Showing papers on "Telemedicine published in 1999"

Examining the technology acceptance model using physician acceptance of telemedicine technology

Abstract: The rapid growth of investment in information technology (IT) by organizations worldwide has made user acceptance an increasingly critical technology implementation and management issue While such acceptance has received fairly extensive attention from previous research, additional efforts are needed to examine or validate existing research results, particularly those involving different technologies, user populations, and/or organizational contexts In response, this paper reports a research work that examined the applicability of the Technology Acceptance Model (TAM) in explaining physicians' decisions to accept telemedicine technology in the health-care context The technology, the user group, and the organizational context are all new to IT acceptance/adoption research The study also addressed a pragmatic technology management need resulting from millions of dollars invested by health-care organizations in developing and implementing telemedicine programs in recent years The model's overall fit, explanatory power, and the individual causal links that it postulates were evaluated by examining the acceptance of telemedicine technology among physicians practicing at public tertiary hospitals in Hong Kong Our results suggested that TAM was able to provide a reasonable depiction of physicians' intention to use telemedicine technology Perceived usefulness was found to be a significant determinant of attitude and intention but perceived ease of use was not The relatively low R-square of the model suggests both the limitations of the parsimonious model and the need for incorporating additional factors or integrating with other IT acceptance models in order to improve its specificity and explanatory utility in a health-care context Based on the study findings, implications for user technology acceptance research and telemedicine management are discussed

“Telestroke” The Application of Telemedicine for Stroke

Abstract: Background —Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are “on call” around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. Summary of Comment —Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics ( Conclusions —Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.

Introduction to Telemedicine

Abstract: Telecommunications and telemedicine systems pre-recorded telemedicine systems teal-time telemedicine how to perform a telemedicine consultation other applications benefits and drawbacks of telemedicine deciding the need for a telemedicine service successfully building a telemedicine service evaluating telemedicine systems and services medicolegal issues the future of telemedicine?

Diffusion of telemedicine: a knowledge barrier perspective

Abstract: Telemedicine, broadly defined as the use of information technology (IT) to deliver medical services over distances, 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, we extend Attewell's theory of knowledge barriers to explain why diffusion of telemedicine remains low. A longitudinal, embedded multiple case study of telemedicine programs in three medical centers in Boston, Massachusetts, reveals 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 champions of applications within adopter organizations. They need to develop technically feasible, medically valid, reimbursable, and institutionally supported a...

Technical and Clinical Progress in Telemedicine

Abstract: TELEMEDICINE IS DEFINED AS THE DElivery of health care and sharing of medicalknowledgeover adistance using telecommunications systems. Although the telephone is certainly the oldest such system, the term telemedicine is usuallyappliedtotelecommunicationssystems of more recent origin: interactive televideo, “store-and-forward” imageand medical record transmission via personal computers, and remote monitoring. Two technological developments in the early 1990shave ledtoasurge in interest in telemedicine. One is the increasing deploymentofhigh-speed,high-bandwidth telecommunications systems around the world. The second development is the invention of devices capable of capturing and transmitting images and other data in digital form. While the costs for the hardware, software, and signal transmission are high, they are declining significantly each year. Interactive video equipment that cost more than $100 000 in 1992can todaybepurchased for less than $20 000—and today’s equipment has more capabilities. Most telemedicine programs in the United States support either interactive video–mediated clinical consultations or store-and-forward teleradiology. Storeand-forward teleconsultations involve exchange of static images (as opposed to video images in motion) that are stored in the telecommunications equipment and forwarded as image files. This takes less bandwidth than motion video. Relatively few programs support both interactive and store-and-forward technologies. Teleradiology is the most common application: in 1997 about 250 000 diagnostic teleradiology studies were done in the United States. During the same period 46 231 interactive video and store-and-forward teleconsultations were done (FIGURE). The most active specialties were psychiatry (17.9%), cardiology (16.7%), ophthalmology (9.6%), and orthopedics (5.7%). Research throughout the world, published in 2 peer-reviewed journals (Journal of Telemedicine and Telecare and Telemedicine Journal), is addressing important concerns: Do telemedicine consultations provide effective, satisfactory health care? Should these services be reimbursed? Are the services worth the stillsignificant cost for equipment and telephone line charges? Starting in January 1999, the Health Care Financing Administration (HCFA) is reimbursing physicians for some telemedicine services to Medicare patients. Many telemedicine advocates are disappointed about HCFA’s restrictions on what will qualify as a reimbursable consultation. Such teleconsultations must be to a patient in an underserved rural area, require the presence of the referring practitioner, exclude storeand-forward technology except for teleradiology, and obligate the consultant to remit 25% of the payment to the presenting practitioner. The first 3 conditions limit the scope of consultations. The last condition raises concerns about antikickback rules. However, Medicare’s reimbursement seems to acknowledge the growing use of telemedicine. Some private health insurance companies, managed care organizations, and state Medicaid programs are reimbursing for telemedicine services and some states (eg, Louisiana and California) have passed laws requiring reimbursement.

Assessing technological barriers to telemedicine: technology-management implications

Abstract: Telemedicine, the use of information technology to deliver health care from one location to another, has the potential to increase the quality and access to health care and to lower costs. This growth of telemedicine installations is occurring even as the utilization rates for installed telemedicine projects are falling well below expectations. Drawing on data collected from three operational telemedicine projects involving different clinical telemedicine applications, we examine how the technological barriers to telemedicine are impacting telemedicine utilization rates. Addressing technological barriers is a necessary but not sufficient condition if telemedicine is to fulfil its promise, and it is predominantly only after such barriers are addressed that the other barriers-professional, legal, and financial-come to the fore. Our findings support end-user and technical training as major barriers but do not support the quality of the video, system reliability, or the perceived inconvenience for physicians to use the equipment as barriers to telemedicine. The mismatch between the sophistication of the technology and end-user requirements for clinical activities and patient confidentiality and privacy issues were supported as barriers, but how they impacted telemedicine utilization was different than expected. Finally, unsatisfactory sound quality of the telemedicine equipment was identified as a frequent and unexpected barrier to telemedicine utilization rates.

Telemedicine and telepharmacy: current status and future implications.

Abstract: 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 for cognitive services remains a problem for telemedicine and telepharmacy. Telemedicine presents profound opportunities and challenges to pharmacy and other health care professions.

Telemedicine by mobile communication

Abstract: We have proposed some techniques for mobile telemedicine and have verified their practical feasibility in experiments. This article presents technical considerations required to realize a practical mobile telemedicine system, techniques developed for multiple medical data transmission, and the satisfactory results of their applications to telemedicine in moving vehicles.

Applying telecommunication technology to health-care delivery

Abstract: The term telemedicine refers to the utilization of telecommunication technology for medical diagnosis, treatment, and patient care. Telemedicine enables a physician or specialist at one site to deliver health care, diagnose patients, give intra-operative assistance, provide therapy, or consult with another physician or paramedical personnel at a remote site. Thus, the aim of telemedicine is to provide expert-based health care to understaffed remote sites and to provide advanced emergency care through modern telecommunication and information technologies. This article briefly describes the current status of telemedicine, including its implementation, acceptance, patient satisfaction, service and applications, system configuration and requirements, and research issues to be resolved.

Telemedicine in the emergency department: a randomized controlled trial

Abstract: Emergency physicians and nurses were trained in telemedicine techniques in two emergency departments, one rural (low volume) and one suburban (high volume). Fifteen patient complaints were selected as appropriate for the study. Of 122 patients who met the inclusion criteria, 104 (85%) consented to participate. They were randomized to control and experimental groups. The suburban emergency physician diagnosed and treated the control patients. Experimental patients presenting to the high-volume emergency department were evaluated and treated by the telemedicine nurse in person and the rural emergency physician via the telemedicine link. Immediately before discharge all telemedicine patients were re-evaluated by the suburban emergency physician. Data collected on each patient included: diagnosis; treatment; 72 h return visits; need for additional care; and satisfaction of patient, physicians and nurses. There were no significant differences (P > 0.05) for occurrence of 72 h return visits, need for additional care or overall patient satisfaction. The average patient throughput time (from admission to discharge) was 106 min for the telemedicine group and 117 min for the control group. Telemedicine was a satisfactory technique for the chosen group of patients in the emergency department and was acceptable to the participants.

Tele-Education in a Telemedicine Environment: Implications for Rural Health Care and Academic Medical Centers

Abstract: Over 50 million people in the United States (about 20% of the population) live in rural areas, but only 9% of the nation's physicians practice in rural communities. It is difficult to recruit and retain rural health care practitioners, partly because of issues relating to professional isolation. New and enhanced telecommunications links between community and academic hospitals show promise for reducing this isolation and enhancing lifelong learning opportunities for rural health care providers. This paper will explore some of the issues involved in using interactive video (telemedicine) networks to transmit continuing medical education programming from an academic center to multiple rural hospitals. Data from a recent University of Iowa survey of the state's health educators will be presented as one approach to assessing the health care marketplace for the deployment of tele-education services.

Physician acceptance of telemedicine technology: an empirical investigation.

Abstract: Fast-growing interest in telemedicine and increased investment in its enabling technology have made physician technology acceptance a growing concern for development and management of telemedicine. At the dawn of large-scale technology implementation by health care organizations around the globe, it is essential to understand physicians' attitudes toward use of telemedicine technology and their intention to use the technology. In this study, we used Theory of Planned Behavior to investigate technology acceptance among physicians who practiced in public tertiary hospitals in Hong Kong. Our data supported the investigated theory and the results suggest that attitude and perceived behavioral control are crucial to physician technology acceptance. Overall, physicians showed positive attitudes toward use of telemedicine technology and exhibited moderate intention to use the technology, primarily for clinical purposes. Implications for development and management of telemedicine also are discussed.

The evolution of a teledentistry system within the Department of Defense.

Abstract: Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented.

Designing smart health care technology into the home of the future

Abstract: This editorial paper presents a vision for intelligent health care in the home of the future, focusing on technologies with the highest potential payoff given targeted government funding over the next ten years. A secure, plug-and-play information framework provides the starting point for identifying technologies that must be developed before smart home-based devices can know their context and assimilate information to make care decisions.

Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.

Abstract: Background: 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. Study Design: 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. Results: 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. Conclusions: 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 limiting travel, expanding services to patients, and increased patient quality assurance.

Overview of telemedicine applications for otolaryngology.

Abstract: Objective/Hypothesis: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on-line. Study Design: Prospective. Methods: The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in-house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral. Results: Videootoscopy captures the image of an eardrum that can be sent from a remote site in a store-forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in-house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology. Conclusion : These efforts performed in a stepwise approach will lead to an otolaryngology-head and neck surgery service that is on-line for the next millennium, with telemedicine advances normalized to the standard of care.

The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture

Abstract: The ratio of physicians to population in Canada peaked in the mid-1990s and is now falling. The decrease in the number of family physicians has had a disproportionate effect on rural and remote communities, and surveys have indicated that the availability of physicians and services is likely to deteriorate in rural and remote communities. Telemedicine is increasingly evident in every Canadian province and territory, and it could assist in more effective use of workforce resources by linking appropriate experts at central sites to patients and practitioners at remote sites. Positive effects on recruitment and retention of health providers and morale of the local workforce can be expected. In spite of national interest, evidence for the effect of telemedicine on staff distribution, roles and recruitment, use of health resources, health management and system integration is very limited. Telephone interviews were therefore conducted to collect information from 12 telehealth projects in Canada, one from each province or territory. The responses confirmed observations in the literature that telemedicine has positive outcomes for the workforce.

Distance technologies for patient monitoring

Abstract: Medical technology once used exclusively in hospitals and general practices is now available for use in the home. A growing selection of innovative electronic monitoring devices is available, but meaningful communication and decision supports are also needed for both patients and clinicians. Several randomised clinical trials of home distance monitoring of glucose concentrations by computer found improved outcomes in diabetes care. Likewise, trials of home distance monitoring of blood pressure show enhanced efficiency. Failure to improve outcomes of high risk pregnancies through home distance monitoring illustrates the difficulties in certain clinical applications. Overall, electronic monitoring at home promises cost effective health services, more active involvement of patients in their own care, and a new sense of realism in making a diagnosis. #### Summary points Emerging home monitoring technologies can transform episode driven health services into a relationship based continuum of care A growing array of home monitoring devices is commercially available and becoming increasingly affordable. Distance monitoring has been shown to improve the clinical outcome of diabetes care. Home monitoring of pregnant women illustrates the challenge of improving health and also the need for economic consideration when outcomes are equal. Nocturnal haemodialysis, home sleep analysis, and measurement of self care behavioursare among the innovative applications of electronic monitoring. The anticipated information surge from patients' homes calls for computerised data processing and active decision support. Further randomised clinical trials of distance technologies could produce the scientific evidence regarding safety and efficacy in various areas of care. With access to home monitoring devices, computers, and communication networks, patients can become more active in their own health care This review lists available technologies for home distance monitoring, assesses its clinical value, and identifies criteria for its appropriate use. Some of the articles included in this review were already in place as part of the Columbia registry—a …

An assessment framework for telemedicine applications.

Abstract: Pressures for the adoption of telemedicine place increased demands on purchasers to assess applications of the technique. Assessment principles are helpful in defining an evaluation framework for u...

Evaluation of telemedical services

Abstract: With the rapidly increasing development of telemedicine technology, the evaluation of telemedical services is becoming more and more important. However, professional views of the aims and methods of evaluation are different from the perspective of computer science and engineering compared to that of medicine and health policy. We propose that a continuous evaluation strategy should be chosen which guides the development and implementation of telemedicine technologies and applications. The evaluation strategy is divided into four phases, in which the focus of evaluation is shifted from technical performance of the system in the early phases to medical outcome criteria and economical aspects in the later phases. We review the study design methodology established for clinical trials assessing therapeutic effectiveness and diagnostic accuracy, and discuss how it can be adapted to evaluation studies in telemedicine. As an example, we describe our approach to evaluation in a teleconsultation network in ophthalmology.

Telemedicine and integrated health care delivery: compounding malpractice liability.

Abstract: INTRODUCTION Telemedicine became a significant part of the health care equation long before we realized what it was or how important it will be in the future. Telephone discussions and consultations between health care providers have been a part of medical practice since Alexander Graham Bell gifted society with telephones.1 Furthermore, who among us has not been transfixed watching and learning about open heart surgery on cable television?2 Propelled by the information superhighway and the breadth of emerging computer and communication technologies, telemedicine will change the face of medicine and methods of interaction between providers and patients.3 Access, quality and cost of health care may all improve, but not without the sacrifice of some time-honored norms in medical practice.4 The changes telemedicine will bring to medical practice exacerbate the changes deriving from the proliferation of managed care integrated delivery systems (IDSs) and the contraction of the health care industry.5 The solo practitioner revered by Norman Rockwell is rapidly becoming extinct, superseded by groups of providers employed by or engaged in contractual partnerships with one or more integrated managed care plans.6 The community hospital of the mid-twentieth century has merged, remerged and now emerged as part of an organized network of hospital services, often affiliated with one or more health plans.7 The traditional Blue Cross and Blue Shield plans spun off for-profit managed care plans that, along with provider partners, are vibrant and successful, while the gutted parent companies languish, relics of the past.8 This Article considers how theories of medical negligence might be applied in the context of telemedicine and integrated delivery health plans. Part Two summarizes the history of telemedicine, its increasing breadth of application and opportunity and promise for the future. Part Three reviews traditional negligence principles and precedents and demonstrates how they might be applied when a telemedicine interaction results in negligence and harm to the patient. Part Four discusses evolving theories of shared liability applicable to health plans and managed care entities. Finally, Part Five demonstrates how shared liability theories will be applied to situations involving telemedicine technologies. II. TELEMEDICINE: HISTORY, PRESENT APPLICATIONS AND FUTURE PROMISE Telemedicine's "simple, but serviceable" definition is the use of telecommunication to diagnose and treat a patient.9 Telemedicine encompasses a panoply of technologies and communication modalities that allow health care providers to connect with, examine, counsel and advise patients about treatment options.10 These include teleradiology and other teleimaging diagnostics,11 telesurgery and robotics,12 video and Internet/e-mail conferencing,l3 transmission of electrocardiographic and other physiological data by telephone, telecommunications, or Internet lines14 and "telehealth" education via the Internet and cable television.15 Although many of these examples rely on relatively recent communications technologies, telemedicine escaped the bounds of the simple telephone call at least thirty years ago and has already acquired an impressive history. A. FOUND IN SPACE: THE HISTORY OF MODERN TELEMEDICINE Although isolated telemedicine experiments date back to the early 1960s,16 telemedicine began with the space program. One of the National Aeronautics and Space Administration's (NASA) pivotal concerns was the medical monitoring of astronauts.17 This concern began with the earliest Mercury and Gemini flights, developed through the Apollo Moon Program and continues today with space shuttle and MIR missions.18 NASA's scientists created telemetric technologies that allowed the long-distance measurement and transmission of physiological data through space. 19 While refining the use of telemetry in space, NASA facilitated the terrestrial use of this and other telemedicine technologies domestically and internationally. …

A child and adolescent psychiatric outreach service for rural New South Wales: a telemedicine pilot study.

Abstract: Objective: To examine the feasibility of a tertiary outreach service in child and adolescent psychiatry to two rural health centres in New South Wales, Australia. Methods: Following a site visit to Dubbo Hospital and Bourke Hospital, telemedical videoconferencing was provided for 2 h/week for 32 weeks. Details of referrers, patients’ diagnosis and outcome, and satisfaction with the service were obtained. Results: Cases were triaged by a nominated rural adolescent mental health worker. The service provided detailed assessment and management of severe, complex, mental and neuropsychiatric disorders. Fifty-four young people were assessed and 72 joint consultative videoconferencing interviews were undertaken, including 26 initial consultations. Twenty-three initial consultations were undertaken on the visit to the rural centres. Clinical descriptions illustrate the flexibility and sensitivity of the service. Conclusion: Telepsychiatry provides access to a flexible, effective tertiary service for those with special, complex needs, including the disadvantaged or isolated. It makes a valuable, economic contribution to supporting and educating rural health professionals, thereby enriching rural mental health services.

Pilot study of store and forward teledermatology services in Perth, Western Australia.

Abstract: In remote areas, telemedicine services can improve the quality of access to specialist medical care and dermatology is well suited to the use of this technology. There is no published work on teledermatology services in Australia. Our purpose was to investigate the reliability of dermatological diagnoses obtained using a store and forward telemedicine system, which is being developed to offer specialist consultative services to patients in remote areas of Western Australia. We report on a small prospective non-randomized pilot study conducted at Royal Perth Hospital, Western Australia which compared diagnoses reached following telemedicine consultations with diagnoses reached following traditional face-to-face consultations. In 25 out of 50 consultations, identical diagnoses were reached. In the remaining five cases, the preferred diagnosis and first differential diagnosis were reversed in order of preference. We feel this system is sufficiently promising to trial more extensively in the field.

The relative cost of outpatient telemedicine services.

Abstract: Objective. This study compares the costs of offering outpatient care to primarily orthopedic and dermatology patients via live, interactive telemedicine to the estimated costs of direct face-to-fac...