The term telemedicine encompasses a wide range of telecommunications and information technologies and many clinical applications, although interactive video may be the most common medium. The first telemedicine programs were established almost 40 years ago, but the technology has grown considerably in the past decade. Despite the expansion of telemedicine, the volume of patients receiving services that use the technology remains relatively low (about 21000 in 1996). In part, this reflects the lack of a consistent coverage and payment policy and concerns about licensure, liability, and other issues. A considerable amount of federal funding has supported telemedicine in recent years, and legislators and federal, regional, and state policymakers are struggling with several crucial policy matters. Research on the effectiveness of telemedicine is somewhat limited, although the work that has been done thus far supports the hypothesis that, in general, the technology is medically effective. The cost-effectiveness of specific telemedicine applications has not yet been rigorously demonstrated.

Telemedicine: where it is and where it's going.

Since 1959, the University of Nebraska Medical Center has been using two-way closed-circuit television for medical treatment and education, largely in psychiatry. Television has been used to link the medical center with hospitals in remote rural areas, as well as to assist in educational programs within the university complex. Electronic communication has been valuable in extending education and services.

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Two-way television: helping the Medical Center reach out.

We evaluated user satisfaction with a PC-based videoconferencing system used for child psychiatry assessments and performed a cost analysis. Thirty patients (aged 5-16 years), accompanied by a parent, completed a psychiatric assessment using the videoconferencing system. One of five child psychiatrists was randomly assigned to each assessment. Satisfaction questionnaires were completed after each assessment by the psychiatrist, patient and parent. Parents also completed a cost questionnaire. The telecommunications bandwidth was 336 kbit/s. The psychiatrists stated that they were either 'very satisfied' or 'satisfied' with the telepsychiatry assessments. On a five-point Likert scale (1 = lowest, 5 = highest), 28 of the 30 parents (93%) rated their satisfaction level as 5; the other two rated it 4. All 30 parents (100%) stated that they 'liked' the telepsychiatry assessment and would use the system again. Twenty-nine parents (97%) indicated that they would prefer to use the telepsychiatry system to travelling to see a child psychiatrist in person. Eleven children (aged 5-12) participated and all (100%) said they 'liked' using the telepsychiatry system. Five out of nine children (56%) stated they liked the 'television doctor' better than the 'real' doctor; four said they had no preference. Nineteen adolescents (aged 13-16 years) participated and most were very satisfied or satisfied with the system. Seventeen of the 19 adolescents (89%) said they would prefer to see the psychiatrist on the videoconferencing system to travelling for an assessment, and the same number said that they would use telepsychiatry again. The estimated total travel cost for the 30 patients was $12,849, an average of $428 per patient. The total cost of the telepsychiatry service for the three-month pilot was $12,575, or $419 per patient.

A prospective satisfaction study and cost analysis of a pilot child telepsychiatry service in Newfoundland.

The use of telemedicine has recently undergone rapid growth and proliferation. Although the feasibility of many applications has been tested for nearly 30 years, data concerning the costs, effects, and effectiveness of telemedicine are limited. Consequently, the development of a strategy for coverage, payment, and utilization policy has been hindered. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal budget cuts and major changes in health service financing. This article reviews the literature on the effects and medical effectiveness of telemedicine. It concludes with several recommendations for research, followed by a discussion of several specific questions, the answers to which might have a bearing on policy development.

Effects and effectiveness of telemedicine.

To meet the needs of part-time and off-campus students, many institutions of higher education are using distance learning technologies. This study addresses the impact of the interactive television...

Interactive Distance Learning: Impact on Student Course Evaluations

Summary

The closed circuit television tools I have discussed here will soon be available to our entire medical school as part of a Biomedical Communications Center which will incorporate and coordinate existing services and explore new methods of communication as well.



I believe that closed circuit television–especially two-way television–will be a valuable tool in our medical education, service and research. It is also logical that its effectiveness will be measured in direct proportion to the amount of careful planning put into the selection of the best system, the determination of the most appropriate uses, and the encouragement of faculty and student interest and participation.

Multi‐purpose television

Telecommunications and nursing education

The Getting Started Together project has developed a validated model of interdisciplinary training to enhance professionals' abilities to work with handicapped or at-risk infants and toddlers and their families. Many health care and educational professionals need additional information in order to comfortably provide the services described in P.L. 99-457 (Education of the Handicapped Amendments of 1986).

A variety of methods of delivery were developed and implemented during the three years of this federally-funded project to meet these in-service needs. Based on needs assessment and goals, a 48-hour curriculum was developed and presented as a series of day-long workshops at multiple sites during the first two years of the project. To provide the most flexible learning opportunities possible to these professionals, the third year of the project focused on packaging the curriculum into 10 self-instructional modules, each consisting of a manual and videocassette. The process, rationale, advantages, and disadvantages of developing and producing self-instructional learning modules are discussed.

Experiences with this project indicate that a variety of delivery formats can be used to meet the in-service needs of professionals with various educational and clinical backgrounds from both urban and rural regions. The flexibility, efficiency, and accessibility of the self-instructional format is most valuable in delivering essential information to professionals who must develop and deliver services as outlined in PL. 99-457.

Reba A. Benschoter

Papers

Multi‐purpose television

Telecommunications and nursing education

Adapting an Established Curriculum to the Self-Instructional Format: Rationale and Process.