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PubMed2001

Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature.

The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.

Humans↗
PubMed2002

Level of diagnostic confidence, accuracy, and reasons for mistakes in teleradiology for minor injuries.

The objective of this study is to determine whether eliminating uncertainty in diagnosis improves accuracy in teleradiology for remote trauma management and to assess the correlation between the probable reason for the mistake and the level of confidence. An emergency physician interpreted 2133 radiological series transmitted from a community hospital to an emergency department using videoconferencing equipment. He marked his level of confidence as 1 = sure positive; 2 = fairly sure positive; 3 = unsure; 4 = fairly sure negative; 5 = sure negative. The emergency physician also entered free-text comments, e.g., feeling tired, to enable a better understanding of what was happening. The accuracy, sensitivity, and specificity were 97.3% (98.6%), 94.48% (96.72%), and 98.63% (99.42%), respectively. Figures in brackets represent the 93.5% of cases in which the level of confidence was graded as sure. Boredom and hurry were the main reasons identified for mistakes. Reducing uncertainty in diagnosis may improve the accuracy of screen interpretation. This first series must be reproducible by others before any general use of such systems can be made for primary diagnosis. American College of Radiology standards must be met.

Adolescent↗
PubMed2002

A prospective evaluation of ENT telemedicine in remote military populations seeking specialty care.

This study evaluated telemedicine use in remote military treatment facilities (MTFs) ashore over a 4-month period to help guide telemedicine applications for shipboard medical departments. A prospective study design was used to evaluate specialty care provided by an ear/nose/throat (ENT) physician via videoconferencing (VC) for patients at remote MTFs in TRICARE Region 9. The study provided a complete and continuous sample of ENT consultations during a planned 4-month period. Data sources included a telemedicine database and telephone interviews to assess attitudes of physician and nonphysician medical personnel. A total of 193 VC consultations (hereafter referred to as teleconsultations) were conducted following referrals from primary providers. Patients were mostly young, male, active-duty personnel. Forty-five percent of the 193 teleconsultations resulted in changed diagnosis by the ENT specialist relative to initial diagnosis by the referring provider. This rate of clinical impact was substantial, and it generalized across various ENT conditions, demographics, and MTFs. Medical personnel reported generally positive attitudes about telemedicine technologies and the telemedicine process in TRICARE Region 9. Nonphysician providers reported slightly more favorable attitudes compared to physicians. These results suggest that ENT telemedicine has substantial clinical impact in the military populations treated at MTFs. A high rate of changed diagnoses (45%) was observed across age, gender, military status, ENT conditions, and treatment facilities. Medical personnel reported positive attitudes about using the telemedicine system. These results support the use of telemedicine in shipboard medical departments.

Adolescent↗
PubMed2003

Telemedicine in the state of Maine: a model for growth driven by rural needs.

As of mid-2002, Maine had one of the largest state-wide telemedicine systems, comprising over 150 facilities among 90 health, mental health, and social service provider organizations in two collaborative networks. The rapid growth of telemedicine in this rural, economically disadvantaged state is largely attributable to collaborative development and the service activities of the Maine Telemedicine Services division of a rural community health center, HealthWays/Regional Medical Center at Lubec (RMCL). Annual clinical uses of the system across a broad array of interactive videoconferencing applications currently exceed 1,000 instances for institutional telemedicine and 800 instances for home telehealth. The major applications include mental health/psychiatry, endocrinology/diabetes management, primary care, specialty pediatrics, genetics, and dermatology. Primary care usage derives from a relatively novel use of a mobile telemedicine boat to serve small islands off mid-coastal Maine. Strong future growth is expected in prison telemedicine, emergency medical triage, and nontraditional services such as video relay interpretive services for the deaf, domestic violence advocacy and legal services, and case management for community reintegration of juvenile offenders. The relative success of the two large networks managed by RMCL's Maine Telemedicine Services is evident from the criteria that system usage (1) addresses defined clinical needs, (2) has demonstrable organizational support, (3) is accepted by physicians and patients, (4) exhibits measurable cost and clinical benefits, and (5) is moving toward sustainable operations. Potential bases for this success are discussed in comparison with other networks.

Cooperative Behavior↗
PubMed2003

The success of emergency telemedicine at the State University of New York at Buffalo.

The Telemedicine Program at the State University of New York at Buffalo, School of Medicine, and the Erie County Medical Center (UB/ECMC) represents a "quiet success story" for telemedicine development. Though a relatively young program starting in 1992, it demonstrates steady and consistent progress in the areas of clinical services, education and research as it continues to develop as a comprehensive university telemedicine program. The Emergency Telemedicine program provided 2,294 consultations in 2001. Other services included clinics in Gastroenterology, Infectious Disease (HIV/AIDS), Psychiatry, Orthopedic Hand Surgery, Dermatology, and Neurology. The UB/ECMC program has sponsored regular education activities with a focus on internet protocol (IP) videoconferencing for grand rounds in emergency medicine and traffic injury research, nursing education, distance precepting of nurse practitioner students on clinical rotations, Megaconference I and II presentations, and the continuing exploration of advanced tools for educational presentation over the internet. The program's research activities have focused on portable, roll-about telemedicine systems and virtual palpation using a data glove.

Academic Medical Centers↗
PubMed2003

Reshaping health care delivery for adolescent parents: healthy steps and telemedicine.

Healthy Steps over Telemedicine uses telemedicine technology to bring child development services to adolescent parents in an urban school district. Videoconferencing units link teen parents at a Kansas City high school to developmental specialists and physicians at the Kansas University Medical Center (KUMC). Program participants receive developmental services and valuable health care information without leaving the school. The Healthy Steps goals are to educate parents about health care issues and to help them access medical care for their children and themselves. The telehealth goals are to implement the established Health Steps program effectively over the new medium. This article describes the process of delivering Healthy Steps services via telemedicine, specifically, selection and description of the site, selection of the technology, services provided, research evaluation, and lessons learned.

Adolescent↗
PubMed2004

Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference.

Delivering psychotherapy by videoconference could significantly increase the accessibility of empirically validated treatments. The aim of this study was to compare the effectiveness of cognitive-behavior therapy (CBT) for panic disorder with agoraphobia (PDA) when the therapy is delivered either face-to-face or by videoconference. A sample of 21 participants was treated either face-to-face or by videoconference. Results showed that CBT delivered by videoconference was as effective as CBT delivered face-to-face. There was a statistically significant reduction in all measures, and the number of panic-free participants among those receiving CBT by videoconference was 81% at post-treatment and 91% at the 6-month follow-up. None of the comparisons with face-to-face psychotherapy suggested that CBT delivered by videoconference was less effective. These results were confirmed by analyses of effect size. The participants reported the development of an excellent therapeutic alliance in videoconference as early as the first therapy session. The importance of these results for treatment accessibility is discussed. Hypotheses are proposed to explain the rapid creation of strong therapeutic alliances in videoconferencing.

Adult↗
PubMed2004

Telehomecare: a comparison of three Canadian models.

The delivery of health care is often segmented into sectors. In Canada, hospital care has traditionally been distinct from community care, and thus the transition of patients across sectors has been challenging. This paper focuses on the systematic development of an integrated model of care for children, for the purpose of smoothing the transition from hospital to home. The new service model uses emerging telecommunications technology to link hospital care providers to patients at home and is termed "telehomecare" (THC). Independent models of THC were developed for three sites across Canada through semistructured interviews and focus groups. Participants included health care providers and administrators from the hospital and community, and patient families. The resulting models were compared using content analysis to determine whether there was a core model of THC that was generalisable across Canada. A core model of THC was identified that includes the use of videoconferencing to enable the integration of hospital- and community-based care to support patients during the initial stages of the transition to home. Each site also articulated unique characteristics in their service model that were related to the nature of their health care delivery system and patient population. This paper describes the core model of transitional care, presents a synopsis of each of the three models, and compares the models. THC provides opportunities to address limitations in the current system and to improve upon equity of access to quality care for children making the transition from hospital to home.

Aftercare↗
PubMed1995

Patient satisfaction with teleoncology: a pilot study.

OBJECTIVE: To assess levels of satisfaction among rural cancer patients being seen for clinic visits by their remote university-based oncologist, using interactive videoconferencing (IAVC). METHODS: A 12-item survey instrument assessing satisfaction with the patient-physician clinical interaction was administered to 39 cancer patients who were seen using IAVC. A similar survey, comprised of 9 of the 12 items used in the initial survey, was administered to 21 of these patients after a subsequent on-site clinical interaction. All items were responded to on a five-point Likert scale. Levels of satisfaction with the two consultation modes (IAVC mediated and on-site) were compared. RESULTS: Relatively high levels of patient satisfaction with the telemedicine encounter were recorded both at the time of the initial IAVC-mediated clinical visit, as well at the follow-up on-site visit. With one exception, for each of the survey items, both initially and on follow-up, mean score was above 3.0 (i.e., positive). CONCLUSION: This small pilot study suggests that rural cancer patients may be satisfied with seeing their oncologist via telemedicine, at least on an occasional basis. Although the accrual numbers are too small to allow the results to be generalizable, the results suggest that patient acceptance is high enough to warrant further investigation of this modality in the care of rural cancer patients with limited access to cancer specialists.

Aged↗
PubMed1995

Tele-endoscopic otorhinolaryngological examination: preliminary study of patient satisfaction.

OBJECTIVE: Modern telecommunications and computer technologies enable the delivery of expert consultations and remote diagnoses that previously required transportation of patients or medical specialists. The purpose of this study was to determine whether patients are satisfied with one form of telemedicine consultation. METHODS: A general practitioner was trained to perform endoscopic otorhinolaryngological examinations. After the training period, he examined patients at a local health center in Alta, 250 km from Tromsø. Images from the endoscopic examination were transmitted to the otorhinolaryngologist at the University Hospital of Tromsø for real-time consultation. Twenty-six patients, on a randomly selected day, were asked to complete a questionnaire after the tele-endoscopic examination. The questionnaire was returned anonymously by 24 of the patients. RESULTS: Although patients interacted with the specialist only via videoconferencing, the results show that most (23/24) were satisfied with this type of consultation, and they reported more advantages than disadvantages. Twenty-one patients indicated that they would accept another tele-endoscopic consultation if they required examination by an otorhinolaryngologist in the future. CONCLUSION: Although the sample is limited, the results justify continued investigation of this and other types of telemedicine consultations.

Adult↗
PubMed1998

Telemedicine activities at memorial University of Newfoundland: a historical review, 1975-1997.

Memorial University of Newfoundland has been continuously involved in telemedicine activities since 1975. Unlike most early telemedicine programs, which did not continue after grant funding ended, Memorial made the transition to create a self-sufficient Telemedicine Centre. Key to its success was the vision and drive of its founder, Dr. Max House, and adherence to the following principles: (1) all activities were based on a legitimate need; (2) the simplest, least expensive technology was used to meet the need; (3) the network was shared by a variety of users; and (4) users were given proper training and support. Over the years, Memorial has been involved in 30 telemedicine projects, many of which became ongoing services. Although most initial activity was health related, educational activities have played an increasingly important role. In 1997, the Telemedicine Centre delivered approximately 7000 hours of programming and administered a network of 247 dedicated audioconference sites in 161 communities (168 of the sites had telewriter workstations and 75 had multimedia workstations) and eight videoconferencing sites. Approximately 70% of all programming was distant high school and university education, 20% health education, 5% clinical activities, and 5% other uses. Current clinical activities include tele-electroencephalograms, tele-ultrasonography, tele-nuclear medicine, child telepsychiatry, general teleconsultation from a remote nursing station, and general teleconsultation from an offshore oil platform. Lessons learned from more than 20 years of telemedicine experience are presented.

Education, Distance↗
PubMed1998

Reliability of telemedicine in evaluating skin tumors.

OBJECTIVES: To determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy. MATERIALS AND METHODS: Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina. RESULTS: The two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis. CONCLUSION: The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

Adult↗
PubMed2005

A retrospective evaluation of TeleMental Healthcare services for remote military populations.

The objective of this study was to compare specific treatment and outcome variables between mental health care via videoconferencing to care provided in person. The study was a retrospective record review of service members and their adult civilian family members seen at two remotely located military bases. One group was seen via video conferencing (telemental health care [TMHC]) while a second group was seen face-to-face care (FTFC) and served as a control group. Chi-square tests were used to test for significance associations between therapy format and secondary variables. The Global Assessment of Functioning was unexpectedly and significantly more improved for the TMHC group than the FTFC care group. Mean change in Global Assessment of Functioning for FTFC (8.4) was significantly less than mean change for TMHC (15.3). There were no significant differences between the groups in the number of laboratories or studies ordered, self-help recommendations made, selected mental status elements, or number of patients prescribed two or more psychotropic medications. The rate of full compliance with the medication plan and follow-up appointments was significantly better for TMHC. Providers using TMHC told more patients to return for follow-up appointments in 30 days or less. Improved compliance, the unique interpersonal processes of care via TMH, and slightly shorter times to next follow-up appointment were the chief contributors. Alterations in the process of communication may have implications in the business, political, and military sectors.

Adolescent↗
PubMed2005

Can subspecialty cancer consultations be delivered to communities using modern technology?--A pilot study.

The objective of this project was to evaluate patient and physician acceptance of subspecialty oncologic teleconsultation for distant communities. Many newly diagnosed cancer patients have to travel several hours and long distances to attend specialty medical oncology consultations at our regional cancer center in Victoria, BC. Difficulties in recruiting of oncologists in Vancouver Island have prompted the search for other means to deliver subspecialty consultation closer to home. Teleconsultation seemed a possible model. Hence, 30 sequential patients with gastrointestinal (GI) malignancy referred from the Central Island region were seen after an informed consent via videoconferencing and 30 sequential patients were seen face to face in Victoria by one oncologist. Patients and the oncologist filled out a satisfaction questionnaire. The age, sex, proportion of patients who subsequently received chemotherapy, and the number of other co-morbid conditions were similar in both groups. No difference was observed in patient satisfaction whether patients were seen via videoconference or in person. However, the oncologist felt the video did not go as well as face-to-face consultation. Patients were very satisfied with teleconsultation, and it saved them hours of travel.

Aged↗
PubMed1999

Telemedicine and telepharmacy: current status and future implications.

Uses of telemedicine are described and potential roles for pharmacists are discussed. Telemedicine has been defined as "the use of electronic information and communications technologies to provide and support health care when distance separates the participants." Technologies included in telemedicine are videoconferencing, telephones, computers, the Internet, fax, radio, and television. Telepharmacy has the same basic definition but refers to pharmaceutical care provision. Although the videotelemedicine market is expected to grow considerably, lack of reimbursement and high costs are continuing obstacles. Pharmacy is using video-conferencing for education, training, and management purposes. The telephone has changed from a dial-and-talk instrument to a multimedia access tool. Medical devices are being attached to telephone lines to provide remote monitoring and therapy, and call centers are providing medication counseling, prior authorization, refill authorization, and formulary compliance monitoring. Although the Internet has quickly become a star performer, utilization by health care lags behind that of other industries. The Internet-fueled empowerment of consumers and their expectations for speed, access, and convenience are creating more unmet expectations of the traditional health care system. Pharmacy has both organizational and individual practitioner Web sites, but it is online drugstores that are attracting most attention. Potential benefits of telemedicine include improved access to care, greater efficiency in diagnosis and treatment, higher productivity, and market positioning for the coming century. Telemedicine will tax the economic, regulatory, legal, ethical, and clinical care expertise of the entire health care system. Studies of the effectiveness, cost, and societal implications of telemedicine are needed, along with practice models and standards, training programs, and solutions to regulatory, licensing, and legal questions. Securing reimbursement for cognitive services remains a problem for telemedicine and telepharmacy. Telemedicine presents profound opportunities and challenges to pharmacy and other health care professions.

Accreditation↗
PubMed2002

Telehealth: implications for social work practice.

Telehealth, the use of modern information technology to deliver health services to remote locations, poses both opportunities and problems for social work. Home health "visits" featuring a social worker in one state and a patient in another, therapy on the Internet, and the transmission of patient records across state and national boundaries raise important ethical and legal questions. This article examines how modern communications technologies such as e-mail, interactive e-mail, and interactive videoconferencing affect social work practice, with emphasis on the legal, ethical, and relationship issues raised.

Computer Security↗
PubMed2001

Real-time Internet connections: implications for surgical decision making in laparoscopy.

OBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.

Cholecystectomy, Laparoscopic↗
PubMed2005

Building a transcontinental affiliation: a new model for academic health centers.

The recent affiliation of The Methodist Hospital (TMH) with Weill Medical College (WMC) of Cornell University and NewYork-Presbyterian Hospital is the first transcontinental primary affiliation between major, not-for-profit academic health centers (AHCs) in the United States. The authors describe the process followed, the issues involved, the initial accomplishments, and the opportunities envisioned. The key enablers of this affiliation were a rapid process, mutual trust based on existing professional relationships, and commitment to the project by Board leadership. Because of their geographic separation, the parties were not competitors in providing clinical care to their regional populations. The affiliation is nonexclusive, but is reciprocally primary in New York and Texas. Members of the TMH medical staff are eligible for faculty appointments at WMC. The principal areas of collaboration will be education, research, quality improvement, information technology, and international program development. The principal challenge has been the physical distance between the parties. Although extensive use of videoconferencing has been successful, personal contact is essential in establishing relationships. External processes impose a slower sequence and tempo of events than some might wish. This new model for AHCs creates exciting possibilities for the tripartite mission of research, education, and patient care. Realizing the potential of these opportunities will require unconstrained ideas and substantial investment of time and other critical resources. Since many consider that AHCs are in economic and cultural crisis, successful development of such possibilities could have importance beyond the collective interests of these three institutions.

Academic Medical Centers↗