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PubMed1998

Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.

Computer Communication Networks↗

PubMed1998

[Responsibilities of the surgeon for therapy planning in solid tumors].

Surgery is still the primary domain for patients suffering from solid cancers, although in many cases multimodal treatment will be required. If the surgeons want to retain this status, the interdisciplinary dialogue must be intensified, as treatment strategies are developed today in an interdisciplinary context. There is a unique chance for future surgeons to establish and lead "tumor boards" within their infrastructure. Tumor boards should be built up in almost every hospital to deal with surgical oncology throughout the entire country. If necessary, specialists from other hospitals or cancer centers must be involved, and modern information technology such as telecommunications should be used to obtain second opinions. Using this technique, smaller hospitals in the area can adapt to the progress and standards of dedicated cancer centers. Modern techniques of telecommunication allow for case presentations and discussions on treatment strategies over long distances, as well as virtual teleconferences in tumor boards meetings. The future role of surgeons in the treatment of solid cancers will depend largely on their ability to resolve the problems outlined here. The surgeon himself must become the modulatory core factor within this evolutionary process.

Combined Modality Therapy↗

PubMed1994

Teleconsultation of patients with otorhinolaryngologic conditions. A telendoscopic pilot study.

OBJECTIVE: We have integrated endoscopic equipment with a network of video conference studios to develop a remote consultation service for diagnoses of patients with otorhinolaryngologic conditions. DESIGN: The study was performed as a diagnostic test in three phases. During the first phase, a general practitioner was instructed in otorhinolaryngologic examination techniques. In the second phase, remote endoscopic examinations were simulated and the diagnostic results were compared with results from a standard examination. In the third phase, the general practitioner made real telendoscopic examinations. SETTING: Signals from a video camera attached to the endoscope are transmitted from the primary care center to the otorhinolaryngologist who is 180 km away via a 2-million-bits-per-second circuit. The specialist observes the endoscopic examination on a monitor and influences the control and movement of the endoscope by communicating over a two-way sound-and-picture connection with the general practitioner. PATIENTS: A convenience sample of 24 patients was examined in the last two phases. RESULTS: Although the video image is compressed before transmission over the telecommunications network, our results show that the quality of the transmitted images was equivalent to the quality of the images from a standard endoscopic examination. CONCLUSIONS: Our study has shown that this method of consultation may be used in the clinic with the same degree of reproducibility as in a conventional consultation situation. This enables us to give patients in remote locations better service at a lower cost.

Adolescent↗

PubMed1996

Telesurgery. Acceptability of compressed video for remote surgical proctoring.

OBJECTIVE: To determine the clinical acceptability of various levels of video compression for remote proctoring of laparoscopic surgical procedures. DESIGN: Observational, controlled study. SETTING: Community-based teaching hospital. PARTICIPANTS: Physician and nurse observers. INTERVENTIONS: Controlled surgical video scenes were subjected to various levels of data compression for digital transmission and display and shown to participant observers. MAIN OUTCOME MEASURES: Clinical acceptability of video scenes after application of video compression. RESULTS: Clinically acceptable video compression was achieved with a 1.25-megabit/second data rate, with the use of odd-screen 43.3:1 Joint Photographic Expert Group compression and a small screen for remote viewing. CONCLUSION: With proper video compression, remote proctoring of laparoscopic procedures may be performed with standard 1.5-megabit/second telecommunication data lines and services.

Adult↗

PubMed2003

Telemedicine in surgery.

BACKGROUND: Telemedicine is influencing surgical training, allows mentoring, proctoring and teleconferencing, and is increasingly being applied to carry out remote surgical procedures. A systematic review of the telemedicine systems available, along with a critical appraisal of their application, potential and limitations in the surgical field, has been undertaken. METHOD: Medline, Ovid and internet searches were carried out using the keywords 'telesurgery', 'telepresence surgery' and 'telemedicine and surgery', along with hand searches of the two peer-reviewed telesurgery journals. RESULTS: Telementoring and teleconferencing have been used widely for surgical teaching and training. Two clinical telesurgery systems are currently available and have been a trial in patients undergoing a variety of operations including cholecystectomy, coronary artery bypass, prostatectomy and gastroplasty. Most studies have reported successful outcomes but with prolonged operating times. In 2002 the first long-distance telesurgery procedure was successfully performed. CONCLUSION: Telemedicine has huge potential to alter surgical practice but improvements are required in telesurgical technology with respect to tactile feedback, instrumentation, telecommunication speed and availability. Issues of liability, legislation, cost and benefit require clarification. The future of telemedicine in surgery may lie in facilitating complex minimally invasive techniques.

Humans↗

PubMed2001

Army medical laboratory telemedicine: role of mass spectrometry in telediagnosis for chemical and biological defense.

An army medical field laboratory presently has the capability of performing standard protocols developed at the US Army Medical Research Institute of Chemical Defense for verification of nerve agent or sulfur mustard exposure. The protocols analyze hydrolysis products of chemical warfare agents using gas chromatography/mass spectrometry. Additionally, chemical warfare agents can produce alkylated or phosphorylated proteins following human exposure that have long biological half-lives and can be used as diagnostic biomarkers of chemical agent exposure. An analytical technique known as matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF/MS) currently is being examined for its potential to analyze these biomarkers. The technique is capable of detecting large biomolecules and modifications made to them. Its fast analysis time makes MALDI-TOF/MS technology suitable for screening casualties from chemical or biological attacks. Basic operation requires minimal training and the instrument has the potential to become field-portable. The limitation of the technique is that the generated data may require considerable expertise from knowledgeable personnel for consultation to ensure correct interpretation. The interaction between research scientists and field personnel in the acquisition of data and its interpretation via advanced digital telecommunication technologies can enhance rapid diagnosis and subsequently improve patient care in remote areas.

Biomarkers↗

PubMed1997

WCALive: broadcasting a major medical conference on the Internet.

Live video and sound from the 11th World Congress of Anaesthesiology in Sydney, Australia were broadcast over the Internet using the CuSeeme software package as part of an ongoing evaluation of Internet-based telecommunication in the delivery of Continuing Medical Education (CME). This was the first time such a broadcast had been attempted from a medical convention. The broadcast lasted for four days, during which a functioning combination of computer hardware and software was established. Technical issues relating to broadcast of these real time signals over ISDN links and the Internet itself were addressed. Over 200 anaesthetists from around the world were able to 'attend' the plenary sessions via the Internet. Evidenced by feedback received audio reception was quite good. Video reception was less successful for those receiving the broadcast via a modem based Internet connection. The received signal in such circumstances was adequate to provide a video presence of the speaker but inadequate to allow details of 35 mm slides to be visualised. We conclude that this technology will be of use in the delivery of CME materials to remote areas provided simultaneous viewing of high resolution still images is possible using another medium, such as the World Wide Web.

Anesthesiology↗

PubMed2005

[Health telematics projects in the perspective of the German federal states].

Starting in autumn 2005 with pilot projects, the new German electronic health card (EHC) and electronic health professional cards (HPC) will be implemented in the German health system. These cards are constituents of the full coverage networking of more than 120,000 doctor's practices, 22,000 pharmacies, 2,200 hospitals and 300 health insurance companies. The functions of the EHC, for example electronic prescriptions, the digital medication recording and the European emergency database, need both the interactions with the HPCs and with a complex network of IT systems and telecommunication services, i. e. with a comprehensive health telematics infrastructure. Model regions for the construction of a telematics infrastructure have been established in numerous federal states, e. g. Baden- Wurttemberg, Bavaria, Bremen, Lower Saxony, North Rhine-Westphalia, Rhineland-Palatinate, Saxony and Schleswig-Holstein, and also recently in Mecklenburg-Vorpommern and Brandenburg. These model regions are designed in a way that allows smooth integration of the specifications of the so-called solution architecture of the EHC and also of electronic HPCs as soon as these are available. The implementation of first pilot trials in the model regions, each with 10,000 insured, is planned for the second half of 2005. A project task force was founded by a group from the German federal states in December 2004. The objective of these implementations is to establish a fully networked health system providing patients various e-Health applications which can be used any place and any time.

Computer Communication Networks↗

PubMed2000

[Telemedicine in otorhinolaryngology exemplified by a Tübingen-Leipzig video conference].

"Telemedicine" is a major new development with great potential for improving health care delivery. It therefore affects each department in medicine. There is a great deal of telemedicine activity around the world. However, the term telemedicine is not clear. It describes all forms of medical information, transferred from a relevant distance by an electronic transfer media. An essential condition for communication is the intelligibility between transmitter and receiver. Because of different transmitting technologies and networks in distinct countries, towns, or even academic institutions, satisfactory contact is not possible. In the last decade, the demand for worldwide audiovisual data transmission has led to the standardization of telecommunication media. Therefore it is no longer necessary to transport medical data (or even patients) by conventional manners, e.g., post, car, or aircraft. Telemedicine for diagnosis and management can be bidirectional in real-time, long-distance videoconferencing, in which the patient consults a specialist located at the remote site, or it can be the transmission of either real-time or pre-recorded images and data to a remote expert, as in teleradiology or telepathology. Another application is the use of videoconference systems in the course of meetings. The remote specialist has the opportunity to take part in the session, e.g., with a lecture. Furthermore, the remote specialist can demonstrate special operative techniques for teleteaching purposes, some of which may be specialities of the particular medical unit, e.g., operation in open NMR, telemanipulation, or telerobotic procedures. In this paper, we describe the use and benefit of a videoconference between the departments of otolaryngology and head and neck surgery of the Universities of Tübingen and Leipzig by means of an "ISDN-based videoconference system". During the meeting, the "operating course for reconstructive surgery in the head and neck", the practicability, reliability, costs and quality were determined and compared with other technologies for audiovisual data transfer.

Curriculum↗

PubMed2005

International transmission of uncompressed endoscopic surgery images via superfast broadband Internet connections.

BACKGROUND: Although telecommunication is increasing in popularity, poor-quality images sent through a narrowband network limit its use in the medical field. METHODS: Kyushu University Hospital in Japan and four hospitals in Korea were linked via superfast broadband Internet connection. The digital video transfer system, which can transmit digital videos without loss of image quality, was used, and the bandwidth was 30 Mbps per line. RESULTS: Of the 16 teleconferences conducted, 6 demonstrated real-time endoscopic surgery. In addition to the surgical images, preoperative diagnostic images, images of the operating room, and images of the staff in the conference room were transmitted to facilitate discussion. The network remained stable, and the sound delay was restricted to less than 0.3 s. In the other 10 teleconferences, recorded video images were used for discussion. CONCLUSIONS: The authors have established a high-quality, practical teleconference system that is economical and easy to use in clinical practice. This system shows promise for remote education beyond geographic borders.

Cholecystectomy, Laparoscopic↗

PubMed2006

The effectiveness of the installation of a mobile voice communication system in a university hospital.

In large hospitals, collaborative clinical practice is currently emphasized, with members of various departments expected to work as a team. The importance of accurate communication among the team members is of utmost importance. To improve such communication, the introduction of mobile voice communication systems has received much attention in Japan. Shimane University Hospital also introduced a Personal Handy-phone System (PHS) for doctors. In the traditional setting, much time was wasted searching for doctors through multiple calls on fixed-line telephones. In order to measure the effectiveness of our system, the change in the number of calls made on fixed-line telephones before and after PHS installation was compared. The total number of calls was reduced by more than 35%, and the number of calls to the wards on weekdays was reduced by half. Mobile telecommunication systems with small output power, such as PHS, are known to cause little interference with medical devices which makes it possible to use mobile voice communication safely in hospitals. The improvement in communication by this systems resulted in an improvement in labor efficiency.

Diffusion of Innovation↗

PubMed1995

HIS priorities in developing countries.

Looking for a solution to fulfill the requirements that the new global economical system demands, developing countries face a reality of poor communications infrastructure, a delay in applying information technology to the organizations, and a semi-closed political system avoiding the necessary reforms. HIS technology has been developed more for transactional purposes on mini and mainframe platforms. Administrative modules are the most frequently observed and physicians are now requiring more support for their activities. The second information systems generation will take advantage of PC technology, client-server models and telecommunications to achieve integration. International organizations, academic and industrial, public and private, will play a major role to transfer technology and to develop this area.

Costs and Cost Analysis↗

PubMed1994

The health care professional's workstation: a call to action.

The environment of health care delivery is changing dramatically, matched by design trends in the organizations that are responsible for care delivery, whether at the hospital or the national level. However, the emerging goals of these organizations have a certain amount of uniformity independent of background, cultural assumptions or organizational size: they are all committed to the delivery of services that maximize satisfaction of system beneficiaries at a minimum of expense. Achievement of these goals will in part require the development of a management and delivery coordination infrastructure that links the key resource utilizers and administrative operators at the point of production. Merged computer and telecommunications systems connecting at user interface nodes called workstations represent a critical enabling technology for meeting the organizational goals described above. Future delivery systems will need to provide compassionate care, retaining the most highly regarded traditions of medical practice without ignoring considerations of cost, clinical outcome and financial sustainability. This paper describes some of the limitations of the current delivery system, and attempts to identify key design concepts and paradigms that might serve to guide future system development.

Computer Communication Networks↗

PubMed1995

Informatics in family practice--an Asia-Pacific perspective.

Recent advances in computer hardware, software and telecommunications, and particularly in the development of the electronic medical record, mean that family practitioners around the world now have access to a multiplicity of tools which offer the potential for significant time savings and improved quality of health care provision. Areas such as practice management medication management and prescription generation, clinical record keeping, decision support, medical research and continuing medical education can all be aided through the use of information technology in a family practice setting. Yet family medicine, or general practice, has largely been slow to take up the challenge of implementing information technology in most parts of the Asia-Pacific region. This contrasts sharply with many other areas of medicine which have been very active in embracing this technology. This paper examines the potential advantages and the difficulties of computerisation for general practitioners and their patients in the Asia-Pacific region. It is hoped that the lessons already learned in some countries in this region can be adapted and applied elsewhere.

Asia↗

PubMed1992

Using strategic planning to drive strategic change.

This article describes a case history of strategic planning, learning and change within a major division of Dowty plc. At Dowty CASE, a telecommunications company, the management team used strategic planning as a structured learning process to generate strategic change. There are many lessons which academics and practitioners alike can learn from this case of strategic planning and change in action.

Administrative Personnel↗

PubMed1994

The ACOSTA accompanying measure A2106.

At a time when the informatics and telecommunications industries are looking for new markets to exploit in relation, for example, to the emerging ISDN and broadband communications networks, there is a need to create a broad consensus in Europe by bringing together systematically the relevant industries including telecom service providers, health care providers, insurance organisations, standardisation experts and policy makers. The aim of the ACOSTA (Consensus Formation and Standardisation Promotion) Accompanying Measure is the creation of more general awareness of the relevant environment among all the parties, better specification of common requirements and options taking better account of the real needs of the users, and enlargement of the common market in health care telematics.

Computer Communication Networks↗

PubMed1991

Pilgrimage of pain: the illness experiences of women with repetition strain injury and the search for credibility.

Repetition strain injury (RSI), a non-specific and controversial constellation of work-related hand, arm and neck symptoms, became epidemic in Australian industry in the early 1980s. Fifty-two women who worked in a telecommunications organisation and a chicken processing factory and had been diagnosed as having RSI were interviewed about their perceptions and experiences of the illness. Their accounts of the search for caring and treatment, including their encounter with health and medical practitioners, suggest that the need to be believed and to establish their integrity dominated their 'pilgrimage'. The failure of the dominant explanations of RSI to accommodate the psychosocial and political dimensions of the illness thwarted this quest and, it is argued, contributed to its chronicity.

Adult↗

PubMed1996

Applications and transfer of information technology in veterinary research in developing countries: the Nigerian experience.

An overview and analysis of the current status of information technology (IT) and its role in animal health research and development (R & D) projects in developing countries have been undertaken. This study is based mainly, but not exclusively, on the Nigerian situation and experience, which are considered to be typical of those in the majority of developing countries where IT is still in its infancy, and few individuals and institutions engaged in R & D projects have access to computing and modern, reliable telecommunications facilities. The analysis has emphasised the following: the limited impact of IT on large-scale field projects; the major factors militating against its successful acquisition, application and transfer; short- and long-term needs and priorities for IT; IT inputs for effective implementation of field projects and exchange of R & D information. Of the numerous factors which have hindered the growth and transfer of IT in much of the developing world, the most important are: (1) weak science and technology (S & T) base; (2) shortage of highly skilled front-line scientists, technologists and information professionals; (3) inadequate financial resources. Experience gained from three field projects highlighted the fact that although IT inputs, such as computers, are vital for the efficient management and rapid communication of research information, careful planning of projects, adequate financial and logistic support, availability of skilled manpower and basic infrastructural facilities are indispensable for the effective utilisation of the inputs. A promising and cost-effective method of transfer of IT inputs to those countries which can hardly afford them at present is through the establishment of institutional research links between developed and developing countries. Successful partnerships usually provide, among other things, computing facilities and manpower training for the latter and opportunity for genuine research collaboration. This form of IT transfer is an important step towards increased application of IT inputs in R & D projects, creation of the much needed inventory of databases and information systems on animal health projects in developing countries. Only then can meaningful exchange of R & D information, in an acceptable format and at affordable price, be realised within and between them. A possible role is envisaged for the major international organisations such as the Food and Agriculture Organization of the United Nations and the United Nations Educational, Scientific and Cultural Organization in ensuring the success and sustainability of these developments.

Animals↗