that is relatively closed to new actors, where the actors tend to be related to single telemedicine applications, the applications have low connectivity, and the most influential...... actors of the ecosystem can be characterised as both being beneficial and inhibitory to the ecosystem prosperity....
Choi, Woo Seok; Park, Joowoong; Choi, Jin Young Brian; Yang, Jae-Suk
Introduction Sufficient infrastructure for information and communications technology (ICT) and a well-established policy are necessary factors for smooth implementation of telemedicine. However, despite these necessary conditions being met, there are situations where telemedicine still fails to be accepted as a system due to the low receptivity of stakeholders. In this study, we analyse stakeholders' resistance to an organization's implementation of telemedicine. Focusing on the physicians' interests, we propose a strategy to minimize conflicts and improve acceptance. Methods The Delphi study involved 190 telemedicine professionals who were recommended by 485 telemedicine-related personnel in South Korea. Results Out of 190 professionals, 60% of enrolled participants completed the final questionnaires. The stakeholders were categorized into four groups: policy-making officials, physicians, patients, and industrialists. Among these, the physicians were most opposed to the adoption of telemedicine. The main causes of such opposition were found to be the lack of a medical services delivery system and the threat of disruption for primary care clinics. Very little consensus was observed among the stakeholders, except on the following points: the need for expansion of the national health insurance budget by the government, and the need for enhancement of physicians' professional autonomy to facilitate smooth agreements. Discussion Our analysis on the causes of the resistance to telemedicine, carried out with the groups mentioned above, has important implications for policy-makers deriving strategies to achieve an appropriate consensus.
Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem
Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs
We know that the leading cause of blindness in working-age adults is eye disease related to poorly managed diabetes. In a prevention research study, telemedicine was shown to increase the number of people getting screened for diabetic eye disease.
Full Text Available Background: It is necessary to deploy mobile and wireless systems in healthcare, because they have many benefits for healthcare systems. The objectives of this article were introducing various systems, applications, and standards of the wireless and mobile telemedicine. Material and Methods: This review study was conducted in 2010. To conduct the study, published articles in the years 2005 to 2012, in English with an emphasis on wireless and mobile technologies in health were studied. Search was done with key words include telemedicine, wireless health systems, health and telecommunications technology in databases including Pubmed, Science Direct, Google Scholar, Web of Sciences, Proquest. The collected data were analyzed. Results: Telemedicine system in the ambulance, telemedicine systems in space, telecardiology systems, EEG system, ultrasound system are some types of wireless and mobile systems in telemedicine. PDA-based mobile and wireless telemedicine application, based PDA drug application, and patient tracking application are some of wireless and mobile applications of telemedicine. The most important standards of wireless and mobile telemedicine are HL7, DICOM, SNOMed, and ICD-9-CM. Conclusion: There are many challenges in the wireless and mobile systems in telemedicine, despite the many benefits. Slow speed in sending pictures and video, lack of attention to the privacy in the design of these systems, environmental variables and the number of users during the day are some of these challenges. It is recommended to consider these challenges during the planning and designing of wireless and mobile systems in telemedicine.
Full Text Available Telemedicine has the potential to help facilitate the delivery of health services to rural areas. In the right circumstances, telemedicine may also be useful for the delivery of education and teaching programmes and the facilitation of administrative meetings. In this paper reference is made to a variety of telemedicine applications in Australia and other countries including telepaediatrics, home telehealth, critical care telemedicine for new born babies, telemedicine in developing countries, health screening via e-mail, and teleradiology. These applications represent some of the broad range of telemedicine applications possible. An overriding imperative is to focus on the clinical problem first with careful consideration given to the significant organisational changes which are associated with the introduction of a new service or alternative method of service delivery. For telemedicine to be effective it is also important that all sites involved are adequately resourced in terms of staff, equipment, telecommunications, technical support and training. In addition, there are a number of logistical factors which are important when considering the development of a telemedicine service including site selection, clinician empowerment, telemedicine management, technological requirements, user training, telemedicine evaluation, and information sharing through publication.
Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.
Telemedicine depends on Information and Communication Technology (ICT) to support remote treatment of patients. This dependency requires the telemedicine system design to be resilient for ICT performance degradation or subsystem failures. Nevertheless, using telemedicine systems create a dependency
Henny, Chris; Hartington, Katharine; Scott, Stuart; Tveiten, Agnar; Canals, Luisa
Following the coming into force of the International Labour Organisation Maritime Labour Convention (ILO/MLC) and International Maritime Organisation Standards for Training, Certification and Watchkeeping, Manila 2010 (IMO/STCW) amendments, the objective of this article is to provide the shipping community with an initial assessment of the economic reasons and business case, in support of both publicly financed and private telemedicine being implemented on board commercial vessels. It provides the global scale of the requirement, the number of Telemedicine Assistance Services (TMAS) calls handled by participating TMAS, the average direct and indirect costs incurred by both TMAS and ship operators, responding to medical emergencies, and also provides a calculation of the market size of about 760 million Euro/year. It estimates a return on investment per ship, of implementing telemedicine on board to meet the MLC and STCW requirements at less than 1 year. 1. There are both financial and soft benefits, such as crew retention and being perceived as a quality employer offering a telemedicine service on board. 2. It is quite possible to obtain a 20% savings to the industry of perhaps 152 million Euro/year from the deployment of telemedicine on board. 3. The deployment of a telemedical service on ships is an opportunity to encourage further cooperation between TMAS and also with the private TMAS sector. 4. There is clearly a great need, on a global basis, for more cooperation, particularly in standardisation of pre-boarding medical files available, the equipmentrequired on board at a minimum, and level of service quality provided. 5. A collection of a common TMAS annual set of normalised statistics from the stakeholders in the maritime industry is needed. Should someone not be tasked with collecting this? 6. Open registries and countries where the private sector only providestele medicine, should be encouraged to work with the global public TMAS system and contribute to
Vaziri, Kamyar; Moshfeghi, Darius M; Moshfeghi, Andrew A
Age-related macular degeneration and diabetic retinopathy are important causes of visual impairment and blindness in the world. Because of recent advances and newly available treatment modalities along with the devastating consequences associated with late stages of these diseases, much attention has been paid to the importance of early detection and improving patient access to specialist care. Telemedicine or, more specifically, digital retinal imaging utilizing telemedical technology has been proposed as an important alternative screening and management strategy to help meet this demand. In this paper, we perform a literature review and analysis that evaluates the validity and feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration. Understanding both the progress and barriers to progress that have been demonstrated in these two areas is important for future telemedicine research projects and innovations in telemedicine technology.
Harst, Lorenz; Timpel, Patrick; Otto, Lena; Wollschlaeger, Bastian; Richter, Peggy; Schlieter, Hannes
This paper presents an approach for an evaluation of finished telemedicine projects using qualitative methods. Telemedicine applications are said to improve the performance of health care systems. While there are countless telemedicine projects, the vast majority never makes the threshold from testing to implementation and diffusion. Projects were collected from German project databases in the area of telemedicine following systematically developed criteria. In a testing phase, ten projects were subject to a qualitative content analysis to identify limitations, need for further research, and lessons learned. Using Mayring's method of inductive category development, six categories of possible future research were derived. Thus, the proposed method is an important contribution to diffusion and translation research regarding telemedicine, as it is applicable to a systematic research of databases.
Chen, Shengnan; Cheng, Alice; Mehta, Khanjan
Telemedicine has become an increasingly popular option for long-distance/virtual medical care and education, but many telemedicine ventures fail to grow beyond the initial pilot stage. Studying the business models of successful telemedicine ventures can help develop business strategies for upcoming ventures. This article describes business models of eight telemedicine ventures from different regions of the world using Osterwalder's "Business Model Canvas." The ventures are chosen on the basis of their apparent success and their diverse value chains. The business models are compared to draw inferences and lessons regarding their business strategy and contextual factors that influenced it. Key differences between telemedicine business practices in developing and developed countries are also discussed. The purpose of this article is to inform and inspire the business strategy of the next generation of telemedicine ventures to be economically sustainable and to successfully address local healthcare challenges.
.... Reports were derived for the following topics: network organizational models, technology development and application, clinical applications, public health, disease surveillance and personal health, education, and telemedicine diffusion...
Khatri, Vikramajeet; Peterson, Carrie Beth; Kyriazakos, Sofoklis
Telemedicine is gaining popularity due to the provision of ubiquitous health care services that is a fundamental need for every socialized society. In this paper, telemedicine services in Finland are discussed, as well as how they came into existence, how they are funded, evaluated, and what...... are their impacts on health care systems and society. Telemedicine services like teleradiology, telelaboratory, telepsychiatry and remote consultations, are being offered in all hospital districts. Primary health care centers in Finland are lacking telemedicine services, and are planning to have them. Electronic...
Siegel, Corey A
Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
Atiyeh, B; Dibo, S A; Janom, H H
Access to specialized burn care is becoming more difficult and is being restricted by the decreasing number of specialized burn centers. It is also limited by distance and resources for many patients, particularly those living in poverty or in rural medically underserved communities. Telemedicine is a rapidly evolving technology related to the practice of medicine at a distance through rapid access to remote medical expertise by telecommunication and information technologies. Feasibility of telemedicine in burn care has been demonstrated by various centers. Its use facilitates the delivery of care to patients with burn injuries of all sizes. It allows delivery of acute care and can be appropriately used for a substantial portion of the long-term management of patients after a burn by guiding less-experienced surgeons to treat and follow-up patients more appropriately. Most importantly, it allows better effective triage which reduces unnecessary time and resource demanding referrals that might overwhelm system capacities. However, there are still numerous barriers to the implementation of telemedicine, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and an inadequate evidence base of its value and efficiency.
Tabak, Monique; Dekker - van Weering, Marit; Vollenbroek-Hutten, Miriam
Background Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. Objective This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. Methods We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Results Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great
de Vette, Frederiek; Tabak, Monique; Dekker-van Weering, Marit; Vollenbroek-Hutten, Miriam
Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies
de Vette, Anna Frederiek Alberdien; Tabak, Monique; van Weering, Marit; Vollenbroek-Hutten, Miriam Marie Rosé
BACKGROUND: Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the
Kidholm, Kristian; Clemensen, Jane; Caffery, Liam J
The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use...
Telemedicine is the most promising one for improving the access to specialized health services to all remote, rural areas in all developing countries. Exploiting the technological advancements in the field of electronics, signal processing and software a communication network for telemedicine is proposedfor the existing ...
Chowdhry, B.S.; Bhatti, M.I.; Baig, M.A.A.
The combination of information and communication technologies (ICTs) for sustainable healthcare through telemedicine focuses on both changes in the access of healthcare information services as well as wider dissemination of healthcare related skills and professional expertise of medical community. Many developing countries are deficient in healthcare services and suffer from a shortage of doctors and other healthcare Professionals. In Pakistan, the inadequate allocation of doctors/specialists, infrastructures of telecommunications, roads and transport make it more difficult to provide in remote and rural areas. Where clinics and hospitals exist, they are often ill-equipped. The aim of this paper is to share knowledge about the use of telemedic solutions in the health sector in order to propose strategies and actions to formulate tactical recommendations for policy makers and advisors as well as researchers. The examples in this paper illustrate that telemedicine has clearly made an impact on healthcare. (author)
Full Text Available Telemedicine scenarios include today in-hospital care management, remote teleconsulting, collaborative diagnosis and emergency situations handling. Different types of information need to be accessed by means of etherogeneous client devices in different communication environments in order to enable high quality continuous sanitary assistance delivery wherever and whenever needed. In this paper, a Web-based telemedicine architecture based on Java, XML and XSL technologies is presented. By providing dynamic content delivery services and Java based client applications for medical data consultation and modification, the system enables effective access to an Electronic Patient Record based standard database by means of any device equipped with a Web browser, such as traditional Personal Computers and workstation as well as modern Personal Digital Assistants. The effectiveness of the proposed architecture has been evaluated in different scenarios, experiencing fixed and mobile clinical data transmissions over Local Area Networks, wireless LANs and wide coverage telecommunication network including GSM and GPRS.
Wetzel, M.C.; Vieira, A.T.; Patton, D.C.
Detailed containment and Ultimate Heat Sink (UHS) performance evaluations often are required to support major plant modifications, such as power up-rates and steam generator replacements. These UHS and containment pressure and temperature response evaluations are interrelated. Not only is the containment heat load to the UHS a factor in these evaluations, but other heat loads, such as those from the spent fuel pool, may change as a result of the plant modification and impact containment or UHS response. Our experience is that if an integrated containment/UHS response model is developed prior to the feasibility evaluations for such plant modifications, significant savings in engineering hours can be achieved. This paper presents an overview of such a front-end engineering tool that has been developed and used to support engineering evaluations. 3 refs., 2 figs
Ayatollahi, Haleh; Sarabi, Fatemeh Zahra Pourfard; Langarizadeh, Mostafa
Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.
Kidholm, Kristian; Ekeland, Anne Granstrøm; Jensen, Lise Kvistgaard
the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study.......Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009...
Telemedicine has evolved to become an important field of medicine and healthcare, involving everything from simple patient care to actual performance of operations at a distance. This groundbreaking volume addresses the complex technical and clinical development in the management of trauma, disaster, and emergency situations using telemedicine. The book explains how telemedicine and related technologies can be used to effectively handle a wide range of scenarios, from a situation as small as a car crash, to major disasters such as an earthquake. Professionals find critical discussions on the p
Elizabeth A. Krupinski
When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation?where the patient is and where the consulta...
Full Text Available Telemedicine has been a technological takeaway for the developed countries. Even in the developing countries, it is increasingly being viewed as a tool for improving care and enhancing access to healthcare. Countries like India where the majority of the population lives in rural areas, where healthcare facilities are inefficient and inadequate, tools like telemedicine can contribute substantially in bridging the gap between the demand and supply. "Sanjeevani"-is an integrated telemedicine application that offers a suite of high utility features as a part of an Indian telemedicine technology. Sanjeevani is based on store and forward as well as real-time models.
Lin, C F; Hung, S I; Chiang, I H
In this paper, an 802.11 n transmission scheme is proposed for wireless telemedicine applications. IEEE 802.11n standards, a power assignment strategy, space-time block coding (STBC), and an object composition Petri net (OCPN) model are adopted. With the proposed wireless system, G.729 audio bit streams, Joint Photographic Experts Group 2000 (JPEG 2000) clinical images, and Moving Picture Experts Group 4 (MPEG-4) video bit streams achieve a transmission bit error rate (BER) of 10-7, 10-4, and 103 simultaneously. The proposed system meets the requirements prescribed for wireless telemedicine applications. An essential feature of this proposed transmission scheme is that clinical information that requires a high quality of service (QoS) is transmitted at a high power transmission rate with significant error protection. For maximizing resource utilization and minimizing the total transmission power, STBC and adaptive modulation techniques are used in the proposed 802.11 n wireless telemedicine system. Further, low power, direct mapping (DM), low-error protection scheme, and high-level modulation are adopted for messages that can tolerate a high BER. With the proposed transmission scheme, the required reliability of communication can be achieved. Our simulation results have shown that the proposed 802.11 n transmission scheme can be used for developing effective wireless telemedicine systems.
O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne
Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.
Pacis, Danica Mitch M.; Subido, Edwin D. C.; Bugtai, Nilo T.
With the growth and popularity of the utilization of artificial intelligence (AI) in several fields and industries, studies in the field of medicine have begun to implement its capabilities in handling and analyzing data to telemedicine. With the challenges in the implementation of telemedicine, there has been a need to expand its capabilities and improve procedures to be specialized to solve specific problems. The versatility and flexibility of both AI and telemedicine gave the endless possibilities for development and these can be seen in the literature reviewed in this paper. The trends in the development of the utilization of this technology can be classified in to four: patient monitoring, healthcare information technology, intelligent assistance diagnosis, and information analysis collaboration. Each trend will be discussed and presented with examples of recent literature and the problems they aim to address. Related references will also be tabulated and categorized to see the future and potential of this current trend in telemedicine.
(3) continuing medical education and (4) Training the medical ... Telemedicine system consists of at least five major subsystems. [l,4]. ... and wire-line (optical network) telecommunication facilities .... An ATM network needs certain traffic control.
Anwar, Sadia; Prasad, Ramjee; Kumar, Ambuj
for telemedicine application. Telemedicine’s applications and high data medical information generally require high definition visuals and lower latency connection, in addition mobility and reliability. The next generation of wireless communication standard, known as 5G, will provide data speed in (Gigabit per...... second) Gb/s with lower latency and higher reliability connection, and can be better approach for future telemedicine. In this paper we survey the current state of telemedicine along with examining the characteristics of 5G technology. We also present research challenges concerning 5G and telemedicine.......The use of smartphones has been increasing rapidly and it is expected that in future most people will have a smartphone capable of high speed Internet connection. The capability of smartphones with high definition display, computation power and multitude of sensors made it an excellent candidate...
Terri-Ellen J. Kiernan
Full Text Available Time sensitive acute stroke treatments and the growing shortage of vascular neurologists compound to create a gap in the delivery of care to meet the American Stroke Association guidelines in underserviced regions. Audio/video consultation (telemedicine, which has been evolving since the late 1990's, is a putative solution. While telemedicine can serve as a valuable facilitative tool, the telestroke consultation is only one piece of a complex collaboration between hub and spoke environments and clinical personnel. The growing use of telemedicine in stroke offers more opportunities for all nurses to participate in the continuum of cerebrovascular disease care. A review of this collaboration will include but will not be limited to: algorithms of the acute stroke evaluation, hub and spoke staff meetings, stroke education for spoke staff, and patient follow–up post acute treatment. Our team's telemedicine experience, utilizing research, education, and clinical practice, will be described.
Lucas, Kenneth W
The primary objective of this research effort is to integrate ViTel Net's MedVizerTM software and Division Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld...
Istepanian, Robert S. H
Future telemedicine systems will exploit mobile communications technology so that patients who are free to move around at home or at work, or in emergency medical situations, can be monitored in a hospital...
.... An assessment of Navy telemedicine as a complex healthcare support system is needed to demonstrate how current practices, training, equipment, and expenditures measure up to the emerging needs of the Fleet...
...(exp TM) software and Division Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld wireless PDA devices, and miniature computers, to existing DoD legacy...
...) software and Dvision Tools with cross platform telemedicine systems, inclusive of computer based systems, handheld wireless PDA devices, and miniature computers, to existing DoD legacy and developing...
.... 0 Necessary telemedicine study equipment was installed at the study sites. (PictureTel monitors and associated VTC equipment, flat-screen monitors, one PC, and VCR with digital video tape/VHS capabilities were installed...
Pearl, Phillip L; Sable, Craig; Evans, Sarah; Knight, Joseph; Cunningham, Parker; Lotrecchiano, Gaetano R; Gropman, Andrea; Stuart, Sheela; Glass, Penny; Conway, Anne; Ramadan, Issam; Paiva, Tania; Batshaw, Mark L; Packer, Roger J
A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE. Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews of medical records. A full consultation report follows each telemedicine session. Between February 29, 2012 and June 26, 2013, 48 weekly 1-h live interactive telemedicine consultations were conducted on 48 patients (28 males, 20 females; age range, 8 months-22 years; median age, 5.4 years). The primary diagnoses were cerebral palsy, neurogenetic disorders, autism, neuromuscular disorders, congenital anomalies, global developmental delay, systemic disease, and epilepsy. Common comorbidities were cognitive impairment, communication disorders, and behavioral disorders. Specific recommendations included imaging and DNA studies, antiseizure management, spasticity management including botulinum toxin protocols, and specific therapy modalities including taping techniques, customized body vests, and speech/language and behavioral therapy. Improved outcomes reported were in clinician satisfaction, achievement of therapy goals for patients, and requests for ongoing sessions. Weekly telemedicine sessions coupled with triannual training conferences were successfully implemented in a clinical program dedicated to patients with neurodevelopmental disabilities by the Center for Neuroscience at CNMC and the UAE government. International consultations in neurodevelopmental
Zundel, K M
This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (inclu...
Barman, Mallika Roy; Pratik Kumar; Subramaniam, Kailash
Transferring of medical electronic data from one place to another is known as telemedicine. All relevant medical opinions and investigations, like EGG, x-ray, sonography, GT scan, MRI and angiography can be transferred from one location to another by telemedicine. In developing countries like India where rural population is more and specialized doctors and hospital are few and located more in cities, it should be very useful
Full Text Available In the recent years, people have been more inclined towards the use of technology to reduce human effort. Telemedicine is one such concept which has gained popularity among the people, providing them easy access to health care. Telemedicine refers to the concept of providing health care from a distance through an integrated approach using information and communication technology (ICT. India, being a geographically wide country has its difficulties when it comes to providing health care facilities to people belonging to the different regions. This is one of the few reasons why India is the best stage to introduce a concept like telemedicine. The use of this technology to counter the various challenges has been highly regarded and termed as something which can revolutionize the medical field. Integrating telemedicine with electronic health record (EHR, which is a digital document of a person’s medical history is said to be a perfect combination which can help improve clinical efficiency. The country has seen initiatives taken up by various organizations, with the main motive of connecting the rural to the urban. Through this paper, we have discussed the potential we have with this technology, and also propose an EHR integrated telemedicine model to make the best use of it in an emergency healthcare situation to help save lives. We have also touched a few factors which can help the government better the current health scenario.
O'Shea, Jesse; Berger, Ryan; Samra, Cynthia; Van Durme, Daniel
The increasing cost and inequitable access to quality healthcare, coupled with the merger of the information technology and health service sectors, has given rise to the modern field of telemedicine. Telemedicine, meaning medicine at a distance, allows us to transcend geographic and socioeconomic boundaries to deliver high quality care to remote and/or in-need patients. As technology becomes more affordable and a physician shortage looms, telemedicine is gaining attention as a possible solution to healthcare delivery. Simultaneously, telemedicine holds great promise with regard to medical education. Several studies integrating telemedicine in medical education have shown positive outcomes, demonstrating similar or greater efficacy compared with traditional educational methods with high student-reported enthusiasm. Other domestic and international telemedicine projects, largely spearheaded by universities, have also achieved great success. In a novel approach, by pairing medical schools with in-need partner communities, utilizing similar faculty resources as traditional learning methods with standardized patients, students can gain valuable experience and skills while serving actual patients. This progressive approach to medical education fosters collaboration, communication, longitudinal care and teaches students needed skills for their future practices as 21 st Century healthcare providers.
Krupinski, Elizabeth A.; Bernard, Jordana
The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. PMID:27429261
Warner, D; Tichenor, J M; Balch, D C
Recent trends in health care informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. The authors present a new model of health care information, distributed medical intelligence, which promotes the development of an integrative medical communication system addressing the process of providing expert medical knowledge to the point of need. The model incorporates audio, video, high-resolution still images, and virtual reality applications into an integrated medical communications network. Three components of the model (care portals, Docking Station, and the bridge) are described. The implementation of this model at the East Carolina University School of Medicine is also outlined.
Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte
participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care......BACKGROUND: For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home...... visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...
Watson, Andrew B.; Ahumada, Albert J., Jr.; Eckstein, Miguel; Null, Cynthia H. (Technical Monitor)
The next era of space exploration, especially the "Mission to Planet Earth" will generate immense quantities of image data. For example, the Earth Observing System (EOS) is expected to generate in excess of one terabyte/day. NASA confronts a major technical challenge in managing this great flow of imagery: in collection, pre-processing, transmission to earth, archiving, and distribution to scientists at remote locations. Expected requirements in most of these areas clearly exceed current technology. Part of the solution to this problem lies in efficient image compression techniques. For much of this imagery, the ultimate consumer is the human eye. In this case image compression should be designed to match the visual capacities of the human observer. We have developed three techniques for optimizing image compression for the human viewer. The first consists of a formula, developed jointly with IBM and based on psychophysical measurements, that computes a DCT quantization matrix for any specified combination of viewing distance, display resolution, and display brightness. This DCT quantization matrix is used in most recent standards for digital image compression (JPEG, MPEG, CCITT H.261). The second technique optimizes the DCT quantization matrix for each individual image, based on the contents of the image. This is accomplished by means of a model of visual sensitivity to compression artifacts. The third technique extends the first two techniques to the realm of wavelet compression. Together these two techniques will allow systematic perceptual optimization of image compression in NASA imaging systems. Many of the image management challenges faced by NASA are mirrored in the field of telemedicine. Here too there are severe demands for transmission and archiving of large image databases, and the imagery is ultimately used primarily by human observers, such as radiologists. In this presentation I will describe some of our preliminary explorations of the applications
.... This paper discusses the airborne flight test of the Sikorsky UH-60 Black Hawk helicopter in turbulent conditions to determine disturbance rejection criteria and to develop a low speed turbulence...
A linear model structure applicable to identification of the UH-60 flight : dynamics in hover and forward flight without rotor-state data is developed. The : structure of the model is determined through consideration of the important : dynamic modes ...
Kennedy, Joshua S; Durbin, David B
Pilot workload, situational awareness (SA), and the pilot-vehicle interface (PVI) characteristics associated with the UH-60M Black Hawk crew station simulator were assessed during the Early User Demonstration...
Ahmad, Jasim Uddin; Yamauchi, Gloria K.; Kao, David L.
A Computational Fluid Dynamics (CFD) simulation using the Navier-Stokes equations was performed to determine the evolutionary and dynamical characteristics of the vortex flowfield for a highly flexible aeroelastic UH-60A rotor in forward flight. The experimental wake data were acquired using Particle Image Velocimetry (PIV) during a test of the fullscale UH-60A rotor in the National Full-Scale Aerodynamics Complex 40- by 80-Foot Wind Tunnel. The PIV measurements were made in a stationary cross-flow plane at 90 deg rotor azimuth. The CFD simulation was performed using the OVERFLOW CFD solver loosely coupled with the rotorcraft comprehensive code CAMRAD II. Characteristics of vortices captured in the PIV plane from different blades are compared with CFD calculations. The blade airloads were calculated using two different turbulence models. A limited spatial, temporal, and CFD/comprehensive-code coupling sensitivity analysis was performed in order to verify the unsteady helicopter simulations with a moving rotor grid system.
... government's Health Insurance Portability and Accountability Act (HIPAA). Communicating with your doctor using other means, such as ... reviewed: August 2016 More on this topic for: Parents Teens Electronic Health Records Talking to Your Child's ...
Pekárová, Pavla; Halmová, Dana; Mitková, Veronika
The extreme rainfall events in Central and East Europe on August 2002 rise the question, how other basins would respond on such rainfall situations. Such theorisation helps us to arrange in advance the necessary activity in the basin to reduce the consequence of the assumed disaster. The aim of the study is to recognise a reaction of the Uh River basin (Slovakia, Ukraine) to the simulated catastrophic rainfall events from August 2002. Two precipitation scenarios, sc1 and sc2, were created. Th...
This first in a two part series on telemedicine in healthcare outlines the background and context for using this technology. It discusses the levels of telemedicine and its possible applications in healthcare, and examines its advantages and disadvantages.
Charrier, Nathanael; Zarca, Kevin; Durand-Zaleski, Isabelle; Calinaud, Christine
With the development of information and communication technologies, telemedicine has been proposed as a way to improve patient management by facilitating access to appropriate diagnosis and treatment. The Paris Ile de France Regional Health Agency is currently funding a comprehensive program of telemedicine experiments. This article describes the protocols for the evaluation of the implementation of telemedicine in the Paris region. Over 2,500 patients have been included in eight studies addressing the use of telemedicine in the context of specific diseases or settings. Two projects are randomized controlled trials, while the six other projects are based on before-after designs (differences in differences studies). Based on the MAST model and the French national framework, we identified endpoints to assess the impact of telemedicine on five dimensions: clinical effectiveness, cost-effectiveness, security of the application, patient satisfaction and quality of life and perception of professionals. Telemedicine encompasses a wide range of services and stakeholders, and thus study protocols must be tailored to the specific constraints and interests of the users. NCT02110433 (03/07/2014), NCT02157740 (05/27/2014), NCT02374697 (02/05/2015), NCT02157727 (05/27/2014), NCT02229279 (08/28/2014), NCT02368769 (02/05/2015), NCT02164747 (NCT02164747), NCT02309905 (11/27/2014).
Qubty, William; Patniyot, Irene; Gelfand, Amy
The aim of this prospective study was to survey our patients about their experience with our clinic's telemedicine program to better understand telemedicine's utility for families, and to improve patient satisfaction and ultimately patient care. This was a prospective survey study of patients and their families who had a routine telemedicine follow-up visit with the University of California San Francisco Pediatric Headache Program. The survey was administered to patients and a parent(s) following their telemedicine visit. Fifty-one of 69 surveys (74%) were completed. All (51/51) patients and families thought that (1) telemedicine was more convenient compared to a clinic visit, (2) telemedicine caused less disruption of their daily routine, and (3) they would choose to do telemedicine again. The mean round-trip travel time from home to clinic was 6.8 hours (SD ± 8.6 hours). All participants thought telemedicine was more cost-effective than a clinic visit. Parents estimated that participating in a telemedicine visit instead of a clinic appointment saved them on average $486. This prospective, pediatric headache telemedicine study shows that telemedicine is convenient, perceived to be cost-effective, and patient-centered. Providing the option of telemedicine for routine pediatric headache follow-up visits results in high patient and family satisfaction. © 2018 American Academy of Neurology.
Kreofsky, Beth L H; Blegen, R Nicole; Lokken, Troy G; Kapraun, Susan M; Bushman, Matthew S; Demaerschalk, Bart M
Telemedicine services in medical institutions are often developed in isolation of one another and not as part of a comprehensive telemedicine program. The Center for Connected Care is the administrative home for a broad range of telehealth services at Mayo Clinic. This article speaks of real-time video services, referenced as telemedicine throughout. This article discusses how a large healthcare system designed and built the infrastructure to support a comprehensive telemedicine practice. Based on analysis of existing services, Mayo Clinic developed a multifaceted operational plan that addressed high-priority areas and outlined clear roles and responsibilities of the Center for Connected Care and that of the clinical departments. The plan set priorities and a direction that would lead to long-term success. The plan articulated the governing and operational infrastructure necessary to support telemedicine by defining the role of the Center for Connected Care as the owner of core administrative operations and the role of the clinical departments as the owners of clinical telemedicine services. Additional opportunities were identified to develop product selection processes, implementation services, and staffing models that would be applied to ensure successful telemedicine deployment. The telemedicine team within the Center for Connected Care completed 45 business cases resulting in 54 implementations. The standardization of core products along with key operational offerings around implementation services, and the establishment of a 24/7 support model resulted in improved provider satisfaction and fewer reported technical issues. The foundation for long-term scalability and growth was developed by centralizing operations of telemedicine services, implementing sustainable processes, employing dedicated qualified personnel, and deploying robust products.
Full Text Available Abstract Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1 the process of adoption of telemedicine in comparison with other technologies; and 2 the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify
Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and
Balch, D C; Tichenor, J M
The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.
Patricoski, Chris; Ferguson, A Stewart
The digital camera is an essential component of store-and-forward telemedicine (electronic consultation). There are numerous makes and models of digital cameras on the market, and selecting a suitable consumer-grade camera can be complicated. Evaluation of digital cameras includes investigating the features and analyzing image quality. Important features include the camera settings, ease of use, macro capabilities, method of image transfer, and power recharging. Consideration needs to be given to image quality, especially as it relates to color (skin tones) and detail. It is important to know the level of the photographer and the intended application. The goal is to match the characteristics of the camera with the telemedicine program requirements. In the end, selecting a digital camera is a combination of qualitative (subjective) and quantitative (objective) analysis. For the telemedicine program in Alaska in 2008, the camera evaluation and decision process resulted in a specific selection based on the criteria developed for our environment.
Groneberg, David A; Rahimian, Shaghayegh; Bundschuh, Matthias; Schwarzer, Mario; Gerber, Alexander; Kloft, Beatrix
As a result of the various telemedicine projects in the past years a large number of studies were recently published in this field. However, a precise bibliometric analysis of telemedicine publications does not exist so far. The present study was conducted to establish a data base of the existing approaches. Density-equalizing algorithms were used and data was retrieved from the Thomson Reuters database Web of Science. During the period from 1900 to 2006 a number of 3290 filed items were connected to telemedicine, with the first being published in 1964. The studies originate from 101 countries, with the USA, Great Britain and Canada being the most productive suppliers participating in 56.08 % of all published items. Analyzing the average citation per item for countries with more than 10 publications, Ireland ranked first (10.19/item), New Zealand ranked second (9.5/item) followed by Finland (9.04/item). The citation rate can be assumed as an indicator for research quality. The ten most productive journals include three journals with the main focus telemedicine and another five with the main focus "Information/Informatics". In all subject categories examined for published items related to telemedicine, "Health Care Sciences & Services" ranked first by far. More than 36 % of all publications are assigned to this category, followed by "Medical Informatics" with 9.72 % and "Medicine, General & Internal" with 8.84 % of all publications. In summary it can be concluded that the data shows clearly a strong increase in research productivity. Using science citation analysis it can be assumed that there is a large rise in the interest in telemedicine studies.
Cai, Hui; Wang, Hongjing
Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments. PMID:27332894
Full Text Available In short-distance wireless communications for telemedicine monitoring, different medical data measurement equipment has different wireless transmission modes. A multistandard receiver is designed that can adapt to different medical data measuring equipment. Using a second-order bandpass sampling for the design of antialiasing filters, two aliasing signals can be separated. Simultaneously, constraint conditions for sampling frequency are not as critical. The design is useful for a multistandard receiver in a telemedicine monitoring system and has the advantages such as saving spectrum resources and facilitating spectrum planning.
The aim of this study is to survey telemedicine services currently in operation across Denmark. The study specifically seeks to answer the following questions: What initiatives are deployed within the different regions? What are the motivations behind the projects? What technologies are being utilized? What medical disciplines are being supported using telemedicine systems? All data were surveyed from the Telemedicinsk Landkort, a newly created database designed to provide a comprehensive and systematic overview of all telemedicine technologies in Denmark. The results of this study suggest that a growing numbers of telemedicine initiatives are currently in operation across Denmark but that considerable variations exist in terms of regional efforts as the number of operational telemedicine projects varied from region to region. The results of this study provide a timely picture of the factors that are shaping the telemedicine landscape of Denmark and suggest potential strategies to help policymakers increase and improve national telemedicine deployment.
Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David
To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.
Panayides, A.; Eleftheriou, I.; Pantziaris, M.
An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. PMID:23573082
Panayides, A; Eleftheriou, I; Pantziaris, M
An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings.
Full Text Available An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN and 3.5G high-speed packet access (HSPA wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings.
Mizushima, H; Uchiyama, E; Nagata, H; Matsuno, Y; Sekiguchi, R; Ohmatsu, H; Hojo, F; Shimoda, T; Wakao, F; Shinkai, T; Yamaguchi, N; Moriyama, N; Kakizoe, T; Abe, K; Terada, M
We started telemedicine projects from 1990 with a telepathology system within Tsukiji Campus of National Cancer Center. In 1994, we connected Tsukiji Campus and Kashiwa Campus by 6 Mbps optical fiber leased line using IP protocol for data transmission, for teleconference, telepathology, and teleradiology projects. We also started connection of regional cancer centers and are now forming a cancer center network of 14 cancer centers. We are at present organizing 130 teleconferences per year with an attendance of more than 16000 people as summary. We have also used a high-resolution image transferring system, such as SHD (2000 pixelsx2000 pixels resolution) system on one side, and an economical telemedicine system using JAVA and a WWW browser (NCC_image) on the other side. We think that providing information is another field of telemedicine. We began the experimental gopher and WWW service in 1993. We are now providing official up-to-date cancer information for patients and healthcare professionals. We are getting more than 400000 hits per month. We are also providing a teleconference video session which is held every week on the Internet using a Real Video system with synchronized slide presentation on the WWW browser. We are also organizing a Cancer Image Reference Database System including DICOM images with viewer software. This paper is a summary of the telemedicine projects performed at the National Cancer Center.
Gunawardane, K J
Since March 1998 up to June 2000, telemedicine activities in Marshall Islands have mainly been for Referrals to Tripler Army Medical Center (TAMC) in Hawaii. The activities are based on a computer which has the Internet connection and accessories including a digital camera, flatbed scanner with a transparency adapter, color printer, a video printer, ophthalmoscope, otoscope and a video Lens, all of which were donated by Project Akamai in Hawaii. Two sessions of training were conducted by representatives from Akamai Project and from PBMA at the very beginning of the establishment of the unit, to all levels of Health Care Providers in Ministry of Health in Majuro. The computer and Internet facility is available 24 hours. Since March 1998 to June 2000, there had been 144 telemedicine consultations to TAMC. Out of a total of 326 off-island referrals for the same period, approximately 80 patients have been sent to TAMC using the PIHCP/Telemedicine program. This accounts for approximately 25% of total off-island referrals. This represents a significant reduction in cost. In addition to cost reduction the telemedicine unit most important impact is on the health providers, especially the physicians working at Majuro Hospital. Availability of medical information through internet has helped them to feel less isolated from the constantly changing field of medical science.
Borbás, János; Forczek, Erzsébet; Sepp, Róbert; Bari, Ferenc
Telemedicine is a young science that integrates innovations of information-technology and telecommunications into medical science. A successful telemedicine procedure should guarantee reduced workload of the healthcare system with well secured and cost-effective processes. Our goal was to collect the development phases of telemedicine projects through existing telecardiology solutions. Subsequent to reviewing international publications we analyzed the past and present situation of blood pressure monitoring, remote diagnostics of electrocardiography, implantable cardioverter defibrillator monitoring and pocket ultrasound devices. In case of new solutions (a) several internationally accepted, confidently reproducible "good practices" are needed for creating (b) guidelines and recommendations of international medical associations. They have to ensure (c) cost-effective work, with well-designed sustainability and (d) patient confidentiality. Improving (e) education for professionals and patients is essential. We recommend to telemedicine developers to use our standards in order to introduce their products more effectively into clinical practice. It is encouraging that current possibilities of telecardiology partly or fully meet the aforementioned criteria. Further development of the topic can contribute to financial sustainability of our healthcare and might be able to resolve limitations of human resources. Orv Hetil. 2017; 158(44): 1741-1746.
Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard
Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942
Full Text Available In this paper, we propose a new reversible watermarking of medical images for the applications in telemedicine. By using a bit-stream insertion scheme, the patient’s information can be treated as a watermark and can be embedded into the bit-stream of a cover image for remote transmission. The proposed method simplifies the design of traditional image coding after a reversible watermarking. Experimental results show that the compression ratio can be achieved up to 3.025. The watermarking capacity can be obtained over 0.75 bpp for some common images. In addition, the watermark can be extracted exactly and the cover image can be reconstructed either in a lossless way or a lossy way. The obtained results also show the improvement with respect to previous works.
SURVIVABILITY ON THE ISLAND OF SPICE : THE DEVELOPMENT OF THE UH-60 BLACKHAWK AND ITS BAPTISM OF FIRE IN OPERATION URGENT FURY......THESIS APPROVAL PAGE Name of Candidate: Major Matthew G. Easley Thesis Title: Survivability on the Island of Spice : The Development of the UH
Schulz, Russel E.; And Others
The report, the first of two documents examining the relationship among job requirements, training, and manpower considerations for Army aviation maintenance Personnel, discusses the development of task data gathering techniques and procedures for incorporating this data into training programs for the UH-1 helicopter mechanic sPecialty (MOS…
Danbjørg, Dorthe Boe; Clemensen, Jane; Rothmann, Mette Juel
together with the patients. Participatory design is a research design and methodology that encourages the participation of users in the design process of technological solutions. Therefore, it has a potential for designing technologies that actually reflect the needs of the users, why it is relevant within...... telemedicine. The aim of this presentation is to explain the process and theoretical framework of a PD project; give an example of a project including the applied methods, and to determine its application to telemedicine with focus on the rationale for genuine participation. Theory: Participation implies....... Methods: Key activities of a Participatory Design project comprise methods such as fieldwork; literature reviewing; development and testing, and user activities as workshops. Methods that support telling, making, enacting. For instance telling activities as drivers for participation, where practitioners...
Singh, Indra Pratap; Kapoor, Lily; Daman, Repu; Mishra, Saroj Kanta
Communication links are the lifelines for telemedicine practice. Various terrestrial and satellite media can be used; however, each has its own plus and minus side. The current study was designed to evaluate three types of telecommunication media used for telemedical videoconference at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow Telemedicine program over a period of 20 months. The evaluation was based on analysis of technical parameters recorded in a prescribed proforma designed for the study purpose and maintained prospectively after completion of each event. Only technical issues were addressed. At the end of the study period, analysis of data revealed that leased line-based terrestrial Internet Protocol (IP) was better than Sky IP. Integrated Services Digital Network media were found technically less acceptable for telemedical videoconference.
Wang, Gengkun; Xiang, Wei; Pickering, Mark
Current telehealth services are dominated by conventional 2D video conferencing systems, which are limited in their capabilities in providing a satisfactory communication experience due to the lack of realism. The "immersiveness" provided by 3D technologies has the potential to promote telehealth services to a wider range of applications. However, conventional stereoscopic 3D technologies are deficient in many aspects, including low resolution and the requirement for complicated multi-camera setup and calibration, and special glasses. The advent of light field (LF) photography enables us to record light rays in a single shot and provide glasses-free 3D display with continuous motion parallax in a wide viewing zone, which is ideally suited for 3D telehealth applications. As far as our literature review suggests, there have been no reports of 3D telemedicine systems using LF technology. In this paper, we propose a cross-platform solution for a LF-based 3D telemedicine system. Firstly, a novel system architecture based on LF technology is established, which is able to capture the LF of a patient, and provide an immersive 3D display at the doctor site. For 3D modeling, we further propose an algorithm which is able to convert the captured LF to a 3D model with a high level of detail. For the software implementation on different platforms (i.e., desktop, web-based and mobile phone platforms), a cross-platform solution is proposed. Demo applications have been developed for 2D/3D video conferencing, 3D model display and edit, blood pressure and heart rate monitoring, and patient data viewing functions. The demo software can be extended to multi-discipline telehealth applications, such as tele-dentistry, tele-wound and tele-psychiatry. The proposed 3D telemedicine solution has the potential to revolutionize next-generation telemedicine technologies by providing a high quality immersive tele-consultation experience. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
The growth of information technology and telecommunications has created promising opportunities for better, faster, more accessible, barrier-free health care; telemedicine (TM). The feasibility of many TM projects depends on resolving legal issues. Mastering technical issues or providing training remain important benchmarks for implementation of TM, but legal issues constrain progress. This article identifies the key legal issues, maps current legislation, and offers a forecast of necessary steps to expedite the dissemination of TM. Copyright © 2011 Elsevier Inc. All rights reserved.
Full Text Available Telemedicine (distance medicine represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project “SHARED” (1996-2000 together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time.
Bruun, Anders; Stage, Jan
a high level of usability in order to enable their users to employ the required functionality, especially if the target user group is elderly people. This paper reports from a usability evaluation of a home telemedicine system. Five elderly persons carried out specified tasks with the system, and based...... on that we identified usability problems with the system. The problems are presented, analysed in relation to 12 different usability themes and related to results from other evaluations of similar systems....
Biedron, Robert T.; Lee-Rausch, Elizabeth
An unsteady Reynolds-averaged Navier-Stokes solver for unstructured grids is used to simulate the flow over a UH-60A rotor. Traditionally, the computed pressure and shear stresses are integrated on the computational mesh at selected radial stations and compared to measured airloads. However, the corresponding integration of experimental data uses only the pressure contribution, and the set of integration points (pressure taps) is modest compared to the computational mesh resolution. This paper examines the difference between the traditional integration of computed airloads and an integration consistent with that used for the experimental data. In addition, a comparison of chordwise pressure distributions between computation and measurement is made. Examination of this unsteady pressure data provides new opportunities to understand differences between computation and flight measurement.
Dykas, Brian; Hood, Adrian; Krantz, Timothy; Klemmer, Marko
An accelerated aging investigation of critical aviation bearings lubricated with MIL-PRF- 81322 grease was conducted to derive an understanding of the mechanisms of grease degradation and loss of lubrication over time. The current study focuses on UH-60 Black Hawk viscous damper bearings supporting the tail rotor driveshaft, which were subjected to more than 5800 hours of testing in a heated environment to accelerate the deterioration of the grease. The mechanism of grease degradation is a reduction in the oil/thickener ratio rather than the expected chemical degradation of grease constituents. Over the course of testing, vibration and temperature monitoring of bearings was conducted and trends for failing bearings are presented.
Denis Souto Valente
Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.
Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn
This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).
L. Van Dyk
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ENGLISH ABSTRACT: For more than a decade, the South African National Department of Health (DoH has recognised the potential benefit of information and communication technology (ICT in the delivery of health care to rural areas. Despite generous funding and proven technology, not many telemedicine systems have proved sustainable after the pilot phase. The purpose of this paper is to develop a maturity model that can be implemented to measure and manage the capability of a health system, for use in the delivery of sustainable health care after the pilot phase of a telemedicine project. The validity of the telemedicine maturity model (TMMM is tested within the context of the South African public health sector.
AFRIKAANSE OPSOMMING: Die Suid Afrikaanse Nasionale Departement van Gesondheid het reeds meer as ’n dekade gelede die voordeel besef wat inligtings- en kommunikasietegnologie kan bied ten opsigte van die lewering van gesondheidsorg in afgeleë gebiede. Ten spyte van ruim befondsing en bewese tegnologie, is daar egter min volgehoue telegeneeskundedienste in die publieke gesondheidstelsel van Suid Afrika. Die doel van hierdie artikel is om ’n volwassenheids-model te ontwikkel wat gebruik kan word om die vermoë van ’n gesondheidstelsel te bepaal en bestuur, ten einde telegeneeskunde loodsprojekte vol te hou. Die geldigheid van hierdie telegeneeskunde volwassenheidsmodel (TMMM is getoets binne konteks van die publieke gesondheidsektor van Suid Afrika.
Russo, Jack E; McCool, Ryan R; Davies, Louise
The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.
Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K
To determine the perceived utility and demand for the application of telemedicine for improved patient care between nonsurgical dental practitioners (GPs) and oral and maxillofacial surgeons (OMS). Two distinct questionnaires were made, one for GPs and one for OMSs. The GP questionnaire was sent to practicing Virginia Dental Association members on an e-mail list (approximately 2,200). The OMS questionnaire was sent by the Virginia Society of Oral Maxillofacial Surgery to members on an e-mail list (approximately 213). Questionnaires included questions about access to care, benefits of telemedicine consultations, reliability of telemedicine consultations, and perceived barriers against and opportunities for the implementation of telemedicine. The questionnaire was completed by 226 GP and 41 OMS respondents. There was a significant difference among responses of GPs based on practice location: rural patients had a longer average time from referral to OMS consultation (P = .003), rural patients traveled longer distances (P telemedicine, whereas OMS respondents were more neutral. GPs responded they would refer more patients (4.4) if consultations could be performed by telemedicine. OMSs agreed that more referrals would influence their decision to provide telemedicine consultations (51%). Practitioners had neutral perceptions about the reliability of telemedicine. OMS respondents agreed they would implement telemedicine in their practice if it provided equally good consultations as in-office visits. According to the present findings, telemedicine could be an important step in the right direction for overcoming current issues with patient access to care and increasing health care costs. The benefits of telemedicine technology have been documented and will continue to be seen with wider application of its use in other areas of health care such as oral and maxillofacial surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier
... DEPARTMENT OF AGRICULTURE Rural Utilities Service Distance Learning and Telemedicine Grant Program AGENCY: Rural Utilities Service, USDA. ACTION: Notice of Funding for FY 2012 of the Distance Learning and... awards for its Distance Learning and Telemedicine (DLT) Grant Program. For Fiscal Year 2012, $15 million...
Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.
Clinical decision-support functions of telemedicine systems use patient's monitored clinical data to support treatment of outpatients. However, the quality of monitored clinical data may vary due to performance variations of technological resources inside a deployed telemedicine system. This paper
Informed consent for telemedicine in South Africa: A survey of consent practices among healthcare professionals in Durban, KwaZulu-Natal. C Jack, M Mars. Abstract. Background. The Health Professions Council of South Africa is drafting guidelines to regulate the practice of telemedicine. These emphasise the need for ...
Aas, I H
The organizational consequences of telemedicine have frequently been mentioned in the telemedicine community, but there are few empirical studies. A study was therefore carried out of what happens in organizations when telemedicine is implemented. Qualitative interviews were undertaken with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. Almost all respondents reported numerous organizational changes, some important. Changes in work processes were the most common. Examples of the organizational consequences of telemedicine were organizational restructuring, new organizational units, changed mechanisms for internal coordination, different flows of patients through the health-care system, improved coordination of care, new job descriptions, relocation of the place of work, employment of personnel living far away from the workplace, effects on employees not directly involved in telemedicine, sharing of experiences, minor staffing changes, clinical teamwork independent of co-location, administrative meetings arranged by telemedicine, merger of organizations independent of location, less travel by staff (and patients), a possible beneficial effect on the quality of care, and limited opposition to the adoption of the technology. Telemedicine may be important in the future organization of the disciplines studied and in health-care generally. The infrastructure of electronic networks may play an important role for organizations as the volume of telemedicine activity increases and economies of scale are realized.
Broens, T.H.F.; Huis in 't Veld, M.H.A.; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.; van Halteren, Aart; Nieuwenhuis, Lambertus Johannes Maria
Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had
van der Heijden, J.P.
The field of dermatology was one of the first adaptors of telemedicine, dating back to 1995, and has one of the highest scientific output in the field of telemedicine. The research described in this thesis expanded on this scientific knowledge base by answering the following research questions: 1.
Wu, Tzu-Ching; Parker, Stephanie A; Jagolino, Amanda; Yamal, Jose-Miguel; Bowry, Ritvij; Thomas, Abraham; Yu, Amy; Grotta, James C
The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist. On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded. Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73). Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500. © 2017 American Heart Association, Inc.
Giansanti, Daniele; Cerroni, Fabio; Amodeo, Rachele; Filoni, Marco; Giovagnoli, Maria Rosaria
Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.
Full Text Available Up to date, tele-pathology in the three different forms of application, "dynamic", "static" and "virtual microscopy" has been mainly based on tele-hystology remote consulting. Today the diffusion of specialized WAN connections is guiding the research of new applications of tele-pathology. A specific analysis has been conducted, focused on digital cytology, in the biomedical laboratory of Sant'Andrea Hospital to investigate the technologies potentially useful to integrate in the LAN/WAN for telemedicine applications. Among the possible tools useful to be integrated in the LAN/WAN for telemedicine applications, the cytometry equipment available in the technical unity of cytometry has been considered important. The study finally provides a proposal for a tele-consulting architecture for the integration of cytometry reports both in the hospital LAN and the WAN for possible cooperative diagnosis and second opinion support.
The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.
Ben-Pazi, H; Browne, P; Chan, P; Cubo, E; Guttman, M; Hassan, A; Hatcher-Martin, J; Mari, Z; Moukheiber, E; Okubadejo, N U; Shalash, A
Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.
Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Espinoza, Alexis Valenzuela; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf
Background: Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third
Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P
Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.
Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P
Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on
Full Text Available This research was aimed at analyzing and finding the principle of liability in telemedicine medical practice proportionally.This research is a legal research with the approach of statute approach, conceptual approach and comparative approach, as well as the approach to the case approach. According to Article 24 paragraph (1 of the 1945 Constitution and Article 5 (1 of Act No. 48 of 2009 on Judicial Authority, determine that the judge shall explore, and understand the legal values and sense of justice in society. Thus Article 1367 paragraph (3 BW and Article 46 of Act No. 44 of 2009 on Hospitals in the application must be in the context of the intended. The principle of liability risk in medical practice telemedicine in proportion refers to professional liability among medical practitioners telemedicine. The theoretical legitimacy is based on professional relationships in the delegation of medical action based on the code of ethics, professional standards, and service standards, and standard operating procedures. Consequences on liability does not necessarily have to be based on errors primary physician (primary care physician / PCP or primary nurse as subordinate as mean vicarious liability doctrine. Nomenclature "proportional" in a significant liability risk as the distribution of rights and obligations of professionals in proportion to each party's fault based on the values of equality (equitability, feasibility and appropriateness (fair and reasionableness. Accountability based on the viewpoint of interactive justice according to the values of professional skill, prudence or accuracy, responsibility, and colleague and the desire to do good for the sake of healing patients (doing good.
Zink, S.; Hahn, H.; Rudnick, J.; Snell, J.; Forslund, D. [Los Alamos National Lab., NM (United States); Martinez, P. [Northern New Mexico Community Coll., Espanola, NM (United States)
A virtual electronic medical record system is being deployed over the Internet with security in northern New Mexico using TeleMed, a multimedia medical records management system that uses CORBA-based client-server technology and distributed database architecture. The goal of the NNM Rural Telemedicine Project is to implement TeleMed into fifteen rural clinics and two hospitals within a 25,000 square mile area of northern New Mexico. Evaluation of the project consists of three components: job task analysis, audit of immunized children, and time motion studies. Preliminary results of the evaluation components are presented.
Prosolovska, Vita V.
The telemedicine optoelectronic biomedical data processing system is created to share medical information for the control of health rights and timely and rapid response to crisis. The system includes the main blocks: bioprocessor, analog-digital converter biomedical images, optoelectronic module for image processing, optoelectronic module for parallel recording and storage of biomedical imaging and matrix screen display of biomedical images. Rated temporal characteristics of the blocks defined by a particular triggering optoelectronic couple in analog-digital converters and time imaging for matrix screen. The element base for hardware implementation of the developed matrix screen is integrated optoelectronic couples produced by selective epitaxy.
Lee, Jaiho [KHNP-Central Research Institute, Daejeon (Korea, Republic of)
Hot process water is pumped from the plant process to the cooling towers. Heat is rejected through evaporation of the process water, interacting with ambient air blown upward by fans.. Plumes generated from exit ports of the cooling tower may have adverse effects on the environment, such as deposition of cooling tower drift release, fogging, icing, shadowing, and ground-level temperature and humidity increase. These kinds of environmental impact of the cooling tower are linked closely with the dispersion of the cooling tower plumes. In this respect, predicting the behavior of the plumes has become one of the most important issues in the environmental assessments of the cooling towers. The SACTI (seasonal/annual cooling tower impact) model is an analytical tool to predict the environmental effect of cooling tower, which was developed by Argonne National Laboratory and University of Illinois with support from EPRI (electric power research institute). The initial version of SACTI has been widely used to assess the environmental effect of cooling towers in many industrial fields such as steam power plants and NPPs. Guo et. al. investigated impact of heat rejection and cooling tower height on plume dispersion using the SACTI model, for the purpose of the future construction of inland NPPs. They found that increasing cooling tower height decreases the plume length and height frequencies. Their simulation results showed that the increase in heat rejection increases the plum radius frequency. The APR1400DC is an advanced light water reactor developed for the purpose of NRC-DC (design certification). The cooling towers for APR1400DC UHS consist of two linear mechanical draft cooling towers (LMDCTs). The LMDCT for APR1400DC UHS is conceptually designed because the plant site has not been decided yet. In the present study, the dependency of plume dispersion on the number of cooling towers is investigated using SACTI-2-beta, for predicting annual environmental effect of APR
Martiniuk, Alexandra; Negin, Joel; Hersch, Fred; Dalipanda, Tenneth; Jagilli, Rooney; Houasia, Patrick; Gorringe, Lilijana; Christie, Annie
Telemedicine has been used in the Solomon Islands since 2000. We used quantitative and qualitative methods to examine telemedicine use in the Solomon Islands from January 2006 to June 2009. During the study period 66 telemedicine cases were submitted to the store and forward telemedicine system being used there. These included orthopaedic, oncology, cardiothoracic, infectious, congenital, gastroenterology and dermatology cases. Most cases (52%) were submitted by doctors at the National Referral Hospital (NRH) in Honiara. The majority of responses came from the NRH (27%). A final, firm recommendation regarding patient diagnosis and/or care was given for 46% of the cases. Interviews were conducted with 23 stakeholders in the Solomon Islands and in Australia to better understand the current and future use of telemedicine. The interviews identified the fragility of the Solomon Islands infrastructure, including the lack of training, as the largest barrier to the future use of telemedicine. The best use of telemedicine appears to be case sharing within the Solomon Islands, with connections to clinicians in other countries as a secondary benefit when particular expertise is required.
Goodarzi, Maryam; Torabi, Mashallah; Safdari, Reza; Dargahi, Hossein; Naeimi, Sara
This paper introduces a telemedicine innovation network and reports its implementation in Tehran University of Medical Sciences. The required conditions for the development of future projects in the field of telemedicine are also discussed; such projects should be based on the common needs and opportunities in the areas of healthcare, education, and technology. The development of the telemedicine innovation network in Tehran University of Medical Sciences was carried out in two phases: identifying the beneficiaries of telemedicine, and codification of the innovation network memorandum; and brainstorming of three workgroup members, and completion and clustering ideas. The present study employed a qualitative survey by using brain storming method. Thus, the ideas of the innovation network members were gathered, and by using Freeplane software, all of them were clustered and innovation projects were defined. In the services workgroup, 87 and 25 ideas were confirmed in phase 1 and phase 2, respectively. In the education workgroup, 8 new programs in the areas of telemedicine, tele-education and teleconsultation were codified. In the technology workgroup, 101 and 11 ideas were registered in phase 1 and phase 2, respectively. Today, innovation is considered a major infrastructural element of any change or progress. Thus, the successful implementation of a telemedicine project not only needs funding, human resources, and full equipment. It also requires the use of innovation models to cover several different aspects of change and progress. The results of the study can provide a basis for the implementation of future telemedicine projects using new participatory, creative, and innovative models.
Full Text Available Kusta adalah penyakit menular yang disebabkan oleh basil lepra. Penderita kusta tersebar di seluruh Indonesia. Dalam Standar Kompetensi Dokter Indonesia, penanganan kusta tanpa komplikasi merupakankompetensi tingkat 4A, sedangkan penanganan reaksi kusta merupakan kompetensi tingkat 3A. Penanganankasus reaksi kusta dengan proses rujukan konvensional ke layanan kesehatan yang memilliki tenaga ahliterkendala oleh berbagai macam penyulit. Pemanfaatan teknologi smartphone berupa aplikasi Whatsapp,dengan menerapkan konsep telemedicine, diharapkan dapat menjadi solusi untuk meretas hambatanjarak, waktu dan finansial dalam proses rujukan pasien secara konvensional. Demi memberikan pelayanan kesehatan yang bersifat paripurna, sebaiknya konsep telemedicine dipelajari lebih lanjut dan diterapkan dalam pelayanan kesehatan. Kata Kunci: kusta, reaksi kusta, rujukan, smartphone, telemedicine, Whatsapp Telemedicine Application for Rural Patients’ Referral Abstract Leprosy is a communicable disease caused by leprosy bacillus. People with leprosy are distributed in all areas of Indonesia. In Indonesian Doctor Competence Standards, leprosy management is at level 4Acompetence; meanwhile leprosy reaction management is at level 3A competence. Management of leprosyreaction that needs a conventional referral to higher level of health centre has faced many obstacles.Smartphone instant messaging application (eg. Whatsapp utilizes the concept of telemedicine, which will bea solution in solving distance, time and financial problems in conventional referral process. In order to provideholistic health service, telemedicine should be learnt further and applied. Keywords: leprosy, leprosy reaction, referral, smartphone, telemedicine, Whatsapp
Guss, Benjamin; Mishkin, David; Sharma, Rahul
Some health systems are piloting telemedicine solutions in the ED to address crowding and decrease patient wait times. One new program, implemented at the Lisa Perry Emergency Center at New York Presbyterian (NYP) Weill Cornell Medical Center in New York, involves offering low-acuity patients the option of visiting an off-site physician via telemedicine hookup. Administrators note that the approach can get patients in and out of the ED within 30 minutes, and patients have thus far been highly satisfied with the approach. However, an earlier telemedicine program piloted at the University of San Diego Health System’s (UCSD) Hillcrest Hospital in 2013 got bogged down due to administrative and insurance reimbursement hurdles, although the approach showed enough promise that there is interest in restarting the program. In the NYP program, patients are identified as appropriate candidates for the program at triage. They can opt to be seen remotely or through traditional means in the ED’s fast-track section. Administrators note that patients with complex problems requiring extensive workups are not suitable for the telemedicine approach. The most challenging aspect of implementing a successful telemedicine program in the ED is getting the workflows right, according to administrators. An earlier ED-based telemedicine program piloted at UCSD ran into difficulties because the model required the involvement of two physicians, and some insurers did not want to pay for the telemedicine visits. However, patients were receptive.
Aas, I H Monrad
Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.
Zachrison, Kori S; Hayden, Emily M; Schwamm, Lee H; Espinola, Janice A; Sullivan, Ashley F; Boggs, Krislyn M; Raja, Ali S; Camargo, Carlos A
Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (ptelemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30-14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49]), and annual volume Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.
Solem, Courtney K.
Several fixed-winged airplanes have successfully used fly-by-wire (FBW) technology for the last 40 years. This technology is now beginning to be incorporated into rotary wing aircraft. By using FBW technology, manufacturers are expecting to improve upon the weight, maintenance time and costs, handling and reliability of the aircraft. Before mass production of this new system begins in new models such as the UH-60MU, testing must be conducted to insure the safety of this technology as well as to reassure others it will be worth the time and money to make such a dramatic change to a perfectly functional machine. The RASCAL JUH-60A has been modified for these purposes. This Black Hawk helicopter has already been equipped with the FBW technology and can be configured as a near perfect representation of the UH-60MU. Because both machines have very similar qualities, the data collected from the RASCAL can be used to make future decisions about the UH-60MU. The U.S. Army AFDD Flight Project Office oversees all the design modifications for every hardware system used in the RASCAL aircraft. This project deals with specific designs and analyses of unique RASCAL aircraft subsystems and their modifications to conduct flight mechanics research.
Full Text Available The presented research validates the capability of a loosely coupled computational fluid dynamics (CFD and comprehensive rotorcraft analysis (CRA code to calculate the flowfield around a rotor and test stand mounted inside a wind tunnel. The CFD/CRA predictions for the Full-Scale UH-60A Airloads Rotor inside the National Full-Scale Aerodynamics Complex (NFAC 40- by 80-Foot Wind Tunnel at NASA Ames Research Center are compared with the latest measured airloads and performance data. The studied conditions include a speed sweep at constant lift up to an advance ratio of 0.4 and a thrust sweep at constant speed up to and including stall. For the speed sweep, wind tunnel modeling becomes important at advance ratios greater than 0.37 and test stand modeling becomes increasingly important as the advance ratio increases. For the thrust sweep, both the wind tunnel and test stand modeling become important as the rotor approaches stall. Despite the beneficial effects of modeling the wind tunnel and test stand, the new models do not completely resolve the current airload discrepancies between prediction and experiment.
Abrego, Anita I.; Meyn, Larry; Burner, Alpheus W.; Barrows, Danny A.
Blade displacement measurements using multi-camera photogrammetry techniques were acquired for a full-scale UH-60A rotor, tested in the National Full-Scale Aerodynamic Complex 40-Foot by 80-Foot Wind Tunnel. The measurements, acquired over the full rotor azimuth, encompass a range of test conditions that include advance ratios from 0.15 to 1.0, thrust coefficient to rotor solidity ratios from 0.01 to 0.13, and rotor shaft angles from -10.0 to 8.0 degrees. The objective was to measure the blade displacements and deformations of the four rotor blades and provide a benchmark blade displacement database to be utilized in the development and validation of rotorcraft prediction techniques. An overview of the blade displacement measurement methodology, system development, and data analysis techniques are presented. Sample results based on the final set of camera calibrations, data reduction procedures and estimated corrections that account for registration errors due to blade elasticity are shown. Differences in blade root pitch, flap and lag between the previously reported results and the current results are small. However, even small changes in estimated root flap and pitch can lead to significant differences in the blade elasticity values.
Full Text Available Mobile Cloud Computing is a significant technology which combines emerging domains such as mobile computing and cloud computing which has conducted to the development of one of the most IT industry challenging and innovative trend. This is still at the early stage of devel-opment but its main characteristics, advantages and range of services which are provided by an internet-based cluster system have a strong impact on the process of developing telemedi-cine solutions for overcoming the wide challenges the medical system is confronting with. Mo-bile Cloud integrates cloud computing into the mobile environment and has the advantage of overcoming obstacles related to performance (e.g. battery life, storage, and bandwidth, envi-ronment (e.g. heterogeneity, scalability, availability and security (e.g. reliability and privacy which are commonly present at mobile computing level. In this paper, I will present a compre-hensive overview on mobile cloud computing including definitions, services and the use of this technology for developing telemedicine application.
Wong, Allan K Y; Lin, Wilfred W K; Dillon, Tharam S; Chang, Elizabeth J
Recent years have seen the development of two significant trends namely: the adoption of some Traditional Chinese Medicine Practices into mainstream Allopathic Western Medicine and the advent of the internet and broad band networks leading to an increased interest in the use of Telemedicine to deliver medical services. In this book, we see the convergence of these two trends leading to a semantically-based TCM Telemedicine system that utilizes an ontology to provide sharable knowledge in the TCM realm to achieve this. The underpinning research required the development of a three-layer architecture and an Ontology of the TCM knowledge. As TCM knowledge like all medical knowledge is not frozen in time it was important to develop an approach that would allow evolution of the Ontology when new evidence became available. In order for the system to be practically grounded it was important to work with an industry partner PuraPharm Group/HerbMiners Informatics Limited. This partnership was initiated through Professo...
Morand, J J
Telemedicine makes it possible to refer clinical, laboratory, and radiological questions to distant experts, sometimes in real time. This study examines a selection of internet messages sent by physicians carrying out overseas missions or assigned to remote locations and analyzes the interest but also the limitations of teleconsultations in dermatology. The effectiveness of the response depended on the quality of the message, including correct symptom descriptions, thorough history-taking, and the definition of the attached images, as well as the field experience of the specialists receiving the message. Feedback is also of fundamental importance in improving remote expert assessment. The main problem is that conclusive diagnosis is often prevented by the lack of equipment and follow-up available in the field, i.e., inability to perform confirmatory testing or obtain sufficient follow-up information to evaluate the outcome of trial treatments. Training of doctors and nurses in the French Army Medical Service in telemedicine and in clearer better structured messages can contribute to the effectiveness of this mode of communication.
and Cultural Affairs HD High Definition ISDN Integrates Services Digital Network IStTeH International Society for Telemedicine and eHealth IT...Lievens1,2, Marlina Jordanova, MD, PhD3,4 1International Society for Telemedicine & eHealth , Switzerland;2Med-e-Tel, Grimbergen, Belgium; 3Med-e-Tel...Approach F. Lievens 1,2,3, M. Jordanova 4,5 1 Board Member and Secretary, International Society for Telemedicine & eHealth (ISfTeH), Switzerland 2
Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali
Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in
Alajlani, Mohannad; Clarke, Malcolm
We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion.
Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.; Napolitano, Carlo
Ubiquity of Information and Communication Technology enables innovative telemedicine treatment applications for disease management of ambulant patients. Development of new treatment applications must comply with medical protocols and ‘way of working’ to obtain safety and efficacy evidence before
Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail
Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care
When Bagayoko chose telemedicine as the focus for his doctoral thesis, he knew it ... and new medical applications for information and communication technologies. While in Switzerland, Bagayoko came across mobile technology used for ski ...
McLean, Thomas R; McLean, Alexander B
At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law.
.... To best accomplish this, a strategic analysis and business case analysis was conducted. Introspective strategic analysis tools revealed an organization that is capable of supporting a telemedicine program at Fort Greely...
Nov 2, 2013 ... 'the use of information communication technology (ICT) for health'. .... Telemedicine serves the ethical principle of beneficence, in that ..... review of the uses, benefits, and limitations of social media for health communication.
.... All instruments were professionally printed. The consultant for the project was hired and telemedicine equipment was evaluated by the consultant based on clinical requirements defined by the research team...
Stoloff, P H; Garcia, F E; Thomason, J E; Shia, D S
The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost
Pierrakeas, C; Georgopoulos, V; Malandraki, G
The use of telemedicine in speech and language pathology provides patients in rural and remote areas with access to quality rehabilitation services that are sufficient, accessible, and user-friendly leading to new possibilities in comprehensive and long-term, cost-effective diagnosis and therapy. This paper discusses the use of online collaboration environments for various telemedicine applications of speech therapy which include online group speech therapy scenarios, multidisciplinary clinical consulting team, and online mentoring and continuing education.
Di Cerbo A
Full Text Available Alessandro Di Cerbo,1,2 Julio Cesar Morales-Medina,3 Beniamino Palmieri,1,2 Tommaso Iannitti4 1Poliambulatorio del Secondo Parere, 2Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy; 3Centro de Investigación en Reproducción Animal, CINVESTAV, Universidad Autónoma de Tlaxcala, Tlaxcala de Xicohténcatl, Mexico; 4Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN, University of Sheffield, Sheffield, UK Background: The use of telemedicine has grown across several medical fields, due to the increasing number of “e-patients”.Objective: This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care.Methods: A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty.Results: Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions.Conclusion: Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time. Keywords: telemedicine, health care, patient
It is important to bring medical help to those living in West Africa. A good way to do this is by telemedicine. Telemedicine, although it uses power, can be achieved easily with solar panels, and the best solar panels are monocrystalline and cadmium telluride. Using graphical scenarios, statistical derivations, theoretical ideologies acquired from literature reviews, usability ideas and two personal case scenarios, the objective of this project was achieved. Criteria like cost, temperatur...
Marrugo, A.; Millán, M. S.; Cristóbal, G.; Gabarda, S.; Šorel, Michal; Šroubek, Filip
Roč. 2012, č. 6 (2012), s. 1-3 ISSN 1818-2259 R&D Projects: GA MŠk 1M0572 Institutional research plan: CEZ:AV0Z10750506 Institutional support: RVO:67985556 Keywords : computer-aided diagnosis * medical and retinal image * deconvolution * telemedicine Subject RIV: JD - Computer Applications, Robotics http://library.utia.cas.cz/separaty/2012/ZOI/sorel-toward computer-assisted diagnosis and telemedicine in ophthalmology.pdf
Angaran, D M
Uses of telemedicine are described and potential roles for pharmacists are discussed. Telemedicine has been defined as "the use of electronic information and communications technologies to provide and support health care when distance separates the participants." Technologies included in telemedicine are videoconferencing, telephones, computers, the Internet, fax, radio, and television. Telepharmacy has the same basic definition but refers to pharmaceutical care provision. Although the videotelemedicine market is expected to grow considerably, lack of reimbursement and high costs are continuing obstacles. Pharmacy is using video-conferencing for education, training, and management purposes. The telephone has changed from a dial-and-talk instrument to a multimedia access tool. Medical devices are being attached to telephone lines to provide remote monitoring and therapy, and call centers are providing medication counseling, prior authorization, refill authorization, and formulary compliance monitoring. Although the Internet has quickly become a star performer, utilization by health care lags behind that of other industries. The Internet-fueled empowerment of consumers and their expectations for speed, access, and convenience are creating more unmet expectations of the traditional health care system. Pharmacy has both organizational and individual practitioner Web sites, but it is online drugstores that are attracting most attention. Potential benefits of telemedicine include improved access to care, greater efficiency in diagnosis and treatment, higher productivity, and market positioning for the coming century. Telemedicine will tax the economic, regulatory, legal, ethical, and clinical care expertise of the entire health care system. Studies of the effectiveness, cost, and societal implications of telemedicine are needed, along with practice models and standards, training programs, and solutions to regulatory, licensing, and legal questions. Securing reimbursement
Park, Dong Kyun; Young Jung, Eun; Chan Moon, Byung
This paper will cover definition and history of telemedicine, changes in medical paradigm and roll of telemedicine and roll of nano-technology for evolution of telemedicine. Hypothetically, telemedicine is distance communication for medical purpose and modern definition explains telemedicine as `a system of health care delivery in which physicians examine distant patients through the use of telecommunications technology. Medical service will change to personalized medicine based on gene information to prevent and manage diseases due to decrease of acute diseases, population aging and increase of prevalence in chronic diseases, which means current medical services based on manualized treatment for diseases will change to personalized medicine based on individual gene information. Also, international healthcare will be activated to provide high quality medical services with low cost using developed transportation. Moreover, hospital centered medical services will change to patients centered medical service due to increase of patient's rights. Development in sensor technology is required for telemedicine to be applied as basic infrastructure for medical services. Various researches in nano-biosensor field are conducted due to introduction of new technologies. However, most researches are in fundamental levels that requires more researches for stability and clinical usefulness. Nano technology is expected to achieve innovative development and define new criteria for disease prevention and management.
Ahn, Joongha; Shin, Jungwoo; Lee, Jongsu; Shin, Kwangsoo; Park, Hayoung
The scope of healthcare has been expanding from caring for sick people to keeping people from becoming sick, and telemedicine will play a significant role in this new healthcare paradigm. This study investigated consumer preferences and willingness to pay for attributes of telemedicine services in South Korea. A market simulation was conducted to examine the market shares of alternative services and their relationships to the perceived usefulness of service types and preferred device types. Using a conjoint survey, we collected data on consumer preferences for six telemedicine service attributes. Data analysis used the Bayesian mixed logit model. The market simulation estimated the probabilities of a specific service alternative being chosen using estimated model coefficients. Wearable devices were the most preferred, followed by smart-home and smartphone devices. Consumers perceived managing blood glucose to be the most useful telemedicine service, followed by monitoring oxygen saturation and blood pressure. The market simulation indicated that consumer preferences for device types were associated with the types of chronic diseases for which management through telemedicine services is perceived to be useful. As the focus of healthcare moves from treating patients to keeping individuals healthy, a key factor for the successful deployment of telemedicine services is understanding consumer perceptions and attitudes. The results of this study revealed the dynamics of consumer preferences with regard to service attributes.
We examined the use of telemedicine at two major medical institutions in Ghana. Doctors and administrators were surveyed to assess their knowledge of computers and familiarity with telemedicine. The use of modern telecommunications and information technology products within the health service was also examined. Thirty questionnaires were distributed to staff at the two hospitals, one urban and one rural. Twenty were returned (a response rate of 67%). Although most of the respondents were computer literate, they were less familiar with telemedicine applications. Only a minority of the respondents were participating in an information-sharing network, transmitting information by fax or telephone, or had Internet access. Financial constraint appeared to be the major barrier to establishing information-sharing networks. Other constraints were technological and organizational. The respondents expressed an interest in using telemedicine, having access to health-care databases and specific telemedicine applications such as tele-education and videoconferencing. Staff in the urban hospital were more likely to be familiar with telemedicine and more likely to have access to information technology than those in the rural hospital.
Adenuga, Kayode I; Iahad, Noorminshah A; Miskon, Suraya
Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (ptelemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians. Copyright © 2017. Published by Elsevier B.V.
Patil, Seema A; Cross, Raymond K
Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing.Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered.Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.
The instability of a low density, electron beam drifting along a magnetic field to nearly perpendicular propagating electrostatic waves near the upper hybrid frequency is investigated for application to an auroral environment. It was found that 4 to 10 KeV beams can interact significantly with the background plasma through anomalous cyclotron resonances which extend the range of unstable parallel wave numbers over a large region of wave number space. This region can include a nonconvective hot spot where the group velocity of the unstable waves approaches zero. Positive slope in the total distribution function is not a necessary requirement for instability; the broken symmetry along the field can allow the transfer of beam drift energy to electrostatic wave turbulence. Using Gurnett's (1974) polar ionospheric model for a representative auroral field line modeled as dipolar (L = 8), one infers that certain heights favor generation of enhanced, beamdriven electrostatic turbulence. Those regions are in the vicinity of where ω/sub UH//Ω/sub c/ approx. 3/2 with an excursion from this value depending on beam parameters. We speculate that electrostatic turbulence will heat the background electrons to a limiting temperature such that the instability becomes marginally effective. This limiting temperature is estimated for auroral beam-plasma conditions as 1 to 6 eV. Quasi-linear beam moment equations are developed to compute an upper bound to electrostatic wave amplitudes that can be maintained by the beam. We find that energy densities approaching E 2 /8πnT approx. 1 over auroral scale lengths can result in effective energy transfer from the beam to the plasma
Full Text Available Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks.
LeRouge, Cynthia; Garfield, Monica J.
Barriers have challenged widespread telemedicine adoption by health care organizations for 40 years. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. The article canvasses recent trends—events and activities in each of these areas as well as US health reform activities that might help to break down these barriers. The key to telemedicine success in the future is to view it as an integral part of health care services and not as a stand-alone project. Telemedicine must move from experimental and separate to integrated and equivalent to other health services within health care organizations. Furthermore, telemedicine serves as vital connective tissue for expanding health care organization networks. PMID:24287864
Lakhe, Aparna; Sodhi, Isha; Warrier, Jyothi; Sinha, Vineet
The stethoscope is a medical acoustic device which is used to auscultate internal body sounds, mainly the heart and lungs. A digital stethoscope overcomes the limitations of a conventional stethoscope as the sound data is transformed into electrical signals which can be amplified, stored, replayed and, more importantly, sent for an expert opinion, making it very useful in telemedicine. With the above in view, a low cost digital stethoscope has been developed which is interfaceble with mobile communication devices. In this instrument sounds from various locations can be captured with the help of an electret condenser microphone. Captured sound is filtered, amplified and processed digitally using an adaptive line enhancement technique to obtain audible and distinct heart sounds.
Full Text Available The medical system is facing a wide range of challenges nowadays due to changes that are taking place in the global healthcare systems. These challenges are represented mostly by economic constraints (spiraling costs, financial issues, but also, by the increased emphasis on accountability and transparency, changes that were made in the education field, the fact that the biomedical research keeps growing in what concerns the complexities of the specific studies etc. Also the new partnerships that were made in medical care systems and the great advances in IT industry suggest that a predominant paradigm shift is occurring. This needs a focus on interaction, collaboration and increased sharing of information and knowledge, all of these may is in turn be leading healthcare organizations to embrace the techniques of data mining in order to create and sustain optimal healthcare outcomes. Data mining is a domain of great importance nowadays as it provides advanced data analysis techniques for extracting the knowledge from the huge volumes of data collected and stored by every system of a daily basis. In the healthcare organizations data mining can provide valuable information for patient's diagnosis and treatment planning, customer relationship management, organization resources management or fraud detection. In this article we focus on describing the importance of data mining techniques and systems for healthcare organizations with a focus on developing and implementing telemedicine solution in order to improve the healthcare services provided to the patients. We provide architecture for integrating data mining techniques into telemedicine systems and also offer an overview on understanding and improving the implemented solution by using Business Process Management methods.
Hahm, Joon Soo; Shimizu, Shuji; Nakashima, Naoki; Byun, Tae Jun; Lee, Hang Lak; Choi, Ho Soon; Ko, Yong; Lee, Kyeong Geun; Kim, Sun Il; Kim, Tae Eun; Yun, Jiwon; Park, Yong Jin
The growth of technology based on internet protocol has affected on the informatics and automatic controls of medical fields. The aim of this study was to establish the telemedical educational system by developing the high quality image transfer using the DVTS (digital video transmission system) on the high-speed internet network. Using telemedicine, we were able to send surgical images not only to domestic areas but also to international area. Moreover, we could discuss the condition of surgical procedures in the operation room and seminar room. The Korean-Japan cable network (KJCN) was structured in the submarine between Busan and Fukuoka. On the other hand, the Korea advanced research network (KOREN) was used to connect between Busan and Seoul. To link the image between the Hanyang University Hospital in Seoul and Kyushu University Hospital in Japan, we started teleconference system and recorded image-streaming system with DVTS on the circumstance with IPv4 network. Two operative cases were transmitted successfully. We could keep enough bandwidth of 60 Mbps for two-line transmission. The quality of transmitted moving image had no frame loss with the rate 30 per second. The sound was also clear and the time delay was less than 0.3 sec. Our study has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video transmission over internet protocol. It is easy to perform, reliable, and also economical. Thus, it will be a promising tool in remote medicine for worldwide telemedical communication in the future.
Finet, Philippe; Gibaud, Bernard; Dameron, Olivier; Le Bouquin Jeannès, Régine
The number of patients with complications associated with chronic diseases increases with the ageing population. In particular, complex chronic wounds raise the re-admission rate in hospitals. In this context, the implementation of a telemedicine application in Basse-Normandie, France, contributes to reduce hospital stays and transport. This application requires a new collaboration among general practitioners, private duty nurses and the hospital staff. However, the main constraint mentioned by the users of this system is the lack of interoperability between the information system of this application and various partners' information systems. To improve medical data exchanges, the authors propose a new implementation based on the introduction of interoperable clinical documents and a digital document repository for managing the sharing of the documents between the telemedicine application users. They then show that this technical solution is suitable for any telemedicine application and any document sharing system in a healthcare facility or network.
Kori S. Zachrison
Full Text Available Introduction: Telemedicine connects emergency departments (ED with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. Methods: We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195 in the six New England states (excluding federal hospitals and college infirmaries. Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Results: Of the 169 responding EDs (87% response rate, 82 (49% reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03; less likely to be academic (1% of users vs. 11% of non-users, p=0.01; and less likely to have 24/7 access to neurology (p<0.001, neurosurgery (p<0.001, orthopedics (p=0.01, plastic surgery (p=0.01, psychiatry (p<0.001, and hand surgery (p<0.001 consultants. Neuro/stroke (68%, pediatrics (11%, psychiatry (11%, and trauma (10% were the most commonly reported applications. On multivariable analysis, telemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30–14.86, and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09–0.49], and annual volume <20,000 (OR 0.24, 95% CI [0.08–0.68]. Conclusion: Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.
Barbosa, Ana Karina P; de A Novaes, Magdala; de Vasconcelos, Alexandre M L
This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system's conceptual model, including the tele-diagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented.
Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. © 2013.
Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models
Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.
... 7 Agriculture 11 2010-01-01 2010-01-01 false Distance Learning and Telemedicine Loan and Grant... § 1700.31 Distance Learning and Telemedicine Loan and Grant Program. RUS, through the Telecommunications Program, makes grants and loans to furnish and improve telemedicine services and distance learning...
Telemedical applications like the electronic patient file, the electronic physician's letter and the electronic consultation ("Telekonsil"), the electronic prescription, the electronic patient's card (the "patient smart card") facilitate and improve the processing of sensitive medical data as well as the possibilities for using medical resources in an unusual degree and can thereby substantially contribute to the well-being of the patient. However, improving the quality of medical supply must not lead to a degradation of the patients' rights, in particular their right of self-determination. The introduction and the use of telemedical applications do not change the legal basic conditions for medical data processing. Therefore, a patient-friendly telemedicine must include data protection as well. Data protective telemedicine requires medical secrecy ensuring the patients' rights of information and transparency, correction of false and the up-to-date deletion of information that is no longer necessary, as well as secure data processing. All electronic processing of patients' data must meet the requirements of data security, i.e. the confidentiality, the integrity, the availability of the data at any time and the verifiability of the data processing have to be guaranteed. For this, electronic signatures and encodings have to be used, medical information systems have to be protected effectively against any risks resulting from open networks, particularly the Internet, and data processing has to be monitored. Electronic patient files may be open only to the treating physician and the medical assistants up to the necessary extent, ensuring the possibility of an emergency access. Any access beyond that does require the special consent of the patient. The medical secrecy has to be ensured. The electronic prescription with a documentation of the patient's medication requires the consent of the patient and must protect the rights of the physicians. In particular it has to
Durupt, Maxime; Bouchy, Olivier; Christophe, Sonia; Kivits, Joëlle; Boivin, Jean-Marc
Introduction: Telemedicine is a rapidly growing new mode of healthcare practice. It is particularly used and needed in remote areas in Lorraine (North East of France) that currently face a shortage of general practitioners and specialists. The objective of this study was to analyse general practitioner’s representations of telemedicine and teleconsultation. The study also identified the advantages and disadvantages of this new mode of medical practice. Methods: A qualitative research was led: 5 focus groups were conducted with 32 doctors in areas faced with the problems of health professional shortages between June 2014 and July 2015. Results: This study reveals a general ignorance of telemedicine. Doctors want to play a central role in this new form of medical practice which must remain optional. Their reluctance essentially concerns financial and legal aspects that constitute obstacles to the development of telemedicine. Finally, this new mode of medical practice must comply with a legal framework regarding medical responsibility and personal data protection. Discussion.More than 100 medical procedures are delivered by telemedicine in Lorraine each month. This new technology is a solution to provide healthcare services in medically underserved areas. However, general practitioners want to preserve the “doctor-patient” relationship and do not wish to change their practice.
Costello, Aimee G; Nugent, Bethany D; Conover, Noelle; Moore, Amanda; Dempsey, Kathleen; Tersak, Jean M
With an increasing number of childhood cancer survivors (CCSs), determining the best model of survivorship transition care is becoming a growing priority. Shared care between pediatric oncology and adult primary care is often necessary, making survivorship a time of transition, but effective standard models are lacking. We sought to provide a more integrated approach to transition using telemedicine. Recruited primary care provider/CCS dyads were instructed to log-in to a password-protected virtual meeting room using telemedicine equipment at the time or a regularly scheduled office visit. Dyads were joined by a pediatric survivorship clinic team member who conducted the telemedicine portion of the transition visit, which consisted of the review of an individualized treatment summary and care plan. Postquestionnaires were developed to evaluate key points such as fund of knowledge, satisfaction with the visit, and effectiveness of this electronic tool. There were 19 transition visits conducted, 13 of which used the telemedicine equipment as planned. Those that did not use the equipment were primarily unable to due to technical difficulties. Postquestionnaires were overall positive, confirming increased knowledge, comfort and abilities, and patient satisfaction in survivorship care. Negative comments were primarily related to equipment difficulties. A gap still remains in helping CCSs transition from oncology to primary care and this pilot study offered insights into how we might better bridge that gap through the use of telemedicine. Further research is needed to refine the transition process for CCSs, including evaluation and testing models for standard of care.
Nicogossian, A. E.; Pober, D. F.; Roy, S. A.
Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.
Lugo, Vera; Villanueva, Jair Asir; Garmendia, Onintza; Montserrat, Josep M
Obstructive sleep apnea (OSA) is a common disease that leads in notorious symptoms and comorbidities. Although general measures are important, continuous positive airway pressure (CPAP) is the best treatment option. However, compliance can be suboptimal and telemedicine may play a role to improve it. Areas covered: Review authors searched EMBASE, PubMed and Cochrane data bases using the following keywords: continuous positive airway pressure, Obstructive sleep apnea, telemedicine, respiratory telemedicine, information and communication technology. Papers published between 2000 and 2016 in English language were considered. Expert commentary: To improve OSA management, there is a pressing need to develop new cost-effective strategies, particularly those related to OSA treatment, from measures such as lifestyle changes to CPAP use. Two broad strategies should be implemented: 1) adequate pre-, peri-, and post-titration measures to ensure correct diagnosis, adequate training, and appropriate support during follow up; and 2) the use of technological advances including both the optimization of CPAP devices and the use of telemedicine, specially focused on the first days or weeks of treatment. Telemedicine can help with these processes, especially when it is personalized to the needs of each patient group.
Worster, Brooke; Swartz, Kristine
With the emergence of telemedicine as a routine form of care in various venues, the opportunities to use technology to care for the most vulnerable, most ill cancer patients are extremely appealing. Increasingly, evidence supports early integration of palliative care with standard oncologic care, supported by recent NCCN guidelines to increase and improve access to palliative care. This review looks at the use of telemedicine to expand access to palliative care as well as provide better care for patients and families where travel is difficult, if not impossible. When telemedicine has been used, often in Europe, for palliative care, the results show improvements in symptom management, comfort with care as well as patient and family satisfaction. One barrier to use of telemedicine is the concerns with technology and technology-related complications in population that is often elderly, frail and not always comfortable with non-face-to-face physician care. There remain significant opportunities to explore this intersection of supportive care and telemedicine.
Chen, Yu-Cheng; Lee, Wen-Jhy; Uang, Shi-Nian; Lee, Su-Hsing; Tsai, Perng-Jy
The objective of this study is to characterize the emissions of polycyclic aromatic hydrocarbons (PAHs) from a UH-1H helicopter turboshaft engine and its impact on the ambient environment. Five power settings of the ground idle (GI), fly idle (FI), beed band check (BBC), inlet guide vane (IGV), and take off (TO) were selected and samples were collected from the exhaust by using an isokinetic sampling system. Twenty-two PAH compounds were analyzed by gas chromatograph (GC)/MS. We found the mean total PAH concentration in the exhaust of the UH-1H engine (843 μg m -3) is 1.05-51.7 times in magnitude higher than those of the heavy-duty diesel (HDD) engine, motor vehicle engine, and F101 aircraft engine. Two- and three-ringed PAHs account for 97.5% of total PAH emissions from the UH-1H engine. The mean total PAH and total BaP eq emission factors for the UH-1H engine (63.4 and 0.309 mg L -1·fuel) is 1.65-23.4 and 1.30-7.54 times in magnitude higher than those for the motor vehicle engine, HDD engine, and F101 aircraft engine. The total emission level of the single PAH compound, BaP, for the UH-1H engine (EL BaP) during one landing and take off (LTO) cycle (2.19 mg LTO -1) was higher than the European Commission standard (1.24 mg LTO -1) suggesting that appropriate measures should be taken to reduce PAH emissions from UH-1H engines in the future.
Full Text Available User surveys in telemedicine networks confirm that follow up data are essential, both for the specialists who provide advice and for those running the system. We have examined the feasibility of a method for obtaining follow-up data automatically in a store-and-forward network. We distinguish between follow-up, which is information about the progress of a patient and is based on outcomes, and user feedback, which is more general information about the telemedicine system itself, including user satisfaction and the benefits resulting from the use of telemedicine. In the present study, we were able to obtain both kinds of information using a single questionnaire. During a 9-month pilot trial in the MSF telemedicine network, an email request for follow-up was sent automatically by the telemedicine system to each referrer exactly 21 days after the initial submission of the case. A total of 201 requests for follow-up were issued by the system and these elicited 41 responses (a response rate of 20%. The responses were largely positive. For example, 95% of referrers found the advice helpful, 90% said that it clarified their diagnosis, 94% said that it assisted with management of the patient and 95% said that the telemedicine response was of educational benefit to them. Analysis of the characteristics of the referrers who did not respond, and their cases, did not suggest anything different about them in comparison with referrers who did respond. We were not able to identify obvious factors associated with a failure to respond. Obtaining data by automatic request is feasible. It provides useful information for specialists and for those running the network. Since obtaining follow-up data is essential to best practice, one proposal to improve the response rate is to simplify the automatic requests so that only patient follow-up information is asked for, and to restrict user feedback requests to the cases being assessed each month by the quality assurance
Full Text Available This paper proposes and evaluates an algorithm to automatically detect the cataracts from color images in adult human subjects. Currently, methods available for cataract detection are based on the use of either fundus camera or Digital Single-Lens Reflex (DSLR camera; both are very expensive. The main motive behind this work is to develop an inexpensive, robust and convenient algorithm which in conjugation with suitable devices will be able to diagnose the presence of cataract from the true color images of an eye. An algorithm is proposed for cataract screening based on texture features: uniformity, intensity and standard deviation. These features are first computed and mapped with diagnostic opinion by the eye expert to define the basic threshold of screening system and later tested on real subjects in an eye clinic. Finally, a tele-ophthamology model using our proposed system has been suggested, which confirms the telemedicine application of the proposed system.
Mat Kiah, M L; Al-Bakri, S H; Zaidan, A A; Zaidan, B B; Hussain, Muzammil
One of the applications of modern technology in telemedicine is video conferencing. An alternative to traveling to attend a conference or meeting, video conferencing is becoming increasingly popular among hospitals. By using this technology, doctors can help patients who are unable to physically visit hospitals. Video conferencing particularly benefits patients from rural areas, where good doctors are not always available. Telemedicine has proven to be a blessing to patients who have no access to the best treatment. A telemedicine system consists of customized hardware and software at two locations, namely, at the patient's and the doctor's end. In such cases, the video streams of the conferencing parties may contain highly sensitive information. Thus, real-time data security is one of the most important requirements when designing video conferencing systems. This study proposes a secure framework for video conferencing systems and a complete management solution for secure video conferencing groups. Java Media Framework Application Programming Interface classes are used to design and test the proposed secure framework. Real-time Transport Protocol over User Datagram Protocol is used to transmit the encrypted audio and video streams, and RSA and AES algorithms are used to provide the required security services. Results show that the encryption algorithm insignificantly increases the video conferencing computation time.
Houtchens, B A; Clemmer, T P; Holloway, H C; Kiselev, A A; Logan, J S; Merrell, R C; Nicogossian, A E; Nikogossian, H A; Rayman, R B; Sarkisian, A E
The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Houtchens, B A; Clemmer, T P; Holloway, H C; Kiselev, A A; Logan, J S; Merrell, R C; Nicogossian, A E; Nikogossian, H A; Rayman, R B; Sarkisian, A E; Siegel, J H
The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Willis, Charles E.; Leckie, Robert G.; Brink, Linda; Goeringer, Fred
The Telemedicine Spacebridge to Moscow was a series of intercontinental sessions sponsored jointly by NASA and the Moscow Academy of Medicine. To improve the quality of medical images presented, the MDIS Project developed a workstation for acquisition, storage, and interactive display of radiology and pathology images. The workstation was based on a Macintosh IIfx platform with a laser digitizer for radiographs and video capture capability for microscope images. Images were transmitted via the Russian Lyoutch Satellite which had only a single video channel available and no high speed data channels. Two workstations were configured -- one for use at the Uniformed Services University of Health Sciences in Bethesda, MD. and the other for use at the Hospital of the Interior in Moscow, Russia. The two workstations were used may times during 16 sessions. As clinicians used the systems, we modified the original configuration to improve interactive use. This project demonstrated that numerous acquisition and output devices could be brought together in a single interactive workstation. The video images were satisfactory for remote consultation in a grand rounds format.
Surveys can be used in the evaluation of telemedicine applications but they must be properly designed, consistent and accurate. The purpose of the survey and the resources available will determine the extent of testing that a survey instrument should undergo prior to its use. The validity of an instrument is the correspondence between what is being measured and what was intended to be measured. The reliability of an instrument describes the 'consistency' or 'repeatability' of the measurements made with it. Survey instruments should be designed and tested following basic principles of survey development. The actual survey administration also requires consideration, for example data collection and processing, as well as the interpretation of the findings. Surveys are of two different types. Either they are self-administered, or they are administered by interview. In the latter case, they may be administered by telephone or in a face-to-face meeting. It is important to design a survey instrument based on a detailed definition of what it intends to measure and to test it before administering it to the larger sample.
Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.
Daly, H L
Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.
Murchison, Ann P; Haller, Julia A; Mayro, Eileen; Hark, Lisa; Gower, Emily; Huisingh, Carrie; Rhodes, Lindsay; Friedman, David S; Lee, David J; Lam, Byron L
Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.
Full Text Available For 18 years, the American Telemedicine Association (ATA Annual International Meeting & Exposition has been the premier forum for professionals in the telemedicine, telehealth and mHealth space -- one of the fastest growing meetings in the country. ATA 2013 is on course to be the largest ATA meeting ever, with over 6,000 projected attendees. The program will include 500 educational sessions and posters, highlighting the latest innovations, applications and research in telemedicine. The 2013 exhibit hall will feature nearly 300 of the leading vendors in remote healthcare technologies. With over 6000 projected attendees, from all around the world, there's no better place to meet and network with your peers and thought leaders in the field. Detailed program information--including courses, sessions and CME information--will be available January 2013 at:http://www.americantelemed.org.
Olsen, D.R.; Bruland, O.S.; Davis, B.J.
Telemedicine facilitates decentralized radiotherapy services by allowing remote treatment planning and quality assurance of treatment delivery. A prerequisite is digital storage of relevant data and an efficient and reliable telecommunication system between satellite units and the main radiotherapy clinic. The requirements of a telemedicine system in radiotherapy is influenced by the level of support needed. In this paper we differentiate between three categories of telemedicine support in radiotherapy. Level 1 features video conferencing and display of radiotherapy images and dose plans. Level 2 involves replication of selected data from the radiotherapy database - facilitating remote treatment planning and evaluation. Level 3 includes real-time, remote operations, e.g. target volume delineation and treatment planning performed by the team at the satellite unit under supervision and guidance from more experienced colleagues at the main clinic. (author)
Rasmussen, O. W.; Lauszus, Finn F; Loekke, M
Introduction Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared...... telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes. Methods Forty patients with type 2 diabetes mellitus allocated from October 2011-July 2012 were randomized to either treatment at home...... by video conferences only or standard outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-hour blood pressure, cholesterol levels and albuminuria. The video-telephone was a broadband solution installed and serviced by the Danish Telephone Company (TDC...
Jakobsen, Neel Kolthoff; Jensen, Lena Sundby; Kayser, Lars
Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were documented and disseminated. Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted and information about project results and dissemination were obtained. More than half of all projects were disseminated to professionals as well as to the public and used two-way communication. However, it was generally difficult to obtain an overview of the projects due to dynamic changes in names and scopes. We propose that the funding authorities require designs comprising proper evaluation models that will subsequently allow the investigators to publish their findings. Furthermore, a dissemination plan comprising both peers and other professions should be made mandatory. The investigators should ensure proper documentation and dissemination of changes both during and after the projects in order to ensure transparency, and national or international organisations should establish a database with relevant data fields. not relevant. not relevant.
Latifi, Rifat; Dasho, Erion; Merrell, Ronald C; Lopes, Miguel; Azevedo, Vanda; Bekteshi, Flamur; Osmani, Kalterina L; Qesteri, Orland; Kucani, Julian; Lecaj, Ismet
Telemedicine and e-health have been suggested as one solution for closing the health disparity gap between the developed world and the developing world. Yet evidence is lacking from current successful programs in the developing world and, in particular, from sub-Saharan Africa. The primary objective of our study was to present the preliminary results of our efforts in building the Integrated Telemedicine and e-Health Program for Cabo Verde (ITeHP-CV), with an emphasis on initial utilization and results. This is a prospective study of data collected while we worked to establish a fully functional, integrated national telemedicine network and virtual education network in Cabo Verde. We used the International Virtual e-Hospital Foundation strategic approach known as "initiate-build-operate-transfer" over a 26-month period (November 2011-December 2013). We describe herein the five main pillars of this process that have been implemented: (1) capacity building; (2) network development and deployment of equipment; (3) implementation of clinical telemedicine; (4) implementation of activities related to continuing medical education, delivered from within the country and from abroad; and (5) establishment and use of the electronic virtual library. Based on comprehensive technical and medical assessment of the country's needs, 10 fully functional telemedicine centers in all nine inhabited islands of the Republic of Cabo Verde have been established. RESULTS are presented under the five main pillars of capacity building, network deployment, implementation of clinical telemedicine, implementation of continuing medical education activities, and establishment of the electronic virtual library. The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure
Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.
BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource
Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy
Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care
Barsten, K. N.; Watkins, S. D.; Otto, C.; Baumann, D. K.
The Exploration Medical Capability Element of the Human Research Program at NASA Johnson Space Center hosted the Telemedicine Workshop in January 2011 to discuss the medical operational concept for a crewed mission to a near-Earth asteroid (NEA) and to identify areas for future work and collaboration. With the increased likelihood of a medical incident on a long duration exploration mission to a near-Earth asteroid, as well as the fact that there will likely be limited medical capabilities and resources available to diagnose and treat medical conditions, it is anticipated that a more structured use of telemedicine will become highly desirable. The workshop was convened to solicit expert opinion on current telemedicine practices and on medical care in remote environments. Workshop Objectives: The workshop brought together leaders in telemedicine and remote medicine from The University of Texas Medical Branch, Henry Ford Hospital, Ontario Telemedicine Network, U.S. Army Institute of Surgical Research, University of Miami, American Telemedicine Association, Doctors Without Borders, and the Pan American Health Organization. The primary objectives of the workshop were to document the medical operations concept for a crewed mission to a NEA, to determine gaps between current capabilities and the capabilities outlined in the operations concept, to identify research required to close these gaps, and to discuss potential collaborations with external-to-NASA organizations with similar challenges. Summary of Discussions and Conclusions: The discussions held during the workshop and the conclusions reached by the workshop participants were grouped into seven categories: Crew Medical Officers, Patient Area in Spacecraft, Training, Electronic Medical Records, Intelligent Care Systems, Consultation Protocols, Prophylactic Surgical Procedures, and Data Prioritization. The key points discussed under each category will be presented.
Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P
Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.
Gilmore, Amanda K; Ward-Ciesielski, Erin F
Introduction Suicide is a major public health problem and its human, emotional, and economic costs are significant. Individuals in rural areas are at highest risk for suicide. However, telemedicine services are typically not rendered to individuals who are actively suicidal. The goals of the current study were to identify the risks of using telemedicine for mental healthcare from the perspective of licensed mental health providers and to determine factors associated with the use of telemedicine with patients who are at high risk for suicide. Methods A total of 52 licensed mental health providers were recruited online through several professional organization listservs and targeted emails. Providers completed online questionnaires regarding demographics, caseload of suicidal patients, perceived risks for using telemedicine with patients at risk for suicide, attitudes towards telemedicine, and use of telemedicine with patients at risk for suicide. Results Three key perceived risks associated with using telemedicine were identified, including assessment, lack of control over patient, and difficulties triaging patients if needed. It was also found that individuals who had more positive attitudes towards telemedicine, younger providers, and more experienced providers were more likely to use telemedicine with patients who are at high risk for suicide. Discussion To our knowledge, this is the first study to examine the perceived risks and use of telemedicine with patients at high risk for suicide. It is essential to continue this line of research to develop protocols for the provision of evidence-based therapy via telemedicine for this high-risk group.
Full Text Available This study scrutinizes telemedicine networks with regard to regionalization and the propensities and determinants of core telemedicine users (doctors and patients by employing two case areas, Choongbook in Korea and Kagawa in Japan. According to the results, telemedicine networks in Choongbook are dominated by an inter-regional level (in particular, a national level, and most of the telemedicine networks are observed between clinical sites in Choongbook and tertiary care centers in Kyunggi. In contrast, telemedicine networks in Kagawa are dispersed within the diagnostic boundary of Kagawa at a regional level. Interviews with crucial decision-makers revealed the reasons why many patients enjoy health care via telemedicine at an inter-regional level, which include psychological considerations regarding quality and level of health care services, personal stakes in telemedicine service sites, acceptability and credibility of good tertiary care centers, and easy access to and use of medical institutions. In Kagawa, both the existing health care system and the telemedicine system support the maintenance of stable regional health care within Kagawa. Importantly, human relationships based on the regional health care system contribute to creating telemedicine networks within the original purpose of the telemedicine system regarding regionalization. Also, telemedicine’s technological value, convenience, and utility are associated with the regionalization of telemedicine networks within one diagnostic area.
Full Text Available Artificial intelligence is assuming an increasing important role in the telemedicine field, especially neural networks with their ability to achieve meaning from large sets of data characterized by lacking exactness and accuracy. These can be used for assisting physicians or other clinical staff in the process of taking decisions under uncertainty. Thus, machine learning methods which are specific to this technology are offering an approach for prediction based on pattern classification. This paper aims to present the importance of neural networks in detecting trends and extracting patterns which can be used within telemedicine domains, particularly for taking medical diagnosis decisions.
Full Text Available The use of assistive technology and telemedicine is likely to continue to shape our medical practice in the future, notably in the field of sleep medicine, especially within developed countries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS is increasing. Telemedicine (TM can be used in a variety of ways in sleep medicine: telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure devices. In this review, we aim to summarize the recent scientific progresses of these techniques and their potential clinical applications and give consideration to the remaining problems related to TM application.
Cadilhac, Dominique A; Moloczij, Natasha; Denisenko, Sonia; Dewey, Helen; Disler, Peter; Winzar, Bruce; Mosley, Ian; Donnan, Geoffrey A; Bladin, Christopher
Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. This research will provide evidence for an effective telestroke program for use in regional Australian hospitals. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.
Falk, Derik M.; Bonello, Robert S.; Kahn, Jeremy M.; Perencevich, Eli; Cram, Peter
Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions: The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology. PMID:22797291
Ken Russell Coelho
Full Text Available Safety-net settings across the country have grappled with providing adequate access to specialty care services. San Francisco General Hospital and Trauma Center, serving as the city's primary safety-net hospital, has also had to struggle with the same issue. With Healthy San Francisco, the City and County of San Francisco's Universal Healthcare mandate, the increased demand for specialty care services has placed a further strain on the system. With the recent passage of California Proposition 1D, infrastructural funds are now set aside to assist in connecting major hospitals with primary care clinics in remote areas all over the state of California, using telemedicine. Based on a selected sample of key informant interviews with local staff physicians, this study provides further insight into the current process of e-referral which uses electronic communication for making referrals to specialty care. It also identifies key services for telemedicine in primary and specialty care settings within the San Francisco public health system. This study concludes with proposals for a framework that seek to increase collaboration between the referring primary care physician and specialist, to prioritize institution of these key services for telemedicine.
Jan 28, 2016 ... medical education in the absence or limited healthcare ... to medical services is inadequate, holds promise in expanding ... Prospects and challenges of telemedicine in Africa. 2 ... experts' opinions and sharing of knowledge between doctors. .... patients now depend on their pastors or spiritual leaders in.
Widya, I.A.; Bults, Richard G.A.; van Beijnum, Bernhard J.F.; Sandsjö, L.; Schaake, L.; Huis in 't Veld, M.H.A.; Jones, Valerie M.; Hermens, Hermanus J.; Ryan, K.; Robinson, W.
This paper presents the early phase requirements elicitation for a work-related neck-shoulder pain teletreatment trial and the assessment of those requirements in respect of their importance to the trial and the feasibility of the needed software adaptations of the telemedicine system within the
McCue, Michael J; Palsbo, Susan E
The objective of this study was to demonstrate the business case for telemedicine in nonrural areas. We developed an interactive spreadsheet to conduct multiple financial analyses under different capital investment, revenue, and expense scenarios. We applied the spreadsheet to the specific case of poststroke rehabilitation in urban settings. The setting involved outpatient clinics associated with a freestanding rehabilitation hospital in Oklahoma. Our baseline scenario used historical financial data from face-to-face encounters as the baseline for payer and volume mix. We assumed a cost of capital of 10% to finance the project. The outcome measures were financial breakeven points and internal rate of return. A total of 340 telemedicine visits will generate a positive net cash flow each year. The project is expected to recoup the initial investment by the fourth year, produce a positive present value dollar return of more than $2,000, and earn rate of return of 20%, which exceeds the hospital's cost of capital. The business case is demonstrated for this scenario. Urban telemedicine programs can be financially self-sustaining without accounting for reductions in travel time by providers or patients. Urban telemedicine programs can be a sound business investment and not depend on grants or subsidies for start-up funding. There are several key decision points that affect breakeven points and return on investment. The best business strategy is to approach the decision as whether or not to build a new clinic.
Wang, Shiyao; Parsons, Michael; Stone-McLean, Jordan; Rogers, Peter; Boyd, Sarah; Hoover, Kristopher; Meruvia-Pastor, Oscar; Gong, Minglun; Smith, Andrew
Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR) system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS) without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER) through mixed reality capture (MRC) and serves as a novel telemedicine platform with remote pointing capabilities. The mentor's hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers' perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform.
Telemedicine, which is defined as providing healthcare and sharing of medical knowledge over distance using telecommunication means, is a promising approach to improve and enhance the healthcare provisioning process. However, only recently, technology has evolved (i.e. miniaturization of high power
Fung, L.S.N.; Jones, Valerie M.; Hermens, Hermanus J.
Objectives: The main objective is to develop and validate a reference information model (RIM) to support semantic interoperability of pervasive telemedicine systems. The RIM is one component within a larger, computer-interpretable "MADE language" developed by the authors in the context of the
Cranen, Karlijn; Cranen, Karlijn; Huis in 't Veld, M.H.A.; IJzerman, Maarten Joost; Vollenbroek-Hutten, Miriam Marie Rosé
Objective: This study aims to investigate whether patients' perceptions regarding a Web-based telemedicine service, for instruction and monitoring of an exercise program, change after brief use. Materials and Methods: Thirty patients were allocated, matched on gender and age, to a control group (10)
Atlantic Research Corp., Alexandria, VA.
As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…
Despite the huge potential of telemedicine services (increasing accessibility of care, increasing quality of care and lowering of healthcare costs), its implementation in daily clinical practice is very limited and most services fade away after a project or pilot phase. The aim of this thesis has
Atlantic Research Corp., Alexandria, VA.
Providing general specifications and system descriptions for segments within the Arizona TeleMedicine Project (a telecommunication system designed to deliver health services to rurally isolated American Indians in Arizona), this document, when used with the appropriate route segment document, will completely describe the project's required…
Pak, Wesley Chong Y.
Providing primary health and specialty services to 3.4 million rural and highly rural veterans is a challenging task because of geographic barriers and the uneven distribution of rural healthcare providers. Although the Veterans Health Administration is hoping that technology such as telemedicine expands availability of specialties' access to…
Bali, Surya; Gupta, Arti; Khan, Asif; Pakhare, Abhijit
In a developing country such as India, there is substantial inequality in health care distribution. Telemedicine facilities were established in Madhya Pradesh in 2007-2008. The purpose of this study was to evaluate the infrastructure, equipment, manpower, and functional status of Indian Space and Research Organisation (ISRO) telemedicine nodes in Madhya Pradesh. All district hospitals and medical colleges with nodes were visited by a team of three members. The study was conducted from December 2013-January 2014. The team recorded the structural facility situation and physical conditions on a predesigned pro forma. The team also conducted interviews with the nodal officers, data entry operator and other relevant people at these centres. Of the six specialist nodes, four were functional and two were non-functional. Of 10 patient nodes, two nodes were functional, four were semi-functional and four were non-functional. Most of the centres were not working due to a problem with their satellite modem. The overall condition of ISRO run telemedicine centres in Madhya Pradesh was found to be poor. Most of these centres failed to provide telemedicine consultations. We recommend replacing this system with another cost effective system available in the state wide area network (SWAN). We suggest the concept of the virtual out-patient department. © The Author(s) 2015.
Reich, Joel J.
Telemedicine, the use of bidirectional telecommunications systems for the delivery of health care at a distance, could create a more equitable distribution of medical care. Many medical tasks can be performed at a distance although some require the presence of a physician's assistant. Cost-benefit analysis of this service is difficult and requires…
Wang, Shiyao; Parsons, Michael; Stone-McLean, Jordan; Rogers, Peter; Boyd, Sarah; Hoover, Kristopher; Meruvia-Pastor, Oscar; Gong, Minglun; Smith, Andrew
Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR) system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS) without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER) through mixed reality capture (MRC) and serves as a novel telemedicine platform with remote pointing capabilities. The mentor’s hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers’ perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform. PMID:28994720
Full Text Available Traditionally, rural areas in many countries are limited by a lack of access to health care due to the inherent challenges associated with recruitment and retention of healthcare professionals. Telemedicine, which uses communication technology to deliver medical services over distance, is an economical and potentially effective way to address this problem. In this research, we develop a new telepresence application using an Augmented Reality (AR system. We explore the use of the Microsoft HoloLens to facilitate and enhance remote medical training. Intrinsic advantages of AR systems enable remote learners to perform complex medical procedures such as Point of Care Ultrasound (PoCUS without visual interference. This research uses the HoloLens to capture the first-person view of a simulated rural emergency room (ER through mixed reality capture (MRC and serves as a novel telemedicine platform with remote pointing capabilities. The mentor’s hand gestures are captured using a Leap Motion and virtually displayed in the AR space of the HoloLens. To explore the feasibility of the developed platform, twelve novice medical trainees were guided by a mentor through a simulated ultrasound exploration in a trauma scenario, as part of a pilot user study. The study explores the utility of the system from the trainees, mentor, and objective observers’ perspectives and compares the findings to that of a more traditional multi-camera telemedicine solution. The results obtained provide valuable insight and guidance for the development of an AR-supported telemedicine platform.
Narasimha, Shraddhaa; Madathil, Kapil Chalil; Agnisarman, Sruthy; Rogers, Hunter; Welch, Brandon; Ashok, Aparna; Nair, Aswathi; McElligott, James
One area where telemedicine may prove to be highly effective is in providing medical care to the geriatric population, an age group predicted to account for 20% of the population in the near future. However, even though telemedicine has certain advantages, the usability of these systems with this population merits investigation. This article reviews the literature published from 2000 to 2016 with the goal of analyzing the characteristics of usability-related studies conducted using geriatric participants and the subsequent usability challenges identified. Articles were found using Web of Knowledge and PubMed citation indexing portals using the keywords (1) Telemedicine* AND Geriatrics* (2) Telemedicine* AND Usability* (3) Telemedicine* AND Usability* AND Older Adults*. A total of 297 articles were obtained from the initial search. After further detailed screening, 16 articles were selected for review based on the inclusion criteria. Of these, 60% of the studies focused on the overall usability of telemedicine systems; 6.25% focused on the usability of a telepresence robot; 12.5% compared a face-to-face medical consultation with the use of telemedicine systems, and 25% focused on the study of other aspects of telemedicine in addition to its usability. Findings reported in the studies included high patient satisfaction with telemedicine in 31.25%, whereas another 31.25% indicated a high acceptance of this method of medical consultation. Care coordination in 6.25% of the studies; confidence in telemedicine in 6.25%; trust, privacy, and reliability in 6.25%; and increased convenience when compared to personal visits in 18.75% were also reported. This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine
Romano, Maria Francesca; Sardella, Maria Vittoria; Alboni, Fabrizio
Aging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research. The objective of our study was to propose new metrics to control the quality of data, along with the well-known indicators of survey methodology. Web questionnaires administered daily to a group of patients for an extended length of time are a Web health monitoring survey (WHMS) in a telemedicine system. We calculated indicators based on paradata collected during a WHMS study involving 12 patients, who signed in to the website daily for 2 months. The patients' involvement was very high: the patients' response rate ranged between 1.00 and 0.82, with an outlier of 0.65. Item nonresponse rate was very low, ranging between 0.0% and 7.4%. We propose adherence to the chosen time to connect to the website as a measure of involvement and cooperation by the patients: the difference from the median time ranged between 11 and 24 minutes, demonstrating very good cooperation and involvement from all patients. To measure habituation to the questionnaire, we also compared nonresponse rates to the items between the first and the second month of the study, and found no significant difference. We
Marrugo, Andrés G.; Millán, María S.; Cristóbal, Gabriel; Gabarda, Salvador; Sorel, Michal; Sroubek, Filip
Medical digital imaging has become a key element of modern health care procedures. It provides visual documentation and a permanent record for the patients, and most important the ability to extract information about many diseases. Modern ophthalmology thrives and develops on the advances in digital imaging and computing power. In this work we present an overview of recent image processing techniques proposed by the authors in the area of digital eye fundus photography. Our applications range from retinal image quality assessment to image restoration via blind deconvolution and visualization of structural changes in time between patient visits. All proposed within a framework for improving and assisting the medical practice and the forthcoming scenario of the information chain in telemedicine.
Shah, R. V.; Mulcahy, R.; Rubin, D.; Antonsen, E. L.; Kerstman, E. L.; Reyes, D.
INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to
Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David
Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…
Oliveira, Tiago Cravo; Branquinho, Maria José; Gonçalves, Luís
Alentejo - one of five Portuguese continental regions - faces major problems impacting the health and social system of the region. Here, the low population density, the low educational and income level as well as an aging population have to be mentioned. Faced with the task of ensuring equal access to healthcare for all its inhabitants, the regional health authorities created the telemedicine program. From 1998 until 2000, the program developed in an experimental fashion, with teleconsultations involving a number of providers: primary health care centers, regional hospitals, and central hospitals. Between 2000 and 2010, there were a total of 135,000 telemedicine acts including teleconsultations, teleradiology (computerised tomography and x-rays), ultrasound telemedicine and telepathology. Presently, the network comprises 20 health centers and 6 hospitals, covering 4 districts. The platform is composed of high resolution videoconferencing equipment, software with patients' clinical records, an image archive, and a number of peripherals, such as electronic dermatoscopes and phonendoscopes. Teleconsultations are provided by fifteen medical specialties, across 3 district hospitals, ranging from neurology to pediatric surgery. In 2008, health authorities started the telelearning program, initially using point to point videoconferencing, and by the end of 2010, 848 healthcare professionals, across 52 locations, had participated in remote learning sessions, covering topics from chronic wound treatment, to infection control, to medical error. As of 2011, point to multipoint telelearning is also in operation. This paper provides an overview of the telemedicine program in Alentejo, including both infrastructure and operations. Preliminary results of an ongoing evaluation of the impact of teleconsultations on key indicators of the regional healthcare system are also presented (including current utilization and plans for future expansion). This article builds on the experience
Lunde, Anita; Drachmann, Astrid Lykke; Christiansen, Karin
has to be meaningful and a flexible and technically reliable solution. The possession of technical skills and a personal in-terest in telemedicine are advantageous. More important, however, are high clinical skills and competences in caring relationships. Nurses from diverse clinical settings report......The introduction of telemedicine will transform the health care sector and bring changes to the role and function of nurses. In this inquiry we ask, what competences are required in the ‘doing’ of telemedicine? The project is based on interviews with two focus groups involving nurses from...... the primary and secondary sectors, working with telemedicine in a project entitled, Hor-sens på forkant med sundhed (Horsens on the frontiers of Health). The analysis is da-ta-driven and reveals that cultivation of competences is closely associated to structural conditions. Nurses emphasize that telemedicine...
Rockwell, Kimberly Lovett; Gilroy, Alexis
Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.
Parmar, Parmvir; Mackie, David; Varghese, Sunil; Cooper, Curtis
Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim of increasing access to infectious diseases specialty care for isolated populations and reducing costs. We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of infectious diseases patients. The use of telemedicine in the management of acute infectious diseases, chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered. We recapitulate and evaluate the advantages of telemedicine described in other studies, present challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine within the realm of clinical infectious diseases. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: email@example.com.
Stuckey, Ruth; Domingues-Montanari, Sophie
Telecommunication technologies are advancing rapidly with huge investment to improve infrastructure in rural areas. Telemedicine brings the benefits of telecommunication to healthcare, especially in resource-limited and remote communities. The recent literature on telemedicine in paediatrics will be reviewed, with particular focus on its application to help children with neurodevelopmental disorders and their families living in remote regions and/or low-income countries, and gaps identified for future research. Studies show that telemedicine can enable a family's access to appropriately qualified help that physically may only be available hundreds of miles away, helping to overcome geographic barriers. Telemedicine can also train parents and equip them with the knowledge and skills to better care for their children. Despite some technological barriers to implementation, telemedicine can help transform all stages of autism treatment. However, more studies are required in low- and middle-income countries to fully elucidate the benefits offered by telemedicine to autistic children and their families.
Walderhaug, Ståle; Hartvigsen, Gunnar
Background Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated
Bullock, Danielle R; Vehe, Richard K; Zhang, Lei; Correll, Colleen K
The United States pediatric rheumatology workforce is committed to a mission of providing children access to pediatric rheumatology care. With a limited number and distribution of pediatric rheumatologists, telemedicine has been proposed as one way to meet this mission, yet the adoption of this modality has been slower than expected. The purpose of this study was to explore the parent perspective on barriers to accessing pediatric rheumatology care and to explore the acceptability of telemedicine and other alternative care models. Over a period of six weeks, all new and return English-speaking parents/guardians of patients visiting a single center were offered an opportunity to complete a survey which assessed barriers to care and interest in alternative models of care. Responses were analyzed using descriptive statistics. Survey response rate was 72% (159/221). Twenty-eight percent (45/159) traveled more than three hours to the pediatric rheumatology clinic, and 43% (65/152) reported travel as inconvenient. An overwhelming majority of respondents (95%, 144/152) reported a preference for in-person visits over the option of telemedicine. This preference was similar regardless of whether respondents reported travel to the clinic as inconvenient vs convenient (inconvenient 92%, 60/65; convenient 97%, 84/87; p = 0.2881) and despite those reporting travel as inconvenient also reporting greater difficulty with several barriers to care. Those familiar with telemedicine were more likely to report a preference for telemedicine over in-person visits (27%, 3/11 vs 3%, 4/140; p = 0.0087). The option of an outreach clinic was acceptable to a majority (63%, 97/154); however, adult rheumatology and shared-care options were less acceptable (22%, 35/156 and 34%, 53/156 respectively). Among survey respondents, in-person visits were preferred over the option of telemedicine, even when travel was noted to be inconvenient. Telemedicine familiarity increased its acceptability
Vega, Silvio; Marciscano, Ivette; Holcomb, Michael; Erps, Kristine A; Major, Janet; Lopez, Ana Maria; Barker, Gail P; Weinstein, Ronald S
Many developing countries have shown interest in embracing telemedicine and incorporating it into their healthcare systems. In 2000, the U.S. Army Yuma Proving Ground (YPG) initiated a program to assist the Republic of Panama in establishing a demonstration Panamanian rural telemedicine program. YPG engaged the Arizona Telemedicine Program (ATP) to participate in the development and implementation of the program. The ATP recommended adoption of a "top-down" strategy for creating the program. Early buy-in of the Panamanian Ministry of Health and academic leaders was regarded as critical to the achievement of long-term success. High-level meetings with the Minister of Health and the Rectors (i.e., Presidents) of the national universities gained early program support. A telemedicine demonstration project was established on a mountainous Indian reservation 230 miles west of Panama City. Today, three rural telemedicine clinics are linked to a regional Ministry of Health hospital for teleconsultations. Real-time bidirectional videoconferencing utilizes videophones connected over Internet protocol networks at a data rate of 768 kilobits per second to the San Felix Hospital. Telepediatrics, tele-obstetrics, telepulmonology, teledermatology, and tele-emergency medicine services became available. Telemedicine services were provided to the three sites for a total of 1,013 cases, with numbers of cases increasing each year. These three demonstration sites remained in operation after discontinuation of the U.S. involvement in September 2009 and serve as a model program for other telemedicine initiatives in Panama. Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model
Cohen, Gail M.; Irby, Megan B.; Boles, Katie; Jordan, Christine; Skelton, Joseph A.
Pediatric obesity is more prevalent in rural areas, yet rural families may not have access to pediatric obesity treatment programs. Use of new technologies, particularly telemedicine, has proven effective in other behavioral fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in pediatric obesity treatment, and describes one tertiary-care pediatric obesity telemedicine program. We performed a systematic review of the literature from 1990–2011 using the fol...
Reviakin, Y; Sukhanov, A
Introduction Common telemedicine consultations can be divided in two classes: real-time telemedicine consultations and asynchronous telemedicine consultations. The advantage of real-time consultations is obvious - this is a natural discussion between physicians, which may be realised on the basis of desktop videoconferences. But the problems are also obvious: the necessity of additional hardware and the elevated demands for channel bandwidth. Because of the latter, the use of asynchronous tel...
Kahn, Elyne N; La Marca, Frank; Mazzola, Catherine A
Telemedicine has seen substantial growth in the past 20 years, related to technologic advancements and evolving reimbursement policies. The risks and opportunities of neurosurgical telemedicine are nuanced. We reviewed general and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies. Despite technologic development, growing interest, and increasing reimbursement opportunities, telemedicine's utilization remains limited because of concerns regarding an apparent lack of need for telemedicine services, lack of widespread reimbursement, lack of interstate licensure reciprocity, lack of universal access to necessary technology, concerns about maintaining patient confidentiality, and concerns and limited precedent regarding liability issues. The Veterans Health Administration, a component of the U.S. Department of Veterans Affairs, represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurologic conditions. Overall, the economic and clinical benefits of telemedicine will likely come from 1) diminished travel times and lost work time for patients; 2) remote consultation of subspecialty experts, such as neurosurgeons; and 3) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and "teletrauma." Telemedicine is effective in many health care scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine's growth. Copyright © 2016 Elsevier Inc. All rights reserved.
Mahadevan, S; Muralidhar, Kanchi; Shetty, Devi
We have used a telemedicine facility to conduct academic teaching/training sessions. The objective of this study was to examine the feasibility, advantages, and disadvantages of this method of e-learning sessions. The teaching/learning sessions were organized twice a week between the two teaching hospitals. The success of each academic session was analyzed in terms of satisfaction of the participating candidates, infrastructure difficulties (if any), and the overall outcome of the program. In total, 293 academic sessions were held from 2008 to 2010. Each session's presentation was 45 min long and was made using Microsoft(®) (Redmond, WA) PowerPoint. We have found that telemedicine proved to be effective in establishing communication not only between the patient and the physician, but also between the teacher and the student. Several candidates benefited from the application of this technology. Candidates expressed satisfaction and were content with the teaching methods adapted.
AFRL-SA-WP-TR-2017-0019 Developing Reliable Telemedicine Platforms with Unreliable and Limited Communication Bandwidth Peter F...Wright-Patterson AFB, OH 45433-7913 DISTRIBUTION STATEMENT A. Approved for public release. Distribution is unlimited. STINFO COPY NOTICE AND...invention that may relate to them. Qualified requestors may obtain copies of this report from the Defense Technical Information Center (DTIC) (http
Mupela, Evans; Mustarde, Paul; Jones, Huw
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach d...
Béatrice Gulbis; María del Mar Mañú Pereira; Emilio J. Armaza Armaza; Pilar Nicolás; for the ENERCA working group
The creation of a telemedicine, tele-expertise platform opens a new challenge within the European Network for Rare and Congenital Anaemias (ENERCA; www.enerca.org). This is a cornerstone in the field of rare anaemias, in which national expertise is usually scarce and a significant number of patients remain undiagnosed. Experts in rare diseases are specially needed of shared knowledge platforms offering the possibility of a faster and more accurate diagnosis and the availability of a better pa...
Bush, Matthew L; Thompson, Robin; Irungu, Catherine; Ayugi, John
The purpose of this study was to assess the feasibility and effectiveness of live telemedicine applications in hearing amplification and cochlear implantation. A systematic search was performed in PubMed, MEDLINE, PsychINFO, CINALH, and Web of Science to identify peer-reviewed research. Inclusion criteria were titles containing words from the search terms 1) audiology, otolaryngology, and hearing impairment, 2) rehabilitative methods, and 3) telemedicine. Exclusion criteria were: 1) non-English articles, and 2) non-original research. Twelve eligible studies were identified. The studies employed a prospective design in nine of the articles and retrospective case series in three. The use of telemedicine for the provision of cochlear implant services was examined in eight of the articles and with hearing aids in four of the articles. The types of services include intraoperative cochlear implant telemetry; implant programming and assessment of electrode-specific measures and speech recognition after implantation. Hearing aid programming and remote gain assessments were also reported. Many studies assess patient and provider satisfaction along with encounter time comparison. The studies occurred from 2009 to 2014 and took place in seven countries. This review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding Internet bandwidth limitations for remote clinics. There is a paucity of research examining reimbursement and cost-effectiveness for services. Further prospective research investigating cost-effectiveness and bandwidth limitations is warranted to assess long-term sustainability of remote audiological rehabilitative service delivery.
Fuzaylov, Gennadiy; Knittel, Justin; Driscoll, Daniel N
Global burn injuries have been described as the "forgotten public health crises" by the World Health Organization. Nearly 11 million people a year suffer burns severe enough to require medical attention; more people are burned each year than are infected with human immunodeficiency virus/acquired immunodeficiency syndrome and tuberculosis combined. Telemedicine has the potential to link experts in specialized fields, such as burn care, to regions of the world that have limited or no access to such specialized care. A multilevel telemedicine program was developed between Massachusetts General Hospital/Shriners Hospital in Boston, Massachusetts, and City Hospital #8 in Lviv, Ukraine. The program should lead to a sustainable improvement in the care of burn victims in Ukraine. The authors helped establish a Learning Center at City Hospital #8 in Lviv, Ukraine, through which they were able to consult from Shriners Hospital in Boston, on a total of 14 acute burn patients in Ukraine. This article discusses two case reports with the use of telemedicine and how it has allowed the authors to provide not only acute care consultation on an international scale, but also to arrange for direct expert examination and international transport to their specialized burn center in the United States. The authors have established a program through doctors from Massachusetts General Hospital/Shriner's Hospital in Boston, which works with a hospital in Ukraine and has provided acute consultation, as well as patient transportation to the United States for treatment and direct assessment.
Kuhn, S; Jungmann, F
The increasing digitization of our lives and work has also reached medicine and is changing the profession of medical doctors. The modern forms of communication and cooperation in everyday medical practice demand new skills and qualifications. To enable future doctors to comply with this digitally competent profile, an innovative blended learning curriculum was developed and first implemented at the University Medical Center Mainz in summer semester 2017-Medicine in the Digital Age. The teaching concept encompasses five modules, each consisting of an e‑learning unit and a 3-hour classroom course. This publication presents the teaching concept, the initial implementation and evaluation of the module "Telemedicine". The competency development in the field of telemedicine showed a significant increase for the subcomponents "knowledge" and "skills". The neutral attitude towards telemedicine at the beginning of the module could be changed to a positive opinion after the session. The teaching of digital skills is a relevant component of future curriculum development in medical studies and also a challenge for continuing medical education.
Full Text Available The ProblemEpilepsy is a common disease worldwide causing significant physical and social. disability. It is one of the most treatable neurological diseases. Yet in rural, poorer countries like much of India and Nepal most people with epilepsy are not on any treatment often because they cannot access doctors. Conventional ApproachesIt is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details however have been put forward about how that might be achieved.Thinking differentlyUntreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine ApproachesTelemedicine might contribute to two steps - diagnosis and review. A tool which enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity and specificity for the diagnosis. There are a number of ways in which the use of phone review or SMS can improve management.ConclusionsTelemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.
Bart M. Demaerschalk
Full Text Available Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2±9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0±9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Ahmadi, Maryam; Sarabi, Roghayeh Ershad; Orak, Roohangiz Jamshidi; Bahaadinbeigy, Kambiz
The first step in each systematic review is selection of the most valid database that can provide the highest number of relevant references. This study was carried out to determine the most suitable database for information retrieval in telemedicine field. Cinhal, PubMed, Web of Science and Scopus databases were searched for telemedicine matched with Education, cost benefit and patient satisfaction. After analysis of the obtained results, the accuracy coefficient, sensitivity, uniqueness and overlap of databases were calculated. The studied databases differed in the number of retrieved articles. PubMed was identified as the most suitable database for retrieving information on the selected topics with the accuracy and sensitivity ratios of 50.7% and 61.4% respectively. The uniqueness percent of retrieved articles ranged from 38% for Pubmed to 3.0% for Cinhal. The highest overlap rate (18.6%) was found between PubMed and Web of Science. Less than 1% of articles have been indexed in all searched databases. PubMed is suggested as the most suitable database for starting search in telemedicine and after PubMed, Scopus and Web of Science can retrieve about 90% of the relevant articles.
Demaerschalk, Bart M; Kiernan, Terri-Ellen J; Investigators, Starr
Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 +/- 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 +/- 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Warren, S.; Craft, R.L.; Parks, R.C.; Gallagher, L.K.; Garcia, R.J.; Funkhouser, D.R.
Telemedicine technology is rapidly evolving. Whereas early telemedicine consultations relied primarily on video conferencing, consultations today may utilize video conferencing, medical peripherals, store-and-forward capabilities, electronic patient record management software, and/or a host of other emerging technologies. These remote care systems rely increasingly on distributed, collaborative information technology during the care delivery process, in its many forms. While these leading-edge systems are bellwethers for highly advanced telemedicine, the remote care market today is still immature. Most telemedicine systems are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver entire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. We propose a secure, object-oriented information architecture for telemedicine systems that promotes plug-and-play interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a lego-like fashion to achieve the desired device or system functionality. The architecture will support various ongoing standards work in the medical device arena.
Theodore, Colin R.; Tischler, Mark B.
An automatic rotor trim control system was developed and successfully used during a wind tunnel test of a full-scale UH-60 rotor system with Individual Blade Control (IBC) actuators. The trim control system allowed rotor trim to be set more quickly, precisely and repeatably than in previous wind tunnel tests. This control system also allowed the rotor trim state to be maintained during transients and drift in wind tunnel flow, and through changes in IBC actuation. The ability to maintain a consistent rotor trim state was key to quickly and accurately evaluating the effect of IBC on rotor performance, vibration, noise and loads. This paper presents details of the design and implementation of the trim control system including the rotor system hardware, trim control requirements, and trim control hardware and software implementation. Results are presented showing the effect of IBC on rotor trim and dynamic response, a validation of the rotor dynamic simulation used to calculate the initial control gains and tuning of the control system, and the overall performance of the trim control system during the wind tunnel test.
Syarip; Tri-Wulan-Tjiptono; Tegas-Sutondo
A criticality analysis of the natural uranium - light water sub-criticalassembly available at the P3TM-BATAN Yogyakarta, converted into a naturaluranium - graphite system has been performed. The purpose of this study is toprovide the research facility on the basic static and kinetics studies forthe high temperature reactor (HTR) in which the HTR fuel system is underdevelopment at the P3TM. For the purpose of this study, a neutroniccalculation was performed using WIMSD/4 code, to determine the neutronmultiplication factor for various fuel configurations of the sub-criticalassemblies. The results show that the effective neutron multiplication factor(k ef ) for U-Be-H 2 O and U-Be-He systems are 1.0474 and 1.4666 respectively,while for the graphite moderated systems with coolants of H 2 O or He(U-C-H 2 O and U-C-He) systems, the corresponding k ef are 0.787 and 0.4211respectively. The results conclude that the modification of U-H 2 O toU-C-H 2 O system, in accordance with neutronic is quite feasible, safe, cheapand practical, and in addition, the treatment of H 2 O is relatively easy.(author)
Full Text Available Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation.A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis.Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%. The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high.Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high
detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651. MILESTONES AND DELIVERABLES: Completion of data...telemedicine system for comprehensive diabetes management and assessment of diabetic retinopathy that provides increased access for diabetic patients to...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy
teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy . Telemedicine and e-Health. 2005;11: 641-651...a telemedicine system for comprehensive diabetes management andassessment of diabetic retinopathy that provides increased access for diabetic ...CDMP developed under this collaborative effort. 15. SUBJECT TERMS Joslin Vision Network, telemedicine, diabetes mellitus, diabetic retinopathy
Dan S Wamala
Full Text Available The use of information and communication technologies (ICT tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa′s socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors′experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality
Antoniotti, Nina; Bernard, Jordana
Abstract Background: The American Telemedicine Association (ATA) Standards and Guidelines Committee develops practice standards and guidelines. Key to the Committee's mission is dissemination so the standards can be used in the practice of telemedicine. Over a 2-year period, when a standards document was accessed from the ATA Web site, a short survey was completed, but it did not assess how the documents were used once downloaded. A more formal survey was conducted to determine the impact ATA standards and guidelines are having on healthcare delivery via telemedicine. Materials and Methods: A survey was developed and distributed via SurveyMonkey to 13,177 ATA members and nonmembers in November 2011. Results were compiled and analyzed after a 90-day open period for responses to be submitted. Results: The majority of respondents (96%) believe the practice of telemedicine/telehealth should have standards and guidelines and that the ATA and other professional societies/associations should be responsible for developing them. The top uses of guidelines include guidance for clinical practice, training, gaining reimbursement, and research. Respondents indicating a need for standards and guidelines said the ATA (78.7%) and other professional societies/associations (74.5%) should be responsible for development. When asked to list specific practice guidelines or standards they are using for telehealth, the majority (21.5%) are using in-house (e.g., hospital, company)-developed guidelines, followed by those from professional associations/societies (20.4%) and those developed by the ATA (18.2%). Conclusions: Overall, the survey results indicate guidelines documents developed by the ATA and other professional societies and those developed in-house are being regularly accessed and used in both public and private sectors. Practitioners of telemedicine believe that standards and guidelines are needed for guidance for clinical practice, training, gaining reimbursement, and research
Wamala, Dan S; Augustine, Kaddu
The use of information and communication technologies (ICT) tools to improve the efficiency of professionalism at work is increasing every time under the dynamic digital environment. Tools such as telemedicine, tele-education, and health informatics have of late been incorporated in the health sector to enable easy access to essential services, for example, in medical areas from referral centers by the patients on one hand and enabling the doctor to doctor consultations for the benefit of patients. Unfortunately, observations indicate dearth efforts and commitment to optimize use of the tools in the majority of the countries south of the Sahara. Sub-Saharan Africa has been left almost behind the rest of the world in terms of development going through decades of economic exploitation by especially the west through its natural and human resources. These factors, ethnic conflicts and endless wars have continued to ruin sub-Saharan Africa's socio-economic development. Information was obtained through a network of telemedicine practitioners in different African countries using internet communication, through E-mail and reviewing existing literature of their activities. This information was compiled from representative countries in each African region and the previous authors'experiences as telemedicine practioners. Most of these countries have inadequate ICT infrastructure, which yet creates sub-optimal application. Sub-Saharan Africa, made up of 33 of the 48 global poorest countries has to extend its ICT diffusion and policy to match the ever developing global economy. In some countries such as Ethiopia and South Africa there is significant progress in Telemedicine while in countries such as Burkina Faso and Nigeria the progress is slow because of lack of political support. Almost all reference to Africa is made in due respect to sub-Saharan Africa, one with big social, economic, and political problems with resultant high morbidity and mortality rates. This also
Bhattacharjya, Rajib Kumar
The unit hydrograph and the infiltration parameters of a watershed can be obtained from observed rainfall-runoff data by using inverse optimization technique. This is a two-stage optimization problem. In the first stage, the infiltration parameters are obtained and the unit hydrograph ordinates are estimated in the second stage. In order to combine this two-stage method into a single stage one, a modified penalty parameter approach is proposed for converting the constrained optimization problem to an unconstrained one. The proposed approach is designed in such a way that the model initially obtains the infiltration parameters and then searches the optimal unit hydrograph ordinates. The optimization model is solved using Genetic Algorithms. A reduction factor is used in the penalty parameter approach so that the obtained optimal infiltration parameters are not destroyed during subsequent generation of genetic algorithms, required for searching optimal unit hydrograph ordinates. The performance of the proposed methodology is evaluated by using two example problems. The evaluation shows that the model is superior, simple in concept and also has the potential for field application.
Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo
The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.
... 7 Agriculture 11 2010-01-01 2010-01-01 false Distance Learning and Telemedicine Loan and Grant Program. 1700.57 Section 1700.57 Agriculture Regulations of the Department of Agriculture (Continued... Authorities § 1700.57 Distance Learning and Telemedicine Loan and Grant Program. (a) Administrator: The...
van den Berg, Neeltje; Schmidt, S; Stentzel, U; Mühlan, H; Hoffmann, W
In rural areas with a low population density and (imminent) gaps in regional health care, telemedicine concepts can be a promising option in supporting the supply of medical care.Telemedicine connections can be established between different health care providers (e.g., hospitals) or directly between health care providers and patients.Different scenarios for the implementation of telemedicine have been developed, from the monitoring of chronically ill patients to the support of acute care. Examples of frequently applied telemedicine concepts are teleradiology, telemedicine stroke networks, and the telemedicine monitoring of patients with heart failure. The development of concepts for other indications and patient groups is apparently difficult in Germany; one reason could be that research institutions are involved in only a small number of projects. However, the participation of research institutes would be of importance in creating more scientific evidence. The development of appropriate evaluation designs for analyzing the effectiveness of telemedicine concepts and economic effects is an important task and challenge for the future. Mandatory evaluation criteria should be developed to provide a basis for the translation of positively evaluated telemedicine concepts into routine care.
Sood, Sanjay P; Negash, Solomon; Mbarika, Victor W A; Kifle, Mengistu; Prakash, Nupur
Telemedicine is the use of communication networks to exchange medical information for providing healthcare services and medical education from one site to another. The application of telemedicine is more promising in economically developing countries with agrarian societies. The American Telemedicine Association (ATA) identifies three healthcare services: clinical medical services, health and medical education, and consumer health information. However, it is not clear how these services can be adopted by different sectors: public and private. This paper looks at four Indian case studies, two each in public and private sectors to understand two research questions: Are there differences in telemedicine adoption between public and private hospitals. If there are differences: What are the differences in telemedicine adoption between public and private sectors? Authors have used the extant literature in telemedicine and healthcare to frame theoretical background, describe the research setting, present the case studies, and provide discussion and conclusions about their findings. Authors believe that as India continues to develop its telemedicine infrastructures, especially with continued government support through subsidies to private telemedicine initiatives, its upward trend in healthcare will continue. This is expected to put India on the path to increase its life expectancy rates, especially for it rural community which constitute over 70% of its populace.
Larburu Rubio, Nekane; Bults, Richard G.A.; van Sinderen, Marten J.; Widya, I.A.; Hermens, Hermanus J.
Purpose: Telemedicine systems must provide clinical data of sufficient quality (according to medical standards) to support safe treatment guidance of outpatients. Quality of clinical data (QoD) typically varies due to unstable performance of ICT-components of these telemedicine systems. Therefore,
Kraai, I H; Luttik, M L A; de Jong, R M; Jaarsma, T; Hillege, H L
Remote monitoring of the clinical status of heart failure patients has developed rapidly and is the subject of several trials. Patient satisfaction is an important outcome, as recommended by the U.S. Food and Drug Administration to use in clinical research, and should be included in studies concerning remote monitoring. The objective of this review is to describe the current state of the literature on patient satisfaction with noninvasive telemedicine, regarding definition, measurement, and overall level of patient satisfaction with telemedicine. The Pubmed, Embase, Cochrane, and Cinahl databases were searched using heart failure-, satisfaction-, and telemedicine-related search terms. The literature search identified 193 publications, which were reviewed by 2 independent reviewers. Fourteen articles were included. None of the articles described a clear definition or concept of patient satisfaction with telemedicine. Patient satisfaction with telemedicine was measured with self-developed questionnaires or face-to-face or telephonic interviews. None of the articles used the same questionnaire or telephonic survey to measure patient satisfaction. Only one questionnaire was assessed for validity and reliability. In general, patients seemed to be satisfied or very satisfied with the use of telemedicine. Measurement of patient satisfaction is still underexposed in telemedicine research and the measurement of patient satisfaction with telemedicine underappreciated with poorly constructed questionnaires. Copyright © 2011 Elsevier Inc. All rights reserved.
Holmner, Asa; Ebi, Kristie L; Lazuardi, Lutfan; Nilsson, Maria
The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers. To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector. A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases. Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car. Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.
The implementation of Telemedicine in behavioral health centers can be expensive if proactive steps were not taken to minimize user perceptions towards the new technology. Despite the significant capital investments on new Telemedicine, no consensus identified and explained what factors determined the acceptance, or rejection, of the technology.…
Huis in 't Veld, M.H.A.; van Dijk, H; Hermens, Hermanus J.; Vollenbroek-Hutten, Miriam Marie Rosé
We reviewed the methodology used in telemedicine research concerning patients with postural and movement disorders. Literature searches were performed using various computerized databases through to October 2005. Twenty-two studies met the criteria for review. Two broad models of telemedicine
Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard
This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ 2 = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having telemedicine (HR = 0.39, 95% CI = 0.16-0.93). Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.
Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E
Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.
Langkamp, Diane L; McManus, Mark D; Blakemore, Susan D
The literature on the use of telemedicine for children with developmental disabilities (DD) is limited and mostly describes telemedicine being used to link patients with distant subspecialty multidisciplinary care. Parents generally have reported satisfaction with such care and have perceived it to be equally effective as in-person care. Here we report on the use of school-based asynchronous telemedicine to connect children with DD with primary care providers. We developed Tele-Health-Kids, a school-based program using asynchronous telemedicine to connect children with DD with their primary care physician for the care of minor illnesses. We surveyed parents at enrollment and after the child's first telemedicine visit to assess satisfaction. We describe 4 cases that illustrate benefits, particularly for children with DD and challenging behaviors, suggesting that asynchronous telemedicine may actually be superior to traditional in-office visits in some circumstances. Most parents expressed a high level of satisfaction with the program. Benefits identified include decreased stress to the child and the parents as well as increasing the likelihood of a successful medical examination due to greater cooperation by the child. Visits using asynchronous or "store and forward" telemedicine technology may be superior in some situations by allowing the visit to be performed at a pace that can be adjusted to the needs of the child with DD. More research in the use of asynchronous telemedicine for children and youth with DD, particularly for children with DD and challenging behaviors, is needed.
In Poland in ageing there still dominates the experience of multiple ailments and polytherapy, something which justifies a search for new, easily accessible, and economically sound solutions for health care. Telemedicine is a promising solution although there is a need for concrete steps to be taken to raise willingness amongst geriatric patients to take advantage of telemedicine.
Objectives: The aim of the article is to provide critical success factors (CSF that will enable the deployment of telemedicine in the cloud in order to improve health care services in developing countries. Methods: A thorough literature review was performed of peer reviewed articles in order to identify possible barriers for telemedicine to be deployed in the cloud. Furthermore, the Technology Organization Environmental Model was used in order to group the barriers according to the various factors and, from this process, critical success factors were formulated for consideration. Conclusion: Five critical success factors were formulated in order to implement telemedicine making use of the cloud in developing countries. These include having a national integrated plan for telemedicine; promoting best practices within a legislation framework; involving the end user; providing education to improve levels of telemedicine awareness amongst staff and patients, and addressing technological issues.
Hong, SungHye; Kim, SangYong; Kim, JungChae; Lim, DongKyu; Jung, SeokMyung; Kim, DongKeun; Yoo, Sun K
The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.
Elliott, Tania; Shih, Jennifer; Dinakar, Chitra; Portnoy, Jay; Fineman, Stanley
The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Schneider, Ruth B; Biglan, Kevin M
Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. Copyright © 2017 Elsevier Ltd. All rights reserved.
Berti, Pierluigi; Verlicchi, Franco; Fiorin, Francesco; Guaschino, Roberto; Cangemi, Adelio
Telemedicine is defined as the use of electronic information and communication technologies to provide health care between distant people. Many activities in transfusion medicine could benefit from the application of telemedicine. To map the spread of the use of telemedicine in transfusion medicine in Italy, the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) performed a nationwide survey: the results are presented in this paper. A survey, dealing with different aspects of the use of telemedicine, was performed by sending a questionnaire to 280 Italian Blood Centres. The survey was designed to evaluate the diffusion of telemedicine and the features of the systems, with special attention to the systems' safety and legal adequacy. One section of the questionnaire was designed to identify the features of the systems considered essential by the respondents. Out of 280 Blood Services contacted, 196 (70%) filled in at least one of the questions of the online questionnaire. Globally the use of some form of telemedicine was reported by 70% of the respondents. Telemedicine is used for remote validation of laboratory tests by 32% of the Centres that responded, for remote biological validation of blood units by 34% and for assignment of blood components by 29%. Less frequently, telemedicine is used to control electronic refrigerators, for electronic blood requests and for bed-side identification of patients. The use of telemedicine is widespread in Italian Blood Services. There appears to be some heterogeneity between structures with regards to the evaluation of the systems' safety and their legal adequacy. No telemedicine system should be introduced into practice until it has proven to have the same standards of safety as the corresponding "on site" activity.
Levin, Klaus; Madsen, Jette R; Petersen, Inge
been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. METHODS: Telemedicine consultations were conducted with the patient and nurse specialist...... in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. CONCLUSION: Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high...... treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction....
Full Text Available Background: Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a ‘clearing house’ might be useful. Objective: To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. Design: We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5–10% suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. Results: The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. Conclusions: This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.
Hunter, Norwood; Caputo, Michael; Billica, Roger; Taylor, Gerald; Gibson, C. Robert; Manuel, F. Keith; Mader, Thomas; Meehan, Richard
For years ophthalmic photographs have been used to track the progression of many ocular diseases such as macular degeneration and glaucoma as well as the ocular manifestations of diabetes, hypertension, and hypoxia. In 1987 a project was initiated at the Johnson Space Center (JSC) to develop a means of monitoring retinal vascular caliber and intracranial pressure during space flight. To conduct telemedicine during space flight operations, retinal images would require real-time transmissions from space. Film-based images would not be useful during in-flight operations. Video technology is beneficial in flight because the images may be acquired, recorded, and transmitted to the ground for rapid computer digital image processing and analysis. The computer analysis techniques developed for this project detected vessel caliber changes as small as 3 percent. In the field of telemedicine, the Portable Dynamic Fundus Instrument demonstrates the concept and utility of a small, self-contained video funduscope. It was used to record retinal images during the Gulf War and to transmit retinal images from the Space Shuttle Columbia during STS-50. There are plans to utilize this device to provide a mobile ophthalmic screening service in rural Texas. In the fall of 1993 a medical team in Boulder, Colorado, will transmit real-time images of the retina during remote consultation and diagnosis. The research applications of this device include the capability of operating in remote locations or small, confined test areas. There has been interest shown utilizing retinal imaging during high-G centrifuge tests, high-altitude chamber tests, and aircraft flight tests. A new design plan has been developed to incorporate the video instrumentation into face-mounted goggle. This design would eliminate head restraint devices, thus allowing full maneuverability to the subjects. Further development of software programs will broaden the application of the Portable Dynamic Fundus Instrument in
Kahn, Jeremy M; Le, Tri Q.; Barnato, Amber E.; Hravnak, Marilyn; Kuza, Courtney C.; Pike, Francis; Angus, Derek C.
Background Intensive care unit (ICU) telemedicine is an increasingly common strategy for improving the outcome of critical care, but its overall impact is uncertain. Objectives To determine the effectiveness of ICU telemedicine in a national sample of hospitals and quantify variation in effectiveness across hospitals. Research design We performed a multi-center retrospective case-control study using 2001–2010 Medicare claims data linked to a national survey identifying United States hospitals adopting ICU telemedicine. We matched each adopting hospital (cases) to up to 3 non-adopting hospitals (controls) based on size, case-mix and geographic proximity during the year of adoption. Using ICU admissions from 2 years before and after the adoption date, we compared outcomes between case and control hospitals using a difference-in-differences approach. Results 132 adopting case hospitals were matched to 389 similar non-adopting control hospitals. The pre- and post-adoption unadjusted 90-day mortality was similar in both case hospitals (24.0% vs. 24.3%, p=0.07) and control hospitals (23.5% vs. 23.7%, ptelemedicine adoption was associated with a small relative reduction in 90-day mortality (ratio of odds ratios: 0.96, 95% CI = 0.95–0.98, ptelemedicine effect across individual hospitals (median ratio of odds ratios: 1.01; interquartile range 0.85–1.12; range 0.45–2.54). Only 16 case hospitals (12.2%) experienced statistically significant mortality reductions post-adoption. Hospitals with a significant mortality reduction were more likely to have large annual admission volumes (ptelemedicine adoption resulted in a small relative overall mortality reduction, there was heterogeneity in effect across adopting hospitals, with large-volume urban hospitals experiencing the greatest mortality reductions. PMID:26765148
Smith, Douglas L
The basic research question that guided this investigation was "Do financial indicators play a major role in decisions to deploy telemedicine?" The study also evaluated the relative importance of five specific financial indicators. Select hospital systems were asked to participate in this research. Because much has been written about the problems of access to health care in rural settings, the study included hospital systems with rural hospitals. The study also examined the importance of financial indicators to representatives of various functional disciplines. A qualitative case study approach was used for the research project.
Rasmussen, O. W.
Objectives: For patients with T2DM does telemedicine, compared with standard care, provide equivalent clinical outcomes? Methods: Forty patients with type 2 diabetes mellitus allocated from October 2011 until July 2012 randomized to either treatment at home by video conferences only or the standard...... outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-h blood pressure, cholesterol levels, and albuminuria. The videotelephone was installed and serviced by the telephone company, TDC, Denmark, as a broadband solution. Results: The improvements in the two...
Full Text Available An important characteristic of contemporarysociety is people mobility; people travel, from manyreasons, all around the world (business, diplomacy,science, sport manifestations, leisure, etc. That increasesthe probability of accidents involving people far fromtheir residence places. The quality of the medical care iscrucial, in such situations, for saving human lives.Geographical, cultural and linguistic frontiers mayharmfully affect the efficiency of medical act. This paperpresents an overview of the actual involvement ofComputer Science in the growth of medical qualityservices and proposes a possible solution in providingessential information on the health state of patients thatneeds medical care far from their residence.
Nguyen, D.; Roehrig, Hans; Borders, Marisa H.; Fitzpatrick, Kimberly A.; Roveda, Janet
In health care applications, we obtain, manage, store and communicate using high quality, large volume of image data through integrated devices. In this paper we propose several promising methods that can assist physicians in image data process and communication. We design a new semi-automated segmentation approach for radiological images, such as CT and MRI to clearly identify the areas of interest. This approach combines the advantages from both the region-based method and boundary-based methods. It has three key steps compose: coarse segmentation by using fuzzy affinity and homogeneity operator, image division and reclassification using the Voronoi Diagram, and refining boundary lines using the level set model.
Steinman, Milton; Morbeck, Renata Albaladejo; Pires, Philippe Vieira; Abreu, Carlos Alberto Cordeiro; Andrade, Ana Helena Vicente; Terra, Jose Claudio Cyrineu; Teixeira, José Carlos; Kanamura, Alberto Hideki
ABSTRACT Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care. PMID:26676268
Full Text Available Telemedicine applications offer innovative approaches for treating and reducing the effects of substance use disorders (SUDs. This analysis assessed the interest in and use of 11 telemedicine applications in a sample of 363 SUD organizations in the United States of America. Fifty percent of the organizations expressed high rates of interest in seven of the telemedicine applications, demonstrating the appeal of telemedicine within this field. The top three self-reported telemedicine applications being used were (1 computerized screening/assessments (44.6%, (2 telephone-based recovery supports (29.5%, and (3 telephone-based therapy (28.37%. The greatest gaps between interest and use were for (1 texting appointment reminders (55.2% differential, (2 mobile apps for posttreatment recovery (46.6% differential, and (3 recovery support chats (46.6% differential. A Latent Class Analysis (LCA of the organizations’ telemedicine use behavior identified three groupings: “Innovators” that were using a range of technologies (n=27, 7.4%; “Technology Traditionalists” that limited their use to telephone, video, and web portal technologies (n=101, 27.8%; and “Low Tech” that had low overall technology use (n=235, 64.7%. Future studies should build on how telemedicine could be applied in SUD settings, organizational behaviors towards its adoption, and telemedicine’s effect on treatment adherence and clinical outcomes.
Iqbal, S.; Khan, N.
Medical/Health care system is spraining in Pakistan because of innovative technology, activities and services as per their financial cost (position) which is increasing day by day. This research is intended for the assessment of Telemedicine/Remote Health Care Management practices (system), which encompasses usability, acceptance and impact in public/private hospitals. To improve the existing remote health care/telemedicine practices in Pakistan by using EM (Engineering Management) based approach. It has been widely and successfully implemented and is considered as a strategic and operational tool. In the 21st century due to the Technological advancements the mode of operation of service and business sector have been changed drastically. In the same way the health sectors activities also have been altered, new methods and techniques have also been devised for the treatment of the patients that were never even thought before. In the health sector Telemedicine/Remote Health Care Management is one of the development which was experienced lately. Telemedicine/Remote Health Careistaken exactly "medicine at a distance". Therefore, hypothetically, some procedures performed with medication which does not take place "face-to-face"and"in person"which can be considered as Telemedicine/Remote Health Care. In the industrialized world telemedicine is being used in full capacity to provide the health care services to remote and un-accessible areas. But Telemedicine/Remote Health Care Management is not very popular and admired in Pakistan; few applications are being functional presently. (author)
Smith, Nancy Marie; Satyshur, Rosemarie DiMauro
Type 1 diabetes mellitus has increased in children by 23% from 2001 to 2009. Rural communities additionally have increased disparities related to access barriers and a large minority population with poorer overall health. Research evidence supports telemedicine as an effective alternative to bring preventive diabetes care to remote areas. This article presents an overview of the leadership role of advanced practice registered nurses (APRNs) with the implementation and evaluation of a pediatric diabetes telemedicine program at a rural pediatric outpatient specialty clinic in partnership with a tertiary center telemedicine network. The telemedicine program quality improvement (QI) project explored caregiver satisfaction with a convenience sample of caregivers (N = 14) using a nine-item Telemedicine Diabetes Caregiver Satisfaction Survey (TDCSS), with responses ranging from 1 = strongly disagree to 5 = strongly agree. Findings indicate caregivers were highly satisfied with communication/ privacy (M = 4.8), access to care (M = 4.1), and quality of services (M = 5.0). The multidisciplinary collaborative teamwork, continuous QI, and dependable technology were integral to the quality of the telemedicine clinical initiative. APRNs provided technology expertise, interdisciplinary collaboration leadership, care coordination, and advocacy for policy changes. Results demonstrate that telemedicine and APRN leadership can help implement innovative programs into rural communities to improve access to care, healthcare cost, and outcomes.
Full Text Available Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine.
Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.
Eibl, Joseph K; Gauthier, Graham; Pellegrini, David; Daiter, Jeffery; Varenbut, Michael; Hogenbirk, John C; Marsh, David C
Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT. We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (telemedicine), mixed (25-75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records. A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14-1.41; pTelemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08-1.47; p=0.001) and had a retention rate of 47% at one year. Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.
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Swinfen, R; Swinfen, P
The Swinfen Charitable Trust uses digital cameras and email to provide specialist advice to doctors in developing countries. The first telemedicine link was set up in July 1999. By the end of a year there were three links to hospitals in Bangladesh, Nepal and the Solomon Islands. Initially the consultants, all of whom give their advice free of charge, were from the UK, but now are worldwide. At present there are 12 links in operation, including one on Tristan da Cunha, and two links approved and awaiting equipment. The advice given by the consultants has been found to be helpful to the referring doctors and to benefit their patients. Failures have been due to the use of obsolescent equipment, computer viruses, lack of communication with the referring hospital before setting up a link, and referring doctors not chasing up their own referrals. Problems yet to be solved include the unreliability of the Internet, certain medicolegal issues and assessing the quality of medical consultants. In future there will be the problem of managing a rapidly growing telemedicine network.
Nazeran, Homer; Setty, Sunil; Haltiwanger, Emily; Gonzalez, Virgilio
Technology has been used to deliver health care at a distance for many years. Telemedicine is a rapidly growing area and recently there are studies devoted to prehospital care of patients in emergency cases. In this work we have developed a compact, reliable, and low cost PDA-based telecommunication device for telemedicine applications to transmit audio, still images, and vital signs from a remote site to a fixed station such as a clinic or a hospital in real time. This was achieved based on a client-server architecture. A Pocket PC, a miniature camera, and a hands-free microphone were used at the client site and a desktop computer running the Windows XP operating system was used as a server. The server was located at a fixed station. The system was implemented on TCP/IP and HTTP protocol. Field tests have shown that the system can reliably transmit still images, audio, and sample vital signs from a simulated remote site to a fixed station either via a wired or wireless network in real time. The Pocket PC was used at the client site because of its compact size, low cost and processing capabilities.
Dóra J. Eszes
Full Text Available Introduction. Diabetic retinopathy (DR is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients’ satisfaction when using such tools (fundus camera examination and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants’ experience during fundus examination (comfort, reliability, and future interest in participation, as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrád County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (Spectra™ software. Large majority of the patients were satisfied with the screening and found it reliable and acceptable to undertake examination under pupil dilation; 67.3% were willing to undergo nonmydriatic fundus camera examination again. There was a statistically significant relationship between economic activity, education and marital status, and future interest in participation. Discussion. Participants found digital retinal screening to be reliable and satisfactory. Telemedicine can be a strong tool, supporting eye care professionals and allowing for faster and more comfortable DR screening.
Digital echocardiography offers several advantages over videotape, including easy review, comparison, storage, postprocessing, and sharing of studies, quantitative analysis, and superior resolution. Newer echocardiography systems can write digital data to computer hardware, whereas older systems require digitization of analog data. Clinical and digital data compression is required to reduce study size. Clinical compression has been validated in several adult studies and one pediatric study. JPEG and MPEG digital compression ratios of 26:1 and 200:1, respectively, approximate S-videotape quality. JPEG is the DICOM 3.0 standard and is ideal for short loops, serial comparisons, and quantitative analysis. MPEG (the motion picture standard) lends itself to digitization of video streams and may be more attractive to pediatric cardiologists. Options for data storage and transfer range from limited local review to multiple offline review stations linked by a wide-area network. Telemedicine expands the capabilities of digital echocardiography in a "store and forward" or "real-time" format. Real-time neonatal telecardiology is accurate, impacts patient care, is cost-effective, and does not increase utilization. Cost, increased reliance on sonographers' skills, lack of accepted standards, and legal, licensure, and billing issues are obstacles to widespread acceptance of digital echocardiography and telemedicine.
Karnowski, Thomas Paul [ORNL; Aykac, Deniz [ORNL; Chaum, Edward [ORNL; Giancardo, Luca [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Tobin Jr, Kenneth William [ORNL
The projected increase in diabetes in the United States and worldwide has created a need for broad-based, inexpensive screening for diabetic retinopathy (DR), an eye disease which can lead to vision impairment. A telemedicine network with retina cameras and automated quality control, physiological feature location, and lesion / anomaly detection is a low-cost way of achieving broad-based screening. In this work we report on the effect of quality estimation on an optic nerve (ON) detection method with a confidence metric. We report on an improvement of the fusion technique using a data set from an ophthalmologists practice then show the results of the method as a function of image quality on a set of images from an on-line telemedicine network collected in Spring 2009 and another broad-based screening program. We show that the fusion method, combined with quality estimation processing, can improve detection performance and also provide a method for utilizing a physician-in-the-loop for images that may exceed the capabilities of automated processing.
Shannon, Gary W.; Smith, Brian R.; Alverson, Dale C.; Antoniotti, Nina; Barsan, William G.; Bashshur, Noura; Brown, Edward M.; Coye, Molly J.; Doarn, Charles R.; Ferguson, Stewart; Grigsby, Jim; Krupinski, Elizabeth A.; Kvedar, Joseph C.; Linkous, Jonathan; Merrell, Ronald C.; Nesbitt, Thomas; Poropatich, Ronald; Rheuban, Karen S.; Sanders, Jay H.; Watson, Andrew R.; Weinstein, Ronald S.; Yellowlees, Peter
Abstract The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings. PMID:24968105
Craft, R.L.; Funkhouser, D.R.; Gallagher, L.K.; Garica, R.J.; Parks, R.C.; Warren, S.
We propose an object-oriented information architecture for telemedicine systems that promotes secure `plug-and-play' interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a ''lego-like'' fashion to achieve the desired device or system functionality. Introduction Telemedicine systems today rely increasingly on distributed, collaborative information technology during the care delivery process. While these leading-edge systems are bellwethers for highly advanced telemedicine, most are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver en- tire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. This paper proposes a reference architecture for plug-and-play telemedicine systems that addresses these issues.
West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S
To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.
Jorge Enrique Londoño
Full Text Available Siguiendo un recorrido por diversos actos del Carnaval de Riosucio, Caldas, Colombia, un caso particular de los posibles. Esta reflexión busca aclarar y precisar las potencialidades del carnaval como tiempo y espacio compartidos para la representación del mundo objetivo desde la risa y la ironía, para el encuentro consigo mismo y con los demás, a partir de la expresión artística paródica, propiciando la fraternidad, la reconciliación, la recuperación de lazos destruidos, la convivencia pacífica.
Orlov, O. I.; Grigoriev, A. I.
Space medicine passed a long way of search for informative methods of medical data collection and analysis and worked out a complex of effective means of countermeasures and medical support. These methods and means aimed at optimization of the habitation conditions and professional activity of space crews enabled space medicine specialists to create a background for the consecutive prolongation of manned space flights and providing their safety and effectiveness. To define support systems perspectives we should consider those projects on which bases the systems are implemented. According to the set opinion manned spaceflights programs will develop in two main directions. The first one is connected with the near space exploration, first of all with the growing interest in scientific-applied and in prospect industrial employment of large size orbit manned complexes, further development of transport systems and in long-run prospect - reclamation of Lunar surface. The second direction is connected with the perspectives of interplanetary missions. There's no doubt that the priority project of the near-earth space exploration in the coming decenaries will be building up of the International Space Station. This trend characteristics prove the necessity to provide crews whose members may differ in health with individual approach to the schedule of work, rest, nutrition and training, to the medical control and therapeutic-prophylactic procedures. In these conditions the importance of remote monitoring and distance support of crew members activities by the earth- based medical control services will increase. The response efficiency in such cases can only be maintained by means of advanced telemedicine systems. The international character of the International Space Station (ISS) gives a special importance to the current activities on integrating medical support systems of the participating countries. Creation of such a system will allow to coordinate international research
Mohd Khanapi Abd Ghani
Full Text Available The Iraqi healthcare services are struggling to regain their lost momentum. Many physicians and nurses left Iraq because of the current situation in the country. Despite plans of calling back the skilled health workforce, they are still worried by the disadvantages of their return. Hence, technology plays a central role in taking advantage of their profession through the use of telemedicine. Studying the factors that affect the implementation of telemedicine is necessary. Telemedicine covers network services, policy makers, and patient understanding. A framework that includes the influencing factors in adopting telemedicine in Iraq was developed in this study. A questionnaire was distributed among physicians in Baghdad Medical City to examine the hypothesis on each factor. The Statistical Package for the Social Sciences was utilized to verify the reliability of the questionnaire and Cronbach’s alpha test shows that the factors have values more than 0.7, which are standard.
Reed, Philip A.
Reviews developments in telemedicine and a number of related areas (telecommunications, virtual presence, informatics, artificial intelligence, robotics, materials science, and perceptual psychology). Provides learning activities for technology education. (SK)
Two types of telemedicine are considered in the paper: pre-recorded and real-time. The advantages and disadvantages of each type are described.The choice of telemedicine type depends on medical speciality. The separate branch of telemedicine--teleprevention of civilization diseases is discussed and examples of relevant WWW services in Poland are given. The own work examples of the Dept. of Medical Informatics, MUW, namely Onco-service of 200 protocols used in hematology and oncology and Cardio.net--a distributed teleinformation system for cardiology, are presented. the barriers of the development of telemedicine in Poland are caused by the organization of health service--Patients Funds using different software, no messaging standards and different reimbursement systems.
Berek, B; Canna, M
Telemedicine has drawn increasing attention as one of the emerging new service delivery vehicles that will run on the information superhighway. In reality, remote diagnosis and consultation through the application of telecommunications technology have been practiced for many years. But advances in technology and reform imperatives to extend access beyond traditional boundaries are pushing telemedicine into new applications. This is evidenced by the explosion in the number of pilot projects begun within the last 12 months. While demonstrating telemedicine's growing capabilities--for education and administration, as well as medical practice--these projects also raise a number of legal, clinical, and technical questions that must be answered before government and other payers will routinely reimburse for remote services. Academic and industry consortia are springing up to deal with the most compelling issues, including documenting telemedicine's safety and efficacy, developing uniform data and transmission standards, and determining the minimum resolution needed to maintain the integrity of clinical transmissions. Almost every type of medical specialty has proved amenable to performing evaluations via telemedicine links; however, specialties with less direct patient contact, like radiology and pathology, are generally identified as better candidates for telemedicine interactions. The telemedicine equipment required for these consults ranges from the simple to the ultra-sophisticated, depending on the type of system used and its clinical application. The most common system configuration involves a base station in the main facility where specialists and other consultants are housed and a number of remote referral sites. Consults are performed by interactively sharing voice, video, or image data. Increasingly, systems are being introduced that use easy-to-learn, intuitive displays and controls. Systems also require the use of any number of different communication media
Abby Swanson Kazley
Full Text Available Stroke is a leading cause of death and disability, and rtPA can significantly reduce the long-term impact of acute ischemic stroke (AIS if given within 3 hours of symptom onset. South Carolina is located in the stroke belt and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality.We used a retrospective cross-sectional design examining Census data from 2000 and Geographic Information Systems (GIS analysis to identify South Carolina residents that live within 30 or 60 minutes of a Primary Stroke Center (PSC or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a Primary Stroke Center (PSC or a REACH MUSC hospital within 30 or 60 minutes. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within sixty minutes given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within sixty minutes of expert stroke care, and 43% of the population to be within 30 minute drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can
Full Text Available Background/Aim. In the last twenty years significant advances have been made in the fields of information and telecommunication technology in health care applications, with a positive impact on the health care practice. The need for remote diagnosis and planning of interventions is of special importance in military health care, and health management of immobile persons, and those with special needs. In cases such as these, availability of specialist health care is mainly limited by geographic and financial factors. The aim of this study was to investigate practical usability of telemedicine approaches in everyday management of oral surgery patients in terms of reliability of established diagnosis and indications for oral surgery treatment of the third molars. Methods. Our experimental randomized study enrolled 432 randomly selected patients of both genders, aged 20 to 87 years, undergoing panoramic radiography for some reason in the Centre for Dental Radiography in Belgrade. In addition to radiography, photographs of the face and mouth cavity were taken. These images were uploaded to the web server specially dedicated to the study purposes, and then transmitted to teledentists, i.e. oral surgeons, who made remote diagnoses. Diagnostic agreement was determined by way of the Cohen's kappa coefficient, and diagnostic sensitivity (SE, specificity (SP, and effectiveness (EFF were also established. Statistical significance was determined and comparisons performed by using the z-test, and testing of non-parametric characteristics by using the McNemar's χ2 test for p = 0.05 significance cut-off. Results. The results obtained by analyzed images and diagnostic assessment of the clinical diagnosis (kappa = 0.99, SE = 99%, SP = 99%, EFF = 99%, for 95% CI indicate an almost complete diagnostic agreement. The differences in diagnosis were not statistically significant. Conclusion. Diagnostic assessment of the clinical diagnosis of impacted or semi
Raphael, Bram P; Schumann, Caitlin; Garrity-Gentille, Sara; McClelland, Jennifer; Rosa, Carolyn; Tascione, Christina; Gallotto, Mary; Takvorian-Bené, Melissa; Carey, Alexandra N; McCarthy, Patrick; Duggan, Christopher; Ozonoff, Al
Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.
Mileski, Michael; Kruse, Clemens Scott; Catalani, Justin; Haderer, Tara
Hypertension is a chronic condition that affects adults of all ages. In the United States, 1 in 3 adults has hypertension, and about half of the hypertensive population is adequately controlled. This costs the nation US $46 billion each year in health care services and medications required for treatment and missed workdays. Finding easier ways of managing this condition is key to successful treatment. A solution to reduce visits to physicians for chronic conditions is to utilize telemedicine. Research is limited on the effects of utilizing telemedicine in health care facilities. There are potential benefits for implementing telemedicine programs with patients dealing with chronic conditions. The purpose of this review was to weigh the facilitators against the barriers for implementing telemedicine. Searches were methodically conducted in the Cumulative Index to Nursing and Allied Health Literature Complete (CINAHL Complete) via Elton B Stephens Company (EBSCO) and PubMed (which queries MEDLINE) to collect information about self-management of hypertension through the use of telemedicine. Results identify facilitators and barriers corresponding to the implementation of self-management of hypertension using telemedicine. The most common facilitators include increased access, increase in health and quality, patient knowledge and involvement, technology growth with remote monitoring, cost-effectiveness, and increased convenience/ease. The most prevalent barriers include lack of evidence, self-management difficult to maintain, no long-term results/more areas to address, and long-term added workload commitment. This review guides health care professionals in incorporating new practices and identifying the best methods to introduce telemedicine into their practices. Understanding the facilitators and barriers to implementation is important, as is understanding how these factors will impact a successful implementation of telemedicine in the area of self-management of
Rochat, Laurence; Genton, Blaise
Telemedicine is emerging as a useful tool to provide expert medical advice to individuals facing health issues while travelling in remote areas. Before embarking on the development of a telemedicine system, we conducted a survey to assess the needs and expectations of travellers for such a service, and evaluate opinions about the importance of various travel criteria that may determine the contract of such insurance. (i) To assess whether a telemedicine service is considered useful by travellers, (ii) to investigate which telecommunication medium is preferred, (iii) to determine which subgroup of travellers would be most interested in this service and (iv) to estimate the amount of money travellers would be willing to pay for a telemedicine service. Travellers coming to our clinic for pre-travel advice were given a questionnaire to be filled in before consultation. The questionnaire focused on demographics, travel details, health status, interest and willingness to pay for a telemedicine service. Among 307 returned questionnaires, 59% of travellers were interested in a telemedicine service. Email was the preferred communication medium for 63%, mobile phone for 46% and video calls for 31% individuals (multiple answers). Travellers aged ≥60 years and those with an immunocompromising condition tended to be more interested in telemedicine (respectively OR = 1.65; 95% CI: 0.75-3.62 and OR = 3.56; 95% CI: 0.41-30.95). The 99% of travellers were willing to pay for such a service. Median price was 50 USD (IQR: 30-50 USD). There was no correlation between travel duration and amount to be paid. Among individuals consulting for pre-travel advice at a specialized clinic, there is considerable interest in telemedicine, particularly among older and immunocompromised travellers. Based on these data, a pilot system using email communication to help travellers confronted with health issues while abroad was developed and implemented in our travel clinic.
Müller, K I; Alstadhaug, K B; Bekkelund, S I
We investigated non-acute headache patients' long-term satisfaction with a telemedicine consultation and consultation preferences in northern Norway. We hypothesized that patients were not less satisfied with telemedicine than traditional consultations. We also examined the influence of gender, age and education on satisfaction. For 2.5 years, patients were consecutively screened, recruited and randomly assigned to telemedicine or traditional visits with a consultation at a neurological outpatient department. The primary endpoint was frequency of satisfied patients at 3 and 12 months. Secondary endpoints were satisfaction with consultation, communication, information, diagnosis, advice and prescriptions, and preferred visit form at 12 months. Of 402 participants, 279 (69.4%) answered questionnaires at both 3 and 12 month, and 291 (72.4%) responded at 12 months. The long-term satisfaction of telemedicine patients was 124/145 (85.5%) compared with 118/134 (88.1%) in the traditional group (P = 0.653). The groups did not differ with respect to secondary endpoints, but females were more satisfied with telemedicine communication (P = 0.027). In the telemedicine group, 99/147 (67.3%) were indifferent to the type of consultation. Age and education did not alter the primary results. At 1 year after a specialist evaluation for headache, telemedicine patients did not express less satisfaction than those with traditional consultation. Telemedicine specialist consultations may be a good alternative for headache patients in secondary care. © 2017 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K
The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Ijaz A. Qureshi; Hassan Raza; Michael Whitty; Syed Zain Ul Abdin
Telemedicine is becoming an important aspect in developing countries to provide better health facilities. Rural areas in developing countries suffer due to lack of health facilities and face difficulties like time to reach health facilities at the faraway places, cost of reaching at a health care facility, and transportation needed to move around for the treatment/consulting purpose. Telemedicine could be used for safe and quality health by specialists at low cost in rural areas in Pakistan. ...
Dawson, Joanna Adobea
Rationale: Attempts to successfully develop telemedicine solutions by specifying the require-ments and critical success factors of these solutions are on-going in sub-Saharan Africa (SSA) countries as a means of improving access to high-quality healthcare. European Space Agency (ESA) (Dario et al. 2005) have explored the challenges and benefits of telemedicine solutions in these regions in the domains of eGovernment such as billing and administrative data management to support the healthcare ...
Full Text Available Introduction: The purpose of this paper is to assess if similar telemedicine services integrated in the management of different chronic diseases are acceptable and well perceived by patients or if there are any negative perceptions. Theory and methods: Participants suffering from different chronic diseases were enrolled in Veneto Region and gathered into clusters. Each cluster received a similar telemedicine service equipped with different disease-specific measuring devices. Participants were patients with diabetes (n = 163, chronic obstructive pulmonary disease (n = 180, congestive heart failure (n = 140 and Cardiac Implantable Electronic Devices (n = 1635. The Service User Technology Acceptability Questionnaire (SUTAQ was initially translated, culturally adapted and pretested and subsequently used to assess patients’ perception of telemedicine. Data were collected after 3 months and after 12 months from the beginning of the intervention. Data for patients with implantable devices was collected only at 12 months. Results: Results at 12 months for all clusters are similar and assessed a positive perception of telemedicine. The SUTAQ results for clusters 2 (diabetes, 5 (COPD and 7 (CHF after 3 months of intervention were confirmed after 12 months. Conclusions: Telemedicine was perceived as a viable addition to usual care. A positive perception for telemedicine services isn’t a transitory effect, but extends over the course of time.
Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies. This study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram. It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension. To implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions.
Narasimha, Shraddhaa; Agnisarman, Sruthy; Chalil Madathil, Kapil; Gramopadhye, Anand; McElligott, James T
Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population. Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures. Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population. Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.
Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.; Garcia, Rudy J.; Parks, Raymond C.; Warren, Steve
Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into 'plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient record systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment
Dario, Claudio; Luisotto, Elena; Dal Pozzo, Enrico; Mancin, Silvia; Aletras, Vassilis; Newman, Stanton; Gubian, Lorenzo; Saccavini, Claudio
The purpose of this paper is to assess if similar telemedicine services integrated in the management of different chronic diseases are acceptable and well perceived by patients or if there are any negative perceptions. Participants suffering from different chronic diseases were enrolled in Veneto Region and gathered into clusters. Each cluster received a similar telemedicine service equipped with different disease-specific measuring devices. Participants were patients with diabetes (n = 163), chronic obstructive pulmonary disease (n = 180), congestive heart failure (n = 140) and Cardiac Implantable Electronic Devices (n = 1635). The Service User Technology Acceptability Questionnaire (SUTAQ) was initially translated, culturally adapted and pretested and subsequently used to assess patients' perception of telemedicine. Data were collected after 3 months and after 12 months from the beginning of the intervention. Data for patients with implantable devices was collected only at 12 months. Results at 12 months for all clusters are similar and assessed a positive perception of telemedicine. The SUTAQ results for clusters 2 (diabetes), 5 (COPD) and 7 (CHF) after 3 months of intervention were confirmed after 12 months. Telemedicine was perceived as a viable addition to usual care. A positive perception for telemedicine services isn't a transitory effect, but extends over the course of time.
Bagot, Kathleen L; Cadilhac, Dominique A; Vu, Michelle; Moss, Karen; Bladin, Christopher F
Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine. Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation. Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine. Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine. © The Author(s) 2015.
Full Text Available Authors in many scientific publications suggest that the telemonitoring of health parameters is a useful tool for supporting patients with long-term conditions staying at home and their self-management of the disease. Those patients are likely to benefit from timely and adequate response to deteriorated conditions detected by the telemedicine system. Almost all of the studies state that telemedicine provided as telemonitoring can be an eﬀective add-on tool in the hands of patients and medical experts for the self-management of patients with, for example, heart failure or diabetes. In this paper the principles of patient telemonitoring are presented as applied within a telemedicine service provided by the Centre for Telehealth (CEZAR at the General Hospital Slovenj Gradec (Slovenia. The centre supports patients with diabetes mellitus type 2 and/or with chronic congestive heart failure. The service was set-up in 2014 as part of a European project called UNITED4HEALTH. Since then over 550 patients from the Carinthia and Saleška regions (Slovenia have been receiving telemedicine support for more than two years. The clinical outcomes of the telemedicine service published elsewhere prove that the selected telemedicine service model is adequate and the implemented technological solution is acceptable for all service users: the patients and the clinicians.
Ladas, P; Giatagatzidis, P; Anogianakis, G; Maglavera, S
Telemedicine dates to the days of "wireless telegraphy". As an "extraordinary" arrangement for medical services delivered at time of need, telemedicine has thus far escaped the developments that have taken place over the last 50 years in the areas of medical liability, safety and confidentiality. Today, however, telemedicine is also used to increase quality and cost effectiveness of healthcare provision. This trend is set by the U.S. where the U.S. federal government funds telemedicine at an annual rate of more than $100 million i.e., at a rate 30 times or more than what the EU does while state and local agency support and private business investment in telemedicine is 3 to 4 times larger than that of the U.S. federal government. In this respect it must be stressed that technology tends to satisfy the relevant demand for telecommunications. Telemedicine is used in diverse areas such as pathology, surgery, physical therapy, and psychiatry. It is expected to revolutionise health care in the coming decade and, therefore, it will certainly take into account requirements for medical liability, safety and confidentiality in the same way as traditional "establishment" medicine does.
MacFarlane, Anne; Murphy, Andrew William; Clerkin, Pauline
The Republic of Ireland is characterised by few urban conurbations and a high rural population, including significant numbers of island dwellers. Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. As in other countries, the recent National Health Information Strategy is regarded as pivotal to the modernisation of the Irish health care system. There is, however, a dearth of research about telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine services, all initiated by local policy, will be presented. Results of an interview study with service providers about their experiences of the practices and processes involved in telemedicine service delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish data with the international literature with particular reference to a recently developed model for the normalisation of telemedicine. For the first time, this model which was developed in the United Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a number of health information policy issues for Ireland and elsewhere arising from our analysis.
King, Gerry; Richards, Helen; Godden, David
We conducted a qualitative interview study to explore the factors that have facilitated and prevented the adoption of telemedicine in general practice in remote and rural Scotland. Face-to-face interviews were carried out with general practitioners (GPs) and practice nurses in 26 of Scotland's most remote practices and five of the seven most rural health boards. The interview study found that GPs were more positive about the use of computers and telemedicine than nurses. Although electronic access to simple data, such as laboratory results, had become widely accepted, most respondents had very little experience of more sophisticated telemedicine applications, such as videoconferencing. There was widespread scepticism about the potential usefulness of clinical applications of telemedicine, although it was perceived to have potential benefit in facilitating access to educational resources. A number of barriers to the adoption of telemedicine were reported, including concerns that videoconferencing could diminish the quality of communication in educational and clinical settings, and that telemedicine would not fit easily with the organizational routines of the practices. Policy-makers should prioritize strategies to develop educational programmes, as these are more likely to succeed than clinical initiatives. It may then follow that clinicians will see opportunities for use in their clinical work.
Setia, Monika; DelliFraine, Jami L
There appear to have been no studies of telemedicine in rural day care centres. We have assessed the feasibility of using telemedicine in eight rural day care centres in Pennsylvania, from the day care centres' perspective. The average number of children in these centres was 76 (range 20-150). The centres sent an average of 4.7 children home each month because of illness. Using telephone and face-to-face interviews, we assessed their perceived need for and familiarity with telemedicine, as well as their openness and preparedness for implementing telemedicine. Most day care centres reported a need for telemedicine and were open to learning how to use it. Some centres were concerned about adequate space for the equipment, but overall, the centres felt that their resources were adequate. Telemedicine in rural day care centres appears to be feasible, and would have the potential to save time and money for parents, as well as perhaps improving health care for children in rural areas.
Craft, Richard L.; Funkhouser, Donald R.; Gallagher, Linda K.; Garcia, Rudy J.; Parks, Raymond C.; Warren, Steve
Commercial telemedicine systems are increasingly functional, incorporating video-conferencing capabilities, diagnostic peripherals, medication reminders, and patient education services. However, these systems (1) rarely utilize information architectures which allow them to be easily integrated with existing health information networks and (2) do not always protect patient confidentiality with adequate security mechanisms. Using object-oriented methods and software wrappers, we illustrate the transformation of an existing stand-alone telemedicine system into `plug-and-play' components that function in a distributed medical information environment. We show, through the use of open standards and published component interfaces, that commercial telemedicine offerings which were once incompatible with electronic patient record systems can now share relevant data with clinical information repositories while at the same time hiding the proprietary implementations of the respective systems. Additionally, we illustrate how leading-edge technology can secure this distributed telemedicine environment, maintaining patient confidentiality and the integrity of the associated electronic medical data. Information surety technology also encourages the development of telemedicine systems that have both read and write access to electronic medical records containing patient-identifiable information. The win-win approach to telemedicine information system development preserves investments in legacy software and hardware while promoting security and interoperability in a distributed environment.
Humer, Michael F; Campling, Barbara G
The purpose of this study is to review the role of telemedicine in providing oncology care; we describe our long-standing, high-volume telemedicine experience. The Interior Health Thoracic Surgical Group (IHTSG) uses telemedicine, through Virtual Thoracic Surgical Clinics (VTSC), to provide service to remote patients. The IHTSG serves a population of 1.01 million people over an area of 807,538 km 2 (1.3 persons/km 2 ) in the Interior and North of British Columbia, Canada. Between 2003 and 2015, the IHTSG conducted 15,073 telemedicine patient encounters at 63 geographic sites. Telemedicine saved these patients a total travel distance of 11.5 million km-an average of 766 km per patient. VTSC supports and strengthens the Hub and Spoke model of healthcare delivery-patients residing remotely can easily access centrally delivered service. Telemedicine makes specialized care available to all patients by overcoming a major impediment to access, namely distance.
Kim, Hyung-Gi; Choi, Young-A; Choi, Eun-Hi; Kim, Dong-Won; Shin, Se-Gye; Park, Kyung-Suk; Han, Jae-Hyun
Objectives This study attempted to identify the factors that contribute to successful telemedicine service. This was done by analyzing the operational state of successful telemedicine services offered in Gangwon Province of Korea and their outcome for the last fifteen years. Methods A comparative analysis was made based on reports and a thesis on the satisfaction rate of patients and providers, patient compliance to treatment, and economic assessment of Gangwon telemedicine service, which were carried out in three periods: the years 2006, 2010, and 2012. Results The satisfaction surveys in all three periods showed similar results for patients (4.46±0.70 point) and healthcare practitioners, including nurses (3.82±0.62 point) and physicians (3.60±0.56 point), in decreasing order from the year 2012. Through the survey of patients' compliance with treatment, it was confirmed that telemedicine services increased patients' compliance with drug administration, facilitated improvement of lifestyle habits, improved glycated hemoglobin for patients with diabetes mellitus, and enhanced the rate of blood pressure control. In the survey conducted on patients' willingness to pay for telemedicine services in 2007, it was found that those patients were willing to pay about $3.5 for services. Conclusions The telemedicine services of Gangwon Province increased patients' compliance with drug administration, improved blood glucose control, enhanced blood pressure control for patients with hypertension, and provided economic advantage. PMID:26618035
Alderighi, Camilla; Rasoini, Raffaele; Mazzanti, Marco; Casolo, Giancarlo
The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor–patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value. PMID:29387464
Full Text Available In this paper, we introduce a telemedicine architecture for supporting emergency patient stabilization and patient transportation to a fully equipped health care center. In particular, we focus on the description of a set of mobile apps, designed for supporting data recording and transmission during patient transportation by ambulance. Some of the apps are interfaced to the monitoring devices in the ambulance, and automatically send all the recorded data to a server at the destination center. One additional app enables the travelling personnel to input and transmit further significant patient data, or comments. At the destination center, the specialist physician is allowed to inspect the data as soon as they are received, possibly providing immediate advice. The exploitation of the apps also allows to maintain the transportation data over time, for medico-legal purposes, or to perform a-posteriori analyses. Some first evaluation results are discussed in the paper.
Full Text Available The creation of a telemedicine, tele-expertise platform opens a new challenge within the European Network for Rare and Congenital Anaemias (ENERCA; www.enerca.org. This is a cornerstone in the field of rare anaemias, in which national expertise is usually scarce and a significant number of patients remain undiagnosed. Experts in rare diseases are specially needed of shared knowledge platforms offering the possibility of a faster and more accurate diagnosis and the availability of a better patients’ follow-up. The platform developed by e- ENERCA will be user friendly and intuitive so it will be used by the majority of professionals without requiring a specific formation. The idea of inter professional consultation is to bring medical experts together for collaborative involvement in activities that maximize the benefits and improvement in patient care.
Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M
As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.
Wannous, Hazem; Treuillet, Sylvie; Lucas, Yves
In telemedicine environments, a standardized and reproducible assessment of wounds, using a simple free-handled digital camera, is an essential requirement. However, to ensure robust tissue classification, particular attention must be paid to the complete design of the color processing chain. We introduce the key steps including color correction, merging of expert labeling, and segmentation-driven classification based on support vector machines. The tool thus developed ensures stability under lighting condition, viewpoint, and camera changes, to achieve accurate and robust classification of skin tissues. Clinical tests demonstrate that such an advanced tool, which forms part of a complete 3-D and color wound assessment system, significantly improves the monitoring of the healing process. It achieves an overlap score of 79.3 against 69.1% for a single expert, after mapping on the medical reference developed from the image labeling by a college of experts.
Buldakova, T. I.; Suyatinov, S. I.
In the report the approach to protection of transmitted data by creation of pair symmetric keys for the sensor and the receiver is offered. Since biosignals are unique for each person, their corresponding processing allows to receive necessary information for creation of cryptographic keys. Processing is based on reconstruction of the mathematical model generating time series that are diagnostically equivalent to initial biosignals. Information about the model is transmitted to the receiver, where the restoration of physiological time series is performed using the reconstructed model. Thus, information about structure and parameters of biosystem model received in the reconstruction process can be used not only for its diagnostics, but also for protection of transmitted data in telemedicine complexes.
Liu, Wei-Li; Zhang, Kai; Locatis, Craig; Ackerman, Michael
Cloud-based videoconferencing versus traditional systems are described for possible use in telemedicine and distance learning. Differences between traditional and cloud-based videoconferencing systems are examined, and the methods for identifying and testing systems are explained. Findings are presented characterizing the cloud conferencing genre and its attributes versus traditional H.323 conferencing. Because the technology is rapidly evolving and needs to be evaluated in reference to local needs, it is strongly recommended that this or other reviews not be considered substitutes for personal hands-on experience. This review identifies key attributes of the technology that can be used to appraise the relevance of cloud conferencing technology and to determine whether migration from traditional technology to a cloud environment is warranted. An evaluation template is provided for assessing systems appropriateness.
Full Text Available Diabetic retinopathy (DR is a growing concern in India. The first step in management of DR is timely screening. With 10% prevalence in rural India, 11 million people are likely to have DR by the year 2030. With limited resources and skilled manpower, it will not be possible to have routine eye examination to identify and treat these patients on a regular basis. Telemedicine is a possible answer in these situations where patients could be remotely screened and appropriately advised. With the advent of several technological advances such as low cost hand-held nonmydriatic camera, increased capabilities of the smartphones to take external eye and retinal photographs coupled with improving broadband connectivity; teleophthalmology in the management of DR could be a reality in the not too distant future.
Edgardo Escobar, MD, FACC, FAHA
Full Text Available There is a growing need worldwide to take medical care to distant locations far from the main urban centers, particularly to rural areas. Furthermore, there is the ethical imperative to provide equal access to medical care to all patients, regardless of their place of residence, so as to satisfy an increasingly demanding population. A widespread problem, from which cardiology is not excepted, is the insufficient number of specialists and their uneven distribution. The upsurge in information and communications technology has made available a large collection of tools, mainly computers, smartphones, e-mail, and the Internet, to name just a few, to meet the needs of communication between individuals and organizations. This article defines telemedicine and describes its application in the practice of cardiology and its impact in Chile.
Jue, Joshua S; Spector, Sydney A; Spector, Seth A
Surgical and nonsurgical specialists are highly centralized, making access to high-quality care difficult for many Americans. We explored the feasibility, benefits, preliminary outcomes, and patient satisfaction with a new type of health visit, in which a surgical oncologist used video telecommunication to manage and treat complex cancer diseases, including patients with severe comorbidities. Patients visited local VA medical centers throughout Florida to engage in video telecommunication visits with a centralized surgical oncologist in Miami, who directed their oncology treatment. The average length of stay and rate of unplanned readmission were calculated within each organ. The total mileage saved was calculated by subtracting the distance between the patient's home address and the local VA from the distance between the patient's home address and the Miami VA. Travel costs were determined by the VA's reimbursement of $0.415/mile for health-related travel and reimbursement of $150.00 for an overnight hotel stay. A Likert scale with both positively and negatively keyed questions was used to assess patient satisfaction. In 24 mo, seven unplanned readmissions occurred among 195 operations. Patients experienced an 80.7% reduction in travel distance and saved a total of 213,007.58 miles by visiting their local VA instead of the Miami VA. Survey results indicate that 86% of patients believed that the telemedicine program made medical care more accessible. The Specialist-Directed Telemedicine Model can save patients substantial time and money by not traveling to centralized areas, while delivering greater continuity of care and patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.
Gamble, John E; Savage, Grant T; Icenogle, Marjorie L
While telemedicine's clinical effectiveness and educational benefits are accepted, its cost-effectiveness is controversial. This study focuses on telemedicine's cost-effectiveness from a provider's perspective. Reviews of the cost-effectiveness literature in telemedicine are critical of past studies' (a) methodological and analytical weaknesses; (b) focus on answering "Can we do this?" rather than "Should we do this?"; and (c) emphasis on patient benefits. Value chain analysis examines structural and executional cost drivers; a self-sustaining business model balances the cost and value associated with each telemedicine activity. We illustrate this analysis in a rural health program, examining teleradiography and telerehabilitation.
Sahn, David J; Kinney, James; Puntel, Robert
... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...
Sahn, David J
... & Science University in Portland, will test the hypothesis that trained primary care practitioners or nurses can, with telemedicine supervision, perform cardiac ultrasound exams on neonates at risk...
Sahn, David J; Kinney, James; Puntel, Robert
... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...
Bobb, Morgan R.; Van Heukelom, Paul G.; Faine, Brett A.; Ahmed, Azeemuddin; Messerly, Jeffrey T.; Bell, Gregory; Harland, Karisa K.; Simon, Christian; Mohr, Nicholas M.
Objective Telemedicine networks are beginning to provide an avenue for conducting emergency medicine research, but using telemedicine to recruit participants for clinical trials has not been validated. The goal of this consent study is to determine whether patient comprehension of telemedicine-enabled research informed consent is non-inferior to standard face-to-face research informed consent. Methods A prospective, open-label randomized controlled trial was performed in a 60,000-visit Midwestern academic Emergency Department (ED) to test whether telemedicine-enabled research informed consent provided non-inferior comprehension compared with standard consent. This study was conducted as part of a parent clinical trial evaluating the effectiveness of oral chlorhexidine gluconate 0.12% in preventing hospital-acquired pneumonia among adult ED patients with expected hospital admission. Prior to being recruited into the study, potential participants were randomized in a 1:1 allocation ratio to consent by telemedicine versus standard face-to-face consent. Telemedicine connectivity was provided using a commercially available interface (REACH platform, Vidyo Inc., Hackensack, NJ) to an emergency physician located in another part of the ED. Comprehension of research consent (primary outcome) was measured using the modified Quality of Informed Consent (QuIC) instrument, a validated tool for measuring research informed consent comprehension. Parent trial accrual rate and qualitative survey data were secondary outcomes. Results One-hundred thirty-one patients were randomized (n = 64, telemedicine), and 101 QuIC surveys were completed. Comprehension of research informed consent using telemedicine was not inferior to face-to-face consent (QuIC scores 74.4 ± 8.1 vs. 74.4 ± 6.9 on a 100-point scale, p = 0.999). Subjective understanding of consent (p=0.194) and parent trial study accrual rates (56% vs. 69%, p = 0.142) were similar. Conclusion Telemedicine is non-inferior to face
Full Text Available Abstract The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available or through Plain Old Telephony Systems (POTS where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three
Rosser, J C; Bell, R L; Harnett, B; Rodas, E; Murayama, M; Merrell, R
Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by
Full Text Available Santanu K Datta1,2, Adam H Buchanan3, Gail P Hollowell4, Henry F Beresford5, Paul K Marcom1,3, Martha B Adams1,61Department of Medicine, Duke University; 2Center for Health Services Research in Primary Care, Durham VA Medical Center; 3Duke Cancer Institute, Duke University; 4Department of Biology, North Carolina Central University; 5School of Nursing, Duke University; 6Department of Community and Family Medicine, Duke University, Durham, NC, USAAbstract: Cancer genetic counseling (CGC provides benefits and is the standard of care for individuals at increased risk of having a hereditary cancer syndrome. CGC services are typically centered in urban medical centers, leading to limited access to counseling in rural communities. Telemedicine has the potential to improve access to CGC, increase efficient use of genetic counselors, and improve patient care in rural communities. For telemedicine CGC to gain wide acceptance and implementation it needs to be shown that individuals who receive telemedicine CGC have high satisfaction levels and that CGC is cost-effective; however little research has been conducted to measure the impact of telemedicine CGC. This paper describes the design and methodology of a randomized controlled trial comparing telemedicine with in-person CGC. Measurement of patient satisfaction and effectiveness outcomes are described, as is measurement of costs that are included in an economic analysis. Study design and methodologies used are presented as a contribution to future comparative effectiveness investigations in the telemedicine genetic counseling field.Keywords: cancer genetics, genetic counseling, rural health services, telemedicine, satisfaction, cost
Wibbenmeyer, Lucy; Kluesner, Karen; Wu, Hongqian; Eid, Anas; Heard, Jason; Mann, Benjamin; Pauley, Alison; Peek-Asa, Corrine
The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with
Vyas, Krishna S; Hambrick, H Rhodes; Shakir, Afaaf; Morrison, Shane D; Tran, Duy C; Pearson, Keon; Vasconez, Henry C; Mardini, Samir; Gosman, Amanda A; Dobke, Marek; Granick, Mark S
Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use
Holderried, Martin; Schlipf, Madeleine; Höper, Ansgar; Meier, Reinhard; Stöckle, Ulrich; Kraus, Tobias Maximilian
The use of information technology (IT) in health care has continuously increased. This includes software solutions for digitalisation, data storage and innovative approaches in diagnostics. The facilitation of the access to specific information, even by the patient, has changed daily clinical work. Patients inform themselves about symptoms, diagnostic methods and treatment options. This urge for information and the wish for the best treatment is summarised in the expression "patient empowerment". In some countries, the gap between do-it-yourself diagnosis and telemedicine via the telephone has already been closed. A sophisticated telemedical hotline may help to improve consultation and treatment of patients living in remote regions or rural communities. Traumatology telemedicine may also be used in trauma environments, such as disasters or mass casualties. Therefore, the purpose of this study was to assess the demand for e-health solutions among patients seeking the help of the emergency department in a trauma hospital. A total of 255 patients (age range 18 - 75 years) were included in the study and were surveyed with the use of a questionnaire. As regards personal data, the questionnaire asked the patient about their Internet habits and about interesting topics they had researched in the world wide web. However, the questionnaire was specifically designed to ask for potential benefits and the patient's expectations for e-health solutions. Expected weaknesses and procedures for telemedical services were also included in a subsection. 43.5% of the patient cohort were woman and 56.5% men. The average distance to the hospital was 39.86 km. 223 patients were insured by the governmental health service providers and 32 had private insurance coverage. Aside from online shopping and online banking, the search for health topics was most frequent. The greatest fear was the lack of personal contact to the doctor (71.2%). Patients were also concerned about the safety of
Vogl, R. [IT-Abteilung, Tiroler Landeskrankenanstalten GmbH, Innsbruck (Austria)
Problem. Due to the rapid progress in the fields of information technology and data networks, telemedicine applications are growing in number. Besides curative telemedicine, the electronic exchange of medical data and the integration of health information systems between health care providers is gaining importance. Through the improved accessibility of electronic patient record information, considerable risks arise.Methods. A project for the interconnection of medical picture archiving and communication systems (PACS) between several hospitals is presented and the possibilities for further developing such networking systems utilizing new software technologies for transparent data access between different locations (GRID) and for decision support (software agents) are considered.Results. The availability of the electronic patient record via the data network and the perspective of semi intelligent software systems automatically preparing the data bears great potential for a boost in treatment quality and efficiency. Systems for unique electronic patient identification and for secure digital signature are a prerequisite, but per se not enough to ensure the protection of data against illegitimate access.Conclusion. Despite quality and efficiency benefits, challenges in the protection of sensible data and in the change of the physicians role result. (orig.) [German] Fragestellung. Durch die rasante Entwicklung der Informationstechnologie und der Datennetzwerke werden auch telemedizinische Applikationen immer zahlreicher eingesetzt. Neben der kurativen Telemedizin, die medienwirksame Erfolge verbuchen kann, gewinnen der elektronische Datenaustausch und die Gesundheitseinrichtungen uebergreifende Informationssystemintegration wachsende Bedeutung. Aus der besseren Zugaenglichkeit der elektronischen Krankengeschichtsinformation ergeben sich neben Chancen auch Risiken.Methodik. Ein Beispielprojekt fuer die Vernetzung von medizinischen Bildarchivierungssystemen (PACS
Altschuler, Bruce R.
The technology to reliably transmit high-resolution visual imagery over short to medium distances in real time has led to the serious considerations of the use of telemedicine, telepresence, and telerobotics in the delivery of health care. These concepts may involve, and evolve toward: consultation from remote expert teaching centers; diagnosis; triage; real-time remote advice to the surgeon; and real-time remote surgical instrument manipulation (telerobotics with virtual reality). Further extrapolation leads to teledesign and telereplication of spare surgical parts through quantitative teleimaging of 3-D surfaces tied to CAD/CAM devices and an artificially intelligent archival data base of 'normal' shapes. The ability to generate 'topogrames' or 3-D surface numerical tables of coordinate values capable of creating computer-generated virtual holographic-like displays, machine part replication, and statistical diagnostic shape assessment is critical to the progression of telemedicine. Any virtual reality simulation will remain in 'video-game' realm until realistic dimensional and spatial relational inputs from real measurements in vivo during surgeries are added to an ever-growing statistical data archive. The challenges of managing and interpreting this 3-D data base, which would include radiographic and surface quantitative data, are considerable. As technology drives toward dynamic and continuous 3-D surface measurements, presenting millions of X, Y, Z data points per second of flexing, stretching, moving human organs, the knowledge base and interpretive capabilities of 'brilliant robots' to work as a surgeon's tireless assistants becomes imaginable. The brilliant robot would 'see' what the surgeon sees--and more, for the robot could quantify its 3-D sensing and would 'see' in a wider spectral range than humans, and could zoom its 'eyes' from the macro world to long-distance microscopy. Unerring robot hands could rapidly perform machine-aided suturing with
Much attention is paid to the technical aspects of telemedicine in the development of new applications, but the enthusiasm about what is technically possible very often leads to the user acceptance of such products being neglected. The number of successful and sustainable telemedicine applications would be much higher if developers concentrated more on matters related to the cognitive-emotional situation of the users involved in telemedicine. The users include the care and cure providers, as well as the care and cure receivers. Based on an informal literature search and discussions with telemedicine implementation staff, nine factors have been identified which are essential for the user acceptance of telemedicine applications. All of them are connected more to the cognitive-emotional than to the cognitive-rational side of information processing. This suggests that in the future the cognitive-emotional side will need more attention. This in turn implies that the nine points mentioned above have to find their way into requirements engineering, development processes and product life cycles.
Morozov, Sergey; Guseva, Ekaterina; Ledikhova, Natalya; Vladzymyrskyy, Anton; Safronov, Dmitry
Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the "scoring" approach and makes the quality control more accessible and objective. A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. The conception of the system for quality management in radiology represents a chain of actions: "discrepancies evaluation - routine support - quality improvement activity - discrepancies evaluation". It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.
Takazawa, Hiroki; Morita, Takahiro; Narisawa, Ayumi; Saito, Atsushi; Koyama, Shinya; Sasaki, Tatsuya; Nishijima, Michiharu
Our hospital is located between Tsugaru and Shimokita Peninsulas that are wide medically depopulated areas. The depopulated Tsugaru District has only 2 neurosurgical units, and many patients have to be transferred from the district general hospitals. Since 1989, we have been using an image transfer system that is useful for accurately diagnosing patients with head injury. Between January 2005 and September 2010, 644 patients with head injury were admitted to our hospital. The patients who used and did not use telemedicine were 78 and 566, respectively. In both groups, the background (age, gender, and type of head injury), surgery rate, and time of entry into the operating room were analyzed. There were no significant differences in the age, gender, and type of head injuries between the 2 groups. The surgery rate was 25.6% (28 patients) in the telemedicine group and 12.4% (70 patients) in the direct admission group. The average amount of time between admission and entry into the operating room was 2 h and 13 min in the telemedicine group and 2 h and 57 min in the direct admission group. There were significant differences between the telemedicine and direct admission groups (p<0.05). These results suggest that telemedicine is useful in the treatment of patients with head injuries in a widely depopulated area. (author)
Adrian Dumitru Tanţău
Full Text Available The main purpose of the present study is to provide a highly comprehensive methodological solution for carrying out products/services which fully comply with customers (i.e. end users functional and performance requirements in Telemedicine field, and furthermore to satisfy multitude end users simultaneously. By bringing into the light Systems Engineering (SE as a multidisciplinary theory used preponderantly in the aero-space segment for realization of complex projects, the paper illustrates the way it can be fulfilled the Functional and Performance Requirements of the end users from Romanian (non emergency medicine services in order to develop an innovative telemedicine product. The case study is based on two sets of qualitative researches as interviews in order to validate the telemedicine triggering idea among users, and to classify them, and secondly, as ample observations in order to gain insights on the users' scenarios and further to elaborate user requirements. Both sets of researches undertaken from users' specific environments were backed up with secondary information gained through document analysis. Relevant for this telemedicine research, it is the fact that the results of this survey have been already successfully used as a baseline to prototype the telemedicine product for Romanian market, in a European Space Agency (ESA Project.
Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching
This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all pexpectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.
Rajesh V Acharya
Full Text Available Introduction: Telemedicine incorporates electronic information and medical technology. It connects healthcare through vast distances which would benefit both patients and doctors. The aim of this questionnaire study was to evaluate the effects of telemedicine on patients and medical specialists. Methods: A cross-sectional study was conducted among 122 participants (71 patients and 51 doctors on satisfaction in quality of service, cost-effectiveness, and problems encountered in healthcare provided by the telemedicine in Apollo Tele Health Services, Hyderabad, Telangana, India. The data for each group were calculated and compared. Results: About 80% patients and all the doctors reported their satisfaction on the quality of treatment given through telemedicine. Approximately, 90% of the participants found telemedicine cost-effective and 61% of the doctors found an increase in patient's inflow apart for their regular practice. Problems encountered in telemedicine were 47% in technical issues and 39% in time scheduling by doctors and 31% of patients were uncomfortable to face the camera, and 24% had technical issues. Conclusions: The results of the present study showed that telemedicine in healthcare could prove to be useful to patients in distant regions and to rural doctors in India. In the near future, telemedicine can be considered as an alternate to face to face patient care.
Alis, Christian; del Rosario, Carlos; Buenaobra, Bernardino; Mar Blanca, Carlo
Current wired telemedicine systems encounter difficulties when implemented in archipelagic developing countries because of the high cost of fixed infrastructure. In this research, we devised Lifelink, a mobile real-time telemonitoring and diagnostic facility to command and control remote medical devices through mobile phones. The whole process is phone-based, effectively freeing offsite medical specialists from stationary monitoring consoles and endowing the system with the potential to increase the number participating consultants. The electrocardiogram (ECG) readings are analyzed using a detrended fluctuation technique and classified into pathological cases using an unassisted K-means clustering algorithm. We analyzed 30 batches of 2-hour ECG signals taken from cardiac patients (20 males, 10 females, mean age 46.7 years) with pre-diagnosed pathologies. The method successfully categorized the 30 subjects without user intervention into the following cases: normal (at 86.7% accuracy), congestive heart failure (86.7%), and atrial fibrillation (80.0%). The synergy of mobile monitoring and fluctuation analysis presents a powerful platform to reach remote, underserved communities with poor or nonexistent wired communication structures. It is likely to be essential in the development of new mobile diagnostic and prognostic measures.
D. S. Kopylov
Full Text Available The paper deals with a result of the network services development for the optodigital complex for telemedicine diagnostics. This complex is designed for laboratory and clinical tests in health care facilities. Composition of network services includes the following: a client application for database of diagnostic test, a web-service, a web interface, a video server and microimage processing server. Structure of these services makes it possible to combine set of software for transferring depersonalized medical data via the Internet and operating with optodigital devices included in the complex. Complex is consisted of three systems: micro-vision, endoscopic and network. The micro-vision system includes an automated digital microscope with two highly sensitive cameras which can be controlled remotely via the Internet. The endoscopic system gives the possibility to implement video broadcasting to remote users both during diagnostic tests and also off-line after tests. The network system is the core of the complex where network services and application software are functioning, intended for archiving, storage and providing access to the database of diagnostic tests. The following subjects are developed and tested for functional stability: states transfer protocol, commands transfer protocol and video-stream transfer protocol from automated digital microscope and video endoscope. These protocols can work in web browsers on modern mobile devices without additional software.
Bossen, Ann L; Kim, Heejung; Williams, Kristine N; Steinhoff, Andreanna E; Strieker, Molly
Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one's progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored.
Full Text Available Rural areas in developing countries are characterized by lack of resources, low population density and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate healthcare services. This paper explains research results achieved by EHAS (Enlace Hispano Americano de Salud - Hispano American Health Link and how they have contributed to improve healthcare in isolated areas of developing countries through the use of Information and Communication Technologies (ICT. As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the healthcare services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned.
Krzystanek, Marek; Krzeszowski, Dariusz; Jagoda, Karolina; Krysta, Krzysztof
Low compliance is one of the crucial problems of contemporary psychiatry. Relapses, deterioration of cognitive functioning, negative symptoms, neuroleptic resistance are the examples of many consequences of noncompliance in schizophrenia The study was designed to assess the compliance in the 200 patients diagnosed with paranoid schizophrenia, all in the state of symptomatic remission and on the stable neuroleptic treatment. The compliance was assessed using a telepsychiatric system, sending reminders: 1 hour before the planned dose to remind them that drug intake is approaching, and at the moment of intake to check if they took the drug. The confirmed drug intakes were counted by the telepsychiatric system. 158 patients completed the study period. The compliance in the first month of the treatment was 44.6% and decreased over the rest of the period to the level of 33.4%. 50% of the schizophrenic patients were compliant at a level lower than 37%. This group was considered the low compliance group, and in this group the compliance increased after 6 months from 9.3% to 10.3% (p<0.0001). The compliance in the group of schizophrenic patients in remission is very low. The telemedicine system improves the compliance in the patients with the worst compliance.
Robaldo, Alessandro; Rousas, Nikolaos; Pane, Bianca; Spinella, Giovanni; Palombo, Domenico
Over a three-year period we performed 630 carotid endarterectomy procedures in 588 patients. From these we selected 90 patients (group A) who fulfilled the criteria for discharge one day after surgery. These patients were given an electronic blood pressure meter, a video phone for use at home and an antihypertensive drug (amlodipine). Using web-based video conferencing, we monitored the patients every 4 hours for the first two days. The other 498 patients (group B) were discharged on the second postoperative day. There were no significant differences between the groups in demographic characteristics, risk factors, carotid lesions, operative time, postoperative complications or blood loss. No cervical hematomas developed in group A. No patients needed to be readmitted because of major complications relating to the carotid endarterectomy. During the video-communication, 28 patients (31%) with a hypertensive crisis were treated by administration of amlodipine. At discharge, a questionnaire showed that there was a feeling of insecurity in both groups: 87% in group A vs. 79% in group B (P > 0.05). In group A, insecurity decreased after the first video connection and disappeared after the 8th day postoperatively. Telemedicine appears feasible and useful in carotid endarterectomy and may have other applications in vascular surgery care.
van den Berg, N; Meinke, C; Hoffmann, W
According to the AGnES concept (general-practitioner-supporting, community-based, e-health-assisted systemic intervention), general practitioners (GPs) can delegate certain components of medical care in the context of home visits by qualified AGnES employees. Within the framework of six AGnES projects, different telemedical applications have been implemented. Telemedical monitoring of patients was implemented to analyse the feasibility and acceptance within GP practices. One hundred sixty-two patients used a telemedical monitoring system (e.g. scale/sphygmomanometer and intraocular pressure measurement system). Regarding communication in cases of acutely necessary GP consultations, telephone calls and videoconferences between the GP and the AGnES employee were analysed. Unscheduled telephone calls or videoconferences were necessary for only a few home visits; the reasons included pain, anomalous values, and medication problems. The main result of the analysis was that implementation of telemedicine in GP practices is feasible and is accepted both by patients and GPs.
Latifi, Rifat; Merrell, Ronald C; Doarn, Charles R; Hadeed, George J; Bekteshi, Flamur; Lecaj, Ismet; Boucha, Kathe; Hajdari, Fatmir; Hoxha, Astrit; Koshi, Dashurije; de Leonni Stanonik, Mateja; Berisha, Blerim; Novoberdaliu, Kadri; Imeri, Arben; Weinstein, Ronald S
Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating
Christensen, Henrik Bærbak; Hansen, Klaus Marius; Kyng, Morten
performed a descriptive, revelatory case study of the Danish telemedicine ecosystem and for ii), we experimentally designed, implemented, and evaluated the architecture of 4S. Results We contribute in three areas. First, we define the software ecosystem architecture concept that captures organization......, and application stove-pipes that inhibit the adoption of telemedical solutions. To which extent can a software ecosystem approach to telemedicine alleviate this? Objective In this article, we define the concept of software ecosystem architecture as the structure(s) of a software ecosystem comprising elements...... experience in creating and evolving the 4S telemedicine ecosystem. Conclusion The concept of software ecosystem architecture can be used analytically and constructively in respectively the analysis and design of software ecosystems....
David A. Bergman
Full Text Available Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P<.05 in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist.
Freiburger, Gary; Holcomb, Mary; Piper, Dave
An early telemedicine project involving NASA, the Papago Tribe (now the Tohono O'odham Indian Nation), the Lockheed Missile and Space Company, the Indian Health Service and the Department of Health, Education and Welfare explored the possibilities of using technology to provide improved health care to a remote population in southern Arizona. The project, called STARPAHC (Space Technology Applied to Rural Papago Advanced Health Care), took place in the 1970s and demonstrated the feasibility of a consortium of public and private partners working together to provide medical care to remote populations via telecommunication. In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and in collaboration with the Arizona Telemedicine Program established the Arizona Archive of Telemedicine. The material is likely to interest those studying early attempts to use technology to deliver health care at a distance, as well as those studying the sociological ramifications of technical and scientific projects among indigenous populations.
Jakobsen, Neel Kolthoff; Jensen, Lena Sundby; Kayser, Lars
documented and disseminated. MATERIAL AND METHODS: Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted......INTRODUCTION: Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging...... to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were...
Jacobsen, Anna Svarre; Laursen, Lars C; Østergaard, Birte
Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable...... phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional...... hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge....
Anwar, Sadia; Kumar, Ambuj
Abstract—The use of smartphones has been increasing rapidly and it is expected that in future most people will have a smartphone capable of high speed Internet connection. The capability of smartphones with high definition display, computation power and multitude of sensors made it an excellent...... candidate for telemedicine application. Telemedicine’s applications and high data medical information generally require high definition visuals and lower latency connection, in addition mobility and reliability. The next generation of wireless communication standard, known as 5G, will provide data speed...... a composite business ecosystem. We also discuss the research challenges concerning 5G and telemedicine. Keywords—5G, Telemedicines, Wireless Communications, Business Modeling, Business Ecosystems....
Christiansen, Sytter; Rethmeier, Anita
Background: The Danish Society for Wound Healing advocates for the use of telemedicine in chronic wound management. It is crucial that student nurses are prepared for the technological demands of the future so that they will be competent to manage chronic wounds. Aim: The aim of this project...... was to integrate the concept of telemedicine for wound care into a simulation-based class for undergraduate student nurses and to evaluate their experiences with this integrated learning method. Methods: Five medium-fidelity mannequins were used in a simulated learning environment consisting of a simulated......, the simulated learning environment seems to be a constructive didactic method. The simulated learning environment should also be tested with postgraduate nurses with less experience in telemedicine....
Hansen, Caroline Raun; Perrild, Hans; Koefoed, Birgitte Gade
is to examine whether telemedicine conferences with a nurse can contribute to achieving good diabetes control among patients with poorly regulated type 2 diabetes. MATERIAL AND METHODS: A total of 165 patients with type 2 diabetes who have formerly undergone a rehabilitation programme are randomized to either...... telemedicine intervention or usual care. The intervention lasts for 32 weeks and consists of monthly videoconferences with a nurse from a health-care centre as an add-on to usual care. Blood sugar, blood pressure and weight are regularly self-monitored and measurements are automatically transferred......: The study will examine whether telemedicine technology can contribute to achieving good diabetes regulation. FUNDING: The City of Copenhagen and the Prevention Fund of the Capital Region of Denmark funded the project. Also "Smedemester Niels Hansen og Hustru Johanne F. Frederiksens Legat" has supported...
Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten
diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...
Mousavi, Mahta; Lurie, Kristen; Land, Julian; Javidi, Tara; Ellerbee, Audrey K.
Telemedicine is an emerging technology that aims to provide clinical healthcare at a distance. Among its goals, the transfer of diagnostic images over telecommunication channels has been quite appealing to the medical community. When viewed as an adjunct to biomedical device hardware, one highly important consideration aside from the transfer rate and speed is the accuracy of the reconstructed image at the receiver end. Although optical coherence tomography (OCT) is an established imaging technique that is ripe for telemedicine, the effects of OCT data compression, which may be necessary on certain telemedicine platforms, have not received much attention in the literature. We investigate the performance and efficiency of several lossless and lossy compression techniques for OCT data and characterize their effectiveness with respect to achievable compression ratio, compression rate and preservation of image quality. We examine the effects of compression in the interferogram vs. A-scan domain as assessed with various objective and subjective metrics.
Gurupur, Varadraj; Shettian, Kruparaj; Xu, Peixin; Hines, Scott; Desselles, Mitzi; Dhawan, Manish; Wan, Thomas Th; Raffenaud, Amanda; Anderson, Lindsey
This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds. These responses were used to identify the individuals' readiness for utilising telemedicine through factor analysis, Cronbach's alpha reliability test, analysis of variance and ordinary least squares regression. The analysis results indicated that the favourable factor (positive readiness item) had a mean value of 3.47, whereas the unfavourable factor (negative readiness item) had a mean value of 2.76. Cronbach's alpha reliability test provided an alpha value of 0.79. Overall, our study indicated a positive attitude towards the use of telemedicine in northern Louisiana.
Full Text Available Introduction. Telemedicine provides a solution to treatment of economically and geographically compromised patients and enhances the level of care. However, a problem has arisen in safeguarding patientsâ€™ rights to informed consent.Objective. To determine the impact of language, translation and interpretation barriers on gaining legally valid informed consent in telemedicine.Design. Forty-one key words relevant to computer terminology and concepts required to gain informed consent for a telemedicine encounter were selected and sent for translation into isiZulu, the local indigenous language of KwaZulu-Natal, South Africa. A questionnaire with the list of words was developed with three domains covering information communication technology (ICT use, ICT terms and ethics terms. This was administered to patients at four outpatient departments in rural KwaZulu-Natal hospitals.Results. Of the 54 participants, 50 (92.6% did not know or understand the term â€˜telemedicineâ€™, 49 (90.7% the term â€˜video conferenceâ€™ and 49 (90.7% the term â€˜electronic recordsâ€™. Words such as â€˜consentâ€™ and â€˜autonomyâ€™ were understood by less than a third of the participants. Only 19 individuals (35.2% understood the word â€˜consentâ€™, and only 4 (7.4% understood both the words â€˜consentâ€™ and â€˜telemedicineâ€™.Conclusions. The results of this study show that obtaining informed consent for a telemedicine consultation is problematic. Alternative ways of gaining informed consent need to be investigated.
Li, Wen-Wen; Lai, Wei-Shu
Racial ethnic minorities are one of the fastest growing populations in Taiwan. In recent years, there has been an increase in literature addressing the efficacy of home blood-pressure (BP) management that uses telemedicine interventions in general healthcare and community settings. However, no study or systematic literature review has yet assessed the effectiveness of using telemedicine HTN interventions in Taiwan's indigenous, new-immigrant, and other minority populations. The purpose of the present paper is to review the current literature on the use of telemedicine interventions to assist HTN management among racial ethnic minorities. A comprehensive literature search was conducted for full-text articles that were published between January 2000 and December 2015 using the following databases: PubMed, WEB of Science, CINAHL (Cumulative Index to Nursing & Allied Health Literature), PsycINFO, Science Direct, ProQuest, Medline, Cochrane Library, National Dissertations and Theses, and airiti Library. The search used the following key search terms both alone and in combination: hypertension, blood pressure, management, telemedicine, telehealth, ehealth, and digital health. The studies were thoroughly assessed under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 6 articles met the criteria for using keywords related to racial ethnic minority populations and were used in the present review. Findings of this systematic review show that telemedicine interventions significantly improve HTN management. The intervention that combined home telemonitoring with culturally competent nurse counseling calls was identified as the best intervention for reducing BP. As the current literature on this topic is limited to African-Americans, more research is necessary to validate our findings. Future studies should target racial ethnic minorities in Taiwan in order to better understand how to provide culturally appropriate
Zhao, Jie; Zhai, Yun-Kai; Zhu, Wei-Jun; Sun, Dong-Xu
The effectiveness of telemedicine for the management of chronic diseases is unclear. This study examined the effectiveness of telemedicine in relieving asthma symptoms. A systematic review of the Medline, Cochrane, EMBASE, and Google Scholar databases was conducted until December 31, 2013 using the following key words: "asthma," "telemedicine," "telehealth," "e-health," "mobile health," "Internet," "telecommunication," "telemanagement," "remote," and "short message service." Inclusion criteria were randomized controlled trial, a diagnosis of asthma, the majority of the patients were ≥18 years of age, and intervention involved any format of telemedicine. A meta-analysis of eligible studies was conducted with the primary outcome being change of asthma symptoms. Of 813 articles identified, 11 were included in the qualitative synthesis, and 6 were included in the meta-analysis. Among the 11 studies, there were 1,460 patients in the intervention groups and 1,349 in the control groups, and the total numbers of participants ranged from 12 to 481 in the intervention groups and from 12 to 487 in the control groups. The mean age of patients ranged in the intervention groups from 34.4 to 54.6 years and in the control groups from 30.7 to 56.4 years. The treatment duration ranged from 0.5 to 12 months. The meta-analysis of six eligible studies revealed no significant difference in asthma symptom score change between the telemedicine and control groups (pooled Hedges's g=0.34, 95% confidence interval=-0.05 to 0.74, Z=1.69, p=0.090). Telemedicine interventions do not appear to improve asthma function scores, but other benefits may be present.
Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I
To evaluate long-term treatment efficacy and safety of one-time telemedicine consultations for nonacute headaches. We randomized, allocated, and consulted nonacute headache patients via telemedicine (n = 200) or in a traditional manner (n = 202) in a noninferiority trial. Efficacy endpoints, assessed by questionnaires at 3 and 12 months, included change from baseline in Headache Impact Test-6 (HIT-6) (primary endpoint) and pain intensity (visual analogue scale [VAS]) (secondary endpoint). The primary safety endpoint, assessed via patient records, was presence of secondary headache within 12 months after consultation. We found no differences between telemedicine and traditional consultations in HIT-6 ( p = 0.84) or VAS ( p = 0.64) over 3 periods. The absolute difference in HIT-6 from baseline was 0.3 (95% confidence interval [CI] -1.26 to 1.82, p = 0.72) at 3 months and 0.2 (95% CI -1.98 to 1.58, p = 0.83) at 12 months. The absolute change in VAS was 0.4 (95% CI -0.93 to 0.22, p = 0.23) after 3 months and 0.3 (95% CI -0.94 to 0.29, p = 0.30) at 12 months. We found one secondary headache in each group at 12 months. The estimated number of consultations needed to miss one secondary headache with the use of telemedicine was 20,200. Telemedicine consultation for nonacute headache is as efficient and safe as a traditional consultation. NCT02270177. This study provides Class III evidence that a one-time telemedicine consultation for nonacute headache is noninferior to a one-time traditional consultation regarding long-term treatment outcome and safety. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
Panlaqui, O M; Broadfield, E; Champion, R; Edington, J P; Kennedy, S
Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit mortality showed no evidence of significant differences between the telemedicine group and the baseline (relative risk 1.02, 95% confidence interval [CI] 0.99-1.06, P =0.25 and relative risk 1.00, 95% CI 0.98-1.03, P =0.67 respectively). The hospital LOS was lower in the baseline group by 1.5 days. There was no significant difference in High Dependency Unit LOS. To adjust for the covariates in LOS, log linear regression analysis was performed. The telemedicine intervention, Acute Physiology and Chronic Health Evaluation II scores and inter-hospital transfers were found to contribute significantly to hospital LOS. The most important result of the study was that the proportion of inter-hospital transfers was lower in the telemedicine group (relative risk 0.88, 95% CI 0.80-0.98, P =0.03) compared to baseline. This means that critically ill patients in our regional centre can continue to receive specialist care remotely through tele-ICU consultations thus avoiding the need for patient transport. However, further study is needed to establish the benefits and risks of telemedicine intervention in ICUs in Australia.
Ossandón, D; Zanolli, M; López, J P; Stevenson, R; Agurto, R; Cartes, C
To study the correlation between expert and non-expert observers in the reporting images for the diagnosis of retinopathy of prematurity (ROP) in a telemedicine setting. A cross-sectional, multicenter study, consisting of 25 sets of images of patients screened for ROP. They were evaluated by two experts in ROP and 1 non-expert and classified according to telemedicine classification, zone, stage, plus disease and Ells referral criteria. The telemedicine classification was: no ROP, mild ROP, type 2 ROP, or ROP that requires treatment. Ells referral criteria is defined as the presence at least one of the following: ROP in zone I, Stage 3 in zone I or II, or plus+ For statistical analysis, SPSS 16.0 was used. For correlation, Kappa value was performed. There was a high correlation between observers for the assessment of ROP stage (0.75; 0.54-0.88) plus disease (0.85; 0.71-0.92), and Ells criteria (0.89; 0.83-1.0). However, inter-observer values were low for zone (0.41; 0.27-0.54) and telemedicine classification (0.43; 0.33-0.6). When evaluating telemedicine images by examiners with different levels of expertise in ROP, the Ells criteria gave the best correlation. In addition, stage of disease and plus disease have good correlation among observers. In contrast, the correlation between observers was low for zone and telemedicine classification. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Parimbelli, E; Bottalico, B; Losiouk, E; Tomasi, M; Santosuosso, A; Lanzola, G; Quaglini, S; Bellazzi, R
The main purpose of the article is to raise awareness among all the involved stakeholders about the risks and legal implications connected to the development and use of modern telemedicine systems. Particular focus is given to the class of "active" telemedicine systems, that imply a real-world, non-mediated, interaction with the final user. A secondary objective is to give an overview of the European legal framework that applies to these systems, in the effort to avoid defensive medicine practices and fears, which might be a barrier to their broader adoption. We leverage on the experience gained during two international telemedicine projects, namely MobiGuide (pilot studies conducted in Spain and Italy) and AP@home (clinical trials enrolled patients in Italy, France, the Netherlands, United Kingdom, Austria and Germany), whose development our group has significantly contributed to in the last 4 years, to create a map of the potential criticalities of active telemedicine systems and comment upon the legal framework that applies to them. Two workshops have been organized in December 2015 and March 2016 where the topic has been discussed in round tables with system developers, researchers, physicians, nurses, legal experts, healthcare economists and administrators. We identified 8 features that generate relevant risks from our example use cases. These features generalize to a broad set of telemedicine applications, and suggest insights on possible risk mitigation strategies. We also discuss the relevant European legal framework that regulate this class of systems, providing pointers to specific norms and highlighting possible liability profiles for involved stakeholders. Patients are more and more willing to adopt telemedicine systems to improve home care and day-by-day self-management. An essential step towards a broader adoption of these systems consists in increasing their compliance with existing regulations and better defining responsibilities for all the
["Baltic Declaration"--telemedicine and mHealth as support for clinical processes in cardiology. The opinion of the Committee of Informatics and Telemedicine of the Polish Society of Cardiology and Telemedicine Clinical Sciences Committee of the PAS].
Piotrowicz, Ryszard; Grabowski, Marcin; Balsam, Paweł; Kołtowski, Łukasz; Kozierkiewicz, Adam; Zajdel, Justyna; Piotrowicz, Ewa; Kowalski, Oskar; Mitkowski, Przemysław; Kaźmierczak, Jarosław; Kalarus, Zbigniew; Opolski, Grzegorz
For several decades we have observed the development of data transmission technology on an unprecedented scale. With the development of such technology there has also appeared concepts on the use of these solutions in health care systems. Over the last decade telemedicine has been joined by the concept of mHealth, which is based on mobile devices mainly to monitor selected biomedical parameters. On 10 October 2014, during the conference Baltic Electrocardiology Autumn - Telemedicine and Arrhythmia (BEATA), a debate was held with the participation of physicians, politicians, businessmen, and representatives of the Government (Ministry of Health, National Health Fund, Social Insurance Institution) concerning the use of telecardiology services in daily practice. During the meeting issues were discussed such as: telemedicine solutions available throughout the world, analysis of their effectiveness based on clinical trials, funding opportunities, their legal status, and the development perspectives of telecardiology in Poland. The result of the meeting was a document called the "Baltic Declaration". The declaration is a call for proven and profitable technologies to be introduced into clinical practice. The declaration also indicates that the variety of available technological solutions are merely tools, and the utility of such tools stems not only from their modernity, but also primarily from matching their functionality to the features of the health interventions that are to be improved.
Panayides, A; Pattichis, M S; Pattichis, C S; Schizas, C N; Spanias, A; Kyriacou, E
Advances in video compression, network technologies, and computer technologies have contributed to the rapid growth of mobile health (m-health) systems and services. Wide deployment of such systems and services is expected in the near future, and it's foreseen that they will soon be incorporated in daily clinical practice. This study focuses in describing the basic components of an end-to-end wireless medical video telemedicine system, providing a brief overview of the recent advances in the field, while it also highlights future trends in the design of telemedicine systems that are diagnostically driven.
Wootton, Richard; Liu, Joanne; Bonnardot, Laurent; Venugopal, Raghu; Oakley, Amanda
Published version. Also available at http://dx.doi.org/10.3389/fpubh.2015.00261 Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sa...
Wołk, Krzysztof; Marasek, Krzysztof; Glinkowski, Wojciech
Machine translation is evolving quite rapidly in terms of quality. Nowadays, we have several machine translation systems available in the web, which provide reasonable translations. However, these systems are not perfect, and their quality may decrease in some specific domains. This paper examines the effects of different training methods when it comes to Polish-English Statistical Machine Translation system used for the medical data. Numerous elements of the EMEA parallel text corpora and not related OPUS Open Subtitles project were used as the ground for creation of phrase tables and different language models including the development, tuning and testing of these translation systems. The BLEU, NIST, METEOR, and TER metrics have been used in order to evaluate the results of various systems. Our experiments deal with the systems that include POS tagging, factored phrase models, hierarchical models, syntactic taggers, and other alignment methods. We also executed a deep analysis of Polish data as preparatory work before automatized data processing such as true casing or punctuation normalization phase. Normalized metrics was used to compare results. Scores lower than 15% mean that Machine Translation engine is unable to provide satisfying quality, scores greater than 30% mean that translations should be understandable without problems and scores over 50 reflect adequate translations. The average results of Polish to English translations scores for BLEU, NIST, METEOR, and TER were relatively high and ranged from 7058 to 8272. The lowest score was 6438. The average results ranges for English to Polish translations were little lower (6758-7897). The real-life implementations of presented high quality Machine Translation Systems are anticipated in general medical practice and telemedicine. Copyright © 2015. Published by Elsevier Ltd.
Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I
Objectives We determined headache patients' satisfaction with telemedicine and assessed how telemedicine influenced headache burden, compliance with diagnosis and treatment, and need for follow-up consultations. Methods During 2.5 years, patients from Northern Norway referred with non-acute headaches for a specialist consultation at Tromsø University Hospital were consecutively randomised to either telemedicine or traditional visits. Baseline data were recorded and compared to data from a three-month follow-up questionnaire (see Supplementary material). The following were evaluated: (1) satisfaction with the consultation; (2) headache status; subjective improvement, average pain intensity, treatment, headache days per month, and Headache Impact Test (HIT-6); and (3) treatment compliance and follow-up visits. Results Out of 402 consultations, 348 (86.6%) answered the questionnaire. Satisfaction was similar in the telemedicine and the traditional group (88.8% vs. 92.3%; p = 0.35). Subgroup analyses were not prespecified, but there were no differences in satisfaction among females, migraineurs, rural patients and urban patients. Improvement from baseline after three months was reported equally in the telemedicine and the traditional groups. There were also no differences in treatment compliance, but rural telemedicine patients had less-frequent headache visits at three months' follow-up (28.9% vs. 48.7%, p = 0.002). Conclusion Telemedicine is non-inferior to traditional consultations in patient satisfaction, specialist evaluation, and treatment of non-acute headaches. ClinicalTrials.gov ID: NCT02270177.
Agnisarman, Sruthy; Narasimha, Shraddhaa; Chalil Madathil, Kapil; Welch, Brandon; Brinda, Fnu; Ashok, Aparna; McElligott, James
Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms-Doxy.me, Polycom, Vidyo, and VSee-to assess possible problems and limitations that could affect the usability of the system from the clinician's perspective. It was found that 5 experts individually evaluated all four systems using Nielsen's list of heuristics, classifying the issues based on a severity rating scale. A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13% (6/46 issues) of the total errors. Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users' language are keys for achieving this. ©Sruthy Agnisarman, Shraddhaa Narasimha, Kapil Chalil Madathil, Brandon Welch, FNU Brinda, Aparna Ashok, James McElligott. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 24.04.2017.
Gibson, Josephine; Lightbody, Elizabeth; McLoughlin, Alison; McAdam, Joanna; Gibson, Alison; Day, Elaine; Fitzgerald, Jane; May, Carl; Price, Chris; Emsley, Hedley; Ford, Gary A; Watkins, Caroline
Telemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff. We recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken. We conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to 'live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48 h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. Although telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The 'remote' nature of the consultation posed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking. © 2015 John Wiley & Sons Ltd.
Menezes, Pedro Monteiro; Cook, Timothy Wayne; Cavalini, Luciana Tricai
To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.
Beauregard, D; Beauregard, G
Telemedicine is a new field and many health-care providers are developing their own products with the help of industry. Most practitioners are novices in the legal tools necessary to protect their own work with regard to any future commercialization. To summarize these issues for the telemedicine practitioner, a review of intellectual property protection has been performed. Intellectual property can be protected by tools such as copyrights, patents, non-disclosure and confidentiality agreements, integrated circuit topographies and industrial design. Knowledge of the intellectual property background should allow telemedicine providers to protect their own work when working with industry.
Glinkowski, Wojciech M; Karlińska, Maria; Karliński, Michał; Krupiński, Elizabeth A
The aim of this study is to present a review based on the literature and proceedings from selected telemedicine conferences. The review was developed using the PRISMA framework. The Embase and PubMed (updated until July 13, 2015) literature databases were searched for telemedicine-related terms and Poland. The literature search identified 129 eligible articles in the databases and 85 in conference proceedings until July 2015. Articles measured as a number of contributions per year presented a similar rising, fluctuating and almost parallel pattern. Fifty-nine percent of the reviewed papers were published in impacted journals. Almost half of all publications presented original papers. The published articles concerned mostly cardiology (16%), family medicine (15%) and pathology (11%). Conference proceedings papers concerned orthopedics (29%, significantly more frequent; p < 0.001) and cardiology (14%). Scientific activity of researchers and practitioners in Poland in the field of telemedicine is not high, but it is increasing over time. There is a tendency to present the research rather in high-quality journals instead of conferences before publication. The occurrence of individual medical specialty telemedicine in Poland may reflect country-specific needs.
access to quality health care in rural areas by providing access to specialists, preventing ... regulatory and ethical framework procedures”. The resulting ... medical journals, the Telemedicine Information Exchange (TIE) website was searched .... all established standards of security measures have been followed to protect the ...
Zayapragassarazan, Zayabalaradjane; Kumar, Santosh
Introduction: Telemedicine is an emerging technology in health sector in India. The success of any new technology depends on many factors including the knowledge and understanding of the concept, skills acquired, attitude towards technology and working environment by the concerned professionals. Aim: The main objective of this study was to assess…
Barker, Gail P; Krupinski, Elizabeth A; Schellenberg, Bonnie; Weinstein, Ronald S
This paper compares the expenses of a telemedicine program to those of a traditional clinical practice using data from two fiscal years (FY) 1998/1999 and 2000/2001. As part of that evaluation, we compared expenses of the University of Arizona's clinical practice group, the University Physicians Incorporated (UPI), to those of the Arizona Telemedicine Program (ATP) practice. For this study, we used the reporting categories published in the year-end UPI financial statement. These categories included clinical services, administration, equipment depreciation, and overhead. Results showed that clinical service expenses and administrative expenses for FY 2000/2001 were higher in the traditional UPI practice, whereas equipment depreciation and overhead expenses are higher in the telemedicine practice. This differs somewhat from FY 1998/1999, where clinical expenses and overhead were higher in the UPI practice and administration and equipment depreciation were higher in the telemedicine practice. We will discuss the relevance of these results and the critical factors that contribute to these differences.
Homenko, Daria R.; Morin, Philip C.; Eimicke, Joseph P.; Teresi, Jeanne A.; Weinstock, Ruth S.
Objective: To evaluate differences between rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, preparation, shopping, obesity, and glycemic control after receiving nutrition counseling through telemedicine. Methods: Food insecurity data were obtained by telephone survey (n = 74).…
Franchimon, F.; Brink, M.
The aging society could have a greater societal impact than the current financial crisis. The percentage of older adults has increased while the size of the health care workforce has remained constant. Home automation, robotics, assistive technology, geriatric telecare and telemedicine can support
Riva, Giuseppe; Bacchetta, Monica; Cesa, Gianluca; Conti, Sara; Molinari, Enrico
e-health, the integration of telehealth technologies with the Internet and shared virtual reality could become a significant enabler of consumer health initiatives. In fact, they provide an increasingly accessible communication channel for a growing part of the population. In the past decade medical applications of virtual reality (VR) and telemedicine have been rapidly developing, and the technology has changed from a research curiosity to a commercially and clinically important area of medical informatics technology. The chapter details the characteristics of the Experiential Cognitive Therapy (ECT), an integrated inpatient/outpatient (4 weeks) and telemedicine approach (24 weeks) that tries to enhance the classical cognitive-behavioral method used in the treatment of eating disorders, through VR sessions and telemedicine support in the follow-up stage. Particularly, using VR and telemedicine, ECT is able to address body experience disturbances, interpersonal relationships, self efficacy and motivation to change, key issues for the development and maintenance of eating disorders that are somehow neglected by actual clinical guidelines.
Lapão, Luís Velez; Correia, Artur
This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians.
Dobke, Marek K; Bhavsar, Dhaval; Gosman, Amanda; De Neve, Joan; De Neve, Brian
The study goal was to evaluate the impact of the telemedicine consult on patients with chronic wounds. Thirty patients from long-term care skilled nursing facilities, referred to the ambulatory wound care program for wound assessment and preparation of management plans, were the subject of this prospective, randomized trial. To facilitate communication with a surgical wound care specialist, telemedicine feedback was provided prior to face-to-face consultation to 15 patients. The telemedicine consult included (1) wound assessment, (2) rationale for the suggested wound management with emphasis on wound risk projections, and (3) prevention and benefits of surgical intervention. This was communicated to the patient by the field wound care nurse. The telemedicine impact was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with further care decisions as well as by validation of a decisional conflict scale. The average duration of the face-to-face consultation was 50 +/- 12 minutes versus 35 +/- 6 (p face-to-face evaluation improved patient satisfaction and understanding of their care as well as increased the perception of shared decision making regarding the wound care.
Nouhi, Mojtaba; Fayaz-Bakhsh, Ahmad; Mohamadi, Efat; Shafii, Milad
Human resources for health have many diverse aspects that sometimes bring about conflicts in the healthcare market. In recent decades issues such as attrition, migration, and different types of imbalances in health workers were not only considered as international problems, but also took on new particular dimensions and complications. Rapid growth in establishing infrastructure of communications and many diseases such as human immunodeficiency virus/AIDS and malaria, as well as shortages in skilled healthcare providers in developing countries, interested many health economists and health professionals to consider telemedicine as an approach to deliver some healthcare and to pursue its effects on human resources management in healthcare. The objective of this communication is to offer a better understanding of the value of telemedicine in human resources management in healthcare. This article briefly reviews related literature on potential contributions of telemedicine in mitigating four different types of imbalances in health workers and points out some of its capabilities. Although there is a great need for systematic, scientific, and analytical studies in effects of telemedicine on health workers, expansion of communication infrastructure throughout and especially in remote areas, political commitment, and provision of useful information and education to reduce problems of human resources for health are beneficial.
N. V. Yaremenko
Full Text Available The problems of a regulatory legal tramewor k tor telemedicine consultations were set. Attention is drawn to the need to regulate these activities in the health system. First of all, we need prudential standards for the protection of patients’ rights.
We sought to test this technology in a group of patients presenting for the first time with undiagnosed ear complaints. Using the VSee telemedicine platform with a Welch Allyn Otoscope over a mobile 3G internet service 90% of patients were diagnosed accurately and furthermore competence in using the equipment was ...
Petruzzi, Massimo; De Benedittis, Michele
Increased use of smartphone and related software applications has created a new era in clinical data exchange among patients and clinicians. This study describes use of the smartphone-based application WhatsApp to share clinical oral medicine information. Clinical images and related questions were submitted by general dentists, physicians, dental hygienists, and patients to the authors via WhatsApp. For each submission, a clinical impression was made and categorized as traumatic, infective, neoplastic, autoimmune, or unclassified. Submissions were summarized by sender type, number of photographs per sender, and category of question. Patients were invited to undergo a clinical examination with biopsy, when indicated. The telemedicine impression was compared to the clinicopathologic diagnosis. Three hundred and thirty-nine images were received for 96 patients; 92 (95.8%) patients underwent clinicopathologic examination, and 45 (49%) received a biopsy. General dentists (62%) and dental hygienists (26%) were the most frequent senders. The most common question was related to diagnosis (56%). The telemedicine impression agreed with the clinicopathologic assessment for 82% of cases. Telemedicine applications, such as WhatsApp, can support communication about oral conditions among clinicians and patients. Telemedicine consultation reduced geographic barriers to initial clinical consultation and encouraged the significant majority of patients to pursue expert clinical examination. Copyright © 2016 Elsevier Inc. All rights reserved.
Conclusion: Most items have been published from high-income, developed countries. Thus the physicians in undeveloped and developing countries, in which telemedicine and teledermatology applications are crucial to deliver medical care and services, should be encouraged to perform novel studies.
Shah, Tariq Kazim; Tariq, Tasneem; Phillips, Roger; Davison, Steve; Hoare, Adam; Hasan, Syed Shahzad; Babar, Zaheer-Ud-Din
Almost half of the world's total population reside in rural and remote areas and a large number of these people remain deprived of most basic facilities like healthcare and education. It is deemed impossible for government with scarce resources in developing countries to open and run a health facility in every remote community using conventional means. One increasingly popular unconventional mean is the use of existing technology to improve exchange of medical information for the purpose of improving health of underprivileged communities. Telemedicine implies the use of information and communication technology to provide health care remotely from a distance. With the induction of telemedicine, patients who live in rural and remote areas can have increased access to medical services. In many developing countries, use of telemedicine however has been limited mainly to teleconferencing between primary and secondary/tertiary care facilities for diagnosis and management of patients. This system still requires patients from remote communities to travel, often long and arduous journeys to the centre where telecom and medical facilities are available. Health Care 4 All International, a not for profit registered charity is providing primary care to patients by taking telemedicine into their homes in remote communities, thus obviating the need and hardships of travel for patient.
Carral, Florentino; Ayala, María del Carmen; Fernández, Juan Jesús; González, Carmen; Piñero, Antonia; García, Gloria; Cañavate, Concepción; Jiménez, Ana Isabel; García, Concepción
The aim of this study was to examine the impact of a Web-based telemedicine system for monitoring glucose control in pregnant women with diabetes on healthcare visits, metabolic control, and pregnancy outcomes. A prospective, single-center, interventional study with two parallel groups was performed in Puerto Real University Hospital (Cadiz, Spain). Women were assigned to two different glucose monitoring groups: the control group (CG), which was managed only by follow-ups with the Gestational Diabetes Unit (GDU), and the telemedicine group (TMG), which was monitored by both more spaced GDU visits and a Web-based telemedicine system. The number of healthcare visits, degree of metabolic control, and maternal and neonatal outcomes were evaluated. One hundred four pregnant women with diabetes (77 with gestational diabetes, 16 with type 1 diabetes, and 11 with type 2 diabetes) were included in the TMG (n=40) or in the CG (n=64). There were no significant differences in mean glycated hemoglobin level during pregnancy or after delivery, despite a significantly lower number of visits to the GDU (3.2±2.3 vs. 5.9±2.3 visits; P3.0±1.7 visits; PWeb-based telemedicine system can be a useful tool facilitating the management of pregnant diabetes patients, as a complement to conventional outpatient clinic visits.
Park, Hayoung; Chon, Yucheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho
Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.
A literature review was conducted to obtain a high-level view of the value of telemedicine in the management of five common chronic diseases (asthma, COPD, diabetes, heart failure, hypertension). A total of 141 randomised controlled trials (RCTs) was identified, in which 148 telemedicine interventions of various kinds had been tested in a total of 37,695 patients. The value of each intervention was categorised in terms of the outcomes specified by the investigators in that trial, i.e. no attempt was made to extract a common outcome from all studies, as would be required for a conventional meta-analysis. Summarizing the value of these interventions shows, first, that most studies have reported positive effects (n = 108), and almost none have reported negative effects (n = 2). This suggests publication bias. Second, there were no significant differences between the chronic diseases, i.e. telemedicine seems equally effective (or ineffective) in the diseases studied. Third, most studies have been relatively short-term (median duration 6 months). It seems unlikely that in a chronic disease, any intervention can have much effect unless applied for a long period. Finally, there have been very few studies of cost-effectiveness. Thus the evidence base for the value of telemedicine in managing chronic diseases is on the whole weak and contradictory. PMID:22674020
Telemedicine is defined as the use of two-way or interactive television to conduct transactions in the field of health care. A history of its development to provide two-way communication between central facilities and remote locations is given, along with descriptions of pioneer systems. Technical, psychological and cultural aspects of the method…
Christensen, Henrik Bærbak
Telemedicine holds a promise of lowering cost in health care and improving the life quality of chronic ill patients by allowing monitoring in the home. The Personal Health Monitoring Record (PHMR) is an international HL7 standard data format for encoding measurements made by devices in the home...
Lyerly, Michael J; Wu, Tzu-Ching; Mullen, Michael T; Albright, Karen C; Wolff, Catherine; Boehme, Amelia K; Branas, Charles C; Grotta, James C; Savitz, Sean I; Carr, Brendan G
Racial and ethnic disparities have been previously reported in acute stroke care. We sought to determine the effect of telemedicine (TM) on access to acute stroke care for racial and ethnic minorities in the state of Texas. Data were collected from the US Census Bureau, The Joint Commission and the American Hospital Association. Access for racial and ethnic minorities was determined by summing the population that could reach a primary stroke centre (PSC) or telemedicine spoke within specified time intervals using validated models. TM extended access to stroke expertise by 1.5 million residents. The odds of providing 60-minute access via TM were similar in Blacks and Whites (prevalence odds ratios (POR) 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.001). The odds of providing access via TM were also similar for Hispanics and non-Hispanics (POR 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.000). We found that telemedicine increased access to acute stroke care for 1.5 million Texans. While racial and ethnic disparities exist in other components of stroke care, we did not find evidence of disparities in access to the acute stroke expertise afforded by telemedicine. © The Author(s) 2015.
Greenup, Edwin P; McCusker, Melissa; Potts, Boyd A; Bryett, Andrew
To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.
Grossman, Daniel; Grindlay, Kate
To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service. We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year. During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11-0.29%] and 0.32% of in-person patients [95% CI 0.23-0.45%]). The difference in adverse event prevalence was 0.13% (95% CI -0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion. Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant
Torabi, Elham; Froehle, Craig M; Lindsell, Christopher J; Moomaw, Charles J; Kanter, Daniel; Kleindorfer, Dawn; Adeoye, Opeolu
The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to treatment in eligible patients. In the context of a regional stroke team, the authors examined the effects of staff location and telemedicine deployment policies on the timeliness of thrombolytic treatment, and estimated the efficacy and cost-effectiveness of six different policies. A process map comprising the steps from recognition of stroke symptoms to intravenous administration of rt-PA was constructed using data from published literature combined with expert opinion. Six scenarios were investigated: telemedicine deployment (none, all, or outer-ring hospitals only) and staff location (center of region or anywhere in region). Physician locations were randomly generated based on their zip codes of residence and work. The outcomes of interest were onset-to-treatment (OTT) time, door-to-needle (DTN) time, and the proportion of patients treated within 3 hours. A Monte Carlo simulation of the stroke team care-delivery system was constructed based on a primary data set of 121 ischemic stroke patients who were potentially eligible for treatment with rt-PA. With the physician located randomly in the region, deploying telemedicine at all hospitals in the region (compared with partial or no telemedicine) would result in the highest rates of treatment within 3 hours (80% vs. 75% vs. 70%) and the shortest OTT (148 vs. 164 vs. 176 minutes) and DTN (45 vs. 61 vs. 73 minutes) times. However, locating the on-call physician centrally coupled with partial telemedicine deployment (five of the 17 hospitals) would be most cost-effective with comparable eligibility and treatment times. Given the potential societal benefits, continued efforts to deploy telemedicine appear warranted. Aligning the incentives between those who would have to fund
Schairer, Edward; Kushner, Laura K.; Heineck, James T.
Positions of vortices shed by a full-scale UH-60A rotor in forward flight were measured during a test in the National Full- Scale Aerodynamics Complex at NASA Ames Research Center. Vortices in a region near the tip of the advancing blade were visualized from two directions by Retro-Reflective Background-Oriented Schlieren (RBOS). Correspondence of points on the vortex in the RBOS images from both cameras was established using epipolar geometry. The object-space coordinates of the vortices were then calculated from the image-plane coordinates using stereo photogrammetry. One vortex from the tip of the blade that had most recently passed was visible in most of the data. The visibility of the vortices was greatest at high thrust and low advance ratios. At these favorable conditions, vortices from the most recent passages of all four blades were detected. The vortex positions were in good agreement with PIV data for a case where PIV measurements were also made. RBOS and photogrammetry provided measurements of the angle at which each vortex passed through the PIV plane.
Theodore, Colin R.
A full-scale wind tunnel test to evaluate the effects of Individual Blade Control (IBC) on the performance, vibration, noise and loads of a UH-60A rotor was recently completed in the National Full-Scale Aerodynamics Complex (NFAC) 40- by 80-Foot Wind Tunnel . A key component of this wind tunnel test was an automatic rotor trim control system that allowed the rotor trim state to be set more precisely, quickly and repeatably than was possible with the rotor operator setting the trim condition manually. The trim control system was also able to maintain the desired trim condition through changes in IBC actuation both in open- and closed-loop IBC modes, and through long-period transients in wind tunnel flow. This ability of the trim control system to automatically set and maintain a steady rotor trim enabled the effects of different IBC inputs to be compared at common trim conditions and to perform these tests quickly without requiring the rotor operator to re-trim the rotor. The trim control system described in this paper was developed specifically for use during the IBC wind tunnel test
Background Improvements in communication and information technologies have allowed for the globalisation of health services, especially the provision of health services from other countries, such as the use of telemedicine. This has led countries to evaluate their position on whether and to what extent they should open their health systems to trade. This often takes place from the context of multi-lateral trade agreements (under the auspices of the World Trade Organisation), which is misplaced as a significant amount of trade takes place regionally or bi-laterally. We report here the results of a qualitative study assessing stakeholders' views on the potential for a bi-lateral trade relationship between India and the UK, where India acts as an exporter and the UK as an importer of telemedicine services. Methods 19 semi-structured interviews were carried out with stakeholders from India and the UK. The themes discussed include prospects on the viability of a bi-lateral relationship between the UK and India on telemedicine, current activities and operations, barriers, benefits and risks. Results The participants in general believed there were good prospects for telemedicine trade, and that this could bring benefits to "importing" countries in terms of cost-savings and faster delivery of care and to "exporting" countries in the form of foreign exchange and quality improvement. However, there were some concerns regarding quality of care, regulation, accreditation and data security. Conclusions There is potential for trade in this type of health services to succeed and bring about important benefits to the countries involved. However, issues around data security and accreditation need to be taken into consideration. Countries may wish to consider entering bi-lateral agreements, as they provide more potential to address the concerns and capitalise on the benefits. Finally, this paper concludes that more data should be collected, both on the volume of telemedicine trade
Vargas, Alejandro; Ugalde, Miguel; Vargas, Reynaldo; Narvaez, Ramiro; Geissbuhler, Antoine
The objective of the RAFT-Altiplano project (RAFT: Réseau en Afrique Francophone pour la Télémédecine, or African Francophone Telemedicine Network) is to evaluate the viability, potential, and risks of implementing and developing a telemedicine network in the context of a developing country-specifically, the Altiplano region of Bolivia-to improve access to medical care and continuing education in a rural area. The activities described in this report took place between 2011 and 2013. Digital telemedicine equipment was donated to the health centers and a Microsoft®-based platform capable of integration with other technologies (using standardized formats) was developed to manage documents and clinical content electronically. Health professionals were trained in teleconsultation and the teleconsultation workflow was designed. The tele-education system used is Dudal, which requires only a small bandwidth. After three years of implementation, an organized working structure of teleconsultation and tele-education tools, adapted to the Latin American context, is now in place and connections have been established with hospitals, institutions, and health centers. The project has improved access to specialized medical care in remote health centers and third-level hospitals in urban areas, and it has become the foundation for development of the national project "TeleSalud for Bolivia" promoted by the Ministry of Health, which involves use of the new Bolivian satellite, Túpac Katari. It is viable to develop and set up telemedicine tools to serve the population in remote regions of Bolivia when they are made available to government and municipal health institutions and communication between them and the health centers takes place in a coordinated manner. The sharing of experiences, challenges, and risks encountered is very useful in designing and implementing the telemedicine project "TeleSalud for Bolivia" on a national scale.
Buliński, Leszek; Błachnio, Aleksandra
Polish ageing society still experiences health-related problems and the increasing difficulties in receiving medical care. The initiation of telemedicine programmes can change this situation for better. The question arises if telemedicine is a solution that the elderly are willing to accept and take advantage of in order to raise their quality of life. Questionnaire based research was conducted in 2015 on a sample group of 312 seniors. The respondents completed the Diener Satisfaction with Life Scale (SWLS) and the subscale of Health States from Fragebogen zur Lebenszufriedenheit (FLZ) by Fahrenberg et al. Each participant gave their consent to take part in the research. SWLS presents a relatively stable value in the subsequent decades of being old (60-69 years M=21.93 SD=6.25; 70-79 years M=21.70 SD=5.52; 80+ M=21.38 SD=5.82). The health related quality of life (the FLZ subscale), varied in the analysed subgroups (F=7.783 p=0.000), and was related to comorbidity and polytherapy. A positive attitude towards telemedicine was expressed by 40% of those surveyed. However the seniors' need for telemedical services was more limited and did not exceed the 10%. In Poland in ageing there still dominates the experience of multiple ailments and polytherapy, something which justifies a search for new, easily accessible, and economically sound solutions for health care. Telemedicine is a promising solution although there is a need for concrete steps to be taken to raise willingness amongst geriatric patients to take advantage of telemedicine.
Full Text Available We have previously proposed a method for assessing the quality of individual teleconsultation cases; this paper proposes an additional step to allow the long-term monitoring of quality. The basic scenario is a teleconsultation system (aka an e-referral system or a tele-expertise system where the referrer posts a question about a clinical case, the question is relayed to an appropriate expert, and the chosen expert provides an answer. The people running this system want assurances that it is stable, i.e. they want routine quality assurance information about the output from the process. This requires two things. It needs a method of assessing the quality of individual patient consultations. And it needs a method for taking into account differences between patients, so that these quality assessments can be compared longitudinally. Building on the previously proposed methodology, the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation. The first is an indirect method, similar to a willingness to pay economic estimation. The second is a direct method. Using these two methods with real data from a telemedicine network showed that the first method was feasible, but did not produce useful results in a pilot trial. The second method, while more laborious, was also feasible and did produce useful results. Thus when output quality is measured, an allowance can be made for the characteristics of the case submitted. This means that fluctuations in output quality can be attributed to variations in the process (network or to variations in the raw materials (queries submitted to the network. Long-term quality assurance should assist those providing telemedicine services in low-resource settings to ensure that the services are operated effectively and efficiently, despite the constraints and complexities of the environment.
The error-free requirement of today's cell-phone based telemedicine systems demands investigations into the potential causes of service degradation, Measuring the Received Signal Strength Indication (RSSI...
Mathieson, Kathleen; Leafman, Joan S; Horton, Mark B
Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Survey data were collected from AI patients with DM during teleophthalmology exams. Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.
Dyrvig, Anne-Kirstine; Gerke, Oke; Kidholm, Kristian
pulmonary disease (COPD) is no exception. METHODS: In this article, the effects of implementing a telemedicine intervention for COPD patients were analysed using data collected before, during, and after a randomised controlled trial (RCT).More specifically, regression techniques using robust variance...... estimators were used to analyse whether the use of telemedicine, patient age, and gender could explain the risk of readmission, length of hospital admission, and death during a five-year observation period. RESULTS: Increased risk of readmission was significantly related to both use of telemedicine...... and increased age in three sub-periods of the study, whereas women showed a more pronounced risk of readmission than men only during and after the RCT period. The number of days admitted to hospital was higher for patients using telemedicine and being of older age. Risk of death during the observation period...
Full Text Available Background: This research have presented focuses upon the cultural side of managerial coordination and control as manifested in Telemedicine Technology. Specifically, the research seeks to analyze and determines the attitude of clinical physicians about the role of specific dimensions of organizational culture and organizational structure may have upon effective managerial coordination and control in Telemedicine Technology in TUMS hospitals. Materials and methods: We assessed the attitude of 82 clinical physicians in five randomly selected TUMS teaching hospitals in a mixed method of pooling Quantitative and Qualitative data using unstructured interview technique. Results: For successful telemedicine utilization, most of clinical physicians believed that we need organic organizations that have involved leadership, open and free communication of mistakes and success, desire to experiment with new ideas, support for continuing education, support for new things, clear rules to follow and acknowledge performance goals. Conclusion: The data indicate that organizational is most important to utilize successfur telemedicine technology.
Oh, Sechang; Kwon, Hyeokjun; Varadan, Vijay K.
Good sleep is critical for one's overall physical and mental health but more than 50 million Americans have experienced or are suffering from sleep disorders. Nevertheless, 85% of them remain undiagnosed or untreated. They can lead to chronic diseases. Sleep disorders are diagnosed through polysomnography, also known as sleep study, performed in a sleep laboratory overnight. This perturbs his/her daily sleep routine, and consequently, an accurate diagnosis cannot be made. Many companies have been developing home sleep test systems to reduce the cost of sleep studies and provide a more convenience solution to patients. The category of the system varies as type II, type III and type IV according to the type of sleep study. Current systems cannot be easily extended from one type to include a higher type. A patient who has a type III system to diagnose sleep apnea should additionally purchase a type II system which has functions that overlap with a type III system, to evaluate sleep stages. In this paper, we propose a wireless telemedicine system for easy extension of channels using the start network topology of the Zigbee protocol. The HST system consists of two wireless HST devices with a Zigbee module, a wireless HST receiver with both a Zigbee and a Wi-Fi module, and a sever which monitors/saves the physiological signals. One transmitter provides 5 channels for 2x EOG, 2x EEG and EMG to evaluate sleep stages. The other transmitter provides 5 additional channels for ECG, nasal air flow, body position, abdominal/chest efforts and oxygen saturation to diagnose sleep apnea. These two transmitters, acting as routers, and the receiver as a coordinator form a Zigbee star network. The data from each transmitter in the receiver are retransmitted to the monitoring unit through Wi-Fi. By building a star network with Zigbee, channels can be easily extended so that low level systems can be upgraded to higher level systems by simply adding the necessary channels. In addition
Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P
The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Wang, Yanjun; Zhao, Ye; Zheng, Jianzhong; Zhang, Ailian; Dong, Haiyuan
Introduction Telemedicine has been implemented in many countries and has captured the attention of many researchers. Herein, we aim to quantify publication hotspots in the field of telemedicine, analyse their evolution, compare them in different countries, and provide visual representations. Methods We used software tools to process PubMed entries for a 54-year period and identified publication hotspots using keyword frequency analysis. We employed a keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and network visualization technology. Results The number of Medical Subject Heading (MeSH) terms increased with time. The most common subcategories of telemedicine between 1962 and 2015 were Remote Consultation, Teleradiology, and Telepathology. The most popular information communication technologies in telemedicine publications were related to the Internet and cell phones. The topics of Patient Satisfaction, Treatment Outcomes, and Home Care Services associated with telemedicine were highlighted after the 1990s. Use frequency of the terms Cell Phones and Self-Care increased drastically in the past six years, and the publication focus in six countries that had the highest output was different. Knowledge network maps and perceptual maps show the relationship between high-frequency MeSH terms. Discussion The telemedicine field has experienced significant growth and expansion in knowledge and innovation in the last 54 years. Publication hotspots for telemedicine lean towards clinical treatment, home care services, and personal care, and countries emphasize publishing in areas related to their national characteristics. This study quantitatively discusses publication hotspots, provides an objective and systematic understanding of this field, and suggests directions for future telemedicine research.
Mendelson, Monique; Vivodtzev, Isabelle; Tamisier, Renaud; Laplaud, David; Dias-Domingos, Sonia; Baguet, Jean-Philippe; Moreau, Laurent; Koltes, Christian; Chavez, Léonidas; De Lamberterie, Gilles; Herengt, Frédéric; Levy, Patrick; Flore, Patrice; Pépin, Jean-Louis
Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Sleep clinics in France. 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. ClinicalTrials.gov identifier: NCT01226641.
Mahtani Chugani, Vinita; Martín Fernández, Roberto Luis; Soto Pedre, Enrique; Yanes López, Virginia; Serrano Aguilar, Pedro
To identify the main benefits and risks related to the implementation of telemedicine programs in Spain, based on the experience of the actors influencing the decision-making process. We performed a qualitative study based on audiotaped semi-structured telephone interviews. Eleven interviews were carried out, and the perspective of four physicians, three administrators, two researchers and two telecommunications industry workers were included. Theoretical sampling was used and thematic inductive analysis was performed. The following factors were identified as necessary to successfully resolve problems by using telemedicine programs: the commitment of the persons involved, technological aspects, economic and institutional support, acceptance by healthcare professionals and patients, the existence of protocols adjusted to the context, the need for information and training prior to the development of telemedicine programs, a forward-looking approach, routine use and full acceptance of telemedicine programs in the organization, and the need to defend equity for professionals and users. Successfully developing a telemedicine program requires a favorable environment in which risk can be foreseen. The main key element seems to be the human factor. The factors identified in this study should be considered when developing strategies to increase the chances of success of telemedicine programs in Spain.
Bell, Rebecca C; Yager, Phoebe H; Clark, Maureen E; Roumiantsev, Serguei; Venancio, Heather L; Chipman, Daniel W; Kacmarek, Robert M; Noviski, Natan N
Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations. Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and FIO2 perfectly correlated (r = 1, all P Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patient-generated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope. Copyright © 2016 by Daedalus Enterprises.
de Souza, Carlos Henrique Amaral; Morbeck, Renata Albaladejo; Steinman, Milton; Hors, Cora Pereira; Bracco, Mario Maia; Kozasa, Elisa H; Leão, Eliseth Ribeiro
In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.
Baig, Mirza M; Antonescu-Turcu, Andrea; Ratarasarn, Kavita
There is growing evidence that demonstrates an important role for telemedicine technologies in enhancing healthcare delivery. A comprehensive sleep telemedicine protocol was implemented at the Veterans Administration Medical Center (VAMC), Milwaukee, WI, in 2008 in an effort to improve access to sleep specialty care. The telemedicine protocol relied heavily on sleep specialist interventions based on chart review (electronic consult [e-consult]). This was done in response to long wait time for sleep clinic visits as well as delayed sleep study appointments. Since 2008 all consults are screened by sleep service to determine the next step in intervention. Based on chart review, the following steps are undertaken: (1) eligibility for portable versus in-lab sleep study is determined, and a sleep study order is placed accordingly, (2) positive airway pressure (PAP) therapy is prescribed for confirmed sleep apnea, and (3) need for in-person evaluation in the sleep clinic is determined, and the visit is scheduled. This study summarizes the 5-year trend in various aspects of access to sleep care after implementation of sleep telemedicine protocol at the Milwaukee VAMC. This is a retrospective system efficiency study. The electronic medical record was interrogated 5 years after starting the sleep telemedicine protocol to study annual trends in the following outcomes: (1) interval between sleep consult and prescription of PAP equipment, (2) total sleep consults, and (3) sleep clinic wait time. Two part-time sleep physicians provided sleep-related care at the Milwaukee VAMC between 2008 and 2012. During this period, the interval between sleep consult and PAP prescription decreased from ≥60 days to ≤7 days. This occurred in spite of an increase in total sleep consults and sleep studies. There was also a significant increase in data downloads, indicating overall improved follow-up. There was no change in clinic wait time of ≥60 days. Implementation of a sleep telemedicine
Ming, Wai-Kit; Mackillop, Lucy H; Farmer, Andrew J; Loerup, Lise; Bartlett, Katy; Levy, Jonathan C; Tarassenko, Lionel; Velardo, Carmelo; Kenworthy, Yvonne; Hirst, Jane E
Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy. To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy. The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of -0.12% (95% CI -0.23% to -0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference -0.14% (95% CI -0.25% to -0.04%). There were no differences in other maternal and neonatal outcomes reported. There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were
McCoy, Allen H.
Helicopter external air transportation plays an important role in today's world. For both military and civilian helicopters, external sling load operations offer an efficient and expedient method of handling heavy, oversized cargo. With the ability to reach areas otherwise inaccessible by ground transportation, helicopter external load operations are conducted in industries such as logging, construction, and fire fighting, as well as in support of military tactical transport missions. Historically, helicopter and load combinations have been qualified through flight testing, requiring considerable time and cost. With advancements in simulation and flight test techniques there is potential to substantially reduce costs and increase the safety of helicopter sling load certification. Validated simulation tools make possible accurate prediction of operational flight characteristics before initial flight tests. Real time analysis of test data improves the safety and efficiency of the testing programs. To advance these concepts, the U.S. Army and NASA, in cooperation with the Israeli Air Force and Technion, under a Memorandum of Agreement, seek to develop and validate a numerical model of the UH-60 with sling load and demonstrate a method of near real time flight test analysis. This thesis presents results from flight tests of a U.S. Army Black Hawk helicopter with various external loads. Tests were conducted as the U.S. first phase of this MOA task. The primary load was a container express box (CONEX) which contained a compact instrumentation package. The flights covered the airspeed range from hover to 70 knots. Primary maneuvers were pitch and roll frequency sweeps, steps, and doublets. Results of the test determined the effect of the suspended load on both the aircraft's handling qualities and its control system's stability margins. Included were calculations of the stability characteristics of the load's pendular motion. Utilizing CIFER(R) software, a method for near
Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in the Balkans has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in Kosova. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy developed by IVeH "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services not only in developing countries, but in developed countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs is described. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the very core of healthcare infrastructure. The end point is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova and Albania has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program is transitioned to the Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Macedonia, Montenegro and other countries
Fong, Bernard; Fong, A C M; Hong, G Y
This paper describes the design of a telemedicine system based on next-generation wireless local area networks (WLANs) operating at 17 GHz. Seventeen gigahertz is proposed for next-generation WLAN services offering numerous advantages over traditional IEEE 802.11 networks that operate in the range of 2.4-5 GHz. Orthogonal polarization is often used to increase spectrum efficiency by utilizing signal paths of horizontal and vertical polarization. Radio waves exceeding 10 GHz are particularly vulnerable to signal degradation under the influence of rain which causes an effective reduction in isolation between polarized signal paths. This paper investigates the influence of heavy rain in a tropical region on wide-band microwave signals at 17 GHz using two links provided by a fixed broad-band wireless access system for two-way data exchange between paramedics attending an accident scene and the hospital via microwave equipment installed in the ambulance. We also study the effects of cross polarization and phase rotation due to persistent heavy rainfall in tropical regions.
Nakajima, I; Natori, M; Takizawa, M; Kaihara, S
We surveyed interactive telemedicine projects via telecommunications satellite (AMINE-PARTNERS, Post-PARTNERS, and Shinshu University Project using Inmarsat satellites) offered by Japan as assistance to developing countries. The survey helped clarify channel occupation time and data transfer rates. Using our survey results, we proposed an optimized satellite model with VSATs simulating the number of required channels and bandwidth magnitude. For future implementation of VSATs for medical use in developing nations, design of telecommunication channels should take into consideration TCP/IP-based operations. We calculated that one hub station with 30-76 VSATs in developing nation can be operated on bandwidth 6 Mbps using with 128 Kbps videoconferencing system for teleconsultation and teleconference, and linking with Internet.
Goel, Neha A; Alam, Amal A; Eggert, Emily M R; Acharya, Soumyadipta
Telemedicine offers a method to bridge the healthcare access gap in low and middle income countries (LMICs) by connecting providers with patients using appropriate technology. Here we describe the design and development of a novel modular telemedicine platform, Intelehealth, that would enable health systems to connect remote doctors with patients in rural clinics using a customizable Android-based platform and a cloud-based electronic health record system at the backend (OpenMRS). This open source platform enables task shifting of medically relevant information gathering by a local health worker, transmission of this information to a remote doctor, and a telephonic conversation between the doctor and the patient that subsequently allows for delivery of an appropriate therapeutic plan. Intelehealth is designed to operate on a low bandwidth internet environment, and will be tested and validated in rural health clinics in India.
Ryu, J.H.; Beack, S.H.; Paek, S.E.; Hong, S.C. [Myongji University, Yongin (Korea)
Acrophobia is an abnormal fear of heights. Medications or cognitive-behavior methods have been mainly used as a treatment. Lately the virtual reality technology has been applied to that kind of anxiety disorders. A virtual environment provides patient with stimuli which arouses phobia, and exposing to that environment makes him having ability to over come the fear. Recently, the patient can take diagnose from a medical doctor in distance with the telemedicine system. The hospital and doctors can get the medical data, audio, video, signals in the actual examination room or operating room via a live interactive system. Audio visual and multimedia conference service, online questionary, ECG signal transfer system, update system are needed in this system. Virtual reality simulation system that composed with a position sensor, head mount display, and audio system, is also included in this telemedicine system. In this study, we tried this system to the acrophobia patient in distance. (author). 16 refs., 7 figs.
Patient empowerment in the digitalized healthcare can be supported by means of telemedicine. As opposed to Electronic Patient Records developed by a few large business suppliers for healthcare professionals, telemedical applications include innovative solutions of small-medium size suppliers...... and are targeted at specific groups of patients (e.g., hip operated or dermatology patients) and their care network. Based on an integration experiment we argue that in order to support the national visions for patient empowerment and connectedness of healthcare at the same time, it is necessary to achieve...... the integration of telemedicine to the national healthcare services on a business logic (functional) integration level. In this paper, (1) we identify the lack of business logic (functional) level integration opportunities for patient oriented telemedical applications with national healthcare services; (2) we...
Hong, Yan Alicia
In October 2015, the "Chinese American Physicians E-Hospital" celebrated its "grand opening" online. All physicians affiliated with this E-Hospital are bilingual Chinese American physicians, who provide services ranging from initial teleconsulting to international transfer and treatment in the United States. Such telemedicine platform for medical tourism not only saves the patients from the hassles of identifying and connecting with an appropriate health service provider but also minimizes the language and cultural barriers. As a growing number of patients from middle- and low-income countries travel to the United States (US) for medical care, we face promising opportunities as well as mounting challenges. The Centers for Disease Control (CDC) in the US has guidance for Americans seeking care overseas, but is not available for international patients seeking care in US. This article opens a dialogue on the challenges associated with flourishing medical tourism and telemedicine, including quality assessment, risk communication, ethical guidelines, and legal concerns.
Raposo, Vera Lúcia
In the framework of European law telemedicine is, simultaneously, a health service and an information service, therefore, both regulations apply. In what concerns healthcare and the practice of medicine there are no uniform regulations at the European level. Concerning health services the most relevant achievement to regulate this domain is Directive 2011/24/EU. In what regards information and telecommunications we must have in consideration Directive 95/46/EU, Directive 2000/31/EC and Directive 2002/58/EC. However, many issues still lack uniform regulation, mainly the domain of medical liability and of medical leges artis. Probably such standardization will never take place, since the European Union does not have, until now, a common set of norms regarding tort and criminal liability, much less specific legal norms on medical liability. These gaps may jeopardize a truly European internal market in health services and hamper the development of telemedicine in the European zone.