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The author provides guidance on implementing a new telecommunications system in a healthcare facility--from pre-sale through completed implementation. He gives advice on what to watch out for and how to avoid potential problems.
Merger mania has been a striking trend in the health and managed care fields during the last decade, promising to improve integration of services, decrease excess capacity, enhance price competition, and increase the ability of providers and insurers to handle risk-based payment. In view of these promises, our first argument in this paper is that undoubtedly strong, well-financed managed care plans and health networks will continue to utilize the merger concept to acquire additional insurers and providers, eventually gaining more control over the organization and the financing of a region's health care delivery system. Our second thesis is that the quasicompetitive, quasiregulatory authority inherent in the Telecommunications Act of 1996, somewhat similar in concept to the American Hospital Association's earlier Ameriplan (1970), might serve as an appropriate model for Congress to use in designing future managed care, health field, and federal/state governmental interrelationships.
Reporting accurate and complete race and ethnicity data in public health surveillance systems provides critical information to target and evaluate public health interventions, particularly for minority populations. A national health objective for 2000 is to improve data collection on race and ethnicity in public health surveillance and data systems. To determine progress toward meeting this goal in CDC's National Electronic Telecommunications System for Surveillance (NETSS), the percentage of case reports of selected nationally notifiable diseases reported through NETSS with information regarding a patient's race and ethnicity was calculated for 1994-1997. The findings of this study indicate these data were received for approximately half of the cases, and the completeness of reporting of race and ethnicity data to NETSS had not improved.
Financial managers are constantly faced with the pressures of running a cost efficient organization, and must look for new and innovative ways to reduce costs and generate revenue. Telecommunications can provide the financial manager with opportunities to save money and produce income. Ideas such as disposable or dispensible telephones, call tracking systems, and pay telephones can all become important steps to improving the financial health of an organization.
The care of patients with chronic disease is a large and growing problem in the United States and other industrialized countries.' it is expensive, and the quality of care received by patients is often sub-optimal, resulting in poor health outcomes. We developed a totally automated computer-controlled telecommunications system, called TLC, that provides--frequent, close monitoring of patients with chronic disease and reports the results to the patients' physicians on a timely basis, so that they can intervene appropriately. TLC also monitors the patients' important self care activities, such as medication-taking, and provides education and counseling to improve the patients' performance of these activities. The system operates through regularly scheduled telephone conversations with patients' in their homes. An evaluation of a TLC chronic disease application for patients with hypertension demonstrated that use of the system was associated with significant improvement of the patients' adherence to their medication regimens and significantly improved blood pressure control. These results show that it is possible to design an information science-based health care delivery system that performs functions usually performed only by health care professionals, and suggests that information science will become an important means of delivering health care services in the next millennium.
A total of 323 workers from 5 different occupational groups in the telecommunication industry were studied in this cross sectional study, which sought to determine the prevalence of Work Related Upper Limb Disorders (WRULD) in 5 occupational groups; operators using the Video Display Terminals, switchboard operators, clerks, data entry processors and the supervisors. WRULD was also studied with regard to factors such as sex, race, height, age, stress and the discomfort perceived due to the work station design. The possibility of WRULD was determined from a self-administered questionnaire and confirmed by history and physical examination. Psychological stress and the discomfort due to the workstation were measured from the questionnaire. The overall prevalence was found to be 31.2% and the prevalence among the various occupations differed with it being the highest in the switchboard operators and data processors and the lowest in the supervisors. The older workers and the female workers were found to have higher prevalences of WRULD. It was also found that a higher stress score and a higher score of discomfort perceived at the work station were associated with higher prevalences of WRULD.
Healthcare telematics, or telemedicine, is a new methodology that applies the potentialities of telecommunications technologies to the needs of medicine, thereby greatly contributing to improving the management of clinical data and medical information for the benefit of the individual patient and the community at large. The fields of application of Telemedicine are becoming increasingly vast, and this gives rise to technical problems (interconnections) as well as professional, ethical, medico-legal and legal problems. The dissemination of Telemedicine will require changes to be made to the organisation and delivery of the medical/administrative services connected to the management of patient data, the remote provision of care, and the impact of Telemedicine itself (e.g. need to standardise the nomenclature for telemedicine services). In addition, it will also call for a careful analysis of costs and benefits for both healthcare providers and patients. One of the most interesting experiences in terms of impact is Teleradiology. This is neither a new discipline nor a (sub)specialty: the practice of Teleradiology must comply with the rules regulating any radiological medical act, the primary aim of which is to contribute to establishing - rapidly and accurately - a diagnosis that will affect treatment strategies. It may be anticipated that in some situations Teleradiology will significantly change the working practices of Radiology Specialists and Radiology Technicians. Because it is better to anticipate problems rather than wait for them to arise, our Scientific Society, which is always sensitive to emerging issues, intends to propose the following recommendations/guidelines for the use of Teleradiology in the common interest of the community and healthcare workers. The invitation to take part in the initiative proposed by the Italian Society of Medical Radiology (SIRM), the Italian Association of Nuclear Medicine (AIMN) and the Italian Association of Neuroradiology (AINR) was received with great satisfaction and is proof that we are working towards common goals. As on other occasions, this was reflected in the excellent collaboration between the National Radiologists' Union (SNR), the Italian Association of Medical Physics (AIFM) and the National Federation of Radiology Technicians (F.N.C.TSRM) in drafting the document. The document aims to highlight the potentialities and limitations in the use of Teleradiology and to provide a set of recommendations/guidelines, which are not, however, to be intended as strict, absolute rules. Because this field is continually evolving both in structural and regulatory terms, and because it is very difficult to establish universal criteria to rigidly define behavioural models for implementing and managing Teleradiology-related activities (which in any case fall into the category of radiological medical acts), the recommendations/guidelines proposed necessarily have an informative rather than prescriptive nature. The document starts by defining the meaning of the following currently used terms: Teleconsultation; Telediagnosis; Teledidactics. It then goes on to analyse the following aspects of Teleradiology: Technological requirements; Qualifications and training of Medical Personnel; Qualifications, training and competences of Radiology Technicians. Based on the regulations in force in Italy, these recommendations are structured in terms of rationale and possible professional issues arising from the use of Teleradiology. A section is devoted to data security and confidentiality, including legal implications, an area which is currently evolving and being studied in Italy and abroad. Finally, the professional liabilities of all the healthcare providers involved in Teleradiology (imprudence, incompetence, negligence) are outlined, as well as the responsibilities related to the necessary maintenance of equipment. The aim of the document is to propose recommendations/guidelines for the correct use and validation of Teleradiology. The Scientific Societies SIRM-AIMN-AINR and the Academic Institutions, together with the SNR, AIFM and the F.N.C.TSRM, the Regional Bodies and the Italian National Health Trusts are required to make a positive and constructive commitment to this new field, which has become the object of considerable attention and interests. While confirming that, if used correctly, this methodology will no doubt increase the overall efficiency of Diagnostic Imaging - in the primary interest of the patient's right to health - it is felt that attention should also be paid to the working practices of the Radiology Specialists and Radiology Technicians and to the training of both. It is necessary to standardise training and practice, and to make an integrated and coherent use of resources with respect to the healthcare goals we wish to attain. Many have described the undisputed advantages of Teleradiology, but there have been relatively few reports on the related risks and recommendations for its use. It is certain that an improper use of the method (forced& interpretation of the bill on complementary diagnostic activities, operational misunderstandings between Radiology Specialists and Radiology Technicians, rarefaction of the relationship between Radiologist and Patient, obligation to use teleconsultation in all situations) will lead to considerable disadvantages for all those working in the field of Radiology, specialists and radiology technicians alike. Therefore, by adopting this document, which is by no means against Teleradiology but for a rational use of the method and full awareness of what it actually implies, the Scientific Society intends on the one hand to participate actively and concretely in the process of regulating all those aspects of Teleradiology for which it is competent - rather than waiting for regulations to be imposed from above - and, on the other, to provide, through its highly qualified Study Group (Specialists in Radiology, Nuclear Medicine, Legal Medicine, Medical Physics, and Radiology Technicians), Radiologists, Specialists in Nuclear Medicine, Neuroradiologists and Radiology Technicians with practical recommendations for use/guidelines for the correct and rational performance of their (tele)radiological acts. These indications and recommendations are also being submitted to the Italian Government. Teleradiology has attracted so much attention that, even as a result of pressure from Industry, an international consensus conference is needed to regulate the rational and informed use of this new methodology.
Scientific and technological advances should be used to give the disabled every possible opportunity for personal development. There is great scope for improving the lot of disabled people by providing access to modern telecommunications systems. In the Third World, such progress could be encouraged if donor agencies stipulated that a certain proportion of funding should serve this purpose.
The National Electronic Telecommunications System for Surveillance (NETSS) was developed by CDC and the Council of State and Territorial Epidemiologists (CSTE) for collecting, transmitting, analyzing, and publishing weekly reports of notifiable diseases and injuries from the 50 states, New York City, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and Commonwealth of the Northern Mariana Islands. Operation of NETSS is facilitated by CDC/CSTE agreements on reportable conditions, protocols for formatting and transmitting data, standard case definitions, and designated staff members in each participating agency who provide and prepare the data for weekly publication in MMWR. This report describes the development and operation of NETSS and presents tabulations of national surveillance data for 1990 (tables on pages 505-510).
Telepathology comprises the transmission of microscopic images via the telecommunications network. This paper describes the first experiences from this new technology in Norway. These include teleconferences based on showing histologic slides from the Department of Pathology at the University Hospital in Tromsø to clinicians at local hospitals. A frozen section service to Kirkenes Hospital, based on remote control of a robotic microscope and transmission of high quality video images of the slide, has also been successfully established.
The electronic automatic telegraph stations are up-to-date telecommunicative equipment. There is no information in literature for hygiene characteristic of the working conditions in this type of modern industrial activity. The study shows, that the basic hygiene problems are related to the microclimate and ionization of the air of the working premises. The climatic installation creates extremely static microclimate during all the periods of the year and systematic aero-ionic insufficiency of the air. Possibilities for regulating the climatic installation regime are discussed in view of establishing physiologically sound and well-grounded microclimate and aero-ionic conditions.
An experiment to transmit ultrasonic tomographic section images required for remote medical diagnosis and care was conducted using the mobile telecommunication satellite OSCAR-10. The images received showed the intestinal condition of a patient incapable of verbal communication, however the image screen had a fairly coarse particle structure. On the basis of these experiments, were considered as the transmission of ultrasonic tomographic images extremely effective in remote diagnosis.
Through telecommunications the computer can create a breadth of personal communication, dialogue, and interaction that has never before been possible. Participants may actively contribute, may simply listen in, and may be selective in terms of both their interests and their schedules. Any personal computer equipped with a device to communicate over an ordinary telephone line provides entry. Once a few reasonably simple procedures are learned, this technologic tool can serve the physician extensively.
To establish the requirements for real-time transfer of an ultrasound examination via telecommunication network the following tests were performed: The ultrasound data were transferred from the video out of an ultrasound system to a basis terminal of the German Telekom. Simultaneously, an external video camera filmed the positioning and movements of the ultrasound transducer, and the verbal comments were recorded. These informations were transmitted to Karlsruhe and London, where they were rerouted to the examination room in Heidelberg. Here the informations were received on a Telecom reception unit/terminal and compared directly with the initial signal. The quality was sufficient if the moving ultrasound images and the camera image of the transducer as well as the oral comment were transmitted over 2 parallel ISDN lines. The delay to a real-time transmission of the examination process is only in the range of milliseconds. If only one ISDN line is used, the image quality is unsatisfactory, three parallel lines do not bring significant improvement of image quality. Telemedicine seems a new possibility to bring the knowledge of specialized centers to the practicing gynaecologists thus avoiding unnecessary referrals. Still unanswered, however, are the problem of liability, data protection and costs.
The information or digital age has turned information communication upside down and inside out. This article describes use of the Internet and World Wide Web information flow and communication for a virtual professional health national event, in Australia. The stored information and subsequent dialogue were available nationally and internationally, making the telecommunication conference a global one. Defined are the background, vision, and assumptions on which the conceptual conference structure was ultimately designed, implemented, and evaluated, including the implications for value-adding nursing information.
Telehealth has many applications, including the education and training of health professionals. This article describes the use of advanced telecommunications technology to educate family nurse practitioners in rural areas of Kansas. Four Kansas universities use compressed video technology (an interactive audio and video system) to offer five common core courses in primary care to students enrolled in FNP programs at the respective institutions. Using technology to educate FNPs in rural communities has resulted in a greater percentage of graduates (approximately 67% of 258 graduates) going to work in rural underserved communities. In addition to learning the course content, students learn to use technology as a tool to access telehealth information and services Knowing how to use these technologies provides greater opportunities to rural health care providers, as well as the recipients of health care.
The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95% of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.
A short experiment was carried out in the sales office and directory enquiries department of the Swedish Telecommunications Administration. VDT workload was set at two levels, a 'normal' level and an 'intensified' level. Visual strain associated with the work on VDTs was assessed by questionnaires and measurements of the near points of accommodation and convergence. When the VDT work routines were intensified an increase in subjective symptoms of visual strain was recorded. Increases in the near points of accommodation and convergence were recorded with intensified VDT workload. The experiment showed that organisational factors such as work spell duration and the rigidity of work routines seemed to play an important role in the frequency with which visual strain occurs in VDT work.