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PubMed2002

Telemedicine by email--experience in neonatal care at a primary care facility in rural India.

During an 18-month study period, teleconsultations were conducted by email between a neonatal intensive care unit at an urban teaching hospital in western India and a rural primary care centre 40 km away. There were email consultations about 182 newborn babies; these consultations comprised 309 messages sent from the primary care centre and 272 messages from the teaching hospital. The average reply time was 11.3 h. Thirty-eight babies were referred to the intensive care unit at the teaching hospital after these consultations. The remaining 144 babies were managed at the primary care centre. Telemedicine helped in the diagnosis, referral, treatment and follow-up of patients. The cost of the email service was estimated to be Rs12,000 and the savings in avoided transfer were estimated to be Rs546,000, a cost-benefit ratio of 1:45.

Child Health Services↗

PubMed2004

Evaluation of an accident and emergency teleconsultation service for north-east Scotland.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.

Adult↗

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↗

PubMed2003

The reliability of diagnosis using store-and-forward teledermatology.

We compared diagnoses made by a teledermatologist from digital photographs and patient histories sent from general practitioners using a store-and-forward technique and those made by another dermatologist in a face-to-face consultation with the same patients. A total of 117 patients (mean age 47 years) were referred by 18 general practitioners for diagnosis of a skin condition. Between one and seven digital images were transmitted per case. In 31% of the cases, three images were transmitted. There was full concordance between store-and-forward and face-to-face diagnoses in 57 of 106 cases (54%); in 10 cases (9%) there was overlap between the differential diagnoses provided by the teledermatologist and the face-to-face consultant. Diagnostic categories with relatively high concordances were eczema and follicular eruptions. General practitioners need to be trained in the making of digital images and in giving a good patient history.

Diagnosis, Differential↗

PubMed2004

Improving the quality of eye care with tele-ophthalmology: shared-care glaucoma screening.

We evaluated a shared-care tele-ophthalmology service initiated by the Rotterdam Eye Hospital and 10 optometrists working in retail optician stores. The optometrists screened their clients with a nerve fibre analyser and the resulting images were then further assessed by trained technicians at the hospital. We analysed data from 1729 patients and measured several indicators of the quality of the work as well as its efficiency and effectiveness. The quality of the images was at least satisfactory in most cases (89%), and the agreement between the optometrists and the hospital about normal or suspect test results was high (81%). Only 27% of the patients were called for additional testing at the hospital department and 11% consulted an ophthalmologist. Eighty new cases of glaucoma were detected. The combination of task redesign and telemedicine accounted for the success of the screening service. Task redesign was needed to transfer screening from the hospital to primary care in a safe and responsible way. Telemedicine was crucial for assuring quality, facilitating information exchange and for coordination.

Diagnostic Techniques, Ophthalmological↗

PubMed2005

Realtime telemedicine for paediatric otolaryngology pre-admission screening.

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a pre-admission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 13 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaediatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.

Adolescent↗

PubMedDate not supplied

Cyberchondriacs.

Over 110 million Americans have accessed the internet for healthcare information. This information is often used in medical consultations and possibly contributing to increasing health care burdens. Although well informed patients are an advantage in disease management, the quality and reliability of information online is variable. Adolescents today have grown up with the Internet as a primary knowledge source, but still lack the skills to effectively filter credible information. Voluntary standards on health information have been attempted by Health on the Net Foundation; however their success has been limited, mainly due to the fact that most people searching for health information on line use a search engine rather than a specific site. This makes regulations almost impossible. Cyberchondriacs, a term used to describe anyone who seeks health-related information on the Internet, are not only at risk of acquiring unreliable information on line and therefore potential unnecessary anxiety, but they could also be financially exploited, for example, by e-health organisations and pharmaceutical companies. Moreover, the vulnerable e-health seeker, such as the inexperienced adolescent, is able to buy any quantity of nearly any medication on-line. Reasons for patients seeking information on line are varied, but include not having enough time at consultations. To try to address these issues, organisations such as NHS direct have been set up but their success is difficult to measure due to a lack of data. However, potential exploitation of a vulnerable population and the motivations behind their search for information on the internet merit further study.

Adolescent↗

PubMedDate not supplied

Personal computer teleradiology interhospital image transmission of neonatal radiographs to facilitate tertiary neonatology telephone consultation and patient transfer.

OBJECTIVE: Our purpose was to study the ability of personal computer teleradiology (PCT) to improve the quality of communication between physicians during newborn infant transfers and consultations. STUDY DESIGN: In the first part of the study 36 radiographs of neonatal intensive care unit patients were transmitted by PCT. The pediatrician reviewed the original films and three neonatologists reviewed the PCT images. Their interpretations were scored by use of criteria established by a neutral reader. In the second part chest x-ray films (CXR) of 31 newborns weighing > 2000 gm with respiratory distress were transmitted by PCT. A pediatrician and three neonatologists participated in an exercise to simulate a telephone neonatology consultation. Patient severity assessments as measured by assignments to receive intermediate or intensive care were compared before and after neonatologists viewed the PCT image of the CXR. RESULTS: In part 1 of the study neonatologists correctly identified 98%, 91%, and 98% of the x-ray interpretation scoring items, whereas at best the pediatrician identified 82% of the scoring items (p = 0.002). In part 2 neonatologists correctly assigned patient care levels an average of 73% after reviewing a standard clinical profile and a written description of the infant's CXR. After reviewing a PCT image of the infant's CXR, patient care level assignments were correctly assigned an average of 67%. The interpretation of the PCT CXR image was consistent with the radiologic report of record in 90 of 93 interpretations (31 cases read by three neonatologists). CONCLUSIONS: PCT represents an inexpensive means to accurately send a radiographic image over the phone as part of a telephone consultation. Neonatologists were able to interpret teleradiology images more accurately than a pediatrician reviewing the original film. Although this did not result in an improvement in the neonatologists' ability to determine patient severity on the basis of the model used in part 2, their identification of serious radiographic findings missed by the pediatrician can only suggest that teleradiology may be beneficial in certain instances. Although verbal communication can often suffice in a telephone consultation or transfer, there may be specific instances when visualizing a radiographic image such as an x-ray film or computed tomographic scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources.

Humans↗

PubMed2003

User satisfaction with allied health services delivered to residential facilities via videoconferencing.

We have investigated the role of videoconferencing in allied health service provision to high-care clients in rural residential facilities. Videoconferencing equipment was set up at a rural aged-care facility and a metropolitan allied health centre; ISDN transmission at 384 kbit/s was used to link the equipment. Twelve residents were assessed by both videoconference and face to face across five allied health disciplines (a total of 120 assessments). User satisfaction was measured using questionnaires and focus groups. Face-to-face assessment took significantly longer than videoconferencing assessment. However, the mean satisfaction ratings for face-to-face assessments were higher than for videoconferencing and the majority of the staff preferred the face-to-face format. Videoconferencing was particularly useful for consultations and the initial stages of the assessment process. A number of issues relating to the videoconferencing equipment, to the environment in which assessments were performed and to the clients themselves need to be addressed in order for this form of service delivery to be effective.

Aged↗

PubMed1999

Integration of quality programs by telemedicine in surgical services.

Surgical procedures can be performed and monitored in operating rooms physically isolated, but electronically linked to a parent medical center, and certainly from distant consultation. Quality of surgical care has been measured in retrospect rather than in real time, and outcomes have generally not had the benefit of immediate consultation and group analysis. However, telemedicine can connect consultants, surgeons, patients, and databases. The Yale Telemedicine Center has developed network schemes, which connect the OR of trainees with the laboratory of the teacher, and has opened a continuum between pedagogy and product. The program has connected regional hospitals, connected components of hospital systems, and has been used in international testbeds. The particular operative procedures studied have been laparoscopic procedures. The consultant is based at Yale and is connected with the distant OR to share the laparoscopic surgical field. Connection includes real time video, audio and the ability to draw instruction on the OR screen. Bandwidths as low as 12kbs(POTS) have been employed with modification with effective intervention. The potential for quality improvement is substantial, and inclusion in quality programs is strongly recommended.

Connecticut↗

PubMed2003

Teledermatology: an intraobserver diagnostic correlation study, part I.

Many studies have been published recently on the effectiveness of teledermatology as a diagnostic tool; however, much of the data comes from live 2-way video teleconferencing consultations and very little comes from more readily available "store and forward" consultations. Moreover, most published studies compare the diagnoses of 2 different dermatologists (interobserver comparison). Given the lack of data on baseline interdermatologist diagnostic variability, the interpretation of currently available diagnostic correlation data is somewhat difficult. The objective of this study is to measure the degree of diagnostic concordance between a dermatologist seeing a patient via a teledermatology consult system and the same dermatologist seeing the same patient face-to-face in a dermatology clinic at a tertiary medical center. A random sample of 404 patients was selected from patients who had routine appointments at our dermatology clinic.

Adolescent↗

PubMed2006

Telephone consultation in palliative care for cancer patients: 5 years of experience in The Netherlands.

GOALS OF WORK: To analyze cancer patient-related consultations of a telephone helpdesk (TH) for palliative care over a period of 5 years in the region of Utrecht, The Netherlands. MATERIALS AND METHODS: A descriptive analysis was performed of consultations over a period of 5 years (2001-2006). The discipline and location of requesting professionals, patient characteristics, reasons for calling, symptoms, palliative care problems and needs for support were registered. MAIN RESULTS: A total of 1,794 consultations were analyzed. There was an increasing number of consultations during the study period. Of the patients, 51% were male and their median age was 65 years (range 0-104). Eighty-four percent were treated at home by their general practitioner. Two thirds of the patients had a life expectancy <4 weeks. Most questions referred to pain (49%), delirium (20%), nausea and vomiting (16%) and dyspnea (12%). The median number of symptoms was 1 (0-6). Of the questions, 54% were related to pharmacological problems, 19% to psychological problems and 21% to the organization of care. Of the requesting professionals, 17% asked for support for themselves. Of the consultations, 14% were related to end-of-life issues: palliative sedation (11%) and euthanasia (3%). CONCLUSION: After more than 5 years, the 24-h telephone consultation service fulfills a need for general practitioners dealing with daily dilemmas in palliative care treatment for cancer patients at home during the last period of their life.

Adolescent↗

PubMed2005

Measurements of the clinical competence of doctors and nurses to process telemedicine referrals for burns patients.

Simulated telemedicine referrals were used to test the ability of groups of clinicians to manage telemedicine referrals of patients with burn injuries. Sixty-one participants recorded burn depth from digital images using a four-point scale. The definitive ('gold standard') diagnoses were based on a review by an experienced consultant burns surgeon. Sixty clinical cases that reflected the routine referrals to a specialist burns service were used for the study. The mean kappa scores for the participants ranged from 0.33 to 0.58, indicating poor to good agreement. The scores for the groups all had a similar pattern, with more experienced staff scoring higher than junior staff. The doctors and nurses specializing in burns had higher scores than the general surgical nurses.

Burns↗

PubMed1999

Integrating interactive television-based psychiatric consultation into an urban community mental health service.

We conducted a pilot study of urban telepsychiatry employing interactive television (IATV) over ISDN links for psychiatric consultation to support a primary-care mental health team. During the six months of the pilot phase, 30 consultations were arranged by the general practitioners for 14 different patients. Of these, 24 were completed by IATV and one by telephone when the IATV link failed. The system was used to manage patients with complex problems, many of whom were difficult to engage in standard services. The results showed high levels of user acceptance. Various problems for the further implementation of such systems were also identified.

Community Mental Health Services↗

PubMed1997

Telepathologic review: utility, diagnostic accuracy, and interobserver variability on a difficult case consultation service.

The diagnostic accuracy of telepathologic analysis has not been compared to that of conventional light microscopic review on a difficult case consultation service. The anatomic pathology consultation files of the University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepathologic and light microscopic review. The telepathologic and light microscopic crude agreement of five pathologists were compared, with use of the original consultation diagnosis as the "gold standard." Cases were scored as correct, partially correct, or incorrect. After making a video diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope. The pathologists performed significantly better with the light microscope, even after excluding cases in areas of inexpertise (P = .005). The mean percentage of cases that the pathologists wanted to review with the light microscope was 64%, and the major reason for review was diagnostic uncertainty. Cases incorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultation service, pathologists perform significantly better with use of light microscopic than with telepathologic analysis; rarely make an incorrect diagnosis and do not request that case for light microscopic review; and exhibit high telepathologic diagnostic accuracy in areas of expertise.

Adolescent↗

PubMed2005

Telemedicine consultation for patients with upper extremity disorders is reliable.

UNLABELLED: Telemedicine is a valuable resource for the delivery of health care to patients in underserved areas. The purpose of this study was to assess the reliability of asynchronous teleconsultation in the diagnosis and establishment of treatment plans for patients with disorders of the upper extremity. One hundred patients with disorders of the upper extremity were prospectively evaluated. Initial patient evaluations, done by an independent evaluator, involved a medical history, physical examination, digital images of the patient, and digitized radiographic studies. This patient information was presented electronically to two hand surgeons 6 months after one surgeon independently evaluated the patients in the outpatient clinic. The physicians formulated diagnosis and treatment plans for the patients based on the blinded electronic information. These findings then were compared with the treatment plans made by the physicians at the time of the patients' visits. Telemedicine consultation resulted in excellent agreement within observers (kappa = .92) and between observers (kappa = .86). Telemedicine consultation seems to be a reliable method for diagnosis and establishment of treatment plans in the management of upper extremity disorders. LEVEL OF EVIDENCE: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2001

Telemedicine in South Africa: success or failure?

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.

Female↗

PubMed2004

Development of teleconsultations systems for e-health.

Two prototype telemedicine systems have been developed: 1) a wireless system for status assessment of cardiology patients (WSCP), 2) a system for medical image management and teleconsultations (IMTS). The former system enables the patient to record an ECG on a personal digital assistant (PDA), view it and send it via a wireless connection. The doctor on duty is then able to view the received ECG and make appropriate decisions, also to apply for consultation by sending the received ECG to the PDA of a cardiology expert. The system logs all performed operations. The hardware used in the system consists of personal computers (PCs), PDAs, analog-digital converters, ECG sensors and GPRS modems. Software consists of programs for patients, doctors on duty, cardiology experts and administration, along with a central database. The second system is intended to be used by professional doctors for management of collected images and for teleconsultations via videoconferencing in order to obtain a second opinion. The system provides an integrated environment eliminating the need to jump between many applications. By using the system, doctors are able to acquire images from analog and digital cameras, process and enhance them, as well as upload them to local or remote databases. Doctors are also able to design custom database forms. The teleconsultation part of the system supports video and audio over ISDN and TCP-IP, using both a hardware codec (Zydacron Z360) and a software codec (based on MS Netmeeting). Images are sent from one client to another using the standard protocol T.120. Images become synchronized immediately upon reception by another client.

Computers, Handheld↗