Showing papers on "Telemedicine published in 1998"

A novel emergency telemedicine system based on wireless communication technology-AMBULANCE

Abstract: Recent studies conclude that early and specialized prehospital management contributes to emergency case survival. We have developed a portable medical device that allows telediagnosis, long distance support, and teleconsultation of mobile healthcare providers by expert physicians. The device allows the transmission of vital biosignals and still images of the patient from the emergency site to the consultation site using the GSM mobile telephony network. The device can telematically "bring" an expert specialist doctor to the site of the medical emergency, allow him/her to evaluate patient data, and issue directions to the emergency personnel on treatment procedures until the patient is brought to the hospital. Legal reasons mandated the inclusion at the consultation site of a multimedia database able to store and manage the data collected by the system. The performance of the system has been validated in four different countries using a controlled medical protocol and a set of 100 patients per country treated has been collected and analyzed.

Towards personal health record: current situation, obstacles and trends in implementation of electronic healthcare record in Europe.

Abstract: In this article, we define the electronic healthcare record and present its purpose as a tool for continuity of care. We briefly describe the current situation of usage and focus on the major challenges to wide implementation in Europe and beyond. Finally, we point out trends that show stronger involvement of the patients-citizens in the health care prevention and promotion processes, and discuss the impact on the future development of the electronic healthcare record into personal health records.

Electronic Patient-Physician Communication: Problems and Promise

Abstract: A critical mass of Internet users will soon enable wide diffusion of electronic communication within medical practice. E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. Unless these technologies are implemented with substantial forethought, they may disturb delicate balances in the patient-physician relationship, widen social disparities in health outcomes, and create barriers to access to health care. This paper seeks to identify the promise and pitfalls of electronic patient-physician communication before such technology becomes widely distributed. A research agenda is proposed that would provide data that are useful for careful shaping of the communications infrastructure. The paper addresses the need to 1) define appropriate use of the various modes of patient-physician communication, 2) ensure the security and confidentiality of patient information, 3) create user interfaces that guide patients in effective use of the technology, 4) proactively assess medicolegal liability, and 5) ensure access to the technology by a multicultural, multilingual population with varying degrees of literacy.

The Legal And Ethical Aspects of Telemedicine

Abstract: There are many issues of concern regarding the legal and ethical aspects of telemedicine. These include the responsibilities and potential liabilities of the health professional, the duty to maintain the confidentiality and privacy of patient records, and the jurisdictional problems associated with cross-border consultations. There is also the issue of reimbursement for care provided using a telemedicine service. Telemedicine allows the transmission of health information across the borders of nation states. Cross-border telemedicine services have begun, particularly in specialties such as teleradiology, but questions of jurisdiction and registration have yet to be answered definitively. While this may be true of many of the legal and ethical aspects of telemedicine generally, it is also the case that health-care professionals who undertake telemedicine in a prudent manner will minimize the possibility of medicolegal complications.

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

Abstract: 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.

A novel method of surgical instruction: international telementoring

Abstract: Telemedicine is the use of communication technologies to deliver health care. Telesurgical telementoring represents an advanced form of telemedicine, whereby an experienced surgeon can guide and teach practicing surgeons new operative techniques utilizing current video technology, medical robots, and high-band-width telecommunications. This technology can potentially enhance surgeons' education, increase patients' access to experienced surgeons, and decrease the likelihood of complications due to inexperience with new techniques. A personal computer-based system was developed to immerse a surgical specialist into a distant operating room utilizing public telephone lines. Telesurgical laparoscopic telementoring has successfully been implemented in 27 prior operations between the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital, whereby the two institutions were separated by 3.5 miles. We report our experience in performing three successful international surgical telementoring operations, one in Innsbruck, Austria, and two in Bangkok, Thailand.

Cost evaluation of a telepsychiatry service in northern Queensland

Abstract: We conducted a simple comparison of the costs associated with delivering a mental health service by telepsychiatry and by conventional methods. The telepsychiatry rural outreach service was delivered to a mining town 900 km from the regional hospital in Townsville. When the telemedicine service was well established, 40 cases a month were seen for general adult psychiatry, four for child and adolescent mental health, four for psychology and two for forensic services. Costs and quality-of-life issues were considered. The savings to the health authority were estimated to be $85,380 in the first year and $112,790 in subsequent years, not allowing for maintenance and equipment upgrading. We also estimated a 40% reduction in patient transfers due to the introduction of telemedicine. Based on the previous year's figures of 27 transfers at $8920 each, this would produce an annual saving of $96,336 for the Royal Flying Doctor Service. The results of the study showed considerable savings from reduced travel by patients and health-care workers.

Using Telerehabilitation to Support Assistive Technology

Abstract: Telerehabilitation--the use of telecommunications technology to provide rehabilitation and long-term support to people with disabilities--offers exciting possibilities for the delivery and support of assistive technology services. This article describes the experiences of a specialty hospital serving persons with disabilities in exploring telerehabilitation to support assistive technology use in the home. Four case studies are presented to illustrate how telerehabilitation may be used in relation to seating evaluation, evaluation of home accessibility, setup of computer access systems, and training in use of augmentative communication devices.

A survey of research in telemedicine. 1: Telemedicine systems.

Abstract: Published work in telemedicine has been surveyed in order to consider the range of current research, highlight some pitfalls and point out areas where it seems that more work is required. This article deals with tests of the safety and efficacy of telemedicine systems. This work can be seen as moving through three phases: first, identify the technical specification of equipment required for the particular telemedicine application; second, test that this is appropriate in particular settings; third, establish a set of standards and guidelines to ensure that the telemedicine system is used to the best advantage. Work in teleradiology seems to be in the second phase. Work in teledermatology, for example, is still in the first phase. Telemedicine is an important and growing area of academic research. The quality of the research ought also to be increasing. While there have been a number of well designed, robust studies with clear conclusions that show the value of telemedicine in certain settings, much more r...

Applications of telemedicine in the United States space program.

Abstract: Since the beginning of human space flight, NASA has been placing humans in extreme and remote environments There are many challenges in maintaining humans in outer space, including the provision of life-support systems, radiation shielding, and countermeasures for minimizing the effect of microgravity Because astronauts are selected for their health, among other factors, disease and illness are minimized However, it is still of great importance to have appropriate medical care systems in place to address illness and injury should they occur With the exception of the Apollo program, exploration of space has been limited to missions that are within several hundred miles of the surface of the Earth At the drawn of the 21st century and the new millennium, human exploration will be focused on operation of the International Space Station (ISS) and preparation for human missions to Mars These missions will present inherent risks to human health, and, therefore, appropriate plans must be established to address these challenges and risks Crews of long-duration missions must become more independent from ground controllers New systems, protocols, and procedures are currently being perfected Application of emerging technologies in information systems and telecommunications will be critical to inflight medical care Application of these technologies through telemedicine will provide crew members access to information, noninvasive procedures for assessing health status, and guidance through the integration of sensors, holography, decision-support systems, and virtual environments These technologies will also serve as a basis to enhance training and medical education The design of medical care for space flight should lead to a redesign of the practice of medicine on Earth

A survey of research in telemedicine. 2: Telemedicine services.

Abstract: This article deals with research which attempts to demonstrate the value of health care delivered via telemedicine. A great variety of telemedicine services have been proposed. Much of the published work concentrates on the power of the technology and the content and quality of interaction it supports. There are other parameters to be considered in assessing telemedicine as a component of a health-care system, parameters which in practice determine the nature of the service being provided. Despite the fact that much work in telemedicine is published as short accounts of pilot projects, there is little research that explicitly addresses the difficulties involved in setting up new telemedicine services. Some studies have been performed which attempt to evaluate telemedicine services, but relatively few studies have been able to collect the data required to provide an unambiguous demonstration of their value.

Patient satisfaction with telemedicine consultation in primary care: Comparison of ratings of medical and mental health applications

Abstract: Objective To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. Methods Satisfaction ratings from 34 mental health encounters were ...

Design and Evaluation of a Real-Time Mobile Telemedicine System for Ambulance Transport

Abstract: A mobile telemedicine system was designed, implemented, and tested for en route neurological examinations which required evaluation of facial expressions and movement of arms and legs The system uses multiple public wireless cellular phones to transmit video and patient biosignals from a moving ambulance and delivers to the desktop computer of the receiving physician Tests and questionnaires completed by users indicated that it conveyed critical clinical information and it was adequate for conducting clinical examinations

Nurse and patient reactions to a developmental home telecare system.

Abstract: Pilot studies have suggested that telemedicine is a satisfactory means of delivering nursing services into the home. A home telecare programme in Kansas provided nursing services to homes in four towns in Kansas. The present study examined patients' and nurses' perceptions of a variety of issues related to home telecare. Data-collection methods included in-depth interviews, observation and analyses of archival data from patient records. Patients suffered an average of 4.6 concurrent illnesses. On the whole, patients perceived the system as a valuable resource that offered great potential, although many saw no immediate health benefits for themselves. Nurses were enthusiastic about the prospect of practising in this way, although they did have strong opinions about what types of nurses, patients and illnesses were suited to telemedicine.

Telemedicine in the national health service

Abstract: The UK Government has lately declared that, where there is evidence that the techniques are cost-effective, telemedicine will be introduced into the National Health Service (NHS). In late September 1998 the Royal Society of Medicine's Telemedicine Forum held a meeting to discuss a strategy whereby telemedicine might be implemented. This report summarizes the recommendations that emerged, and also incorporates some guidance notes based on the collective experience of those present (see Acknowledgment).

Knowledge barriers to diffusion of telemedicine

Abstract: Telemedicine is one proposed solution to problems of accessibility, quality, and costs of medical care. Although telemedicine applications have proliferated in recent years, their diffusion has remained low in terms of the volume of consultations. In this study, Attewell’s (1992) theory of knowledge barriers is extended to explain why diffusion of telemedicine remains low. In case studies of telemedicine programs in three worldrenowned medical centers in Boston, Massachusetts, we find that, in addition to technical knowledge barriers, as suggested by Attewell, there are economic, organizational, and behavioral knowledge barriers that inhibit the diffusion of telemedicine. The lowering of these barriers entails intensive learning efforts by proponents of applications within adopter organizations. They need to develop technically feasible, medically valid, reimbursable, and institutionally supported applications in order to justify the value of telemedicine and engender frequent and consistent use by physicians.

Teledermatology--high technology or not?

Abstract: As an alternative to attending a conventional dermatology clinic, patients had a high-resolution conventional photographic image taken by a professional medical photographer. The photographic images were viewed by a dermatologist together with referral details from the general practitioner and any other relevant information from the patient's notes. From the images, a dermatological diagnosis was derived and a management plan for each patient instituted. After treatment, histological assessment of the tumours allowed diagnostic accuracy to be determined. The preliminary diagnostic accuracy (71%) was greater than that of the referring general practitioners (49%). However, when the diagnostic ability of the method to detect the nature of malignant lesions was examined, telemedicine was able to detect malignancies in 94% of cases compared with only 70% detected by general practitioners. The results of the present study indicate that teledermatology is achievable using a low-technology, low-cost approach.

The use of videoconferencing for telepsychiatry in Finland.

Abstract: Some of the first telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, occupational counselling, consultation and teaching. In 1996 videoconferencing was used for a total of 249 hours, which increased to 434 hours in 1997. During 1997, 45 of the time was used for teaching, 26 for occupational counselling, consultations and therapies, 23 for training and 6 for administration mainly testing the connections . In a survey, 37 participants rated aspects of the quality of the videoconferences on a scale from 4 poor to 10 excellent . The audio quality had a mean value of 8.0 SD0.9 , the picture quality 7.5 SD1.5 , and the general value of the videoconference was rated 7.5 SD1.0 . Preliminary results with telepsychiatry in Finland have been promising. Interactive videoconferencing provides an easy, fast and relatively inexpensive method of providing psychiatric services over long distances.

Telemedicine in Pediatric Transport: A Feasibility Study

Abstract: Objective. Investigate the hypothesis that telemedicine, in the form of real-time audiovisual transmission, would permit accurate assessment of illness severity and allow improved triage for transport. Methods. A prospective study comparing assessments of patients examined conventionally (in person) and remotely by a telemedicine link. Fifteen patients (3 months to 14 years of age) admitted to our emergency department were evaluated as if for transport. Patients were evaluated simultaneously by a physically present pediatric emergency room physician and by a pediatric critical care physician linked to the examining room by a broadband audiovisual link. Each physician completed a patient assessment questionnaire independently. The sensitivity and specificity of the patient assessment by the audiovisually linked physician were calculated. Results. Sensitivity, ie, the ability of the remote, audiovisually connected telemedicine physician to detect abnormal findings, is 87.5%. Specificity, the ability of the remote physician to detect normal findings, is 93%. It is likely that sensitivity would be markedly improved with addition of an electronic stethoscope. Conclusion. This study demonstrates that pediatric patients may be assessed accurately with a broadcast-quality real-time audiovisual system. Such a system may have dramatic implications for providing pediatric specialty and subspecialty care in underserved areas.

Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

Abstract: While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.

A randomized controlled trial of telemedicine in an emergency department.

Abstract: A prospective study of emergency department telemedicine was carried out at two hospitals in northern New Jersey. One hundred and twenty-two patients met the inclusion criteria. One hundred and fou...

The use of telemedicine to treat ophthalmological emergencies in rural Australia.

Abstract: A retrospective analysis was made of a cohort of patients who presented sequentially with acute ophthalmological conditions which were managed by telemedicine consultation. Twenty-four patients presented with acute problems requiring specialist ophthalmological advice to the emergency department of a remote hospital in Mt Isa, Queensland, between December 1996 and February 1997. Tele-ophthalmology consultations were carried out with three ophthalmologists working in a specialist eye clinic in Townsville, 900 km away. Patients and doctors were extremely positive about the telemedicine facility. Tele-ophthalmology was an effective means of providing acute specialist consultation in a remote emergency department. By reducing the need for acute transfers to the tertiary hospital in Townsville, significant benefits can be anticipated--both financial and in terms of convenience for the patient. Benefits for medical staff in skills acquisition and education were also evident.

Pathologists' attitudes to implementing telepathology

Abstract: If pathologists will benefit so much from using telepathology, why is it taking so long to be introduced? This question has been discussed between experts, but the potential users are rarely asked for their opinions. A questionnaire was sent to the 256 members of the Austrian Society of Pathology; this addressed general aspects of telemedicine, telepathology in frozen-section services and expert consultation, videoconferencing technologies, teleteaching and teletraining. The response rate was 46%. In general, the pathologists thought that telemedicine could become valuable in their daily routine. However, pathologists were most afraid of sampling errors in remote diagnosis and would not readily accept an alternative to the conventional method of looking at a sample. This is only possible using realtime, remotely controlled microscopes. Telepathology systems providing only still images would not be acceptable to most respondents. There was interest in the use of videoconferencing for clinicopathological conferences. Teleteaching and teletraining were seen as welcome additional techniques, but were nevertheless judged unable to replace classical methods of teaching and training.

Health Care and the Next Generation Internet

Abstract: The Internet phenomenon-spurred on since the early 1990s by the creation of its most successful application, the World Wide Web-has had a remarkable impact on our global society in just a few years [1]. The penetration of the Internet into our homes, schools, and workplaces has arguably exceeded the rate at which earlier popular consumer technologies (such as television and video-cassette recorders) were adopted. The world of medicine and health care has not escaped the impact of the Internet, and health-related sites are among the most frequently accessed information resources on the Web. Medical observers are rethinking the optimal methods for implementing electronic medical record systems that are based on Internet technology [2], and distribution of biomedical information through the Internet is increasingly commonplace and accepted [3]. This issue includes two articles that describe both the promise and the problems related to the expanding uses of telecommunications in health care. Grigsby and Sanders [4] summarize the burgeoning activities in the area of telemedicine, acknowledging the logistic, fiscal, and regulatory barriers that have prevented more rapid adoption of these promising methods. de Groen and colleagues [5] describe a clever Internet application that monitors for rare diseases that previously would have defied efficient or comprehensive tracking. We should anticipate many more such applications as our horizons broaden and more health care workers realize how networking infrastructure can support new and innovative biomedical applications. Biomedicine is not a recent initiate to the world of the Internet. Medical research computers (such as the National Institutes of Health-funded SUMEX-AIM resource at Stanford University, Stanford, California) were connected to the ARPAnet (the predecessor to today's Internet) as early as the 1970s. Scientists began to realize that this marvelous, federally funded network was potentially a great boon to biomedical research and would allow collaboration among scientists around the United States in ways that would previously have been unthinkable [6]. Some 25 years later, despite remarkable advances and the transfer of the network to the private sector, we see our fragmented health care system only beginning to understand and adopt the Internet as a tool for health care delivery and information access. With proper leadership, investment, and commitment, the networking technology that is already available to us will provide great opportunities for innovative medical uses. But despite growing enthusiasm for the Internet, any Web user can attest to its severe limitations. Recognizing that significant research questions need to be addressed in promoting the continued growth and usefulness of the Internet in the decades ahead, the federal government has committed substantial, incremental fiscal year 1998 research dollars to the creation of the Next Generation Internet (NGI) program; ongoing investments are anticipated in fiscal year 1999 and beyond. (Information about the federal program is available at http://www.ccic.gov/ngi.) The federal research programs have strong bipartisan support in Congress and are cooperating with a consortium of academic institutions that are investing heavily in improving their own campus networks while seeking government support for test-bed experiments. The consortium, initially known as Internet-2, now has more than 100 U.S. member universities. It recently created a not-for-profit corporation, the University Consortium for Advanced Internet Development (UCAID, http://www.ucaid.org), which will continue to promote experimentation and demonstrations using high-speed networking of a sort that is not yet generally available to the Internet community. What will the future networking infrastructure mean to the practice of medicine, to personal health practices, and to health science education? Imagine the day when citizens will no longer have several medical records scattered in the offices of various physicians and in the medical record rooms of numerous hospitals. Instead, their records will be linked electronically over the Internet so that each person has a single virtual health record, the distributed but unified summary of all of the health care they have received in their lives. Furthermore, this record will be secure, treated with respect and confidentiality, and released to providers only with the patient's permission or under strictly defined and enforced criteria at times of medical emergency [7]. The work of de Groen and colleagues [5] presages what will someday be possible in clinical investigation. These authors have demonstrated that current Internet technology can already facilitate the secure sharing of patient information for purposes of data pooling and analysis, thereby supporting the integration of clinical practice with clinical research. With further standardization of patient-record formats and clinical terminology [8], linkages to the Internet will in turn support cross-institutional research coordination and multicenter trials. But the Internet's implications extend well beyond its impact on linkages among distributed medical records. For example, today's early telemedicine experiments, such as those summarized by Grigsby and Sanders [4], depend on specialized equipment and expensive communication lines. We can anticipate that as the Internet evolves and supports higher-speed communications, it will become the standard vehicle for linking medical experts with other clinicians and patients at a distance. Clear, full-motion video images will be transferred; high-fidelity audio links will allow physicians to listen to patients' hearts and lungs; and common computing platforms at both ends of the link will help to make this kind of medical practice cost-effective. Patients will avoid unnecessary travel from rural settings to major medical centers, primary care clinicians will have personalized expert consultation delivered to them in their offices, and patients will accomplish in single office visits what now takes several visits and imposes major inconvenience. Before long, a medical student who is on an orthopedics rotation and is preparing to observe her first arthroscopic knee surgery will use the Internet to access and manipulate a three-dimensional virtual reality model of the knee on a computer at another location, such as the National Institutes of Health. She will use new, immersive technologies to enter the model knee, to look from side to side and learn the anatomic structures and their spatial relationships, and to manipulate the model with a simulated arthroscope. This will give her a surgeon's-eye view of the procedure before she experiences the real thing. Physicians will soon be able to prescribe specially selected educational video programs that will be delivered to home television sets by a direct Internet connection. Our hospitals and clinics will use video servers over the Internet not only to deliver such materials to patients but also to provide continuing medical and nursing education to staff. Health science schools will similarly provide distance-learning experiences through the Internet for postgraduate education, refresher courses, and home study by health science students. Furthermore, the video link into the home will be two-way, allowing physicians to move beyond the simple use of telephones and to use visual senses to manage patient problems at a distance. Patients will have home visits through video links, avoiding unnecessary office or emergency department visits, and physicians will have important new tools for monitoring patients and for emphasizing prevention rather than crisis management. Early experiments show that patients are remarkably enthusiastic when familiar physicians and nurses provide videoconferencing or Internet-based interactions for disease management in the home. The examples I have cited here have one thing in common: They could not be effectively and reliably implemented on today's Internet. Each requires transmission speeds that are currently unavailable, but the problems are more significant than speed alone and point to the research agenda that motivates the NGI projects. We clearly need faster speeds, but many applications will fail to be effective or accepted if the quality of that information-carrying capacity (bandwidth) is also inadequate. How do certain kinds of applications obtain guaranteed transmission speeds, even if they are only needed for a short period? How can we best deal with the problems of latency, the inherent delays caused by the time required for transmission of signals? A surgeon who is attempting telepresence surgery over the Internet and is bringing specialized expertise to an operating room hundreds of miles away will be unable to assist directly in the procedure if the movements he makes with hand devices are not instantly reflected in what is happening, and what he sees happening, with the actual instruments at the other end of the link. How do we ensure that the necessary bandwidth for the applications I have proposed is available not only on the major backbone networks but also on the last segment of wire, cable, or wireless network that comes into our homes and offices? The research agenda for the NGI is being defined and, as was the case in the early days of the ARPAnet, it will need an effective partnership between government and academia that is informed by and coordinates with the changes occurring in industry. We would not have an Internet today if the government had not created the ARPAnet 30 years ago [9]; industry would not have made the long-term investments necessary to create the technology and to gradually demonstrate its use and practicality. It was 1995 before the national backbone network was finally fully handed off to the commercial sector. Leaders in the telecommmunications industry acknowledge that the inno

A proposed framework for economic evaluation of telemedicine

Abstract: Economic evaluation of telemedicine compares the costs and other consequences of delivering specific services through telemedicine vs. alternative means. Cost-effectiveness analysis, the most common method used for health issues, helps to assess whether the expected health benefits are worth the investment. Telemedicine raises particular challenges for evaluators: a telemedicine system may have multiple uses and joint costs that are difficult to apportion to one service, the existence of a system may lead to expanded indications for use, and technological change may rapidly make an evaluation outdated. Public and private regulation and payment may affect the diffusion of telemedicine. Uncertainty surrounds the policy.of the U.S. Food and Drug Administration, which is still formulating its position. Changes are underway in policies on licensure and credentialing of clinicians, which have traditionally been done by state and by site, to reflect the fact that telemedicine services may cross these regional bo...

Financial analysis of savings from telemedicine in Ohio's prison system.

Abstract: The Ohio Department of Rehabilitation and Corrections (ODRC) implemented a telemedicine pilot project in March of 1995. The project brought together the Southern Ohio Correctional facility in Lucasville, the Corrections Medical Center in Columbus, and The Ohio State University Medical Center, also located in Columbus. Its purpose was to evaluate the use of two-way interactive video for the delivery of health -services. With two-way interactive video, physicians in one location established audio and video links with inmates hundreds of miles away. Data were collected on the potential savings as a result of telemedicine usage in the Ohio prison system. Costs associated with telemedicine and those incurred without telemedicine were determined on per-consult basis for comparison. The cost for a medical consult to be performed at the Corrections Medical Center averaged $263.51 per inmate. The cost for a medical consult via telemedicine varied from month to month, depending on the utilization volume. The ODRC e...

Enabling student nurses to use the information superhighway.

Abstract: Nursing graduates must be sophisticated in the use of information technologies and understand how these technologies interface with various health care systems. The purpose of this project was to evaluate the impact of a newly developed Internet course, focusing on current information technologies, on 20 RN-to-MSN students. Author-developed instruments were used to measure weekly computer use, perceived computer skill, and knowledge related to the information superhighway. The Stronge & Brodt Nurses Attitudes Toward Computerization Questionnaire was used to assess attitudes toward computerization. Qualitative data was elicited using weekly evaluation forms. When compared to 23 students at a similar stage of their nursing program, quantitative findings indicated that, at the end of the semester, students in the pilot course had more computer knowledge, reported greater computer skill, and used computers more. Qualitative findings suggested that pilot students: * Were connected with nursing networks and expressed their intent to maintain these networks. * Were able to use current health information found on the Internet in their nursing practices. * Used skills learned in the pilot class to complete projects in other classes. * Communicated with classmates via the Internet, thus forming a potentially valuable professional support system. * Used the library and librarians early in their programs. * Understood the relevancy of telemedicine and the Internet to the future survival of nursing in a changing health care arena. While the authors caution that an adequate infrastructure must be available to support such an endeavor, they emphasize that knowledge of the relevancy and use of the information superhighway is crucial to the future survival of nursing in a rapidly changing health care arena.