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PubMed1994

Delivery of health care to the underserved: potential contributions of telecommunications technology. Consensus conference entitled "Telemedicine and Access to Care.".

OBJECTIVE: To evaluate the potential uses of telecommunications in medicine (telemedicine), determine the most important principles in designing telemedicine applications, decide what research questions to address, and identify potential barriers to full use of telemedicine. DESIGN: A consensus conference on telemedicine was convened in October 1993 to assemble a wide variety of participants with the assigned task of addressing the objective. RESULTS: Consensus was achieved on several key principles for implementation of successful telemedicine. Two of the most important principles will be (1) to focus on the needs of the underserved people more than on the capabilities of the available technologies and the regional centers and (2) to use the least expensive but appropriate telecommunications technology for any specific application. Greater professional connectivity between providers of health care in underserved areas and colleagues in tertiary medical centers is expected to minimize professional isolation in underserved areas. CONCLUSION: Telecommunications technologies have considerable potential for improving health care to the rural and underserved populations, but a systematic approach to implementation, which takes into account the identified key principles, is needed.

Humans↗
PubMed1996

A 10-year experience in pediatric after-hours telecommunications.

A rapidly growing area within the field of telephone medicine is the use of centralized telephone triage systems to help in the after-hours coverage of pediatric practices. This paper describes a 10-year experience with a pediatric telecommunications program within the 302,000-member Health Centers Division of Harvard Pilgrim Health Care. Telephone volume averages 3,000 calls per month, and over 175,000 telephone calls have been received since the program began. This article highlights the linkage to the primary care physician, the enhancement of service by the automated medical record system, and the application of the telecommunications program to resident teaching. The literature review focuses on the rationale for structured telecommunications programs, including improved quality of care, reduction of medicolegal risk, and the potential for reimbursement of services.

Child↗
PubMed1998

Reliability and acceptability of psychiatric diagnosis via telecommunication and audiovisual technology.

The reliability of psychiatric diagnoses made remotely by telecommunication was examined. Two trained interviewers each interviewed the same 30 psychiatric inpatients using the Structured Clinical Interview for DSM-III-R. Fifteen subjects had two in-person interviews, and 15 subjects had one in-person and one remote interview via telecommunication. Interrater reliability was calculated for the four most common diagnoses: major depression, bipolar disorder, panic disorder, and alcohol dependence. For each diagnosis, interrater reliability (kappa statistic) was identical or almost identical for the patients who had two in-person interviews and those who had an in-person and a remote interview, suggesting that reliable psychiatric diagnoses can be made via telecommunication.

Alcoholism↗
PubMed2006

A case analysis of INFOMED: the Cuban national health care telecommunications network and portal.

BACKGROUND: The Internet and telecommunications technologies contribute to national health care system infrastructures and extend global health care services markets. The Cuban national health care system offers a model to show how a national information portal can contribute to system integration, including research, education, and service delivery as well as international trade in products and services. OBJECTIVE: The objectives of this paper are (1) to present the context of the Cuban national health care system since the revolution in 1959, (2) to identify virtual institutional infrastructures of the system associated with the Cuban National Health Care Telecommunications Network and Portal (INFOMED), and (3) to show how they contribute to Cuban trade in international health care service markets. METHODS: Qualitative case research methods were used to identify the integrated virtual infrastructure of INFOMED and to show how it reflects socialist ideology. Virtual institutional infrastructures include electronic medical and information services and the structure of national networks linking such services. RESULTS: Analysis of INFOMED infrastructures shows integration of health care information, research, and education as well as the interface between Cuban national information networks and the global Internet. System control mechanisms include horizontal integration and coordination through virtual institutions linked through INFOMED, and vertical control through the Ministry of Public Health and the government hierarchy. Telecommunications technology serves as a foundation for a dual market structure differentiating domestic services from international trade. CONCLUSIONS: INFOMED is a model of interest for integrating health care information, research, education, and services. The virtual infrastructures linked through INFOMED support the diffusion of Cuban health care products and services in global markets. Transferability of this model is contingent upon ideology and interpretation of values such as individual intellectual property and confidentiality of individual health information. Future research should focus on examination of these issues and their consequences for global markets in health care.

Computer Communication Networks↗
PubMed1993

Evaluating managed care's special telecommunications needs.

Right now, managed care is a vast cosmic soup. But whether its ultimate form is the result of a bureaucratic big bang or a series of small industry explosions, one thing seems clear: telecommunications is the framework upon which managed care will be built. Managed care's primary players--purchasers, providers and payors--have already discovered the unifying power of telecommunications within their respective worlds. However, as the three worlds collide, an entirely new set of special telecommunications needs arises. And most of these needs can be distilled into three basic requirements: bigger networks, faster networks and smarter networks.

Computer Communication Networks↗
PubMed1998

[Telecommunication in routine surgical practice].

In an internal inquiry on the use of telecommunication, 267 operations were documented. In 62 cases an interruption was necessary: 43 of them for a second opinion and 29 for a new orientation resulting from findings, and in 10 cases for both. A purely verbal communication/consultation was sufficient in 8 cases, in 29 questions an on-site demonstration was necessary to come to a decision. In the opinion of the operating surgeon, a picture transmission telecommunication system would have been helpful for solving the problem in 27 (44%) of the interruptions. Looking at the minimal invasive operations, the percentage was specially high (60%). We think that in future telecommunication systems can be used for time saving in operating rooms and on a long-term basis contribute to cost cutting and quality improvement in surgical routine.

Forecasting↗
PubMed2005

Quality of service provision assessment in the healthcare information and telecommunications infrastructures.

The continuous increase in the complexity and the heterogeneity of corporate and healthcare telecommunications infrastructures will require new assessment methods of quality of service (QoS) provision that are capable of addressing all engineering and social issues with much faster speeds. Speed and accessibility to any information at any time from anywhere will create global communications infrastructures with great performance bottlenecks that may put in danger human lives, power supplies, national economy and security. Regardless of the technology supporting the information flows, the final verdict on the QoS is made by the end user. The users' perception of telecommunications' network infrastructure QoS provision is critical to the successful business management operation of any organization. As a result, it is essential to assess the QoS Provision in the light of user's perception. This article presents a cost effective methodology to assess the user's perception of quality of service provision utilizing the existing Staffordshire University Network (SUN) by adding a component of measurement to the existing model presented by Walker. This paper presents the real examples of CISCO Networking Solutions for Health Care givers and offers a cost effective approach to assess the QoS provision within the campus network, which could be easily adapted to any health care organization or campus network in the world.

Computer Communication Networks↗
PubMed1998

Telecommunications and disabled people: a rural perspective.

In the context of the National Health Service and Community Care Act 1990 this paper focuses on the role of home- and community-based telecommunication services in sustaining the life-style and independence of elderly and disabled people in rural Britain. It draws on findings from a recent survey in the North Cotswolds to evaluate four models of telecommunication support: telephone trees; community alarm systems; community teleservice centres (CTCs); and on-line computer systems. The arguments in favour of a "low-cost-voluntary-care-support-model", a variant of the CTC, are discussed with respect to client need and community setting.

Activities of Daily Living↗
PubMed1995

Voice-processing technologies--their application in telecommunications.

As the telecommunications industry evolves over the next decade to provide the products and services that people will desire, several key technologies will become commonplace. Two of these, automatic speech recognition and text-to-speech synthesis, will provide users with more freedom on when, where, and how they access information. While these technologies are currently in their infancy, their capabilities are rapidly increasing and their deployment in today's telephone network is expanding. The economic impact of just one application, the automation of operator services, is well over $100 million per year. Yet there still are many technical challenges that must be resolved before these technologies can be deployed ubiquitously in products and services throughout the worldwide telephone network. These challenges include: (i) High level of accuracy. The technology must be perceived by the user as highly accurate, robust, and reliable. (ii) Easy to use. Speech is only one of several possible input/output modalities for conveying information between a human and a machine, much like a computer terminal or Touch-Tone pad on a telephone. It is not the final product. Therefore, speech technologies must be hidden from the user. That is, the burden of using the technology must be on the technology itself. (iii) Quick prototyping and development of new products and services. The technology must support the creation of new products and services based on speech in an efficient and timely fashion. In this paper I present a vision of the voice-processing industry with a focus on the areas with the broadest base of user penetration: speech recognition, text-to-speech synthesis, natural language processing, and speaker recognition technologies. The current and future applications of these technologies in the telecommunications industry will be examined in terms of their strengths, limitations, and the degree to which user needs have been or have yet to be met. Although noteworthy gains have been made in areas with potentially small user bases and in the more mature speech-coding technologies, these subjects are outside the scope of this paper.

Automation↗
PubMed1994

Musculoskeletal disorders among visual display terminal users in a telecommunications company.

The relationship between workplace factors and work-related upper extremity musculoskeletal disorders (UE disorders) was assessed in a cross-sectional study of 533 telecommunication employees utilizing video display terminals (VDTs). Cases of UE disorders were defined using symptom questionnaires and physical examinations. Data on demographics, individual factors (medical conditions and recreational activities), work organization and practices, and psychosocial aspects of work, including electronic performance monitoring (EPM), were obtained by questionnaire. Associations between workplace factors and UE disorders were assessed by multiple logistic models generated for each of the four UE areas (neck, shoulder, elbow, hand/wrists). One-hundred and eleven (22%) participants met our case definition for UE disorders. Probable tendon-related disorders were the most common (15% of participants). Probable nerve entrapment syndromes were found in 4% of participants. The hand/wrist was the area most affected, 12% of participants. The following variables had associations in the final models (p < 0.05) with at least one of the four UE disorders, although the strength of these associations were modest. Non-white race, a diagnosis of a thyroid condition (self-reported) use of bifocals at work, and seven psychosocial variables (fear of being replaced by computers, increasing work pressure, surges in workload, routine work lacking decision-making opportunities, high information processing demands, jobs which required a variety of tasks and lack of a production standard) were associated with UE disorders. This study indicates that work-related UE musculoskeletal disorders are relatively common among telecommunication workers who use VDTs, and adds to the evidence that the psychosocial work environment is related to the occurrence of these disorders.

Adult↗
PubMed2001

The School of Posture as a postural training method for Paraíba Telecommunications Operators.

This work proposes to show the experience of posture training accomplished in the Paraíba State Telecommunication Company, using the knowledge of the Back School. The sample was composed of 12 operators, employees of the company, representing 31% of this population. The model applied in TELPA (Paraíba Telecommunication Company, Brazil) was based on the models of Sherbrooke, Canada, and of the School of Posture of Paraìba Federal University. Fifty-eight point four percent of participants showed a reduction of column pain, 25% improved the quality of the rest and the received training was considered enough for the learning of correct postures at work in 75% of the cases. The whole population approved of the training, and 83.3% of the cases considered that this training influenced their lives very positively.

Adult↗
PubMed1980

Telecommunications, computers and other complementary communication means on behalf of the disabled.

It took the author eleven months (1-3-1979 to 31-1-1980) to carry out the first part of a study and coordinate a number of working sessions in which he examined the state of the arts and put forward a program for the application of telecommunications, computers and other complementary communication means to the welfare of the disabled. The five areas of study are described in the present article: blindness, deaf-blindness and visual impairment; disability in the family; home-boundness due to disability, chronic illness or advanced age; speech impairments due to non-auditory causes; mental illness and related disorders. The study was carried out as a part of the activities of the "Foundation for the Development of the Social Function of Communications" (Fundacion para el Desarrollo de la Funcion Social de las Comunicaciones) and tries to open up a new perspective in Spain on technological applications for the handicapped. The main feature of the study is the proposal of Rehabilitation Engineering and Technical Aids Centre for the Disabled which starting from the telecommunications area, intends to make available to the handicapped the possibilities offered by technology.

Adult↗
PubMedDate not supplied

Telecommunications technology as an aid to family caregivers of persons with dementia.

OBJECTIVE: The aging of the population implies that an increased number of people are going to need some form of care or assistance. Caregiving poses a range of physical, emotional, and financial demands and often causes burden and stress for family members. This article describes how technology can be used to provide support to caregivers and increase the quality of life for both caregivers and care recipients. Preliminary data from an ongoing study of dementia caregivers is provided to demonstrate the feasibility of using technological interventions for this population. METHODS: The intervention involves a telecommunications system designed to augment a family therapy intervention by enhancing access to formal and informal support services. Specifically the system is intended to facilitate linkages between caregivers and other family members, friends, and other caregivers as well as to facilitate access to information on available resources. A total of 76 caregivers of dementia patients, including Cuban American and white American caregivers, received the telecommunications intervention. Data include real-time usage data and measures of usability at 6 months, 12 months, and 18 months after the initiation of the intervention. RESULTS: The data reported in this article are based on responses to the usability questionnaire at 6 months from a sample of 44 caregivers. Overall the results indicate that the system is easy to use and the caregivers find it valuable. The most common reason that the caregivers use the system is to communicate with other caregivers, especially those who are not nearby. The caregivers, especially the Cuban Americans, reported that the system facilitated their ability to communicate with family members and their therapist. The caregivers also indicated that they found participation in the "online discussion" groups to be very valuable and also found the "online resource guide"useful. CONCLUSIONS: The results demonstrate how current information and communication technologies can be used to help caregivers meet the challenges of caregiving and improve the quality of life for caregivers. The potential benefit of this type of technology for health care providers is also discussed.

Aged↗
PubMed2001

Telemedicine system using computed tomography van of high-speed telecommunication vehicle.

The current medical system provides medical services to patients who visit hospitals. However, medical services can be provided at or close to the home of the patient using fully equipped mobile telemedicine systems. Such a system can identify the disease at an early stage, improve quality of life and prognosis through early diagnosis and treatment, and reduce the costs of medical service. Furthermore, the unit can provide mass screenings of the population, as well as full medical service to remote areas. The Telecommunications Advanced Organization of Japan, Matsumoto, Japan, and Shinshu University Hospital, Matsumoto, Japan, established a research center for a unique telemedicine project using a mobile system. The mobile unit consists of a van that houses a spiral computed-tomography (CT) machine and various telecommunications equipment. The unit allows medical examination, CT scanning, and on-line two-way transfer of image data/teleconferencing to a medical center for consultation with various specialists. We have used the system thus far for the early detection of lung cancer through mass screenings over a four-year period in 29 administrative districts. Mass screenings of 19117 residents resulted in the identification of 75 cases of early lung cancer who were later treated by partial pneumonectomy at Shinshu University Hospital and affiliated hospitals. We have also used the system to provide medical services to rural areas, as telemedicine support at remote areas, wintertime telemedicine support to an international sports competition, and various medical services to a home-care facility.

Humans↗
PubMed2000

Advances in telecommunications concerning epilepsy.

Telemedicine is a rapidly expanding discipline. Looking back on a long tradition of telemetric measurement and transmission of brain electrical data, one might ask how relevant telecommunication techniques have become for clinical work in epileptology. In principle, communication can be either between patient and doctor or between doctor and doctor. The former includes telephone reports on frequency and severity of seizures and on mental and physical state. Because of the special problems of patients with epilepsy, the need for traveling should be minimized. To maintain close contact, telemetric transmission of electroencephalograms (EEG), seizure video-registration, and monitoring of anti-epileptic drug (AED) blood levels from home are desirable, but the technical tools now available are not of sufficiently high performance for these applications. However, physicians and medical units can communicate using high-rate data transfer. There are major problems with this technology. Transfer rates using the internet are not fixed. Moreover, using six digital telephone lines simultaneously, good-quality transmission of a 3-min video may take more than 1 h, restricting interactivity. In contrast to imaging (e.g., magnetic resonance imaging), there is no generally accepted protocol for handling EEG/electrocorticography data. There are also legal problems relating to the responsibility for failures and safety of personal or medical data. Nevertheless, the expenses of installation and use of such equipment appear justified by the expected benefits, for the patients (avoiding travel and multiple investigations, checking diagnosis and therapy, amending quality of life), for the physician (sparing equipment and manpower, accelerating and improving diagnosis), for the epilepsy center (increased database for expert systems, improved logistic and data storage) and, finally, for insurance providers (reduced overall costs). When the neurosurgical procedure is remote from the place of presurgical evaluation, telecommunication should be obligatory.

Confidentiality↗
PubMed2005

Modern wireless telecommunication technologies and their electromagnetic compatibility with life-supporting equipment.

Hospitals rely on pagers and ordinary telephones to reach staff members in emergency situations. New telecommunication technologies such as General Packet Radio Service (GPRS), the third generation mobile phone system Universal Mobile Telecommunications System (UMTS), and Wireless Local Area Network (WLAN) might be able to replace hospital pagers if they are electromagnetically compatible with medical devices. In this study, we sought to determine if GPRS, UMTS (Wideband Code Division Multiple Access-Frequency Division Duplex [WCDMA FDD]), and WLAN (IEEE 802.11b) transmitted signals interfere with life-supporting equipment in the intensive care and operating room environment. According to United States standard, ANSI C63.18-1997, laboratory tests were performed on 76 medical devices. In addition, clinical tests during 11 operations and 100 h of intensive care were performed. UMTS and WLAN signals caused little interference. Devices using these technologies can be used safely in critical care areas and during operations, but direct contact between medical devices and wireless communication devices ought to be avoided. In the case of GPRS, at a distance of 50 cm, it caused an older infusion pump to alarm and stop infusing; the pump had to be reset. Also, 10 cases of interference with device displays occurred. GPRS can be used safely at a distance of 1 m. Terminals/cellular phones using these technologies should be allowed without restriction in public areas because the risk of interference is minimal.

Cell Phone↗
PubMed1998

The International Telecommunication Union's report on Telemedicine and Developing Countries.

This paper reviews some of the main conclusions and recommendations from the Report on Telemedicine and Developing Countries, which was prepared for the International Telecommunication Union (ITU). The report is the result of three years' effort by a group of experts in telecommunications and telemedicine from around the world. It provides an extensive survey of the telemedicine experience of various countries. It discusses the different types and applications of telemedicine, the technologies used, costs and benefits, trends, prospects for global standards, and provides guidelines and recommendations to developing countries for implementation of telemedicine services. The ITU study group which prepared the report is expected to begin some new tasks in 1998, including the identification of a set of pilot telemedicine projects for developing countries.

Developing Countries↗
PubMed1995

Social and cognitive processes in interpersonal communication: implications for advanced telecommunications technologies.

Interactive multimedia conferencing systems, in which two or more remotely located people can work on cooperative tasks through shared audio, video, and data, appear to be the wave of the future. However, because of great advances in the underlying technology of multimedia conferencing systems, many design decisions have been driven by what is technically feasible as opposed to what will best suit the needs of the users. In this paper we provide a framework for the design and evaluation of features in advanced telecommunications products and services which is derived from empirical research on interpersonal communication. We also discuss implications of this research for the development and use of advanced telecommunications technologies.

Cognition↗