American Telemedicine Association's Fall Forum: Telemedicine Technology Summit and Venture Capital for Telemedicine.
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Focus Groups↗
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Telemedicine in a box: overcoming complexity and high-cost telemedicine barriers using self-contained videoconferencing units.
This report describes our experience using low-and moderate-cost videoconferencing systems for telemedicine. After determining that low-cost systems using a standard personal computer and personal computer camera were unsatisfactory, a demonstration project was carried out using a $4000 self-contained videoconferencing unit (telemedicine in a box), using eight simulated telemedicine consultation scenarios. The quality of the videoconferencing was good for all eight scenarios. All eight consultation simulations demonstrated different ways of improving patient care. Two of the major problems hindering the broad proliferation of telemedicine (high cost and high complexity) are solved by the telemedicine in a box concept. Focussing on the telemedicine in a box concept when planning a telemedicine system will improve its feasibility in the real world of health care.
Humans↗
Telemedicine odyssey customised telemedicine solution for rural and remote areas in India.
There is a significant potential for delivering medical services in rural areas of India using Telemedicine methods. However, there is a continuous emphasis on patient privacy, which is usually not a concern in traditional consultation. We at Centre for Development of Advance Computing, Mohali Punjab have developed a customized Telemedicine solution, which overcomes the barrier--technological as well as professional, legal and financial--to Telemedicine. We implement Telemedicine in rural areas as 70% of total population in India is living in villages. We have, as a pilot project, established Telemedicine Technology at six major locations in India. These locations were subsequently connected to nearby districts and primary health centres to make a Telemedicine hub. Currently, our major project is to deploy Telemedicine sites at various locations in the hilly and remote state of Himachal Pradesh. During these developments, we have faced unavoidable hurdles and tried to overcome them with team effort, perseverance and never give up attitude. This paper will shed light on our journey from scratch to what we have achieved till date.
Humans↗
Diffusion theory and telemedicine adoption by Kansas health-care providers: critical factors in telemedicine adoption for improved patient access.
Twenty counties in Kansas were randomly selected from those designated as rural on the basis of their populations. A sample of 356 physicians and physicians' assistants in these counties was chosen. A postal survey was sent to the identified providers up to three times. One hundred and eighty-six of the questionnaires were returned (a response rate of 52%). In all, 76% of the respondents were physicians, 76% were men and 42% were family practitioners. Practitioners were classified as adopters or non-adopters of telemedicine, based on their report of whether they had ever referred one or more patients for a health-care consultation via telemedicine. Of the 167 participants who marked this item, 30 (18%) were adopters and 137 (82%) were non-adopters. Among the adopters, 16 (53%) said that they expected to use telemedicine with about the same frequency or more often in the future. In contrast, 61 (45%) non-adopters reported that they did not expect to refer patients by telemedicine in the future and 51 (37%) were unsure. Neither age (r = 0.16, P = 0.44) nor gender (chi2 = 2.35, P = 0.13) was related to the adoption variable or the number of referrals made to telemedicine clinics. The results suggest that adopters and non-adopters of telemedicine perceive its value very differently, and that an opportunity exists to promote the concept to non-adopters more effectively.
Age Factors↗
A survey of research in telemedicine. 1: Telemedicine systems.
Published work in telemedicine has been surveyed in order to consider the range of current research, highlight some pitfalls and point out areas where it seems that more work is required. This article deals with tests of the safety and efficacy of telemedicine systems. This work can be seen as moving through three phases: first, identify the technical specification of equipment required for the particular telemedicine application; second, test that this is appropriate in particular settings; third, establish a set of standards and guidelines to ensure that the telemedicine system is used to the best advantage. Work in teleradiology seems to be in the second phase. Work in teledermatology, for example, is still in the first phase. Telemedicine is an important and growing area of academic research. The quality of the research ought also to be increasing. While there have been a number of well designed, robust studies with clear conclusions that show the value of telemedicine in certain settings, much more remains to be done.
Computer Communication Networks↗
A survey of research in telemedicine. 2: Telemedicine services.
This article deals with research which attempts to demonstrate the value of health care delivered via telemedicine. A great variety of telemedicine services have been proposed. Much of the published work concentrates on the power of the technology and the content and quality of interaction it supports. There are other parameters to be considered in assessing telemedicine as a component of a health-care system, parameters which in practice determine the nature of the service being provided. Despite the fact that much work in telemedicine is published as short accounts of pilot projects, there is little research that explicitly addresses the difficulties involved in setting up new telemedicine services. Some studies have been performed which attempt to evaluate telemedicine services, but relatively few studies have been able to collect the data required to provide an unambiguous demonstration of their value.
Consumer Behavior↗
Transcending the technology of telemedicine: an analysis of telemedicine in North Carolina.
This study investigated the telemedicine program at East Carolina University School of Medicine. In-depth interviews, organizational texts, and archival records provided data for a case study that sought to understand what telemedicine is to organizational members and how they came to create this contextual reality. The goal of this study was to apply interpretive paradigmatic assumptions in the privileging of telemedicine as the very context of the organization. The findings explain how organizational members make sense of this new way of providing health care. Organizational members' talk revealed that telemedicine is multifaceted: It is access, an economic tool, education, technology, and a grant activity. With the single exception of technology, these themes emerged equally, regardless of whether the telemedicine provider was located at the urban hub site or the rural spoke site. Interestingly, members at both locations talked about critical events in relation to receipt of grant or financial support for new projects. Implications for future research are advanced.
Humans↗
[Telemedicine and general practice--future or present. Telemedicine, a way to strengthen the gatekeeper role?].
Electronic communication and data-processing are by no means a new phenomenon in general practice. The next logical step might be to include telemedicine, i.e. images, sound, video, and other kinds of medical information in the communication process. The potential for applying telemedicine in the adjoining areas between the general practice and the hospitals and patients is reviewed. We assume that an increase in the use of electronic communication and telemedicine will strengthen the central role of general practice. A representative sample of international literature is reviewed. The findings are that patients have no substantial misgivings against the use of telemedicine, but scientific documentation of the influence on the patient-doctor relationship, on the quality and quantity of the medical work, and on the job satisfaction of general practitioners is still not available. We present a number of suggestions regarding the use of electronic communication between the general practitioner and the patient. The importance of providing clear, in-depth information to the patient about the use of medical IT communication is underlined. The aspect of data-security is evaluated, and for lack of precise guidelines from health officials it is our suggestion that the report from the Danish Ministry of Finance regarding data-security in public administration is consulted. As to data-access, doctors and patients should be placed on two different safety-levels. It's suggested that doctors should be equipped with a digital key, whereas patients should use a pin code and their social security number. The use of traditional e-mail is dissuaded when exchanging sensitive, person-related information. The importance of valid evaluation of new IT functions is underlined.
Computer Communication Networks↗
Development of telemedicine technology in India: ''Sanjeevani''--an integrated telemedicine application.
Telemedicine has been a technological takeaway for the developed countries. Even in the developing countries, it is increasingly being viewed as a tool for improving care and enhancing access to healthcare. Countries like India where the majority of the population lives in rural areas, where healthcare facilities are inefficient and inadequate, tools like telemedicine can contribute substantially in bridging the gap between the demand and supply. "Sanjeevani"-is an integrated telemedicine application that offers a suite of high utility features as a part of an Indian telemedicine technology. Sanjeevani is based on store and forward as well as real-time models.
Computer Communication Networks↗
The Telemedicine benchmark--a general tool to measure and compare the performance of video conferencing equipment in the telemedicine area.
In this paper, we describe the 'Telemedicine Benchmark' (TMB), which is a set of standard procedures, protocols and measurements to test reliability and levels of performance of data exchange in a telemedicine session. We have put special emphasis on medical imaging, i.e. digital image transfer, joint viewing and editing and 3D manipulation. With the TMB, we can compare the aptitude of different video conferencing software systems for telemedicine issues and the effect of different network technologies (ISDN, xDSL, ATM, Ethernet). The evaluation criteria used are length of delays and functionality. For the application of the TMB, a data set containing radiological images and medical reports was set up. Considering the Benchmark protocol, this data set has to be exchanged between the partners of the session. The Benchmark covers file transfer, whiteboard usage, application sharing and volume data analysis and compression. The TMB has proven to be a useful tool in several evaluation issues.
Benchmarking↗
Evolution of telemedicine in Russia: the influence of the space program on modern telemedicine programs.
Telemedicine education and application throughout Russia has its roots in Russia's space program. The concepts of telemedicine have evolved during the course of 40 years of space exploration. This paper reviews the evolution of telemedicine and the achievements of the Soviet/Russian Space Program.
Diffusion of Innovation↗
Development of the Telemedicine Satisfaction Questionnaire to evaluate patient satisfaction with telemedicine: a preliminary study.
We developed a questionnaire for the evaluation of patient satisfaction with telemedicine. Items related to patient satisfaction with telemedicine were identified through a review of the literature. The internal consistency and the intraclass correlation coefficient were used to evaluate the reliability of the proposed instrument. Content validity was examined using a panel of experts. The predictive validity of the proposed instrument was assessed by correlating scores on the Telemedicine Satisfaction Questionnaire (TSQ) with haemoglobin A(1c) levels and adherence to self-management activities among 38 patients with type 2 diabetes, after they had completed a four-session interactive diabetes tele-education programme. A principal-components analysis with varimax rotation was performed to reduce the number of questionnaire items from 15 to 14, and the scree test was used to select significant factors. There were three components with eigenvalues over 1.0, which together explained 68% of the total variance. These were: quality of care provided, similarity to face-to-face encounter and perception of the interaction. The TSQ demonstrated preliminary reliability and validity but more extensive testing will be required before it can be considered generally applicable.
Adult↗
Explaining the adoption of telemedicine services: an analysis of a paediatric telemedicine service.
Since 1998, over 1300 telemedicine consultations have been provided to 12 schools in Kansas City. Despite the success of the programme, effective utilization of services has not occurred at all sites. We used a focus group and survey methods to investigate barriers to and catalysts for service adoption. The results showed that the school nurses strongly supported the programme. They valued its ability to provide health-care for the children and they welcomed their enhanced role. However, technical complexities and difficulties in obtaining parental consent were found to impede adoption. The nurses also expressed frustration with school personnel who had a poor understanding of their role in general as well as that of the telemedicine service. A new state reimbursement policy may promote greater understanding and provide a financial incentive for schools to adopt the telemedicine service.
Attitude of Health Personnel↗
A Latin American telemedicine social perspective from a Colombian telemedicine center initiative.
This paper describes a collaborative initiative for developing a telemedicine model on for Colombia and Latin America from a social perspective. This was led by the Colombian Telemedicine Center (CTMC) with the participation of teams from Mexico, Costa Rica, Panama, and Argentina, in addition to on-going interaction with academic institutions such as Javeriana University, Icesi University, and Murcia University.
Colombia↗
Telemedicine in Australia. 1: The health-care system and the development of telemedicine.
Telemedicine developments are intimately linked to the society in which they occur. Some of the salient factors are: the structure of the health-care system, especially its funding arrangements and the relationship between hospital and community care; the telecommunications network environment and business developments in communications technology; geographic factors of distance and isolation; and government policy dealing with interacting sectors. These factors are all considered in this review of the background to telemedicine developments in Australia.
Australia↗
The legal and ethical aspects of telemedicine. 3: Telemedicine and malpractice.
This paper reviews the difficulties raised by the need to obtain valid consent from telemedicine patients to the treatment that they receive and evaluates the legal principles that the courts will apply to an allegation of negligence brought against a teleconsultant or telemedicine service by a patient. While many of the processes that take place during a telemedical consultation will be unique, it is suggested that the legal principles that apply to the conventional, face-to-face, doctor-patient relationship are equally as valid in the context of the practice of medicine at a distance.
Consent Forms↗
Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge.
UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Armenia↗
Telemedicine and international disaster response: medical consultation to Armenia and Russia via a Telemedicine Spacebridge.
UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Aerospace Medicine↗