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PubMedDate not supplied

Desiderata for personal electronic communication in clinical systems.

Electronic communication among clinicians and patients is becoming an essential part of medical practice. Evaluation and selection of these electronic systems, called personal clinical electronic communication (PCEC) systems, can be a difficult task in institutions that have no prior experience with such systems. It is particularly difficult in the clinical context. To directly address this point, the authors consulted a group of potential users affiliated with a nationally recognized telemedicine project, to determine important characteristics of a hypothetical PCEC system. They compiled a list of these characteristics and produced a desiderata, or list of desired features, for PCEC systems. Two conventional e-mail implementations and three Web-based PCEC systems were evaluated with respect to the features. The Web-based systems all scored higher than conventional e-mail. It is the hope of the authors that this paper will initiate further discussions about the features of PCEC systems and how to evaluate them.

Computer Communication Networks↗
PubMed2003

Development of a clinical data warehouse for hospital infection control.

Existing data stored in a hospital's transactional servers have enormous potential to improve performance measurement and health care quality. Accessing, organizing, and using these data to support research and quality improvement projects are evolving challenges for hospital systems. The authors report development of a clinical data warehouse that they created by importing data from the information systems of three affiliated public hospitals. They describe their methodology; difficulties encountered; responses from administrators, computer specialists, and clinicians; and the steps taken to capture and store patient-level data. The authors provide examples of their use of the clinical data warehouse to monitor antimicrobial resistance, to measure antimicrobial use, to detect hospital-acquired bloodstream infections, to measure the cost of infections, and to detect antimicrobial prescribing errors. In addition, they estimate the amount of time and money saved and the increased precision achieved through the practical application of the data warehouse.

Blood-Borne Pathogens↗
PubMed2003

PalmCIS: a wireless handheld application for satisfying clinician information needs.

Wireless handheld technology provides new ways to deliver and present information. As with any technology, its unique features must be taken into consideration and its applications designed accordingly. In the clinical setting, availability of needed information can be crucial during the decision-making process. Preliminary studies performed at New York Presbyterian Hospital (NYPH) determined that there are inadequate access to information and ineffective communication among clinicians (potential proximal causes of medical errors). In response to these findings, the authors have been developing extensions to their Web-based clinical information system including PalmCIS, an application that provides access to needed patient information via a wireless personal digital assistant (PDA). The focus was on achieving end-to-end security and developing a highly usable system. This report discusses the motivation behind PalmCIS, design and development of the system, and future directions.

Computer Communication Networks↗
PubMed1996

Ethical and legal issues in e-mail therapy.

Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.

Adolescent↗
PubMed1996

Ethical issues in a study of Internet use: uncertainty, responsibility, and the spirit of research relationships.

In this article we explore ethical issues arising in a study of home Internet use by low-income families. We consider questions of our responsibility as educational researchers and discuss the ethical implications of some unanticipated consequences of our study. We illustrate ways in which the principles of research ethics for use of human subjects can be ambiguous and possibly inadequate for anticipating potential harm in educational research. In this exploratory research of personal communication technologies, participants experienced changes that were personal and relational. These unanticipated changes in their way of being complicated our research relationships, testing the boundaries of our committment to the principle of trustworthiness and forcing us to reevaluate our responsibilities.

Behavioral Research↗
PubMed1996

Case vignette: cybertherapy.

Dr. Neuro Transmitter, a psychotherapist in Paramus, New Jersey, provides services through an online, real-time consultation service known as CyberShrink, Inc., of Dallas, Texas. He is paid by the hour for his consultation services to subscribers who are billed by credit card through CyberShrink. One afternoon he logs on and is connected via private "chat channel" to a new subscriber to the service. She is Ann Hedonia of Simi Valley, California. Ten minutes into the session, Dr Transmitter recognizes that Ms. Hedonia is seriously depressed with suicidal ideation and is feeling on the edge of her ability to cope. He gently suggests that perhaps she ought to think about hospitalization near her home. Ms. Hedonia replies, "Even you don't care about me! That's it. I'm going to do it!" and disconnects. Discussion questions: Is offering psychotherapy services online ethical? What are Dr. Transmitter's obligations in general and at this particular moment to Ms. Hedonia? Suppose Ms. Hedonia has a complaint about Dr. Transmitter. From whom can she seek a remedy? Which state's laws apply regarding professional practice, confidentiality, or licensing qualifications? Must Dr. Transmitter be licensed in any state to offer this service?

Communication↗
PubMed1998

The emerging relationship of psychology and the Internet: proposed guidelines for conducting Internet intervention research.

The Internet is rapidly developing into an important medium of communication in modern society, and both psychological research and therapeutic interventions are being increasingly conducted using this new communication medium. As therapeutic interventions using the Internet are becoming more prevalent, it is becoming increasingly important to conduct research on psychotherapeutic Internet interventions to assist in the development of an appropriate standard of practice regarding interventions using this new medium. In this article, we examine the Internet and the current psychological uses which are being initiated using this medium. Ethical concerns related to the psychological use of the Internet are discussed, and guidelines are proposed for the conduct of Internet intervention research.

Behavioral Research↗
PubMed1996

Home health visits using a cable television network: user satisfaction.

There are about 1.5 million home patients who receive home health care (nurses visiting patients in their homes) in the US each year. In a significant proportion of these visits, hands-on care is not needed. Rather, the nurse needs to verify compliance with medication regimes, assess mental or emotional status, or check blood sugar levels, blood pressure and the like. Many of these activities might be handled by a nursing visit using interactive video to the patient's home, saving the nurse's time wasted in driving, finding parking, etc. A system for delivering home health care using interactive video has been piloted in the state of Kansas. Using the local cable television infrastructure for audio and video transmission, this system permits a nurse to see patients in their homes for a fraction of the cost of an on-site visit. This new method of delivering home health care is being evaluated with an ongoing study of utilization and user satisfaction. We conducted a prospective survey administered to home health nurses (n = 2) and homebound patients (n = 3) using a cable TV-mediated interactive video system, to assess utilization and user satisfaction with televideo-mediated home health care visits. One hundred and eighty-one patient questionnaires and 193 nurses questionnaires were completed. The average length of a visit was 15 minutes (range 1-91). All mean scores tabulated for the questions indicated strong nurse and patient satisfaction with the system. Participating nurses and clients were satisfied with the televideo encounters. The mean score for all questions was better than neutral. Recognizing that this was a pilot study, hampered by small numbers and subject to the inherent biases of a single institution study, the results support further investigation and implementation of this modality for home health care.

Aged↗
PubMed1999

Internet electronic mail: a tool for low-cost telemedicine.

Electronic mail, in addition to the sending of text messages, may be used to transfer multimedia and privacy-enhanced messages. Email can be used for so-called store-and-forward telemedicine, which can be particularly useful for remote consultations. This paper reviews the standards used in Internet email, from communication protocols to the message formats, and pays special attention to multimedia and confidential messages; it then describes some email-based telemedicine applications. The problems of the Internet are principally the lack of any guarantee of quality of service and the low bandwidth; intranets can guarantee appropriate performance.

Computer Communication Networks↗
PubMed1999

Virtual microscopy and public-key cryptography for Internet telepathology.

The Internet is a potentially inexpensive, widely available medium for telepathology, but there are concerns about its reliability and security. Using a digital camera, 41 photomicrographs of transbronchial biopsies, at x 100 optical magnification, were captured and digitized at 2700 x 3400 pixel, 24 bit/pixel resolution. The image files were saved in JPEG format at medium compression, attached to text files with patient information, encrypted for security in the S/MIME format using a digital signature and digital envelope, and transmitted by email. Received email files were decrypted automatically and the images viewed with standard software. Telepathology diagnoses were compared with original interpretations. The images averaged 810 kByte in size. The encryption and decryption did not cause significant delays in overall transmission time and, together with transmission, did not produce noticeable image degradation. The received image files could be viewed in a manner that simulated light microscopy. There was agreement between telepathology and original diagnoses in 92% of the cases. All the discrepancies were due to inadequate area selection because the pathological features of interest were present in histological levels other than those photographed. The use of high-resolution digital photomicrography, the Internet and public-key cryptography offers an effective and relatively inexpensive method of telepathology consultation. The method is best suited for the diagnosis of small biopsy specimens that require the transmission of only a few digital images that represent the majority of the biopsy materials.

Bronchi↗
PubMed1994

Imlink and continuing medical education: the use of an image transfer system to broadcast teaching cases nationally.

Imlink, a personal computer based image storage and transfer system, has been used regularly in Oxford since 1989, primarily to transmit computed tomography (CT) brain scans to the regional neurosurgery centre for management advice. Recently this system has been used to send a weekly educational programme (CT and magnetic resonance imaging neuroradiology cases) to district general hospitals.

Computer Communication Networks↗
PubMed1996

Specification and initial evaluation of a multiple application teleradiology system.

The digitization and transmission of medical images is becoming increasingly more important and available. The selection of appropriate clinical applications for teleradiology systems is an important factor in determining the success of such ventures. In this paper, the selection of such applications and the evaluation of the teleradiology system is described. The system (LIAISON, CAPTEC Ltd, Malahide, Ireland) is PC based and is capable of digitization and transmission of three categories of medical images: (1) plain film radiographs; (2) CT film data and (3) video sequences such as ultrasound scans. A comprehensive technical evaluation was carried out on the acquisition and display station in which various parameters such as spatial resolution, signal-to-noise ratio (SNR), and distortion were investigated. Results showed that the system performed well within specifications. An exploratory clinical evaluation was performed using a case mix of subtle fractures, chests and dislocations, and CT scans. Here the system performed well with a diagnostic accuracy of 95% for the digital image compared with the analogue image.

Computer Communication Networks↗
PubMed2005

Short communication: A method for verified access when using soft copy display.

Soft copy display is a rapidly developing area. To date, most soft copy systems can be classed by their application, e.g. review or reporting. With technology convergence this distinction is becoming less defined by the hardware and more defined by the software functionality. Although it is accepted that routine quality assurance should be conducted on soft copy monitors, this would be logistically difficult to achieve if any monitor within a hospital could be used for image review or reporting. This work proposes a simple psychophysical check to ensure optimal display performance before viewing software can be run. This is in the form of a challenge/response code constructed from letters just above the threshold of detection. This verified login would act as a portal to launching the image viewing software. The developed system was tested on three different types of monitor and five observers. Results indicate that the verified login was able to control access for displays below the optimal settings but was not as sensitive for adjustments above the optimum. However it is believed this is still of value as the lower presentation will compress the display gamma curve and reduce detail contrast. It also provides a minimum level of audit and quality control that might otherwise be missing.

Computer Communication Networks↗
PubMedDate not supplied

Nursing and the Net.

Web technologies, including intranet and internet applications, have become pervasive throughout society. Applications in healthcare settings are evolving rapidly and clearly demonstrating that professional and departmental activities can be enhanced, streamlined, and supported by this new technology. At Mount Sinai Hospital, Toronto, obvious benefits are being derived from evolving internet and intranet applications that support nursing practice and management. The purpose of this paper is to discuss the advantages of internet/intranet functionality for nurses, and to describe an intranet application designed specifically for the adult critical care unit.

Adult↗