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

Problems associated with telemedicine systems include high telecommunications costs, lack of physician interest, and failure to build evaluation into the design process from the onset of the telemedicine project. An overview of the human-factors engineering approach to systems design and how it can be applied to the development of telemedicine systems is described. Design of an interface is based on an analysis of user capabilities, tasks, and work environment. Task analyses are performed to understand and document the interaction between a user's work activities and a system. Two characteristics of a human factors approach that are important for telemedicine are: (1) defining and measuring user performance, and (2) involving users in the design and testing of a system. Usability goals are operationally defined and tracked to quantify performance. Having users participate in the design, testing, and critique of a system also increases the likelihood that the system will be accepted and used after it is released.

This paper introduces the activities of the National Space Development Agency of Japan (NASDA), focusing the activities of its newly established division of the Satellite Mission Application Center. The major objective of the center is to further promote the utilization of the space-based technologies and the creation of new satellite missions. The center is exploring future cooperative activities that may work with countries in Asia and the Pacific. The application of satellite communications for the field of telemedicine is one of its potential activity areas.

Purpose: To develop a uniform file format of ocular imaging data, including, but not limited to, ultrasound biomicroscopy, optical coherence tomography, and nerve fiber analyzer, capable of being transmitted via Internet or intranet for collaborative research and telemedicine use.

Method: File filters were developed as dynamic link libraries (DLLs). These can read the original raw data format of each ocular imaging device. A data file format was also designed to describe these raw data uniformly in three different types of compression: noncompressed, run length compression, and differential pulse code modulation (DPCM). These three file formats were then tested in the following aspects: file size, speed of reading, and speed of writing.

Results: Run length compression failed to compress raw data, while DPCM compressed raw data successfully (< or =35.5%). The speed of reading and writing files was slowest in DPCM. However, the actual time of reading and writing was fast enough (<0.6 s) for daily work regardless of file compression methods.

Conclusion: The format designed has robust potential to be the standard file format for transmission of any ocular imaging raw data.

Objectives: To determine patient satisfaction with telemedicine encounters among adults with sickle cell disease and compare their scores with SCD patients who have standard medical encounters (as controls).

Methods: Adults patients were recruited from a list of participants in sickle cell telemedicine clinics and prospectively at the time of clinic encounter. Patients were assigned to telemedicine or standard encounter groups. Demographic and pertinent clinical data were obtained for all subjects, and the Client Satisfaction Questionnaire (CSQ-8) was administered. Patients were also asked for open-ended comments regarding their satisfaction with the service. Their responses were recorded verbatim.

Results: Patients with telemedicine (n = 60) and standard encounters (n = 60) were comparable in gender, genotype, education, employment, and mean number of sickle cell disease-related complications. Patients in the telemedicine group were younger (p< 0.005), more likely to have Medicaid insurance (p = 0.009), and more likely be taking hydroxyurea (p = 0.003) than patients in the control encounter group. Mean CSQ scores for the telemedicine group were high (total: 28.82+/-3.06), and there was no difference for any item between encounter groups (p = 0.389). Patients in the standard encounter group were more likely to provide positive open-ended comments regarding the encounter (95% vs. 70%; p = 0.001). Negative comments were generally in the area of confidentiality.

Conclusions: While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.

Telemedicine, broadly defined as the use of information technology (IT) to deliver medical services over distances, is one proposed solution to problems of accessibility, quality, and costs of medical care. Although telemedicine applications have proliferated in recent years, their diffusion has remained low in terms of the volume of consultations. In this study, we extend Attewell's theory of knowledge barriers to explain why diffusion of telemedicine remains low. A longitudinal, embedded multiple case study of telemedicine programs in three medical centers in Boston, Massachusetts, reveals that, in addition to technical knowledge barriers, as suggested by Attewell, there are economic, organizational, and behavioral knowledge barriers that inhibit the diffusion of telemedicine. The lowering of these barriers entails intensive learning efforts by champions of applications within adopter organizations. They need to develop technically feasible, medically valid, reimbursable, and institutionally supported applications in order to justify the value of telemedicine and engender consistent and frequent use by physicians.

Background: Rural hospitals generally lack staffing with infectious disease specialists or pathologists. Without on-site pathologists, the range of microbiology services offered by clinical laboratories may be limited as well.

Objective: To study the feasibility of using static-image telepathology to evaluate Gram stains of microbiologic preparations.

Materials and methods: In this retrospective feasibility study, three pathologists evaluated Gram stains of slides from 50 cases by two viewing modalities: static-image telepathology and conventional light microscopy. Digital video images of slides were captured at two magnifications (using 40x and 100x objective lenses) at 1024 x 768 x 24-bit color and transmitted over standard telephone lines at 14,400 kbps. Pathology reports and culture results served as "truth diagnoses." Categories of interpretations were correct, minor discrepancy, or major discrepancy with regard to the implications for patient care.

Results: The diagnostic accuracy of video image readings and conventional light microscopy readings were nearly identical, with no statistically significant differences in the performances of specialty and nonspecialty pathologists (P > 0.05). The mean accuracies of readings of the video images and light microscopy images were 95.3% and 95.4%, respectively. Taking into account the time required by a referring pathologist to capture video digital images, telemicrobiology was somewhat less efficient than conventional light microscopy.

Conclusions: Pathologists can accurately evaluate digital video images of preselected fields on Gram-stained slides. In clinical practice, however, a limiting factor may be the availability of local personnel qualified to select the microscopic fields for evaluation by telepathologists. The adequacy of the video images suggests that telepathology may also be used for remote supervision of quality assurance programs in microbiology laboratories, as well as for remote proficiency training of laboratory personnel.

Economic evaluation of telemedicine compares the costs and other consequences of delivering specific services through telemedicine vs. alternative means. Cost-effectiveness analysis, the most common method used for health issues, helps to assess whether the expected health benefits are worth the investment. Telemedicine raises particular challenges for evaluators: a telemedicine system may have multiple uses and joint costs that are difficult to apportion to one service, the existence of a system may lead to expanded indications for use, and technological change may rapidly make an evaluation outdated. Public and private regulation and payment may affect the diffusion of telemedicine. Uncertainty surrounds the policy of the U.S. Food and Drug Administration, which is still formulating its position. Changes are underway in policies on licensure and credentialing of clinicians, which have traditionally been done by state and by site, to reflect the fact that telemedicine services may cross these regional boundaries. Lack of insurance coverage for telemedicine services has been considered an impediment to adoption with fee-for-service payment. Under capitation payment and fixed budgets, however, providers have financial incentives to use the most efficient method to deliver services, and these arrangements would favor telemedicine if it is the less costly alternative. If telemedicine were most costly and the health benefits worth the cost, monitoring might be needed to ensure the quality of care.

The Canadian climate and geography are particularly well suited to the adoption of communications technologies for long-distance medical care and education. Canada has a long history of use of telemedicine applications, and in recent years, the number and variety of telehealth activities in Canada have increased dramatically. Using information gathered for a competitive framework study of the telehealth industry in Canada, this article documents these changes. The trends observed have been encouraged by the development of provincial and national infrastructure for the health information highway, changes in the health care system, increased technological capacity and speed, and government intervention and assistance. The pace of growth is apparent in the increases in the number of projects, the number of companies offering telehealth products and services, the adoption by public organizations of telehealth technologies for a wider range of applications, and the increasing amount of research being undertaken. The article concludes with comments on the role of government intervention in fostering these developments.

Objective: Surgical specialists have generally underutilized telemedicine technologies. This report describes the use of real-time interactive-video telemedicine to augment the care of vascular surgical patients in underserved rural areas within our region.

Materials and methods: The telemedicine system at Fletcher-Allen Health Care (FAHC) and the University of Vermont in Burlington utilizes desktop video conferencing technology with terrestrial transmission at 384 kbps. The current system was initiated in January 1996, and there are at present 18 external sites and multiple locations at FAHC, including the vascular laboratory, angiography suites, operating rooms, and the home of one vascular surgeon. During the first 12 months of operation, the vascular surgeons were asked to complete a questionnaire to evaluate the technology and its usefulness in clinical care. The use of the telemedicine system by the vascular surgeons was monitored by the questionnaires, phone bills, and a special "no charge" billing code. Telemedicine events were classified as clinical or educational.

Results: In the 26 months since implementation, 107 events have taken place, including both clinical and educational uses. There were 103 clinical uses by three vascular surgeons, including five emergency uses. A joint Vermont-Maine vascular educational conference has taken place four times. Overall, use by vascular surgery represented 14.2% of all telemedicine events in the first year or 30.9% of all clinical events during that time period. Use of telemedicine was reported to have improved patient care in 96% of the cases. Eighty percent of the telemedicine uses in the first year saved patient travel. There were no diagnostic errors, as determined by in-person clinical follow-up, attributable to the telemedicine system use.

Conclusions: Use of a real-time video telemedicine has great potential for vascular surgeons, but cost-effectiveness studies may be needed prior to its widespread adoption.