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At least 343 records · Page 19Linked to original sources
PubMed1999

Efficiency analysis of a multi-specialty telemedicine service.

OBJECTIVE: The goal of this project was to assess case turn-around times for store-and-forward and real-time video consultations in the Arizona Telemedicine Program. MATERIALS AND METHODS: Five components contributing to total case turn-around time were analyzed. Each parameter was submitted to statistical analysis and compared for store-and-forward and real-time sessions. RESULTS: Turn-around for real-time are longer than for store-and-forward sessions. Real-time sessions take longer, from when the consulting clinician is contacted to the time the case is reviewed. This is compounded by the fact that real-time sessions sometimes need to be rescheduled. For both types of consults, the time to deliver the final report is the longest segment of the total turn-around time. CONCLUSION: Several factors contribute to case turn-around times. By identifying and analyzing each contributing factor, it is possible to revise consult protocols to improve efficiency.

Arizona↗
PubMed1996

Provider attitudes toward a rural telepathology program.

OBJECTIVE: To assess the attitudes of referring and consulting pathologists toward a recently initiated live video telepathology network in rural Vermont. METHODS: A semistructured interview was conducted with each referring pathologist before implementation of the telepathology program and again 9 months later. The interview consisted of questions concerning reasons for seeking a consultation in general and attitudes toward telepathology specifically. A questionnaire with Likert-type response categories was administered at the 9-month timepoint to the referring (N = 4) and consulting (N = 10) pathologists. This questionnaire contained items regarding communication, cost, education, quality, and timeliness aspects of telepathology. In addition, a brief mail survey was sent to attending physicians who utilized pathology services at the rural hospitals. RESULTS: The referring pathologists found the timeliness of consults using telemedicine to be a significant advantage. They also cited educational benefits both from attending telepathology conferences and from the interactive nature of the consultations. Two areas of concern were difficulties in minimizing scheduling inconveniences and uncertainty about the financial sustainability of the network. Overall, the telepathology system was well received by the consulting pathologists. Recurrent technical difficulties with the system were mentioned as a problem area. CONCLUSION: The pathologists participating in the Vermont telepathology network have reported benefiting from using this technology. Whether these benefits will outweight the costs of using telepathology for routine consultations remains to be determined.

Attitude↗
PubMed2000

Multidimensional telecare strategies for rural residents with brain injury.

Rural residents with brain injury have difficulty in accessing care from qualified psychologists for consequent cognitive, emotional and behavioural symptoms. We examined high-quality videoconferencing to enhance care for persons with brain injury in three areas: cognitive assessment, psychotherapy and rural mental health training. The assessment study evaluated 52 outpatients seen for diagnostic visits over videoconferencing, and compared their experiences with those of 52 age- and diagnosis-matched controls seen in person. Persons seen via telemedicine were more likely than controls to want to repeat their experience and more satisfied than were the neuropsychologists who examined them. In the psychotherapy study, neurorehabilitation patients were seen via videoconferencing for therapy related to brain injury or stroke. Persons receiving psychotherapy were less likely than persons receiving assessment services to want to repeat their experience. In the training study, 39 rural mental health providers were trained via videoconferencing, and trainees demonstrated significant improvement on tests of knowledge about brain injury. Trainees formed a network of mental health provider referrals for persons with brain injury in a wide geographic area. Given adequate training and ongoing support, rural clinicians can treat many brain-injury adjustment issues locally, reserving specialist consultation for emergency or complex problems.

Brain Injuries↗
PubMed1998

Can patients predict which consultations can be dealt with by telephone?

The use of telephone consultations to reduce the workload of general practitioners is well established both in this country and abroad. The principal aim of this study was to discover the proportion of consultations currently carried out in the surgery that would be suitable, for both doctor and patient, to be managed over the telephone. The second aim was to establish what proportion of such consultations could be predicted.

England↗
PubMed2004

Videoconferencing in family therapy: a review.

Videoconferencing is used in psychiatry for various purposes. There is a need for research on videoconferencing in family therapy, as there are hardly any reports on the topic: in a literature search, we found only four references to family therapy and videoconferencing. In the Department of Psychiatry at Oulu University Hospital, the use of videoconferencing has steadily increased over the last few years, and in 2002 the equipment was used for 600 hours, of which 84 hours (14%) involved consultation and 12 hours (2%) family therapy. We postulate that the use of videoconferencing for family therapy will incur various restrictions, but may also open up new opportunities. Videoconferencing may allow people in remote regions to benefit from family therapy services. Using modern equipment, it is possible to attain television broadcast quality in a videoconference, but we do not know the effect of videoconferenced delivery on the outcome of therapy. It will therefore be important to collect systematic data on family therapy delivered via videoconference.

Communication↗
PubMed2002

Physician-to-physician consultation via electronic mail: the Walter Reed Army Medical Center Ask a Doc system.

INTRODUCTION: Physician-to-physician consultation and discussion have traditionally been conducted by telephone, paper, and "curbside" (face to face meetings). The implementation and use of physician-to-physician consultation via electronic mail in a military health care system has not been reported previously. METHODS: The group mail function of the Composite Health Care System, the main outpatient medical automation system for the Department of Defense, was modified to create mailgroups for every specialty of the Walter Reed Army Medical Center to facilitate ease of physician-to-physician consultation. This modification was called the "Ask a Doc" system. The system was deployed to a 21-state health care network among triservice participants. RESULTS: There were 3,121 consultations logged from April 22, 1998, to December 31, 2000. Growth in use expanded initially and was sustained during a 3-year period. Average response time to consultations was less than 1 day (11.93 hours). Additional training and maintenance requirements were minimal. In general, the use of electronic consultation mirrored that of clinical practice. Most specialty consultations involved the disciplines of internal medicine. CONCLUSIONS: Use of the Ask a Doc system was representative of total clinical workload and increased access to specialty medical care over a wide geographic area. The distribution of use indicated that user statistics were legitimate, and quality improvement programs could easily troubleshoot the system. Ask a Doc was inserted into a regional health care network with minimal cost to support and implement and was sustained with very little effort for 3 years. Barriers to even wider use currently include lack of secure communications and the difficulty in assigning workload credit for electronic consultations.

Computer Communication Networks↗
PubMed1997

Digital imaging and teledermatology: educational and diagnostic applications of a portable digital imaging system for the trainee dermatologist.

Teledermatology is no longer a futuristic curiosity; several general practices across the UK are now preparing to be electronically linked to other medical services for the purposes of referral and telediagnosis. Further, digital imaging in dermatology has been the subject of considerable research in recent years, largely because of its application to telemedicine. Indeed in the UK, geographically isolated general practices in North Powys have already demonstrated the effective delivery of dermatological expertise through a video-conferencing link to a consultant dermatologist at Aberystwyth Hospital, thereby reducing the need for patients or the consultant to travel long distances.

Dermatology↗
PubMed2001

Telemedicine: Strabismus e-consultation.

BACKGROUND: Volunteer ophthalmologists can achieve success with teaching and service programs working with high intensity over a short term. Continuation of initially successful programs may be limited by lack of timely, effective communication and follow-up. In an attempt to overcome these limitations, a total of 6 telemedicine programs were established after a successful trial program at the Ramon Pando Ferrer Hospital in Havana, Cuba. METHODS: Two pediatric ophthalmology-strabismus clinics, one in Cuba and one in Romania, were provided a digital camera and a computer in order to obtain and then transmit by e-mail patient images obtained according to a prescribed format. Ophthalmologists in both of these programs were instructed personally during an orientation period in their clinics. Training included use of a digital camera and computer, patient examination, and surgical technique in the operating room. Four additional programs referred patients via digital images after receiving only written and oral instruction. RESULTS: The diagnosis and treatment plan determined by one of us (E.M.H.) for each of the first 15 Cuban patients after study of digital images sent by e-mail was the same as the diagnosis and treatment plan determined by the same observer after in-person examination of the patients. On the basis of the level of confidence attained in these patients, 35 additional patients from a total of 6 clinics were seen by digital consultation only. CONCLUSION: A store-and-forward telemedicine consultation technique that uses digital images and e-mail holds promise to be an effective means for carrying out consultation for patients with strabismus.

Child↗
PubMed2002

The benefits of a qualitative approach to telemedicine research.

We used qualitative research to evaluate the experience of the participants in teleconsultations between primary and secondary care. Semistructured interviews were conducted with 15 hospital specialists, 24 general practitioners and 30 patients. Focus groups were also held with hospital specialists (two groups), general practitioners (six groups) and administrative staff (five groups). Sixty teleconsultations in six different specialties were video-recorded. Early findings show that the participants (hospital specialists, general practitioners and patients) had different perceptions of the same teleconsultations. Furthermore, the participants perceptions of consultations differed from those of the researchers.

Attitude of Health Personnel↗
PubMed2002

Social presence in telemedicine.

We studied consultations between a doctor, emergency nurse practitioners (ENPs) and their patients in a minor accident and treatment service (MATS). In the conventional consultations, all three people were located at the main hospital. In the teleconsultations, the doctor was located in a hospital 6 km away from the MATS and used a videoconferencing link connected at 384 kbit/s. There were 30 patients in the conventional group and 30 in the telemedical group. The presenting problems were similar in the two groups. The mean duration of teleconsultations was 951 s and the mean duration of face-to-face consultations was 247 s. In doctor-nurse communication there was a higher rate of turn taking in teleconsultations than in face-to-face consultations; there were also more interruptions, more words and more 'backchannels' (e.g. 'mhm', 'uh-huh') per teleconsultation. In doctor-patient communication there was a higher rate of turn taking, more words, more interruptions and more backchannels per teleconsultation. In patient-nurse communication there was relatively little difference between the two modes of consulting the doctor. Telemedicine appeared to empower the patient to ask more questions of the doctor. It also seemed that the doctor took greater care in a teleconsultation to achieve coordination of beliefs with the patient than in a face-to-face consultation.

Communication↗
PubMed2004

[Rules of telephone poison information service: guidelines for call management].

A rules of telephone poison information service for general public and telephone toxicological consultation for medical staff, mainly physicians, are presented in the study. Guidelines for call management: necessity of caller assessment while dealing with information given to the general public and factors that influence successful telephone encounters are presented. The types of questions that are appropriate to ask about patient, considering both the patient state and the toxin(s) involved while dealing with a telephone toxicological consultation are also presented.

Drug Information Services↗
PubMed1996

Extending the multimedia patient record across the wide area network.

The Dept. of Veterans Affairs is developing and testing a wide area medical network with multimedia capabilities for coordination and consolidation of medical services across locations. The system is composed of multimedia information systems at individual medical centers connected by a high speed wide area network. The DHCP Imaging System, which has been in clinical use for six years, provides storage management and workstation acquisition and display of the multimedia data. Teleconsulting capability using a variety of mechanisms' is being prototyped and tested to meet medical staffing and consultation needs.

Computer Communication Networks↗