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PubMed2002

International distance education and the transition from ISDN to high-bandwidth Internet connectivity.

The Thailand-Hawaii Assessment of Interactive Healthcare Initiative (THAI-HI) is an international distance-education project between two teaching hospitals in Honolulu and Bangkok that uses videoconferencing over three ISDN lines. A 'morning report' format is used to discuss clinical cases primarily covering infectious disease and critical-care topics. An audience response system is used at both sites to add interactivity. From July 2001 to May 2002, 816 health-care providers attended 20 clinical conferences. Audiences rated the conferences as highly relevant and as having high training value. Since the ISDN connection is expensive, we plan to convert the telecommunications to a high-bandwidth Internet connection. The Honolulu site will use a 45 Mbit/s commercial connection to the Hawaii Intranetwork Consortium, which links to the Abilene Network on the US mainland. The Bangkok hospital will use a 155 Mbit/s wireless optical connection to UNINET Thailand, which has a 45 Mbit/s circuit to Abilene.

Attitude of Health Personnel↗

PubMed2002

Logistical aspects of large telemedicine networks. 1: Site directories.

We carried out a survey of the site coordinators in a mature telemedicine network of about 200 sites. The site directory contained information about 221 videoconference facilities. There were 191 site coordinators in all (i.e. some coordinators were responsible for more than one site). Of the 221 sites, we were able to contact 87 on first attempt and 155 by the fourth attempt. Thus there were 66 sites (30%) which were not contactable. We asked each site coordinator to describe any videoconference activity that had taken place over the previous five working days. Of the contacted 155 sites, 78 reported some videoconference activity during the period in question. The total reported videoconference activity was 12,800 min during the one-week monitoring period, that is, an estimated 924 h per month. The most common categories of work were education or training (511 h) and management or administration (225 h), which between them accounted for 80% of all reported videoconference activity. Fifty of the 155 sites (32%) reported that the equipment was not located in an area suitable for patient consultations. In addition, 20 sites (13%) volunteered that their videoconferencing facilities were not in working order at the time of the survey. We did not ask this question in the survey, so that this result represents a lower bound for the true number of inoperable systems.

Attitude of Health Personnel↗

PubMed2002

Logistical aspects of large telemedicine networks. 2: Measurement of network activity.

We carried out a retrospective review of the videoconference activity records in a university-run hospital telemedicine studio. Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company. During a seven-month period there were 211 entries in the studio log: 108 calls made from the studio and 103 calls made from a far-end location. We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log. The remaining 92 calls were not recorded, probably for one of several reasons, including: failed calls--a large number of unrecorded calls (57%) lasted for less than 2 min (median 1.6 min); origin of videoconference calls--calls may have been recorded incorrectly in the usage diary (i.e. as being initiated from the far end, when actually initiated from the studio); and human error. Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place. Those responsible for recording and analysing videoconference activity, particularly in large telemedicine networks, should do so with care.

Australia↗

PubMed2003

[Telementoring in surgery].

Tele-mentoring is an interactive experimental method that allows young surgeons' education by distant learning tutoring of an expert surgeon. The problem about assessment of efficacy and quality of computer-assisted instruction is under evaluation today. Tele-mentoring is supported by videoconferencing system and it is not an exclusive methodology but an additional methodology to traditional didactic for clinicians and surgeons. It allows personal virtual trainings by computers and telecommunication systems. Videoconference allows tutoring for telemedicine, teletriage and telesurgery also.

Education, Distance↗

PubMed2003

Assessing home care agencies' readiness for telehealth.

Home healthcare is facing a set of challenging new realities in the 21st century such as funding limitations and increased life expectancy. Many believe that the use of telehealth enabling patients at home to interact with nurses at the clinical site using videoconferencing technology, will be a cost-effective solution to providing quality care services. Many agencies have adopted or are planning on implementing a telehealth solution. Level of agencies' readiness can lead to a lower level of risk, and a more successful innovation outcome. We developed a framework for assessing home care agencies' readiness for telehealth consisting of 35 items. This instrument can be used as a decision support tool for agencies that are about to implement a telehealth system as well as a formative or summative evaluation tool for agencies already utilizing telehealth.

Data Collection↗

PubMed2003

A needs assessment study for the Missouri Tele-hospice Project.

Hospice care focuses on palliation and the relief of suffering aiming to improve the quality of patients' last days. Telemedicine is considered to be a tool that can address challenges such as staff shortage, funding limitations and limited access to services in rural areas. Hospice services via telemedicine can be delivered directly into a patient's home by utilizing videoconferencing technology. The Missouri Telehospice Project aims to investigate the impact of a telehospice model on satisfaction with delivered care, caregiver burden, crisis prevention rates and overall cost of delivered care. Five urban and rural hospice agencies in Missouri are participating. A needs assessment study was conducted where hospice staff members responded to a set of questions within focus group and interview sessions providing feedback about the design, type of technology, frequency of usage and perceived impact on quality of hospice care.

Aged↗

PubMed2004

[Teledermatological consultation].

Teledermatological consultation can be effected in two ways. One is 'store-and-forward' which involves storing photographic digital images and sending them to a consultant dermatologist who then replies by e-mail, and the other is by videoconferencing using a real time interactive audiovisual link. In daily general practice the first method is the easiest to implement. In 76-90% of cases, a diagnosis or differential diagnosis made in this way corresponds with the diagnosis made at the more usual face-to-face examination. The advantage of teledermatological consultation is that diagnosis and therapy take place faster than after regular referral and it is better than no referral at all. The referring physician should deliver data on the patient's history and physical examination in a standardized format. The same is true for the encoded personal data, the working diagnosis, and referral request. One overview and 2 detailed photos from two angles are normally taken. The overview shows the extent and localization of the skin abnormality. The patient has to consent to a teledermatological consultation. The responsibility for the treatment lies with the doctor who sees the patient face-to-face. The data that is transmitted must be encrypted or coded in such a way that it cannot be traced back to one particular person.

Adult↗

PubMed2004

Can absence make a team grow stronger?

Some projects have such diverse requirements that they need a variety of specialists to work on them. But often the best-qualified specialists are scattered around the globe, perhaps at several companies. Remarkably, an extensive benchmarking study reveals, it isn't necessary to bring team members together to get their best work. In fact, they can be even more productive if they stay separated and do all their collaborating virtually. The scores of successful virtual teams the authors examined didn't have many of the psychological and practical obstacles that plagued their more traditional, face-to-face counterparts. Team members felt freer to contribute--especially outside their established areas of expertise. The fact that such groups could not assemble easily actually made their projects go faster, as people did not wait for meetings to make decisions, and individuals, in the comfort of their own offices, had full access to their files and the complementary knowledge of their local colleagues. Reaping those advantages, though, demanded shrewd management of a virtual team's work processes and social dynamics. Rather than depend on videoconferencing or e-mail, which could be unwieldy or exclusionary, successful virtual teams made extensive use of sophisticated online team rooms, where everyone could easily see the state of the work in progress, talk about the work in ongoing threaded discussions, and be reminded of decisions, rationales, and commitments. Differences were most effectively hashed out in tele-conferences, which team leaders also used to foster group identity and solidarity. When carefully managed in this way, the clash of perspectives led not to acrimony but, rather, to fundamental solutions, turning distance and diversity into competitive advantage.

Benchmarking↗

PubMed2003

Virtual Visit: improving communication for those who need it most.

We are developing a videoconferencing system designed specifically to cater to the needs of the elderly and their distant friends and family. Focus group research has led to the incorporation of several key features that enhance the usability of the system. Audio and video transmission quality are optimized by separation, using the proven and familiar capability of analog phone for voice and the slightly less reliable, but faster data transmission of broadband Internet for video. A simple and intuitive user interface was designed based on the familiar steps of an actual household visit. The graphical interface is presented on the user's conventional television receiver and controlled by a simple seven-button remote control with integrated wireless microphone, which provides high quality audio pickup. The system can be remotely activated by a wearable wireless alarm button or by visitors with passkey privileges. A functional prototype has been developed and is currently undergoing field-testing. Preliminary response has been very encouraging. Future plans include extended focus group research, collaboration to integrate improved video transmission schemes, and in-home testing by seniors to gauge long-term user response.

Aged↗

PubMed2004

An online learning course in Ergonomics.

For the past two years, the Department of Occupational Therapy at the University of Haifa has offered an online course to third year occupational therapists on the topic of Ergonomics for Health Care Professionals. The development and implementation of this course was funded by the Israeli Ministry of Education. Unique teaching materials, developed and uploaded to the University's server via "High Learn", included interactive and self-directed documents containing graphics, animations, and video clips. Extensive use was made of the discussion forum and survey tools, and students submitted all assignments online. For the final topic, an expert in ergonomics from Boston University delivered a lecture via two-way videoconferencing. The course site included comprehensive library listings in which all bibliographic materials were made available online. Students accessed course materials at the University in a computer classroom and at home via modem. In an accompanying research study, the frequency of student usage of the various online tools was tracked and extensive data were collected via questionnaires documenting students' demographic background, preferred learning style, prior usage of technology, satisfaction with the course and academic achievement. This paper focuses on the results of the research study that examined how the students responded to and coped with teaching material presented and accessed in this format.

Adult↗

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↗

PubMed2004

Experiences and perspectives in using telematic prevention on sensitive health issues.

The new information and communication technologies, telematics - such as the Internet, telephone services and videoconferencing - are simultaneously both an instrument and a symbol - a sign of progress - but also a potential addiction problem. Sensitive topics - like substances or mental health - bring out all these characteristics of telematics. Therefore the computer world, substances and addictions are closely connected.

Attitude to Computers↗

PubMed2004

Home based E-health applications.

Home based e-health applications use telecommunication and videoconferencing technologies to enable a healthcare provider at the clinical site to conmunicate with patients at their home. Such an interaction is called a 'virtual visit'. Numerous applications are utilizing commercially available monitoring devices and the Internet to enable home based disease management and monitoring. The aim to meet older adults' desire to remain independent at home while controlling home health care costs has also led to the development of "smart home" technologies. A smart home is a residence equipped with technology that enhances safety of patients at home and monitors their health conditions. Therefore, the devices and sensors chosen to be installed and maintained in the older adults' residences need to address functional limitations and social and health care needs. This paper provides an overview of home based e-health applications and discusses the challenges of implementing and evaluating e-health applications.

Home Care Services↗

PubMed2005

[How could telemedicine improve the quality of health care in Poland?].

From the view-point of the health-care system there is possibility of application of modern communication and informatics technologies to optimize some important aspects of patient treatment. This new fields of medical interest are called: telemedicine and medical telecare. Telemedicine deals with distance diagnose (for example: during emergency transport) and specialist consultations based on videoconferencing programs. Medical telecare concerns with home monitoring of patients with chronic diseases by means of computer control of important diagnostic parameters and automatic signaling when the variables exceed the defined values. Both disciplines share problems of standards of electronic medical documentation, virtual medical care networks and tele-education of health-care professionals and patients. The preliminary trials of introduction of some telemedicine programs in the health service units of local and specialist levels should make possible to evaluate the applicability and advantages of using these technologies in the whole Polish health care system in the future.

Humans↗

PubMedDate not supplied

Hemodialysis patient management by telemedicine: design and implementation.

The authors describe the design and implementation of a personal computer based telemedicine system for managing patients by telemedicine. With three identical systems connected by high speed T1 lines, the physician (or allied healthcare giver) can interact, by videoconferencing, and by using multimedia files, with patients at two remote hemodialysis sites. The physician is able to visualize specifically the patient's fistula/graft, and auscultate fistula, heart and lung sounds, and incorporate still pictures or audio sounds in the patient's multimedia database folder, which also contains an electronic and paperless medical record. In addition there is the capability of downloading into this database all the machine parameters during dialysis.

Databases, Factual↗

PubMed1998

A system of tele-oncology at the University of Wisconsin Hospital and Clinics and regional oncology affiliate institutions.

Collaborative associations between academic medical centers and community hospitals can use telemedicine to promote and enhance cancer treatment and clinical research. It is expensive to duplicate communications technology at all sites, but it is possible to share technologies using telemedicine. This paper describes a system in evolution that provides regional oncology services at the University of Wisconsin Hospital and Clinics and regional oncology affiliates. The system requires integrated hardware and software to provide Internet access, videoconferencing, and data transmission. This system is comprised of several forms of technology that promote education and training, continuing medical education, patient evaluation and protocol eligibility, data transfer for radiation therapy treatment planning, and clinical and technologic quality assurance and peer review programs for medical oncology and radiation oncology.

Academic Medical Centers↗

PubMed1997

Respiratory care education goes the distance.

The availability of interactive videoconferencing technology has ignited interest in distance learning programs. Interactive courses can be offered via various technologies as dictated by the needs of educational programs. Allied health programs are employing interactive systems to increase accessibility of quality education to remote, isolated, and underserved areas. A model program in the Central Texas area is meeting the educational needs of respiratory care professionals in a Mexican-American border town. The interactive infrastructure of this project is also being used to offer college courses and continuing education classes in other programs, including Health Information Management and Health Administration.

Allied Health Personnel↗

PubMedDate not supplied

Telemedicine enters eye care: practical experience.

1. A combination of store-and-forward technology and videoconferencing technology can be used in eye care and other medical specialties. 2. Bandwidth is a rate-limiting factor for obtaining a high-resolution, real-time image. 3. Protocols, clinical and technical, must be used to implement telemedicine in an efficient and high-quality manner.

Humans↗