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PubMed2001

Telecardiology: potential impact on acute care.

Echocardiography is often used to diagnose and exclude important cardiac diagnoses in adults and children. Evolving telemedicine technology has the potential to improve access to echocardiography diagnoses in the intensive care unit, emergency room, and newborn nursery. The two primary modes of telemedicine practice are "store and forward" and "real-time" videoconferencing. A digital echocardiogram (often several one cardiac cycle loops) can be stored at one site and forwarded across a telemedicine network to a receiving station for review at a later time. Pediatric cardiologists often favor "real-time" telemedicine because of the ability to guide sonographers with limited experience in congenital heart disease. A complete telemedicine system requires a modified computer, a low- or high-speed connection, and telemedicine inputs. Several adult and pediatric clinical studies have shown telemedicine to be accurate and cost-effective, improve patient care, enhance echocardiogram quality and sonographer proficiency, and promote practice expansion. Obstacles to widespread implementation of telemedicine include lack of standardization of telemedicine components, confusing legal issues and licensure requirements, and poor reimbursement.

Adult↗
PubMedDate not supplied

The role of nurses in telemedicine and child abuse.

Telemedicine allowed for imaging and videoconferencing between staff at a medical center hub and registered nurses who performed child abuse examinations at community hospitals. By means of electronic communication and information technology, a network was designed to facilitate the examination of children at distant locations when abuse was suspected. Telemedicine provided for expert consultation, rapid evaluation, response to community needs, and an expanded role for nurses. This anecdotal evaluation explored the experience from the view of the registered nurses and an advanced registered nurse practitioner who participated in the telemedicine network. Findings indicated that nurses went through phases of adjustments while becoming familiar with the information technology, cameras, and setup while focusing on the needs of the children and their own responses. Telemedicine nurses were able to draw upon their clinical backgrounds in caring for children and apply their knowledge and skills when assessing victims of abuse. On the basis of interviews and observation, it was concluded that telecommunication did not interfere with the nurse-patient relationship.

Adult↗
PubMedDate not supplied

Technical overview of a web-based telemedicine system for wound assessment.

This report provides a technical overview of a Web-based telemedicine system for monitoring wounds in patients who do not have immediate access to the services of a consulting physician, including patients at home or in long-term-care facilities. Such a system would allow for the easy transmission and access of digital images of a patient's wounds and would allow multiple types of data required for comprehensive management of a patient's condition to be summarized and displayed. A store-and-forward method of data transmission was chosen for this project, rather than real-time videoconferencing, to limit the use of expensive technology and to maximize convenience for both the patient and the consulting physician. Under the store-and-forward technique, a clinician obtains wound data from the patient, then transmits these data to a Web site where the telemedicine physician can view data from multiple patients at his or her convenience.

Humans↗
PubMedDate not supplied

Strategic partnerships: bridging the collaboration gap.

"Teambuilding," "partnering," "outreach," and "collaboration" all are terms of the new millennium. Such terms suggest a continuing trend in healthcare. Partnering and collaboration are the hallmark of many successful models implemented by practice and academic healthcare settings worldwide. Strategic partnering, within and beyond institutions, provides opportunities for personal and professional growth, outreach, and collaboration. Within the global nursing community, cross-national partnerships represent a vehicle for extending knowledge sharing, and for using on-site visits, tele- and videoconferencing, electronic mail, and other resources. The World Wide Web has opened doors to distance learning programs that were once a dream, and that now represent reality. The author addresses the partnering concept and applications within the local healthcare community, within the country, and worldwide.

Attitude of Health Personnel↗
PubMed2000

Practical low-cost visual communication using binary images for deaf sign language.

Deaf sign language transmitted by video requires a temporal resolution of 8 to 10 frames/s for effective communication. Conventional videoconferencing applications, when operated over low bandwidth telephone lines, provide very low temporal resolution of pictures, of the order of less than a frame per second, resulting in jerky movement of objects. This paper presents a practical solution for sign language communication, offering adequate temporal resolution of images using moving binary sketches or cartoons, implemented on standard personal computer hardware with low-cost cameras and communicating over telephone lines. To extract cartoon points an efficient feature extraction algorithm adaptive to the global statistics of the image is proposed. To improve the subjective quality of the binary images, irreversible preprocessing techniques, such as isolated point removal and predictive filtering, are used. A simple, efficient and fast recursive temporal prefiltering scheme, using histograms of successive frames, reduces the additive and multiplicative noise from low-cost cameras. An efficient three-dimensional (3-D) compression scheme codes the binary sketches. Subjective tests performed on the system confirm that it can be used for sign language communication over telephone lines.

Algorithms↗
PubMed2002

Multimedia telehomecare system using standard TV set.

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

Computer Communication Networks↗
PubMed1998

Telemedicine in neonatology: lessons from North Queensland.

Using videoconferencing technology, educational programs in neonatology were provided for staff at rural hospitals. The technology was also used to reunite babies with their families and its usefulness in long-distance diagnosis was assessed. Eighty-two educational sessions were delivered over a 9 month period and, despite problems with technology, operation and presentation, were considered worthwhile by the audiences. Family reunions were very successful. Neonatal diagnosis was impossible at the narrow bandwidth used (128 kilobits/s). Valuable lessons were learned regarding optimum use of this medium.

Education, Medical, Continuing↗
PubMed1998

Technology in education: what is appropriate for rural and remote allied health professionals?

Recent technological advances provide exciting opportunities for the delivery of education to rural and remote allied health professionals. Distance education modes can overcome barriers of distance and cost. However, the use of technologies may allow distance education to be more interactive for rural and remote professionals. Technologies that can be used are audioconferencing, videoconferencing, electronic mail (email), CD-ROM and the Internet. Combinations of any of these technologies and traditional forms of educational delivery are possible. The important objective is to create a learning environment that maximises interactivity and develops information literacy.

Allied Health Personnel↗
PubMed2006

Continuing professional development for rural physicians: an oxymoron or just non-existent?

There is geographic maldistribution of physicians across Australia and their professional isolation, particularly in relation to continuing professional development, is a definite problem. It tends to be worse in smaller centres where there is no critical mass that allows for peer support. Although some academic research has been carried out concerning the needs of rural GP, none has targetted rural specialists. Several activities, including the Commonwealth-funded Support Scheme for Rural Specialists, have been well received and other initiatives, including the rural clinical schools and university departments of rural health, are beginning to provide an infrastructure that will help overcome the professional isolation through the use of innovative technologies such as interactive videoconferencing. This is being used to deliver RACP initiatives such as the basic physician trainee lecture series and the potential for vertical integration of training in rural settings which offer some promise to address the rural workforce shortage in the years to come.

Australia↗
PubMed2005

Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world.

Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).

Humans↗
PubMed1996

Enhancing the role public health nurses play in serving children with special health needs: an interactive videoconference on Public Law 99-457 Part H.

Public Law 99-457 Part H supports the development of systems to identify infants and toddlers with special health needs and provide these children the comprehensive care they need. Although public health nurses traditionally provide many of the mandated services. Part H, with its roots in education, presents new terminology, conceptual models, and challenges to public health nurses. An interactive videoconference entitled "Public Health Nurses and Part H: Putting the Pieces Together" was broadcast to 525 public health nurses in 11 states. The program goals were to increase knowledge of Part H among public health nurses and to enhance their role in its implementation. An evaluation was conducted to assess knowledge change and satisfaction with the program format. Results revealed a high degree of satisfaction with distance learning and no difference across sites in knowledge acquisition or participant satisfaction. A need identified through this project is increased interdisciplinary communication among those who serve infants and toddlers with special needs. In an era when financial resources are dwindling, interactive videoconferencing is an innovative and cost-effective method for decreasing the isolation of many public health nurses by offering opportunities for education and networking from their local communities.

Child Health Services↗
PubMed2005

Recruiting and retaining mental health professionals to rural communities: an interdisciplinary course in Appalachia.

CONTEXT: Faculty from 5 disciplines (health administration, nursing, psychology, social work, and special education) collaborated to develop and teach a distance-learning course designed to encourage undergraduate and graduate students to seek mental health services employment in rural areas and to provide the skills, experience, and knowledge necessary for successful rural practice. METHODS: The primary objectives of the course, developed after thorough review of the rural retention and recruitment literature, were to (1) enhance interdisciplinary team skills, (2) employ technology as a tool for mental health practitioners, and (3) enhance student understanding of Appalachian culture and rural mental health. Didactic instruction emphasized Appalachian culture, rural mental health, teamwork and communication, professional ethics, and technology. Students were introduced to videoconferencing, asynchronous and synchronous communication, and Internet search tools. Working in teams of 3 or 4, students grappled with professional and cultural issues plus team process as they worked through a hypothetical case of a sexually abused youngster. The course required participants to engage in a nontraditional manner by immersing students in Web-based teams. FINDINGS: Student evaluations suggested that teaching facts or "content" about rural mental health and Appalachian culture was much easier than the "process" of using new technologies or working in teams. CONCLUSIONS: Given that the delivery of mental health care demands collaboration and teamwork and that rural practice relies increasingly more on the use of technology, our experience suggests that more team-based, technology-driven courses are needed to better prepare students for clinical practice.

Adult↗
PubMedDate not supplied

Rural telemedicine data/image transfer methods and purposes of interactive video sessions.

A national survey conducted for the Office of Rural Health Policy in 1995 identified 558 participants in rural telemedicine; 499 (89%) responded to a detailed follow-up survey to describe type of use. While 84% of respondents reported using interactive video, only 25% reported access to e-mail for exchange of data. The challenge to medical informatics is to connect dispersed providers, not just with videoconferencing, but also with other information-sharing methods.

Computer Communication Networks↗
PubMedDate not supplied

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) project: technical implementation.

The Columbia University Informatics for Diabetes Education and Telemedicine IDEATel) project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine. The focal point of the intervention is the home telemedicine unit (HTU), which provides four functions: synchronous videoconferencing over standard telephone lines, electronic transmission for fingerstick glucose and blood pressure readings, secure Web-based messaging and clinical data review, and access to Web-based educational materials. The HTU must be usable by elderly patients with no prior computer experience. Providing these functions through the HTU requires tight integration of six components: the HTU itself, case management software, a clinical information system, Web-based educational material, data security, and networking and telecommunications. These six components were integrated through a variety of interfaces, providing a system that works well for patients and providers. With more than 400 HTUs installed, IDEATel has demonstrated the feasibility of large-scale home telemedicine.

Case Management↗
PubMedDate not supplied

Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: rationale and design.

The Columbia University Informatics for Diabetes Education and Telemedicine (IDEATel) Project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine in the management of older patients with diabetes. The study is designed as a randomized controlled trial and is being conducted by a state-wide consortium in New York. Eligibility requires that participants have diabetes, are Medicare beneficiaries, and reside in federally designated medically underserved areas. A total of 1,500 participants will be randomized, half in New York City and half in other areas of the state. Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project-based nurse, electronic transmission of home fingerstick glucose and blood pressure data, and Web access to a project Web site. End points include glycosylated hemoglobin, blood pressure, and lipid levels; patient satisfaction; health care service utilization; and costs. The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services.

Case Management↗
PubMed2000

Current experiences with internet telepathology and possible evolution in the next generation of Internet services.

The last five years experience has definitely demonstrated the possible applications of the Internet for telepathology. They may be listed as follows: (a) teleconsultation via multimedia e-mail; (b) teleconsultation via web-based tools; (c) distant education by means of World Wide Web; (d) virtual microscope management through Web and Java interfaces; (e) real-time consultations through Internet-based videoconferencing. Such applications have led to the recognition of some important limits of the Internet, when dealing with telemedicine: (i) no guarantees on the quality of service (QoS); (ii) inadequate security and privacy; (iii) for some countries, low bandwidth and thus low responsiveness for real-time applications. Currently, there are several innovations in the world of the Internet. Different initiatives have been aimed at an amelioration of the Internet protocols, in order to have quality of service, multimedia support, security and other advanced services, together with greater bandwidth. The forthcoming Internet improvements, although induced by electronic commerce, video on demand, and other commercial needs, are of real interest also for telemedicine, because they solve the limits currently slowing down the use of Internet. When such new services will be available, telepathology applications may switch from research to daily practice in a fast way.

Humans↗
PubMed2000

Experience with a dynamic inexpensive video-conferencing system for frozen section telepathology.

AIM: To evaluate the feasibility of an inexpensive, generally applicable video-conferencing system for frozen section telepathology (TP). METHODS: A commercially widely available PC-based dynamic video-conferencing system (Picture-Tel LIVE, model PCS 100) has been evaluated, using two, four and six ISDN channels (128-384 kilobits per second (kbs)) bandwidths. 129 frozen sections have been analyzed which were classified by TP as benign, uncertain (the remark probably benign, or probably malignant was allowed), malignant, or not acceptable image quality. The TP results were compared with the original frozen section diagnosis and final paraffin diagnosis. RESULTS: Only 384 kbs (3 ISDN-2 lines) resulted in acceptable speed and quality of microscope images, and synchronous image/speech transfer. In one of the frozen section cases (0.7%), TP image quality was classified as not acceptable, leaving 128 frozen sections for the analysis. Five of these cases were uncertain by TP, and also deferred by frozen section procedure (FS). One more benign and three malignant FS cases were classified as uncertain by TP. Three additional cases were uncertain by FS, but benign according to TP (in agreement with the final diagnosis). In one case, FS diagnosis was uncertain but TP was malignant (in agreement with the final diagnosis). Thus, test efficiency (i.e., cases with complete agreement) was 120/128 (93.8%, Kappa = 0.88) between FS and TP. Sensitivity was 93.5%, specificity 98.6%, positive and negative predictive values were 97.7% and 96.0%. Between TP and final diagnosis agreement was even higher. More importantly, there was not a single discrepancy as to benign-malignant. Moreover, there was a clear learning effect: 5 of the 8 FS/TP discrepancies occurred in the first 42 cases (5/42 = 11.9%), the remaining 3 in the following 86 cases (3/86 = 3.5%). DISCUSSION: The results are encouraging. However, TP evaluation is time-consuming (5-15 min for one case instead of 2-4 min although speed went up with more experience) and is more tiring. The system has the following technical drawbacks: no possibility to point at objects or areas of interest in the life image at the other end, resolution (rarely) may become suboptimal (blocky), storage of images evaluated (which is essential for legal reasons) is not easy and no direct control of a remote motorized microscope. Yet, all users were positive about the system both for telepathology and personal contact by video-conferencing. CONCLUSION: With a relatively simple videoconferencing system, accurate dynamic telepathology frozen section diagnosis can be obtained without false positive or negative results, although a limited number of uncertain cases will have to be accepted.

Costs and Cost Analysis↗