Showing papers on "Telemedicine published in 2010"

A systematic review of economic analyses of telehealth services using real time video communication

Abstract: Background: Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods: A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, noncomparative studies and those where patient satisfaction was the only health outcome were excluded. Results: 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion: Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.

The reported benefits of telehealth for rural Australians

Abstract: Objective.A literature review was conducted to identify the reported benefits attributed to telehealth for people living and professionals working in rural and remote areas of Australia. Data sources.Scopus and relevant journals and websites were searched using the terms: telemedicine, telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory. Publications since 1998 were included. Study selection.The initial search resulted in 176 articles, which was reduced to 143 when research reporting on Australian rural, regional or remote populations was selected. Data synthesis.A narrative review was conducted using an existing ‘benefits’ framework. Patients are reported to have benefited from: lower costs and reduced inconvenience while accessing specialist health services; improved access to services and improved quality of clinical services. Health professionals are reported to have benefited from: access to continuing education and professional development; provision of enhanced local services; experiential learning, networking and collaboration. Discussion.Rural Australians have reportedly benefited from telehealth. The reported improved access and quality of clinical care available to rural Australians through telemedicine and telehealth may contribute to decreasing the urban–rural health disparities. The reported professional development opportunities and support from specialists through the use of telehealth may contribute to improved rural medical workforce recruitment and retention. What is known about the topic?An extensive international literature has reported on the efficacy of telehealth, and to a lesser extent the clinical outcomes and cost-effectiveness of telemedicine. Systematic reviews conclude that the quality of the studies preclude definitive conclusions being drawn about clinical and cost-effectiveness, although there is some evidence of effective clinical outcomes and the potential for cost-benefits. Little attention has been paid to the benefits reported for people who live in rural and remote Australia, despite this being a rationale for the use of telehealth in rural and remote locations. What does this paper add?Patients in rural and remote locations in Australia are reported to benefit from telehealth by increased access to health services and up-skilled health professionals. Health professionals are reported to benefit from telehealth by up-skilling from increased contact with specialists and increased access to professional development. The review findings suggest that one strategy, the increased use of telehealth, has the potential to reduce the inequitable access to health services and the poorer health status that many rural Australians experience, and contribute to addressing the on-going problem of the recruitment and retention of the rural health workforce. What are the implications for practitioners?The use of telehealth appears to be a path to up-skilling for rural and remote practitioners.

Diabetic retinopathy screening: a systematic review of the economic evidence

Abstract: This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were 'diabetic retinopathy', 'screening', 'economic' and 'cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost-utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients.

Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review

Abstract: Aim: A systematic literature review, covering publications from 1994 to 2009, was carried out to determine the effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to usual care. Two types of teleconsultation were distinguished: (1) asynchronous teleconsultation for monitoring and delivering feedback via email and cell phone, automated messaging systems, or other equipment without face-to-face contact; and (2) synchronous teleconsultation that involves real-time, face-to-face contact (image and voice) via videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to connect caregivers and one or more patients simultaneously, e.g., for the purpose of education. Methods: Electronic databases were searched for relevant publications about asynchronous and synchronous teleconsultation [Medline, Picarta, Psychinfo, ScienceDirect, Telemedicine Information Exchange, Institute for Scientific Information Web of Science, Google Scholar]. Reference lists of identified publications were hand searched. The contribution to diabetes care was examined for clinical outcomes [e.g., hemoglobin A1c (HbA1c), dietary values, blood pressure, quality of life], for behavioral outcomes (patient–caregiver interaction, self-care), and for care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of access to care). Randomized controlled trials with HbA1c as an outcome were pooled using standard meta-analytical methods. Results: Of 2060 publications identified, 90 met inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1 and 2 or gestational diabetes. Studies that evaluated teleconsultation not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (e.g., HbA1c or lipid profiles). In 63 of 90 interventions, the interaction had an asynchronous teleconsultation character, in 18 cases interaction was synchronously (videoconferencing), and 9 involved a combination of synchronous with asynchronous interaction. Most of the reported improvements concerned clinical values (n = 49), self-care (n = 46), and satisfaction with technology (n = 43). A minority of studies demonstrated improvements in patient–caregiver interactions (n = 28) and cost reductions (n = 27). Only a few studies reported enhanced quality of life (n = 12), transparency of health care (n = 7), and improved equity in care delivery (n = 4). Asynchronous and synchronous applications appeared to differ in the type of contribution they made to diabetes care compared to usual care: Asynchronous applications were more successful in improving clinical values and self-care, whereas synchronous applications led to relatively high usability of technology and cost reduction in terms of lower travel costs for both patients and care providers and reduced unscheduled visits compared to usual care. The combined applications (n = 9) scored best according to quality of life (22.2%). No differences between synchronous and asynchronous teleconsultation could be observed regarding the positive effect of technology on the quality of patient–provider interaction. Both types of applications resulted in intensified contact and increased frequency of transmission of clinical values with respect to usual care. Fifteen of the studies contained HbA1c data that permitted pooling. There was significant statistical heterogeneity among the pooled randomized controlled trials (χ2 = 96.46, P < 0.001). The pooled reduction in HbA1c was not statically significant (weighted mean difference −0.10; 95% confidence interval −0.39 to 0.18). Conclusion: The included studies suggest that both synchronous and asynchronous teleconsultations for diabetes care are feasible, cost-effective, and reliable. However, it should be noted that many of the included studies showed no significant differences between control (usual care) and intervention groups. This might be due to the diversity and lack of quality in study designs (e.g., inaccurate or incompletely reported sample size calculations). Future research needs quasi-experimental study designs and a holistic approach that focuses on multilevel determinants (clinical, behavioral, and care coordination) to promote self-care and proactive collaborations between health care professionals and patients to manage diabetes care. Also, a participatory design approach is needed in which target users are involved in the development of cost-effective and personalized interventions. Currently, too often technology is developed within the scope of the existing structures of the health care system. Including patients as part of the design team stimulates and enables designers to think differently, unconventionally, or from a new perspective, leading to applications that are better tailored to patients' needs.

A Blueprint for Telerehabilitation Guidelines

Abstract: Telerehabilitation refers to the delivery of rehabilitation services via information and communication technologies. Clinically, this term encompasses a range of rehabilitation and habilitation services that include assessment, monitoring, prevention, intervention, supervision, education, consultation, and counseling. Telerehabilitation has the capacity to provide service across the lifespan and across a continuum of care. Just as the services and providers of telerehabilitation are broad, so are the points of service, which may include health care settings, clinics, homes, schools, or community-based worksites. This document was developed collaboratively by members of the Telerehabilitation SIG of the American Telemedicine Association, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and safe services that are based on client needs, current empirical evidence, and available technologies. Telerehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a template for developing discipline-specific standards, guidelines, and practice requirements.

In Situ Monitoring of Health in Older Adults: Technologies and Issues

Abstract: With the upcoming reform of the healthcare system and the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy, and patient safety. Current understanding of the dynamic nature of chronic illnesses, their effects on health over time, and the ability to manage them in the community are limited to measuring a set of variables at discrete points in time, which does not account for the dynamic interactions between physiological systems and the environments of daily life. Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care. This article identifies and discusses the important issues regarding the use of monitoring technologies in elderly patients. The goals are fourfold. First, some emerging technology that may improve the lives of older adults and improve care are highlighted. Second, the possible applications of technology in geriatrics settings are discussed, with a focus on acute falls, dementia, and cardiac conditions. Third, real and perceived concerns in using monitoring technology are identified and addressed, including technology adoption by elderly people; stigma; and the reduction in social contact; ethical concerns of privacy, autonomy, and consent; concerns of clinicians, including information overload, licensure, and liability; current reimbursement schemes for using technology; and the reliability and infrastructure needed for monitoring technology. Fourth, future approaches to make monitoring technology useful and available in geriatrics are recommended.

A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology

Abstract: The authors present a pilot study of 12 veterans diagnosed with combat-related PTSD and treated with prolonged exposure therapy (PE) via telehealth technology. A reference sample of 35 combat veterans treated with in-person PE in the same clinic is also included for a comparison. Feasibility and clinical outcomes of interest include technical performance and practicality of the telehealth equipment, patient safety, treatment completion rates, number of sessions required for termination, and clinical outcomes. Results indicated large statistically significant decreases in self-reported pathology for veterans treated with PE via telehealth technology. Preliminary results support the feasibility and safety of the modality. Suggestions for the implementation of PE via telehealth technology are discussed.

Telehealth in audiology: The need and potential to reach underserved communities

Abstract: Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree. A shortage of trained healthcare professionals and associated infrastructure and resource limitations mean that hearing health services are unavailable to the majority of the world population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined with automation offer unique opportunities for improved clinical care, widespread access to services, and more cost-effective and sustainable hearing health care. Tele-audiology demonstrates significant potential in areas such as education and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and intervention services. Global connectivity is rapidly growing with increasingly widespread distribution into underserved communities where audiological services may be facilitated through telehealth models. Although many questions related to aspects such as quality control, licensure, jurisdictional responsibility, certification and reimbursement still need to be addressed; no alternative strategy can currently offer the same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.

A systematic review of telehealth applications in audiology.

Abstract: Hearing loss is a pervasive global healthcare concern with an estimated 10% of the global population affected to a mild or greater degree. In the absence of appropriate diagnosis and intervention it can become a lifelong disability with serious consequences on the quality of life and societal integration and participation of the affected persons. Unfortunately, there is a major dearth of hearing healthcare services globally, which highlights the possible role of telehealth in penetrating the underserved communities. This study systematically reviews peer-reviewed publications on audiology-related telehealth services and patient/clinician perceptions regarding their use. Several databases were sourced (Medline, SCOPUS, and CHINAL) using different search strategies for optimal coverage. Though the number of studies in this field are limited available reports span audiological services such as screening, diagnosis, and intervention. Several screening applications for populations consisting of infants, children, and adults have demonstrated the feasibility and reliability of telehealth using both synchronous and asynchronous models. The diagnostic procedures reported, including audiometry, video-otoscopy, oto-acoustic emissions, and auditory brainstem response, confirm clinically equivalent results for remote telehealth-enabled tests and conventional face-to-face versions. Intervention studies, including hearing aid verification, counseling, and Internet-based treatment for tinnitus, demonstrate reliability and effectiveness of telehealth applications compared to conventional methods. The limited information on patient perceptions reveal mixed findings and require more specific investigations, especially post facto surveys of patient experiences. Tele-audiology holds significant promise in extending services to the underserved communities but require considerable empirical research to inform future implementation.

Monitoring patients via a secure and mobile healthcare system

Abstract: Patient monitoring provides flexible and powerful patient surveillance through wearable devices at any time and anywhere The increasing feasibility and convenience of mobile healthcare has already introduced several significant challenges for healthcare providers, policy makers, hospitals, and patients A major challenge is to provide round-the-clock healthcare services to those patients who require it via wearable wireless medical devices Furthermore, many patients have privacy concerns when it comes to releasing their personal information over open wireless channels As a consequence, one of the most important and challenging issues that healthcare providers must deal with is how to secure the personal information of patients and to eliminate their privacy concerns In this article we present several techniques that can be used to monitor patients effectively and enhance the functionality of telemedicine systems, and discuss how current secure strategies can impede the attacks faced by wireless communications in healthcare systems and improve the security of mobile healthcare

Increasing access to specialty care: A pilot, randomized controlled trial of telemedicine for Parkinson's disease

Abstract: We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the study's conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinson's Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson's Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinson's disease living remotely is feasible.

History of Telemedicine: Evolution, Context, and Transformation

Abstract: cation technology, and have long-standing problem of improving human health in healthcare systems. The History of Telemedicine provides a comprehensive and in-depth historical view of telemedicine from ancient Greece to the present time. The authors started the task of writing the book with open mind and put aside whatever preconceived notion or information about telemedicine. Bashshur and Shannon really give historical insight to us on telemedicine. It would be a good guide and rationale for the telemedicine. Before authors began to trace and document the history of telemedicine, they reviewed the published literature. They clearly realized the storytelling of telemedicine, because telemedicine has a long and rich history and a story that has not been told, certainly not in its entirety. Two common characteristics were revealed after careful review of the history of telemedicine in the published literature. First, they tend to be very brief, often cursory or selective, sometimes limited to a couple of paragraphs, and are typically included as a prelude to another topic. Second, they are invariably simple accounts of early attempts to connect providers and patients through telecommunication devices available at that time. They wanted to be guided solely by the documented not by any preexisting ideas or notions, and therefore they were to minimize bias in reporting. The journey started with ancient societies and the early attempts to establish rudimentary communication connectivity between settlements when faced with internal or external threats and subsequently to establish clinical connectivity between patient and physician/caregiver/priest. Thus, throughout this book, authors emphasized the continuing underlying theme of connectivity between those in need of care and those who provide it. Authors traced the history of long-distance communication from its humble origins History of Telemedicine: Evolution, Context, and Transformation

The challenge to delivering oral health services in rural America.

Abstract: Objectives This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations. Methods This descriptive article is based on literature reviews and personal communications. Results Rural populations have lower dental care utilization, higher rates of dental caries, lower rates of insurance, higher rates of poverty, less water fluoridation, fewer dentists per population, and greater distances to travel to access care than urban populations. Improving the oral health of rural populations requires practical and flexible approaches to expand and better distribute the rural oral health workforce, including approaches tailored to remote areas. Solutions that involve mass prevention/public health interventions include increasing water fluoridation, providing timely oral health education, caries risk assessment and referral, preventive services, and offering behavioral interventions such as smoking and tobacco cessation programs. Solutions that train more providers prepared to work in rural areas include recruiting students from rural areas, training students in rural locations, and providing loan repayment and scholarships. Increasing the flexibility and capacity of the oral health workforce for rural areas could be achieved by creating new roles for and new types of providers. Solutions that overcome distance barriers include mobile clinics and telehealth technology. Conclusions Rural areas need flexibility and resources to develop innovative solutions that meet their specific needs. Prevention needs to be at the front line of rural oral health care, with systematic approaches that cross health professions and health sectors.

Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals.

Abstract: Objective:To determine the impact of a telemedicine system, the electronic intensive care unit (eICU), on ICU, and non-ICU mortality, total mortality, total and ICU-specific length of stay, and total hospital cost at two community hospitals.Design:Observational study with one baseline period and two

What About Telepsychiatry? A Systematic Review

Abstract: Mental illness has become a significant worldwide health issue in recent years. By 2020, it is projected that the burden of mental and neurologic disorders will have increased to 15%.1 The widespread and pervasive nature of mental illness, and many nations’ limited ability to recognize and treat such conditions, has led the World Health Organization to attempt to increase international awareness of the dangers and prevalence of mental illness. Thus, it is clear that most people with mental disorders remain either untreated or poorly treated.2 It is therefore critical to develop more effective mental health service delivery systems to enhance treatment access and quality.3 There is presently insufficient evidence to definitively determine the clinical effectiveness and cost-effectiveness of different health care models.4 Nevertheless, there is a trend toward collaborative care models, including those incorporating a case management approach and/or using the services of a care manager or primary mental health care worker, showing some modest benefit, at least in the short term.4 In addition, telephone care management interventions appear to be of some benefit to patients with mild-to-moderate mental health problems; however, telehealth care may be a more effective model of service delivery if combined with delivering specific interventions of proven effectiveness, such as cognitive-behavioral therapy.4 Videoconferencing plays an important role in most telemedicine initiatives.5 Medical and mental health services often are inadequate in remote geographical areas with few specialist providers. Telepsychiatry provides clinical, consultative, and educational services to populations in remote regions and other isolated groups.6 Telepsychiatry, in the form of videoconferencing, has been well received in terms of increasing access to care and user satisfaction.7 Questions persist, however, about its effectiveness, because there are few clinical outcome studies8 and limited patient populations for whom telepsychiatry is most suitable.9 The objective of this review is to evaluate the effectiveness of telepsychiatric services delivered via videoconferencing techniques.

A Smart ECG Measurement System Based on Web-Service-Oriented Architecture for Telemedicine Applications

Abstract: The opportunity for cardiac patients to have constantly monitored their health state at home is now possible by means of telemedicine applications. In fact, today, portable and simple-to-use devices allow one to get preliminary domestic diagnoses of the heart status. In this paper, the authors present an original ECG measurement system based on web-service-oriented architecture to monitor the heart health of cardiac patients. The projected device is a smart patient-adaptive system able to provide personalized diagnoses by using personal data and clinical history of the monitored patient. In the presence of a pathology occurrence, the system is able to call the emergency service for assistance. An ECG sensor has the task to acquire, condition, and sample the heart electrical impulses, whereas a personal digital assistant (PDA) performs the diagnosis according to the measurement uncertainty and, in case of a critical situation, calls the medical staff. The system has two removable and updatable memory devices: the first memory device stores the clinical and personal data of the patient, and the second memory device stores information on the metrological status of the measurement system. This way, according to the personal data and historical information of the patient, the measurement system adapts itself by selecting the best fitted ECG model as a reference to configure the computing algorithm. Further information on the measurement uncertainty is used to qualify the reliability of the final clinical response to reduce the occurrence of a faulty diagnosis. Through the PDA graphic interface, the user can display his personal data, observe the graph of his ECG signal, and read diagnosis information with the relative reliability level. Moreover, the patient can choose to print his ECG graph through a Bluetooth printer or to send it to a specialist by a General Packet Radio Service (GPRS) modem.

Health technology assessment review: Remote monitoring of vital signs - current status and future challenges

Abstract: Recent developments in communications technologies and associated computing and digital electronics now permit patient data, including routine vital signs, to be surveyed at a distance. Remote monitoring, or telemonitoring, can be regarded as a subdivision of telemedicine - the use of electronic and telecommunications technologies to provide and support health care when distance separates the participants. Depending on environment and purpose, the patient and the carer/system surveying, analysing or interpreting the data could be separated by as little as a few feet or be on different continents. Most telemonitoring systems will incorporate five components: data acquisition using an appropriate sensor; transmission of data from patient to clinician; integration of data with other data describing the state of the patient; synthesis of an appropriate action, or response or escalation in the care of the patient, and associated decision support; and storage of data. Telemonitoring is currently being used in community-based healthcare, at the scene of medical emergencies, by ambulance services and in hospitals. Current challenges in telemonitoring include: the lack of a full range of appropriate sensors, the bulk weight and size of the whole system or its components, battery life, available bandwidth, network coverage, and the costs of data transmission via public networks. Telemonitoring also has the ability to produce a mass of data - but this requires interpretation to be of clinical use and much necessary research work remains to be done.

Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

Abstract: The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?

Telehealth in palliative care in the UK: a review of the evidence.

Abstract: We reviewed telehealth applications which were being used in palliative care settings in the UK. Electronic database searches (Medline, CINAHL, PsychInfo and Embase), searches of the grey literature and cited author searches were conducted. In total, 111 papers were identified and 21 documents were included in the review. Telehealth was being used by a range of health professionals in oncology care settings that included specialist palliative care, hospices, primary care settings, nursing homes and hospitals as well as patients and carers. The most common applications were: out-of-hours telephone support, advice services for palliative care patients, carers and health professionals, videoconferencing for interactive case discussions, consultations and assessments, and training and education of palliative care and other health-care staff. The review suggests that current technology is usable and acceptable to patients and health professionals in palliative care settings. However, there are several challenges in integrating telehealth into routine practice.

Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona. The Initial Mayo Clinic Experience Trial

Abstract: Background and Purpose— Telemedicine techniques can be used to address the rural–metropolitan disparity in acute stroke care. The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trial reported more accurate decision making for telemedicine consultations compared with telephone-only and that the California-based research network facilitated a high rate of thrombolysis use, improved data collection, low risk of complications, low technical complications, and favorable assessment times. The main objective of the STRokE DOC Arizona TIME (The Initial Mayo Clinic Experience) trial was to determine the feasibility of establishing, de novo, a single-hub, multirural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol. Methods— Methods included prospective, single-hub, 2-spoke, randomized, blinded, controlled trial of a 2-way, site-independent, audiovisual telemedicine system designed for remote examination of ad...

A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy:

Abstract: We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months. The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.

Remote health monitoring using mobile phones and Web services.

Abstract: Diabetes and hypertension have become very common perhaps because of increasingly busy lifestyles, unhealthy eating habits, and a highly competitive workplace. The rapid advancement of mobile communication technologies offers innumerable opportunities for the development of software and hardware applications for remote monitoring of such chronic diseases. This study describes a remote health-monitoring service that provides an end-to-end solution, that is, (1) it collects blood pressure readings from the patient through a mobile phone; (2) it provides these data to doctors through a Web interface; and (3) it enables doctors to manage the chronic condition by providing feedback to the patients remotely. This article also aims at understanding the requirements and expectations of doctors and hospitals from such a remote health-monitoring service.

Online Communication Between Doctors and Patients in Europe: Status and Perspectives

Abstract: Background: Use of the Internet for health purposes is steadily increasing in Europe, while the eHealth market is still a niche. Online communication between doctor and patient is one aspect of eHealth with potentially great impact on the use of health systems, patient-doctor roles and relations and individuals’ health. Monitoring and understanding practices, trends, and expectations in this area is important, as it may bring invaluable knowledge to all stakeholders, in the Health 2.0 era. Objective: Our two main goals were: (1) to investigate use of the Internet and changes in expectations about future use for particular aspects of communication with a known doctor (obtaining a prescription, scheduling an appointment, or asking a particular health question), and (2) to investigate how important the provision of email and Web services to communicate with the physician is when choosing a new doctor for a first time face-to-face appointment. The data come from the second survey of the eHealth Trends study, which addressed trends and perspectives of health-related Internet use in Europe. This study builds on previous work that established levels of generic use of the Internet for self-help activities, ordering medicine or other health products, interacting with a Web doctor/unknown health professional, and communicating with a family doctor or other known health professional. Methods: A representative sample of citizens from seven European countries was surveyed (n = 7022) in April and May of 2007 through computer-assisted telephone interviews (CATI). Respondents were questioned about their use of the Internet to obtain a prescription, schedule an appointment, or ask a health professional about a particular health question. They were also asked what their expectations were regarding future use of the Internet for health-related matters. In a more pragmatic approach to the subject, they were asked about the perceived importance when choosing a new doctor of the possibility of using email and the Web to communicate with that physician. Logistic regression analysis was used to draw the profiles of users of related eHealth services in Europe among the population in general and in the subgroup of those who use the Internet for health-related matters. Changes from 2005 to 2007 were computed using data from the first eHealth Trends survey (October and November 2005, n = 7934). Results: In 2007, an estimated 1.8% (95% confidence interval [CI], 1.5 - 2.1) of the population in these countries had used the Internet to request or renew a prescription; 3.2% (95% CI 2.8 - 3.6) had used the Internet to schedule an appointment; and 2.5% (95% CI 2.2 - 2.9) had used the Internet to ask a particular health question. This represents estimated increases of 0.9% (95% CI 0.5 - 1.3), 1.7% (95% CI 1.2 - 2.2), and 1.4% (95% CI 0.9 - 1.8). An estimated 18.0% (95% CI 17.1 - 18.9) of the populations of these countries expected that in the near future they would have consultations with health professionals online, and 25.4% (95% CI 24.4 - 26.3) expected that in the near future they would be able to schedule an appointment online. Among those using the Internet for health-related purposes, on average more than 4 in 10 people considered the provision of these eHealth services to be important when choosing a new doctor. Conclusions: Use of the Internet to communicate with a known health professional is still rare in Europe. Legal context, health policy issues, and technical conditions prevailing in different countries might be playing a major role in the situation. Interest in associated eHealth services is high among citizens and likely to increase. [J Med Internet Res 2010;12(2):e20]

Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach.

Abstract: Variation in the quality of critical care services across hospitals coupled with an emerging workforce crisis necessitates system-level change in the organization of intensive care. In this review, we evaluate three alternative organizational models that may expand access to high-quality critical care: tiered regionalization, intensive care unit telemedicine, and quality improvement through regional outreach. These models share a potential to increase survival and reduce costs. Yet there are also major barriers to implementation, including the lack of a strong evidence base and the need for significant upfront financial investment. Reorganization of intensive care will also require the support of all involved stakeholders: patients and their families, critical care practitioners, administrative and public health professionals, and policy makers. To varying degrees these models require a central authority to implement and regulate the system, as well as specific legislation, investment in information technology, and financial incentives for providers. The existing evidence does not strongly support exclusive use of a particular model, and creation of a hybrid model that integrates the three complementary approaches is a practical option. A potential framework for implementation involves triage guidelines developed by professional societies leading to demonstration projects and national legislation in support of optimal systems. Additional research is needed to determine the comparative effectiveness and cost implications of these approaches, with a goal of best matching high-quality critical care to patients' needs and professional preferences at the hospital, regional, and national level.

Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring

Abstract: Background: Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology. Objective: The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring. Methods: A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology. Results: The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (P< .001). Patients were also confident in using mobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications. Conclusions: Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal issues, and difficulty of use for some patients due to lack of visual acuity or manual dexterity. [J Med Internet Res 2010;12(4):e55]

Wireless, Multipurpose In-Home Health Monitoring Platform: Two Case Trials

Abstract: We propose a general purpose home area sensor network and monitoring platform that is intended for e-Health applications, ranging from elderly monitoring to early homecoming after a hospitalization period. Our monitoring platform is multipurpose, meaning that the system is easily configurable for various user needs and is easy to set up. The system could be temporarily rented from a service company by, for example, hospitals, elderly service providers, specialized physiological rehabilitation centers, or individuals. Our system consists of a chosen set of sensors, a wireless sensor network, a home client, and a distant server. We evaluated our concept in two initial trials: one with an elderly woman living in sheltered housing, and the other with a hip surgery patient during his rehabilitation phase. The results prove the functionality of the platform. However, efficient utilization of such platforms requires further work on the actual e-Health service concepts.

Cost-effectiveness Analysis of a Rural Telemedicine Collaborative Care Intervention for Depression

Abstract: CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention. DESIGN: Randomized controlled trial of intervention vs usual care. SETTING: Seven small (serving 1000 to 5000 veterans) Veterans Health Administration community-based outpatient clinics serving rural catchment areas in 3 mid-South states. Each site had interactive televideo dedicated to mental health but no psychiatrist or psychologist on site. Patients Among 18 306 primary care patients who were screened, 1260 (6.9%) screened positive for depression; 395 met eligibility criteria and were enrolled from April 2003 to September 2004. Of those enrolled, 360 (91.1%) completed a 6-month follow-up and 335 (84.8%) completed a 12-month follow-up. Intervention A stepped-care model for depression treatment was used by an off-site depression care team to make treatment recommendations via electronic medical record. The team included a nurse depression care manager, clinical pharmacist, and psychiatrist. The depression care manager communicated with patients via telephone and was supported by computerized decision support software. MAIN OUTCOME MEASURES: The base case cost analysis included outpatient, pharmacy, and intervention expenditures. The effectiveness outcomes were depression-free days and quality-adjusted life years (QALYs) calculated using the 12-Item Short Form Health Survey standard gamble conversion formula. RESULTS: The incremental depression-free days outcome was not significant (P = .10); therefore, further cost-effectiveness analyses were not done. The incremental QALY outcome was significant (P = .04) and the mean base case incremental cost-effectiveness ratio was $85 634/QALY. Results adding inpatient costs were $111 999/QALY to $132 175/QALY. CONCLUSIONS: In rural settings, a telemedicine-based collaborative care intervention for depression is effective and expensive. The mean base case result was $85 634/QALY, which is greater than cost per QALY ratios reported for other, mostly urban, depression collaborative care interventions. Language: en