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PubMed2005

Teleneurology.

Teleneurology enables neurology to be practised when the doctor and patient are not present in the same place, and possibly not at the same time. The two main techniques are: (1) videoconferencing, which enables communication between a doctor and a patient who are in different places at the same time (often called realtime or synchronous), and (2) email, where the consultation is carried out without the patient being present, at a time convenient to the doctors involved (asynchronous or store-and-forward teleneurology). Some problems that can be solved by teleneurology include: (1) patients admitted to hospital with acute neurological symptoms rarely see a neurologist; (2) delayed treatment for acute stroke; (3) non-optimum management of epilepsy; (4) unproductive travel time for neurologists; (5) extremely poor access to a neurologist for doctors in the developing world; (6) long waiting times to see a neurologist. Neurology is a specialty that, because of the emphasis on accurate interpretation of a history, does lend itself to telemedicine. It has been a late starter in realizing the benefits of telemedicine and most of the publications on teleneurology have been in the last five years. Its uptake within the neurological community is low but increasing. Telemedicine requires a significant change in how neurologists practise. The evidence to date is that teleneurology can narrow the gap between patients with neurological disease and the doctors who are trained to look after them.

Electronic Mail↗
PubMed2006

Teledermatology reduces the number of patient referrals to a dermatologist.

During a two-year study, 505 teledermatology consultations were carried out on 503 patients of 29 participating general practitioners (GPs) in the province of Friesland. One overview and two detail digital photographs of the skin problems were taken on a digital camera and attached to an email message containing standard clinical information. These email messages were sent to a dermatologist, who replied by email after evaluation. After a median follow-up time of 548 days, the GPs were interviewed about the dermatological referrals. The reduction in referrals was 51% (0.95 confidence interval = 47-58%) when the GP had the intention to refer. When the GPs had no intention to refer, there turned out to be a secondary traditional consultation in 17% of cases. The reduction of 51% of referrals after store-and-forward teledermatology consultation was similar to that seen in other studies of videoconferencing. Consultation using digital store-and-forward teledermatology by the GP can halve the number of referrals to a dermatologist for selected patients.

Adolescent↗
PubMed2006

Tele-education.

Tele-education has been used for many years to deliver continuing education programmes to rural health-care professionals. The main modes are audio, video and computer. Audio technologies involve the transmission of the spoken word (voice) between learners and instructors, either synchronously or asynchronously. Examples of the former include audioconferencing and short-wave radio; examples of the latter include audiotape or audiocassette. Video for distance learning, like audio, can be used in either synchronous or asynchronous fashion. Videoconferencing, or interactive television, are considered synchronous because there is the opportunity for live visual and verbal interaction between instructors and learners. Asynchronous instructional video tools include slow-scan video, interactive videodiscs and videotapes. Computer-assisted learning or instruction can be defined as any learning that is mediated by a computer and which requires no direct interaction between the user and a human instructor in order to run. It is becoming increasingly common. Examples include: the Internet and World Wide Web, email, synchronous and asynchronous computer-mediated communication applications and interactive multimedia applications on CD-ROM. Tele-education technologies have an important role to play in addressing the professional isolation which is experienced by rural and remote health-care professionals.

Audiovisual Aids↗
PubMed1996

Experimental telemedicine in orthopaedics.

There have so far been few telemedical applications in orthopaedics. This experiment involved clinicians in three different locations, two in Helsinki and the third in Tampere, consulting one another simultaneously. We used an ATM network to transfer X-ray pictures, digitized by a 12-bit CCD scanner and archived in a central image server. The consultations between the clinicians and the examination of the patient were transmitted by a videoconferencing system using the ISDN. We found that telemedicine offers new possibilities in orthopaedics, for clinical work, for training and for research.

Finland↗
PubMed1996

Telemedicine applications in an integrated mental health service based at a teaching hospital.

Psychiatric applications have predominated in Australian telemedicine in recent years. This paper describes the development of the first telemedicine system for an integrated mental health service based at a teaching hospital. Much effort was devoted to training and education for staff. Within about six weeks of the system being installed, over 80% of all clinical administrative staff, from all the mental health disciplines of the integrated service, had completed a formal training programme. Applications within the service included direct clinical work and the use of videoconferencing in preference to standard telephony over short distances. Applications external to the service, over distances of thousands of kilometres, included clinical supervision and teaching. Evaluation is continuing.

Community Mental Health Services↗
PubMed1997

Telemedicine and the New Children's Hospital (Royal Alexandra Hospital for Children).

Telemedicine is an important factor in the future strategy of the Royal Alexandra Hospital for Children. As a state, national and international centre of excellence, it is the hospital's role to assist in the development of the best child health services. An important aim is to provide easy access to a full range of paediatric services through the provision of a comprehensive telemedicine service, which encompasses videoconferencing and tele-imaging, and positions the child as the centre of service provision. Experience so far suggests that in Australia, as in other countries, the adoption of telemedicine may outstrip the ability of the legislative and administrative frameworks to keep pace. Thus, the enablers appear to be cultural and technological while the obstacles are rooted in the way in which health systems are financed and administered.

Hospitals, Pediatric↗
PubMed1997

A pilot study in medical education using interactive television.

Medical students in the United Arab Emirates do not receive postmortem teaching. This is because postmortems are not normally carried out, for cultural reasons. In order to address this problem a collaborative project was established between the medical schools of Aberdeen University and the United Arab Emirates University to evaluate the feasibility, acceptability and effectiveness of telepathology teaching. A videoconferencing link was established between the UK and the Middle East using ISDN at a transmission speed of 384 kbit/s. Although some technical problems relating to line continuity were encountered, the results relating to feasibility, acceptability and effectiveness were very positive. Although expensive, this form of teaching may still be cost-effective in relation to the benefits.

Autopsy↗
PubMed1997

A protocol for telemedical consultation.

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384 kbit/s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 degrees. The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.

Clinical Protocols↗
PubMed1998

Patient satisfaction with realtime teledermatology in Northern Ireland.

Teledermatology consultations were organized between two health centers and two hospitals in Northern Ireland using low-cost videoconferencing equipment. A prospective study of patient satisfaction was carried out. Following each teleconsultation, patients were asked to complete a questionnaire assessing their satisfaction with the service. Over 22 months, 334 patients were seen by a dermatologist over the video-link, and 292 patients (87%) completed the 16-item questionnaire. Patients reported universal satisfaction with the technical aspects of teledermatology. The quality of both the audio and the display was highly acceptable to patients. Personal experiences of the teledermatology consultation were also favourable: 85% felt comfortable using the video-link. The benefits of teledermatology were generally recognized: 88% of patients thought that a teleconsultation could save time. Patients found the teledermatology consultation to be as acceptable as the conventional dermatology consultation. These findings suggest overall patient satisfaction with realtime teledermatology.

Adolescent↗
PubMed1998

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: is clinical management by realtime teledermatology possible?

Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment. Phase 2 of the trial aimed to assess its effectiveness as a management tool for dermatological disease. Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded. A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime. A comparison of these management plans revealed that the same plan was recommended in 64% of cases; the teledermatologist was unable to advocate a suitable management plan in 19% of cases; a suboptimal treatment plan was suggested by the teledermatologist in 6% of cases; and in 11% of cases, the teledermatologist suggested an inappropriate treatment plan. These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link.

Adolescent↗
PubMed1998

Telepsychiatry: an island pilot project.

A telemedicine link was established in 1996 between the island of Inishmore and the department of psychiatry in University College Hospital, Galway. The link was mainly used to facilitate emergency consultations between patients on the island and the duty psychiatrist, always at the request of the island's general practitioner. Nine patients were referred for assessment in this manner over eight months. Three patients had their first psychiatric contact and assessment through the video-link, and were followed up as outpatients via the link to eventual resolution of the episode of illness and discharge at the outpatient clinic. Our experience has been that videoconferencing systems are acceptable and satisfactory for patients and staff alike.

Adult↗
PubMed1998

Telemedicine in primary care in Israel.

A primary-care teleconsulting system was established between an academic family medicine centre and a clinic about 50 km away. The videoconferencing units were connected at 384 kbit/s. Seven patients were examined by a physician in the clinic and then examined by a consulting physician using the telemedicine system. Four other patients were examined through the telemedicine system first and by a local physician later. The telemedicine consultation solved five of the patients' medical problems. The waiting period before receiving expert medical consultation was reduced. There was full patient satisfaction regarding this method of consultation, patient 'run around' was avoided and patients felt at ease. The telemedicine consultation process improved the patient-physician bond and the attending physician's level of confidence.

Adult↗
PubMed1998

A pilot study of tele-oncology in Scotland.

A pilot study of tele-oncology linking a cancer centre with a rural district general hospital was carried out; it involved patients, physicians, surgeons, radiologists and nursing staff. Its purpose was to complement the existing on-site outpatient services, providing oncological advice on non-clinic days. During the six months of the trial, 18 videoconferences were conducted. Their median duration was 17 min (range 7-40). Eight videoconferences involved patients directly. Acceptability of videoconferencing to doctors, nurses and patients was assessed by a questionnaire. Patients and staff found the technique acceptable and were satisfied with the results. The addition of a teleradiology system to teleconsultations was found to be important when decisions on patient management were taken. Following the success of this pilot trial, large studies of tele-oncology in the UK with measures of cost-effectiveness are needed.

Cost-Benefit Analysis↗
PubMed1998

Patient reactions to specialist telemedicine consultations--a sociological approach.

A sociological study was made of patient experiences of telemedical specialist consultations in northern Norway. The study made use of a qualitative methodological approach. The data were collected through unstructured in-depth interviews of patients or the parents of very young patients. The patients were referred for a telemedical otolaryngology consultation in a randomly selected period of three months. Of a total of 35 patients, 15 refused to participate in the study. Of the 20 remaining, three were excluded for practical and financial reasons. The telemedicine consultation consisted of a general practitioner examining patients endoscopically and realtime transmission of the examination to a specialist by means of a videoconferencing system. Video-communication seemed to restrict personal contact with the specialist. In spite of that, it was not the video-communication itself but the social situation that mattered to the patients. Compared with an ordinary medical consultation, a telemedical consultation represented a wider interaction system, with more channels for access, inspection and information, which gave the patients different options for participation in the consultation.

Adolescent↗
PubMed1999

Evaluation of a telepsychiatry pilot project.

We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist (C$610 per consultation); with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.

Canada↗
PubMed1999

Patient satisfaction with telemedicine in a prison environment.

Prison inmates were surveyed about their perceptions of the use of videoconferencing in clinical consultations. A 14-item questionnaire was used to assess satisfaction with the patient-physician clinical interaction. Of the 299 inmates surveyed immediately after their teleconsultations, 221 completed questionnaires that were suitable for analysis (74%). Only 9% of patients indicated that they were not satisfied with the teleconsultation. They rated the telemedicine context well above the midpoint of the scale (16) on both an information-exchange and a patient-comfort dimension, with means of 29 and 24, respectively. There was a significant difference (P < 0.01) in the patient-comfort dimension in terms of the location of the prisoners. No significant differences were found in patient satisfaction related to the specialty of the physician. The results suggest that many contextual factors must be considered to understand the communicative implications of patient satisfaction with telemedicine.

Female↗
PubMed1999

School-based telemedicine: using technology to bring health care to inner-city children.

In the USA, children in low-income, medically understaffed areas have difficulty accessing health care. A pilot telemedicine service was established in Kansas, linking four elementary schools with a local hospital at 128 kbit/s. PC-based videoconferencing systems, a stethoscope, an otoscope and fax machine were installed for each school's nurse. During the first three months of operation, 187 consultations were conducted by a hospital physician over the video-link. Ear, nose and throat problems were the most common reason for referral (29%), followed by dermatological problems (20%) and mandatory school physicals (20%). Prescriptions were issued in 67% of cases. Eighteen per cent of children required referrals for specialist care. The pilot service successfully enabled medically disadvantaged children to receive health care and prompted four additional schools to join the project.

Child↗
PubMed1999

Telemedicine and distance learning--experience in Georgia and future prospects.

Telemedicine and distance learning have a high priority in Georgia owing to the uneven distribution of health-care resources. Outside the country's capital, Tbilisi, resources and manpower are scarce, so telemedicine may be the best option for health-care delivery in spite of the costs. However, an adequate infrastructure must be in place to make this possible. The National Information Learning Centre (NILC) provides access to the Internet and MEDLINE and is currently assessing the best software for low-bandwidth distance learning and videoconferencing.

Computer Communication Networks↗