Telemedicine journal : the official journal of the American Telemedicine Association最新文献

Objective: This report describes the design, development, and technical evaluation of a teledermatology system utilizing digital images and electronic forms captured through, stored on, and viewed through a common web server in an urban capitated delivery system.

Materials and methods: The authors designed a system whereby a primary care physician was able to seek a dermatologic consultation electronically, provide the specialist with digital images acquired according to a standardized protocol, and review the specialist response within 2 business days of the request. The settings were two primary care practices in eastern Massachusetts that were affiliated with a large integrated delivery system. Technical evaluation of the effectiveness of the system involved 18 patients. Main outcome measures included physician and patient satisfaction and comfort and efficiency of care delivery.

Results: In 15 cases, the consultant dermatologist was comfortable in providing definitive diagnosis and treatment recommendations. In 3 cases, additional information (laboratory studies or more history) was requested. There were no instances where the dermatologist felt that a face-to-face visit was necessary.

Conclusions: This novel approach shows promise for the delivery of specialist expertise via the internet. Cost-effectiveness studies may be necessary for more widespread implementation.

A low-cost usability engineering methodology (heuristic evaluation combined with small-scale expert assessment) is examined in the context of the design and development of a Web-based telemedicine system. Six experts - three human-computer interaction (HCI) experts and three medical-content experts - examined the Spacebridge to Russia Web site for usability. The HCI experts identified 52 interface problems using a set of ten usability criteria or heuristics; these problems ranged in severity from cosmetic to a major failure. The content experts completed a series of six simple tasks while describing their actions. The usage difficulties were related to the HCI problems identified and were primarily characterized by a mismatch of the designer model and the content expert model. This heuristic/usage methodology can provide an incremental benefit in a variety of other design activities. It is suggested herein that the combined heuristic/usage methodology should be included as a standard design component of dynamic telemedicine systems.

This paper describes a conceptual framework and human factors evaluation for usability assessment of commercially available telemedicine technology. Four criteria of human factors evaluation are utilized: (1) technical acceptability; (2) operational effectiveness; (3) clinical appropriateness; and (4) equipment selection. These criteria were applied to commercially available video-otoscope systems for otological evaluations.

This telemedicine test was developed to determine the relative ease with which an off-the-shelf ophthalmic telemedicine package could be successfully applied from within a remote theatre of operations. The project was conducted at the Camp Doha Health Clinic, located just outside Kuwait City, during the period from April 12(th) through April 23(rd), 1998. The deployed signal unit had contracted for a direct T-1 commercial satellite link (via MCI), which allowed for direct internet connectivity using a PCMCIA network card. Digital images were sent via this connection to 140 e-mail sites throughout the world, including an unsolicited image to each of 134 Army optometry officers for their review, analysis, and diagnosis. Return responses to this unsolicited survey were 53 out of 134, for a 39.7% response rate. Half of the respondents were able to view the image with ease and clarity, rendering an accurate clinical diagnosis. The other half of the respondents either did not have the software to display an image on their clinical desktop PC, or did not know how to use their provided software. This project clearly indicates that an off-the-shelf ophthalmic digital system can be successfully used from a remote deployed site. However, the consulting clinicians require up-to-date training, and their computer packages should have as wide a capability base as possible.

Objective: To study the accuracy, patient satisfaction, and cost of telecardiographic evaluations of pediatric patients.

Materials and methods: Patients referred to a rural pediatric cardiology outreach clinic were examined in person by a pediatric cardiologist. A second pediatric cardiologist who had no knowledge of the findings of face-to-face examination reevaluated the same patients utilizing a 768-Kbps telemedicine system. Any additional testing was performed by personnel who had no knowledge of the face-to-face evaluation. The main outcome measures included the final cardiac diagnosis, frequency of additional tests such as electrocardiography, (ECG) echocardiography (ECHO), and patient satisfaction.

Results: The diagnosis was agreed upon in 19 of the 21 patients studied. Two patients with small ventricular septal defects were missed during the telemedicine evaluation. The utilization rates of additional studies for both the face-to-face cardiologist and the telemedicine cardiologist were not significantly different. Patient satisfaction with the telemedicine encounter was good.

Conclusions: Telemedicine appears to be effective and useful for the cardiac evaluation of pediatric patients. In spite of high data-transfer rates, differences between telemedicine and face-to-face patient encounters were observed.