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PubMed2000

Evaluating telemedicine for minor injuries units.

Low-cost telemedicine equipment consisting of ISDN videoconferencing units and a store-and-forward system was installed in two minor injuries units (MIUs) and a hospital accident and emergency department in Lincolnshire. Over six months, 45 patients were treated using telemedicine in one MIU and 26 in another. Anecdotally, there were no reported radiograph discrepancies or missed diagnoses. Data collected during teleconsultations by both referring and consulting clinicians suggested that in some cases teleconsultation had helped to avoid transfer or onward referral. There were some changes in diagnosis and treatment after using telemedicine, indicating some decision-making value for the remote practitioners. In the context of minor injuries telemedicine, videoconferencing in realtime may prove to be more valuable than store-and-forward interactions. A cost-benefit analysis is being conducted using a pragmatic prospective case-control study.

Case-Control Studies↗
PubMed2001

Army medical laboratory telemedicine: role of mass spectrometry in telediagnosis for chemical and biological defense.

An army medical field laboratory presently has the capability of performing standard protocols developed at the US Army Medical Research Institute of Chemical Defense for verification of nerve agent or sulfur mustard exposure. The protocols analyze hydrolysis products of chemical warfare agents using gas chromatography/mass spectrometry. Additionally, chemical warfare agents can produce alkylated or phosphorylated proteins following human exposure that have long biological half-lives and can be used as diagnostic biomarkers of chemical agent exposure. An analytical technique known as matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF/MS) currently is being examined for its potential to analyze these biomarkers. The technique is capable of detecting large biomolecules and modifications made to them. Its fast analysis time makes MALDI-TOF/MS technology suitable for screening casualties from chemical or biological attacks. Basic operation requires minimal training and the instrument has the potential to become field-portable. The limitation of the technique is that the generated data may require considerable expertise from knowledgeable personnel for consultation to ensure correct interpretation. The interaction between research scientists and field personnel in the acquisition of data and its interpretation via advanced digital telecommunication technologies can enhance rapid diagnosis and subsequently improve patient care in remote areas.

Biomarkers↗
PubMed2003

An estimation of costs of a pediatric telemedicine practice in public schools.

BACKGROUND: Costs per consult are a vital consideration in determining the viability of a telemedicine practice. This study estimated total, average, and marginal cost curves for an ambulatory pediatric telemedicine practice. OBJECTIVE: The objective of this study was to estimate the costs of providing 386 telemedicine clinical consults at school clinics during one school year (September, 1999 to May, 2000). Cost curves were used to estimate costs of clinics with varying numbers of consults. RESEARCH DESIGN: This analysis used cost data from school clinics and a university medical center, which provided physician inputs. Standard cost-accounting procedures were used. SUBJECTS: Cost analyses were conducted using 10 school clinics. Three hundred eighty-six consults were completed with 286 children. Seventy-one percent of the children were black or Hispanic. RESULTS: The average costs of a telemedicine consult ranged from a high of $7328.17 when only one consult was done to a low of $173.13 when 129 consults were completed. At 165 consults, extrapolations from the cost curves suggested that the average costs of a telemedicine consult and a medical center pediatric ambulatory consult were approximately equal, a little more than $153. At 200 consults, telemedicine was estimated to be equal to or less costly than conventional ambulatory care visits by some 9.5%. CONCLUSIONS: Point and CI estimates of average costs suggest that telemedicine is cost competitive with conventional clinics when 200 or more consults are provided. The limited evidence available suggests that telemedicine consults also may be quality competitive.

Ambulatory Care↗
PubMed1999

Virtual outreach: a telemedicine pilot study using a cluster-randomized controlled design.

A pilot study was carried out in preparation for a full-scale randomized controlled trial of teleconsultations versus routine outpatient consultation. The method of study recruited sufficient numbers of patients and avoided selection bias. Over five months, 439 referrals were received, but 297 patients were not eligible to enter the trial because they did not fall within the specialties/consultants included in it. Of the 132 referrals entering the trial, 62 were randomized to the intervention group and 70 to the control group. Consent to participate in the experimental arm of the trial was obtained for all but 13 patients. The results also suggested that patient satisfaction with teleconsultation may exceed that with conventional outpatient consultation, with a strong indication of overall time savings for patients.

Ambulatory Care↗
PubMed1993

Use of remote video microscopy (telepathology) as an adjunct to neurosurgical frozen section consultation.

We investigated the use of remote video microscopy (telepathology) to assist in the diagnosis of 52 neurosurgical frozen section cases. The TelMed system (Discovery Medical Systems, Overland Park, KS), in which the referring pathologist selects appropriate fields for transmission to the consultant, was used for the study. There was a high degree of concordance between the diagnosis rendered on the basis of transmitted video images and that rendered on the basis of direct evaluation of frozen sections; however, in seven cases there was substantial disagreement. Remote evaluation was associated with a more rapid consultation from the standpoint of the consultant, who spent approximately 2 minutes less per case when using remote microscopy; this was achieved at the expense of considerably greater effort on the part of the referring pathologist, who spent approximately 16 minutes per case selecting an average of 4.5 images for transmission to the consultant. The use of remote video microscopy for pathology consultation is associated with a complex series of tradeoffs involving cost, information loss, and timeliness of consultation.

Frozen Sections↗
PubMed1995

Evaluation of a distance consulting service based on interactive video and integrated computerized technology.

Telemedicine equipment was installed at a rural site in Drumheller and at Calgary, 85 miles (136 km) away. It allowed consultation between health-care providers at Drumheller and specialists and subspecialists at the Faculty of Medicine in Calgary. The efficacy of the system in providing more equitable access to health care for persons living in geographically remote sites was evaluated during a 12-month pilot project. Seventy-five encounters were attempted during the study. A total of 55 encounters (42 clinical and 13 non-clinical) were completed. The completed clinical encounters were distributed across a wide spectrum of medical specialties. Users of the system reported favourably on the impact of the telemedicine system on access to health services for rural patients, on diagnostic, investigative and management decisions, on patient and physician travel times, on feelings of professional isolation and educational opportunities and on overall patient health status. The study provides new knowledge and demonstrates the success of the technology in this project. As expected, other problems were raised and addressed in a preliminary manner including: the potential for health-provider education; acquisition and retention of rural physicians; ethical, legal and patient confidentiality issues; minimum acceptable technology; and network management issues.

Canada↗
PubMed1997

Reliability of telemedicine examination.

OBJECTIVES: To assess the reliability of telemedicine examination and identify the issues to be addressed if the conduct of physical examination and the reading of images and tracings by telemedicine are to be as reliable as conventional examination and reading. METHODS: Patients were examined both conventionally and by telemedicine in 12 clinics, and the results were compared. There were 1826 matched pairs of observations. Cardiac auscultation, echocardiography, electrocardiography, electroencephalography, obstetric ultrasonography, ophthalmologic examination, physical therapy assessment, pulmonary auscultation, and the reading of chest radiographs with telemedicine cameras and monitors were studied. The main outcome measure was agreement between the telemedicine findings and a criterion standard. RESULTS: For ophthalmology, physical therapy, and cardiac auscultation, 91.2% of the conventional findings and 86.5% of the telemedicine findings were identical or similar to the criterion standard. The kappa coefficient on matched-pair analysis was 0.66. For pulmonary auscultation and reading of chest films with a telemedicine camera and monitor abnormalities were suppressed at default settings but subsequently revealed with extensive manipulation of system settings. For tracings and images, both conventional and telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87. CONCLUSIONS: On the basis of these observations and the methods used, reliability varied with the type of examination, clinician experience with telemedicine, and participant knowledge of system limitations. Clinicians without experience or knowledge of system limitations missed findings of clinical importance. Improvements in equipment since the clinics were conducted in 1994 may have resolved some of these problems. Our findings raise doubts about the reliability of occasional telemedicine consultations by clinicians inexperienced in the technology.

Bias↗
PubMed2003

Videoconferencing for orthopaedic outpatients: one-year follow-up.

We studied whether consultations via videoconferencing and traditional outpatient clinic visits differ in terms of the implementation of the patient management plan during a one-year follow-up. First-admission and follow-up orthopaedic patients were randomly allocated to an outpatient visit at the surgical department of Oulu University Hospital or to videoconferencing at a health centre in Pyhäjärvi. In a prospective one-year study, there were 145 consecutive orthopaedic patients who met the inclusion criteria: 84 referred for their first visit to a specialist and 61 of them for follow-up. There were 66 males (46%) in the study population. Over half the patients had some form of regenerative arthritis: 15% had hip arthritis, 33% knee arthritis and 4% other arthritis. There were no differences in the implementation of the management plan between the two groups. The study showed that videoconferencing is a valid alternative to outpatient clinic visits for orthopaedic specialist consultations.

Ambulatory Care↗
PubMed2003

[Inter-hospital teledermatology conference using a videophone network].

We organized an inter-hospital teledermatology conference with images through a digital telephone line (ISDN, 128kbps). Our conference system consists of two videophones. A videophone "Phoenix PICSEND-R" (NTT) in the multi-point connection mode is used for discussion among doctors from five hospitals. In addition, using another videophone "Phoenix mini type-S" (NTT), clinical and dermoscopic findings obtained with a digital video camera and a videomicroscope "VMS-1900" (Scalar, Tokyo) respectively were transmitted to Shinshu University Hospital from four rural sites. We have found that the quality of the images obtained is entirely sufficient to make an accurate diagnosis. To calibrate the color and size of skin lesions, a matching sticker "CASMATCH" (Bearmedic, Tokyo) has proved useful. Forty-one times of conference were held from September 1999 to August 2002. In total, the concordance rate between the telediagnosis and the finally confirmed diagnosis was 69% (77 of 112 cases). In cases limited to pigmented skin lesions, the rate was higher (84%) and it was concluded that such conditions are suited for the telediagnosis. The ease with which the data can be manipulated enables us to discuss difficult cases in detail. This style of teleconference system may have benefits for dermatologists especially at rural hospitals in consultation with senior doctors.

Computer Communication Networks↗
PubMed1998

The Spacebridge to Russia Project: internet-based telemedicine.

The National Aeronautics and Space Administration (NASA) has been a pioneer in telemedicine since the beginning of the human spaceflight program in the early 1960s. With the rapid evolution in computer technology and equally rapid development of computer networks, NASA and the Department of Surgery in Yale University's School of Medicine created a telemedicine testbed with the Russia Space Agency, the Spacebridge to Russia Project, using multimedia computers connected via the Internet. Clinical consultations were evaluated in a store-and-forward mode using a variety of electronic media, packaged as digital files, and transmitted using Internet and World Wide Web tools. These systems allow real-time Internet video teleconferencing between remotely located users over computer systems. This report describes the project and the evaluation methods utilized for monitoring effectiveness of the communications. The Spacebridge to Russia Project is a testbed for Internet-based telemedicine. The Internet and current computer technologies (hardware and software) make telemedicine readily accessible and affordable for most health care providers. Internet-based telemedicine is a communication tool that should become integral to global health care.

Computer Systems↗
PubMed1996

Field test to evaluate telepathology in telemedicine.

Telepathology is currently performed only on prototype systems. The application of telepathology consultations differs from the conventional procedure because of the technical and cost restrictions. This paper outlines technical concepts and the principal hardware and software modules necessary for telemicroscopy equipment. A field test to gather information concerning the user needs and to evaluate parameters of telepathology consultation sessions is reported.

Computer Communication Networks↗
PubMed1999

Tele-otolaryngology consultations between two rural primary-care centres in southern Lapland and the University Hospital of Umeå.

In 1996 a telemedicine link was established between two primary-care centres of Västerbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultation. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.

Health Care Costs↗
PubMed2005

Cost-effectiveness of telephone or surgery asthma reviews: economic analysis of a randomised controlled trial.

BACKGROUND: Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review. AIM: To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews. DESIGN OF STUDY: Cost-effectiveness analysis based on a 3-month randomised controlled trial. SETTING: Four general practices in England. METHOD: Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation. RESULTS: A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. Onehundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P <0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P <0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = pounds sterling 64.49 [SD = 73.33] versus surgery = pounds sterling 59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = pounds sterling 725.84 versus surgery = pounds sterling 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = pounds sterling 7.19 [SD = 2.49] versus surgery = pounds sterling 11.11 [SD = 3.50]; mean difference = - pounds sterling 3.92 [95% confidence interval = - pounds sterling 4.84 to pounds sterling 3.01], P <0.001). CONCLUSIONS: Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved.

Asthma↗
PubMed2001

Realtime fetal ultrasound by telemedicine in Queensland. A successful venture?

We have established a realtime fetal tele-ultrasound consultation service in Queensland, which has been integrated into our routine clinical practice. The service, which uses ISDN transmission at 384 kbit/s, allows patients in Townsville to be examined by subspecialists in Brisbane, 1500 km away. For the 90 tele-ultrasound consultations performed for the first 71 patients, 90% of the babies have been delivered, and outcome data have been received on all the pregnancies. All significant anomalies and diagnoses have been confirmed. The referring clinicians would have physically referred 24 of the 71 patients to Brisbane in the absence of telemedicine. A crude cost-benefit calculation suggests that the tele-ultrasound service resulted in a net saving of A$6340, and at the same time enabled almost four times the number of consultations to be carried out.

Cost-Benefit Analysis↗
PubMed2000

[Internet use for telemedecine: fetal medicine applications].

PURPOSE: Assessment of the transmission of still and moving images via the Internet for teleconsultations in fetal medicine. MATERIAL: and methods: Implementation fo two PC systems linked via the internet for the transmission of fixed ultrasound, radiography and scanner images, as well as moving ultrasound images. The assessment took into account was based upon the compression factor. RESULTS: The commutative telephone network transmitted ultrasound and radiographic images by e-mail without difficulty, rapidly (3min 46s for 4Mo files, after compression), inexpensively, and well. The transmission of video ultrasound files using the same procedure was also of good quality, but and exorbitant amount of time was required to send and receive the files. A more advanced configuration could improve the transmission time only sligthly, to 2h30 min 19s for 15s sequences. Live tranmission of video ultrasound sequences by the internet cannot be considered with anything less than a connection including ISDN lines, the minimum to provide the necessary bandwith. CONCLUSION: The Internet is a valuable tool to allow expert consultation in foetal medicine of live still images and recorded moving images.

Evaluation Studies as Topic↗