Showing papers in "Telemedicine Journal in 1996"

"Wellsprings of Knowledge: Building and Sustaining the Sources of Innovation"

Abstract: Dorothy Leonard-Barton warns readers upfront that her new book, "Wellsprings of Knowledge: Building and Sustaining the Sources of Innovation," is not a quick read. Indeed it is not, though the author, a Harvard Business School professor, tries hard to soften a knot of strategy research with true-life examples from several technology companies. Unfortunately, business books tend to be like Arnold Schwarzenegger movies: the special effects and twists are a lot more important than the basic plot, which doesn't change much.

Health systems evaluation of telemedicine: a staged approach.

Abstract: Telemedicine promises greater access to health care of higher quality, potentially at lower cost. The diverse applications of telemedicine technology developed to date have not been evaluated systematically in terms of their ability to achieve these goals. Furthermore, the great variety in telemedicine applications and the far-reaching consequences of new information systems for health care delivery pose challenges to traditional methods of technology assessment. Methods appropriate for mature technologies may not be suitable for emerging ones and, indeed, may risk stifling their development with premature negative conclusions. The staged approach to technology assessment proposed here matches the analysis to the technology's stage of development. It focuses on access, quality, and cost and considers the communication pathway employed in the telemedicine application. A staged approach to technology assessment can inform and foster the development of new telemedicine technology while allowing health care delivery systems to make rational decisions about adopting telemedicine.

The University of Texas Medical Branch— Texas Department of Criminal Justice Telemedicine Project: Findings from the First Year of Operation

Abstract: Background The University of Texas Medical Branch (UTMB) and Texas Tech Health Science Center (TTHSC) are responsible for providing health care for approximately 130,000 inmates of the Texas Depart...

Experience-related differences in diagnosis from medical images displayed on monitors.

Abstract: Objective To compare diagnostic accuracy using conventional versus monitor-displayed medical images in order to determine if years of experience as a board-certified clinician influences diagnostic...

Telemedicine and telepathology at the Armed Forces Institute of Pathology: history and current mission.

Abstract: The Armed Forces Institute of Pathology uses telepathology and telemedicine programs to support its mission of providing pathology consultation, education, and research. The telepathology service is based on a static imaging or "store-and-forward" approach using both proprietary equipment and open systems through the Internet. Initiated in 1993, the service provides rapid expert consultation to pathologists globally. Diagnoses are provided by pathologists in 22 specialized departments. Educational programs are delivered through the World Wide Web. Category I continuing medical education credits can be obtained through Internet-based courses. Research activities are focused on forensic applications and the creation of image databases.

Transmission of full-length echocardiographic images over ISDN for diagnosing congenital heart disease.

Abstract: Objectives To study the feasibility of transmitting full-length diagnostic-quality echocardiograms with video conferencing systems linked by ISDN. Methods Forty-three previously video-recorded full-length echocardiograms (22 complete two-dimensional Doppler studies, 21 separate M-mode studies) were transmitted from a site 30 miles distant using desktop video conferencing systems linked with one ISDN line (128 kbps). Blinded interpretations of the original recorded and transmitted studies were made by two pediatric cardiologists (two-dimensional Doppler) and a pediatric sonographer (M-mode). Results Diagnoses of normal (N = 12) and abnormal (N = 10) conditions were made from the original tapes; the same interpretations were made from the transmitted studies. Twenty-one specific abnormalities in the 10 abnormal studies were seen on both original and transmitted videotapes. These abnormalities ranged from simple congenital heart defects, including ventricular septal defect, a trial septal defect, and patent ...

Tertiary telemedicine support during global military humanitarian missions.

Abstract: Objective The U.S. military medical units face the challenge of delivering the latest medical knowledge and advances to remote areas of the world. This study details the tertiary care telemedicine ...

Operation Joint Endeavor in Bosnia: telemedicine systems and case reports.

Abstract: Objective For the last several years the U.S. Department of Defense (DoD) has operated a telemedicine test bed at the U.S. Army Medical Research and Materiel Command's Medical Advanced Technology Management Office. The goal of this test bed is to reengineer the military health service system from the most forward deployed forces to tertiary care teaching medical centers within the United States by exploiting emerging telemedicine technologies. Methods The test bed has conducted numerous proof-of-concept telemedicine demonstrations as part of military exercises and in support of real-world troop deployments. The most ambitious of those demonstrations is Primetime III, an ongoing effort to provide telemedicine and other advanced technology support to medical units supporting Operation Joint Endeavor in Bosnia. Results Several of the first instances of the clinical use of the Primetime III systems are presented as case reports in this paper. These reports demonstrate capabilities and limitations of telemedic...

"Telepsychometry": a remote psychometry consultation in clinical gerontology: preliminary study.

Abstract: Objective Evaluation of the clinical feasibility of remote psychometric consultation with elderly patients. Methods Remote consultation with six women and four men (average age 87) was compared wit...

Wavelet compression of medical imagery.

Abstract: Wavelet compression is a transform-based compression technique recently shown to provide diagnostic-quality images at compression ratios as great as 30:1. Based on a recently developed field of applied mathematics, wavelet compression has found success in compression applications from digital fingerprints to seismic data. The underlying strength of the method is attributable in large part to the efficient representation of image data by the wavelet transform. This efficient or sparse representation forms the basis for high-quality image compression by providing subsequent steps of the compression scheme with data likely to result in long runs of zero. These long runs of zero in turn compress very efficiently, allowing wavelet compression to deliver substantially better performance than existing Fourier-based methods. Although the lack of standardization has historically been an impediment to widespread adoption of wavelet compression, this situation may begin to change as the operational benefits of the technology become better known.

Virtual reality and telemedicine: exploring advanced concepts.

Abstract: Virtual reality (VR) has provided a new methodology for interacting with information. Since telemedicine is principally involved with transmitting medical information, VR has the potential to enhance the telemedicine experience. The two principle ways in which VR can be applied are as an interface, which enables a more intuitive manner of interacting with information, and as an environment that enhances the feeling of presence during the interaction. Since there are no current clinical applications of VR in the telemedicine experience, this report reviews concepts and experiences with the potential to enhance the delivery of telemedicine.

An Ohio telemedicine system for prison inmates: a case report.

Abstract: Background A project was established by The Ohio State University Medical Center (OSUMC) and the Ohio Department of Rehabilitation and Corrections (ODRC) to investigate the use of telemedicine in providing health care to Ohio's prison inmates. Objectives To determine the effects of telemedicine on continuity of inmate care, the sense of isolation experienced by health care providers at remote institutions, the security risks incurred when transporting inmates to outside facilities, and the overall cost of care. In tracing the initial adoption and implementation of the project, the authors describe health care in Ohio's prisons and the unique nature of providing that care. Methods The project was conducted over a 1-year period, from November 1994 through December 1995, using a variety of methods: direct observation of inmate consultations; participation in task force meetings; unstructured interviews with physicians, prison administrators, ancillary health care personnel, and security guards; and initial collection of survey data. Results Telemedicine enables Ohio's inmates to receive health care in a more timely fashion than before. Physicians and inmates were generally satisfied, and the costs of providing inmate medical care were reduced by lessening or eliminating the need for additional security guards, vans, chase vehicles, and travel time for physicians. Conclusions Some initial hurdles in using the system, such as scheduling and triage, are being overcome as new methods are devised, and additional incentives for specialty physicians to use the system are being investigated. The OSUMC/ODRC project suggests that the advantages of using telemedicine in prison settings are immense, and the ODRC plans to expand the network to include two more remote sites early in 1996.

State Initiatives to Promote Telemedicine

Abstract: Objective To identify states that have played a key role in promoting, developing, and supporting telemedicine initiatives aimed at improving access to basic health care and to characterize the range of actions and policymaking roles taken by the states. Methods State agencies involved in telemedicine initiatives and state-funded telemedicine programs were interviewed by telephone. An informal case study approach was used with a standard, open-ended questionnaire. Twenty-seven states were contacted in early 1995. Results Sixteen states have been active in telemedicine development since 1989, with the level of activity expanding considerably in the last 2 years. Some states, particularly Georgia, Kansas, Texas, South Dakota, and Louisiana, have.well-developed programs. Policy actions taken by the states in support of telemedicine differ considerably. They include planning and coordination, development of networks, more limited program development, funding, building a telecommunications infrastructure for t...

Telemedicine in Micronesia.

Abstract: Distance and isolation profoundly affect the delivery of health care in the islands of Micronesia. The lack of specialty services on most of the islands has led to a costly off-island referral system that strains health care budgets. Care providers there have incorporated advances in telecommunications to create a telemedicine network amongst themselves and with a tertiary care hospital in Hawaii. They developed an interactive video conferencing system, a still-image transmission network, and a data transfer network for use principally in patient care and continuing education. Patients now receive earlier evaluation by off-island specialists as part of an effort to improve the appropriateness of off-island referrals. Regularly scheduled medical lectures are broadcast from Pohnpei, a main island, to physicians in several more remote locations. Transmission costs are kept low by using, when possible, preexisting public-service satellites, such as the PEACESAT system that serves the entire Pacific basin. The telemedicine system is evolving, and its success depends greatly on the cooperative relationships among the partners.

Provider attitudes toward a rural telepathology program.

Abstract: Objective To assess the attitudes of referring and consulting pathologists toward a recently initiated live video telepathology network in rural Vermont. Methods A semistructured interview was conducted with each referring pathologist before implementation of the telepathology program and again 9 months later. The interview consisted of questions concerning reasons for seeking a consultation in general and attitudes toward telepathology specifically. A questionnaire with Likert-type response categories was administered at the 9-month timepoint to the referring (N = 4) and consulting (N = 10) pathologists. This questionnaire contained items regarding communication, cost, education, quality, and timeliness aspects of telepathology. In addition, a brief mail survey was sent to attending physicians who utilized pathology services at the rural hospitals. Results The referring pathologists found the timeliness of consults using telemedicine to be a significant advantage. They also cited educational benefits bot...

Rural telemedicine: a national snapshot.

Abstract: Objectives To estimate the use of telemedicine in rural hospitals in the U.S. and to identify and describe those rural hospitals that are active in telemedicine. Materials and Methods Nationwide mailed survey, with telephone follow-up, to all hospitals not located in a Metropolitan Statistical Area. Results The overall response rate was 95% of all rural hospitals. Of these, 416 (17.55%) reported having telemedicine, and more than 530 more have plans to begin telemedicine programs during the next few years. Rural hospitals of all sizes and in all regions of the country are initiating telemedicine programs, but there is significant variation by region. Specifically, hospitals located in more populous rural counties near metropolitan areas are less likely to have telemedicine than are hospitals located in less populous rural counties in more remote areas. Conservatively, more than 4000 teleconsults per month are estimated among rural hospitals nationwide in 1995, including all forms of telemedicine. Conclusi...

Status of electronic reporting of notifiable conditions in the United States and Europe.

Abstract: Objective To improve the computer connectivity and network strategies to connect U.S. county health departments (CHDs), state health departments (SHDs), and the Centers for Disease Control (CDC) for reporting notifiable conditions. Methods HSPNET-L mailing list discussions and individual Internet communications were used to compare selected features of notifiable conditions networking in the United States, France, and the United Kingdom. Results In the US, the CHD is the agency that first responds to an infectious disease outbreak on receiving notifications from physicians. Prompt recognition by the SHD that a widespread outbreak has occurred depends on the way in which county data are received, the "age" of the data, and the time taken to analyze them. Similarly, the recognition of the national scale of the outbreak depends on the promptness with which SHDs report to the CDC and the age of the data. An analysis of the French Communicable Disease Network suggests that an expansion of electronic links betw...

Beyond adoption to sustained use: telemedicine for rural communities.

Abstract: The objective of this paper is to identify factors that affect the sustained use of telemedicine in rural communities and to suggest possible ways to improve such utilization. We draw on innovation and network theory to develop hypotheses about conditions that will hinder or facilitate sustained use of telemedicine. Telemedicine systems are expected to achieve sustained use in communities with higher physician-to-population ratios, greater availability of nonphysician providers, and greater consumer knowledge of and support for telemedicine. Additionally, telemedicine is more likely to be used in settings where hospital medical staff structures use contractual arrangements that encourage the use of telemedicine or reimburse through capitated systems. Rural physicians are more likely to use telemedicine if they have previous experience in facilities that serve as telemedicine hubs and if they have strong relationships with physicians in a hub location or with local physicians who are supportive of telemedi...

Prospects for telediagnosis using ultrasound.

Abstract: Keywords: LTS1 Reference LTS-ARTICLE-1996-011 Record created on 2006-06-14, modified on 2016-08-08

Experimenting with feasibility of telemedicine in Alaska: successes and lessons learned.

Abstract: Alaska may be ideally suited as a test site for telemedicine. It is by far the nation's largest state, with a population of only 550,000 clustered around a few cities and towns or widely spread across an area almost two and a half times as large as Texas. Its ratio of doctors to patients is the second lowest in the nation, and the cost of medical care exceeds that in the lower 48 states by 90%. Almost half of its residents are affiliated with the federal government in some way. Active duty and retired members of the military and their families (including children) represent 70,000 of the state's residents, and another 160,000 are affiliated with the Coast Guard, the Indian Health Service, and the Department of Veteran Affairs. In 1995, a telemedicine initiative was launched under the auspices of the 3rd Medical Center at Elmendorf Air Force Base. Its mission was to integrate video conferencing and store-and-forward technology into patient care. Brief but well-documented efforts yielded many valuable lesso...

A Brief Survey of Department of Defense Telemedicine

Abstract: This paper describes current telemedical projects sponsored by the Department of Defense (DoD) and provides points of contact for further communication. The scope and scale of these projects demonstrate the DoD commitment to the development and deployment of telemedicine and advanced medical information technologies in health care delivery.

Telemedicine and economic realities.

Abstract: There are two reasons for doing something. One is a very good reason and the other is the real reason. —Spanish proverb

"Robo-Rad": an inexpensive user-friendly multimedia report system for radiology.

Abstract: Background and Purpose. The complex information obtained by CT, MR, and ultrasound examinations is often difficult to convey with a written report. Today's multimedia computer technology provides a medium within which the audio and the visual components of a radiologic consultation can be made available simultaneously, with the projected capability of remote access from any personal computer. A system was developed to run on low-end computer systems with image quality adequate for reporting purposes and prudent memory management (each report occupies < 4 MB). With this "system—"Robo-Rad"—the image and radiologist are recorded simultaneously while he or she describes and points out (with a mouse) areas of interest. This dynamic report, along with patient data, can be retrieved and viewed by the consulting physician at his/her convenience using a low-end PC or Macintosh computer. Materials and Methods. To assess the clinical utility of Robo-Rad, survey responses were solicited from clinical physicians at th...

Accuracy of interpretation of microscopic images of cytologic, hematologic, and histologic specimens using a low-resolution desktop video conferencing system.

Abstract: Objective To determine the accuracy of interpretation of microscopic images for pathologic study transmitted over Switched-56 lines using a desktop interactive video conferencing system. Materials ...

Telephone transmission of 20-channel digital electroencephalogram using lossless data compression.

Abstract: Background The use of telecommunications for computer-assisted transmission of neurophysiological signals is a relatively new practice. With the development of digital technology, it is now possibl...