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PubMedDate not supplied

Telemedicine in the neonatal intensive care unit.

A program of telemedicine has been developed in the NICU at the Beth Israel Deaconess Medical Center (BIDMC), in Boston, Massachusetts. The telemedicine project, "Baby Care Link," allows families to have increased access to their infant, care team, and educational information during hospitalization and following discharge. The goal of this multidisciplinary project is to provide an approach to managing the care of the very low birth weight (VLBW) infant. Workstations in the families' homes provide education, care schedules, remote sensor links to clinical providers, and videoconferencing. The linkage of home, clinician, and community centers will allow for the episodic needs of high-risk infants while continuously monitoring progress and managing treatments systematically in the home rather than the NICU setting. It is believed that the use of this emerging technology might lead to shorter hospital stays as well as increased parental understanding and comfort, overall parental satisfaction with care, improvement in health status, improvement in clinician satisfaction, and lastly, a reduction in hospital associated costs.

Adult↗
PubMed1999

Using multi media to enhance a flexible learning program: lessons learned.

Central Queensland University is a well-established distance education provider with an internationally recognized reputation in flexible learning. It has a well-developed infrastructure for the preparation of quality print and multimedia learning materials. A symposium and working conference linking twelve sites, including Auckland NZ via video conferencing, and supported by print based materials and web based conferencing was held during November 1998 with the assistance of Telstra's Conferlink. This paper provides the background, organisation, and evaluation results. Our conclusions are that appropriate use of a combination of print based materials, videoconferencing and a web based classroom works well for the provision of continuing education to health professionals. In addition this symposium was able to reach clinicians and demonstrate the value of informatics to support evidence based practice.

Attitude of Health Personnel↗
PubMed1999

The application of teleophthalmology in examining patients with glaucoma: a pilot study.

PURPOSE: To test the feasibility of teleophthalmology applications in examining patients with glaucoma, test its use for training purposes in an ophthalmology residency program and as a consultation link between primary healthcare unit and university eye clinic, and to introduce a preliminary model for economic assessment of telemedicine application in ophthalmology. METHODS: A video slit-lamp, an automated perimeter, a nonmydriatic fundus camera and a videoconferencing system were installed in a healthcare center in a rural area. Twenty-nine patients with glaucoma were examined in the rural healthcare center instead of the university eye clinic. A control group consisted of 41 glaucoma patients examined at the eye clinic one year earlier. An ophthalmic resident examined the patients together with the local general practitioner. An interactive video consultation was created with the university glaucoma clinic using ISDN connections and special application software. RESULTS: Both patient groups were equally satisfied with the ophthalmic service. Nearly all patients in the telemedicine group (96%) wanted to have their next visit in their own healthcare center instead of the university clinic. The most important reasons were reduction in traveling (97%), costs (92%), and time (92%). The costs of the telemedicine and conventional visits were equal, but decreased traveling saved $55 per visit. However, the quality of the images obtained in the remote center was poorer than that of the images obtained at the university clinic. CONCLUSION: The results of this pilot study indicate that further research with a larger number of patients is warranted to evaluate both methods, technology, and economics of teleophthalmology.

Academic Medical Centers↗
PubMed1999

Recent advances in telemedicine.

With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health care, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in high-bandwidth telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the Web. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household.

Humans↗
PubMed1999

Evaluation of a Canadian telepsychiatry service.

A telepsychiatry pilot project linking five rural general hospitals and Alberta Hospital Ponoka was implemented in June 1996 as a response to both a scarcity of psychiatric resources in the Province of Alberta and the emphasis on community-based care. Psychiatrists located at Alberta Hospital Ponoka provided psychiatric consultations using videoconferencing technology in response to referrals from general practitioners. The project was evaluated through the use of questionnaires administered to consumers, service providers, and psychiatric consultants. Questionnaires were supplemented by interviews, site visits, logs, telephone interviews with consumers, and surveys to general practitioners at the rural sites. A total of 109 consultations occurred during the pilot stage. Results strongly suggested acceptance and satisfaction with the consultation by consumers, general practitioners and psychiatrists. The patient's perceived benefits included timeliness of service, service within their own community, decreased work time loss for self or family, and positive outcomes as a result of specialist expertise. Up until September 30, 1998 a total of 535 consultations had been completed, 381 of which were new referrals and 154 of which were follow up referrals. Seventy-two different physicians referred to the service. The practice profile is dramatically different to outpatient psychiatric practice in which approximately 90% of patient contacts are follow-up visits.

Adolescent↗
PubMed1999

MediLink: a wearable telemedicine system for emergency and mobile applications.

The practical needs of the medical professional faced with critical care or emergency situations differ from those working in many environments where telemedicine and mobile computing have been introduced and tested. One constructive criticism of the telemedicine initiative has been to question what positive benefits are gained from videoconferencing, paperless transactions, and online access to patient record. With a goal of producing a positive answer to such questions an architecture for multipurpose mobile telemedicine applications has been developed. The core technology is based upon a wearable personal computer with a smart-card interface coupled with speech, pen, video input and wireless intranet connectivity. The TransPAC system with the MedLink software system is designed to provide an integrated solution for a broad range of health care functions where mobile and hands-free or limited-access systems are preferred or necessary and where the capabilities of other mobile devices are insufficient or inappropriate. Structured and noise-resistant speech-to-text interfacing plus the use of a web browser-like display, accessible through either a flatpanel, standard, or headset monitor, gives the beltpack TransPAC computer the functions of a complete desktop including PCMCIA card interfaces for internet connectivity and a secure smartcard with 16-bit microprocessor and upwards of 64K memory. The card acts to provide user access control for security, user custom configuration of applications and display and vocabulary, and memory to diminish the need for PC-server communications while in an active session. TransPAC is being implemented for EMT and ER staff usage.

Emergency Medical Services↗
PubMed2000

[Multimedia (visual collaboration) brings true nature of human life].

Videoconferencing system, high-quality visual collaboration, is bringing Multimedia into a society. Multimedia, high quality media such as TV broadcast, looks expensive because it requires broadband network with 100-200 Mpbs bandwidth or 3,700 analog telephone lines. However, thanks to the existing digital-line called N-ISDN (Narrow Integrated Service Digital Network) and PictureTel's audio/video compression technologies, it becomes far less expensive. N-ISDN provides 128 Kbps bandwidth, over twice wider than analog line. PictureTel's technology instantly compress audio/video signal into 1/1,000 in size. This means, with ISDN and PictureTel technology. Multimedia is materialized over even single ISDN line. This will allow doctor to remotely meet face-to-face with a medical specialist or patients to interview, conduct physical examinations, review records, and prescribe treatments. Bonding multiple ISDN lines will further improve video quality that enables remote surgery. Surgeon can perform an operation on internal organ by projecting motion video from Endoscope's CCD camera to large display monitor. Also, PictureTel provides advanced technologies of eliminating background noise generated by surgical knives or scalpels during surgery. This will allow sound of the breath or heartbeat be clearly transmitted to the remote site. Thus, Multimedia eliminates the barrier of distance, enabling people to be just at home, to be anywhere in the world, to undergo up-to-date medical treatment by expertise. This will reduce medical cost and allow people to live in the suburbs, in less pollution, closer to the nature. People will foster more open and collaborative environment by participating in local activities. Such community-oriented life-style will atone for mass consumption, materialistic economy in the past, then bring true happiness and welfare into our life after all.

Endoscopy↗
PubMed2000

Virtual university applied to telesurgery: from teleeducation to telemanipulation.

UNLABELLED: PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

Computer Simulation↗
PubMed2000

Utilising multimedia for training merchant mariners as paramedics.

MERMAID is a telemedicine project with global reach and a 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model is not limited to medical diagnostics but it encompasses all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications are considered while the full range of network choices is explored in terms of the cost/performance tradeoffs inherent to them and the developmental stage each of these options occupies in its life cycle. MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialty care best suited to each particular case. Finally, the development of programme modules for training and education of the seafarers in the use of the MERMAID medical communications system is given top priority as such modules constitute the firmest basis for the promotion of proper practice of telemedicine at sea.

Commerce↗
PubMed2001

Introducing telemedicine technology to rural physicians and settings.

OBJECTIVE: The researchers investigated rural health providers' perceptions of telemedicine, developed a framework for assessing their readiness to adopt this type of technology, and offered a guide for its implementation. STUDY DESIGN: Qualitative data were collected from semistructured interviews with thematic analysis. POPULATION: The study population included physicians, nurses, and administrative personnel located in 10 health care practices in 4 communities in 3 rural Missouri counties. OUTCOMES MEASURED: The researchers measured how often health providers used telemedicine technology and their perceptions of the advantages, disadvantages, barriers, and facilitators involved in adopting it. RESULTS: Participants varied widely in their perceptions of telemedicine. Providers in practices affiliated with the university's tertiary center were more likely to use it than were those in private practice. Interviews and other data yielded 6 themes related to a provider's receptivity to technological change: These themes were turf, efficacy, practice context, apprehension, time to learn, and ownership. Each theme applies to the computer and videoconferencing components of telemedicine, and each may operate as a perceived barrier or facilitator of change. CONCLUSIONS: Care providers and administrators consider a range of factors, including economic ramifications, efficacy, social pressure, and apprehension, when deciding whether and how fast to adopt telemedicine. Since adopting this technology can be a major change, agencies trying to introduce it into rural areas should take all these factors into account in their approach to health care providers, staff, and communities.

Adult↗
PubMed2001

Survey and analysis of satellite-based telemedicine projects involving Japan and developing nations: investigation of transmission rates, channel numbers, and node numbers.

We surveyed interactive telemedicine projects via telecommunications satellite (AMINE-PARTNERS, Post-PARTNERS, and Shinshu University Project using Inmarsat satellites) offered by Japan as assistance to developing countries. The survey helped clarify channel occupation time and data transfer rates. Using our survey results, we proposed an optimized satellite model with VSATs simulating the number of required channels and bandwidth magnitude. For future implementation of VSATs for medical use in developing nations, design of telecommunication channels should take into consideration TCP/IP-based operations. We calculated that one hub station with 30-76 VSATs in developing nation can be operated on bandwidth 6 Mbps using with 128 Kbps videoconferencing system for teleconsultation and teleconference, and linking with Internet.

Asia↗
PubMed2001

EMR-based TeleGeriatric system.

INTRODUCTION: As medical services improve due to new technologies and breakthroughs, it has lead to an increasingly aging population. There has been much discussion and debate on how to solve various aspects such as psychological, socio-economic and medical problems related to aging. Our effort is to implement a feasible telegeriatric medical service with the use of the state of the art technology to deliver medical services efficiently to remote sites where elderly homes are based. The TeleGeriatric system will lead to rapid decision-making in the presence of acute or subacute emergencies. This triage will also lead to a reduction of unnecessary admission. It will enable the doctors who visit these elderly homes once a week basis to improve their geriatric management skills by communication with geriatric specialist. Nursing skills in the geriatric care will also benefit from this system. Integrated electronic medical record (EMR) system will be indispensable in the face of emergency admissions to hospitals. Evolution of EMR database would lead to future research in telegeriatrics and will help to identify the areas where telegeriatrics can be optimally used. METHODOLOGY: This system is based on current web browsing technology and broadband communication. The TeleGeriatric web based server is developed using Java Technology. The TeleGeriatric database server was developed using Microsoft SQL server. Both are based at the Medical Informatics Programme, National University of Singapore. Two elderly homes situated in the periphery of Singapore and a leading government hospital in geriatric care have been chosen for the project. These 3 institutions and National University of Singapore are connected via ADSL protocol. ADSL connection supports high bandwidth, which is necessary for high quality videoconferencing. Each time a patient needs a teleconsultation a nurse or a doctor in the remote site sends the patient's record to the TeleGeriatric server. The TeleGeriatric server forwards the request to the Alexandra Hospital for consultation. Geriatrics specialists at the Alexandra Hospital carry out teleward rounds twice weekly and on demand basis. SUMMARY OF RESULTS: Following the implementation of the system, a trial run has been done. Total results have demonstrated a high degree of coordination and cooperation between remote site and the Alexandra Hospital. Also the patient compliance is very high and they prefer teleconsultation. CONCLUSION: Initial results show that the TeleGeriatric system has definite advantages in managing geriatric patients at a remote site. As the system evolves, further research will show the areas where telegeriatrics can be used optimally.

Aged↗
PubMed2001

The nature of communication in virtual home care visits.

The study's objective was to analyze "virtual" home care visits that utilize telemedicine technology and to investigate the type and quality of interaction between provider and patient. The setting was the TeleHomeCare Project which provides TV-based videoconferencing. Patients are receiving standard home care services with an addition of virtual visits. 122 virtual visits were reviewed and a content analysis was performed for 30 of these. Time was apportioned among the following categories of communication: assessing the patient's clinical status, promoting compliance, addressing psychosocial issues, general informal talk, education, administrative issues, technical issues, assessing patient satisfaction and ensuring accessibility. The findings indicate that technology does not interfere with but rather enriches the care process. Although there are activities that cannot be conducted in virtual visits, they can address most of the important aspects of care delivery giving strength to the argument that they could in some cases substitute traditional visits.

Communication↗
PubMed2001

Making grandma's data secure: a security architecture for home telemedicine.

Home telemedicine presents special challenges for data security and privacy. Experience in the Informatics for Diabetes Education And Telemedicine (IDEATel) project has demonstrated that data security is not a one-size-fits-all problem. The IDEATel users include elderly patients in their homes, nurse case managers, physicians, and researchers. The project supports multiple computer systems that require a variety of user interactions, including: data entry, data review, patient education, videoconferencing, and electronic monitoring. To meet these various needs, a number of different of security solutions were utilized, including: UserID/Password, PKI certificates, time-based tokens, IP filtering, VPNs, symmetric and asymmetric encryption schemes, firewalls and dedicated connections. These were combined in different ways to meet the needs of each user groups.

Aged↗
PubMed2002

Distributed medical informatics education using internet2.

The curricula of most medical informatics training programs are incomplete. We used Internet2-based videoconferencing to expand the educational opportunities of medical informatics students at Oregon Health & Science University and the University of Pittsburgh. Students and faculty in both programs shared extra-curricular research conferences and journal club meetings. A course in Information Retrieval was made available to students in both programs. The conferences, meetings and class were well accepted by participants. A few problems were experienced with the technology, some of which were resolved, and some non-technical challenges to distributing academic conferences, meetings and coursework were also uncovered. We plan to continue our efforts with expanded course and extra-curricular offerings and a more comprehensive evaluation strategy.

Education, Distance↗
PubMed2003

Telemedicine applications in pediatric cardiology.

Echocardiography is often used to diagnose and exclude important cardiac diagnoses in 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, improve patient care, be cost-effective, 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.

Cardiology↗
PubMed2002

Telehealth for older patients: the Hong Kong experience.

We studied the feasibility, acceptability and cost-effectiveness of using telemedicine to provide geriatric services to residents of nursing homes. A local 200-bed nursing home supported by the community geriatric assessment team (CGAT) participated in a one-year study, during which videoconferencing was used to replace conventional outreach or clinic-based geriatric care. The feasibility of telemedicine was evaluated by participating specialists in a total of 1001 consultations. Other outcome measures included productivity gains, utilization of hospital emergency and inpatient services, and user satisfaction. Telemedicine was adequate for patient care in 60-99% of cases in seven different disciplines. The CGAT was able serve more patients and see them earlier and more frequently. Telemedicine was cheaper than conventional care, and well accepted by health-care professionals as well as clients. Substantial savings were achieved in the study period through a 9% reduction in visits to the hospital emergency department and 11% fewer hospital bed-days. Telemedicine was a feasible means of care delivery to a nursing home and resulted in enhanced productivity and cost-savings. Linking more such institutions to care providers would further increase cost-effectiveness.

Aged↗
PubMed2002

The cost-effectiveness of telehealth in metropolitan hospitals.

We established a telehealth link between two inner-city health services about 10 km apart. The video-link between the sites was based on IP videoconferencing; ISDN connections were maintained as a form of system redundancy and to connect to sites beyond the local area network. The cost of a conventional consultation, in which the patient travelled to an outpatient appointment, was 170 Australian dollars. Because existing equipment and telecommunications could be used, the cost of a telehealth consultation was only 74 Australian dollars. During the study approximately 15 teleconsultations were completed and a number of patient transfers were cancelled because they were deemed clinically unnecessary. The preliminary results suggest that the cost-savings from telehealth can be substantial. In addition there were major benefits to continuity of patient care and clinical communication within the organization.

Ambulatory Care↗