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

Background and objectives: Ultrasound practice in Alberta requires direct supervision by an ultrasound-accredited specialist physician (sonologist). This requirement limits access to ultrasound examinations in many rural communities. A prospective study was performed to evaluate the adequacy of teleultrasound service in High Level, Alberta, with remote sonologist supervision from Edmonton, Alberta.

Methods: A total of 146 patients were evaluated in two groups. Group A (72 patients) was evaluated by both an on-site radiologist in High Level and a remote supervising radiologist in Edmonton. Group B (74 patients) was evaluated only by the remote supervising radiologist in Edmonton. The teleultrasound service included digital store-and-forward capabilities using a commercially available teleradiology system, with videoconferencing review for real-time scanning.

Results: The teleultrasound service was helpful to the referring physician. It made transfer unnecessary in 42% of patients, and the results of the ultrasound assessment influenced management in 59% of patients. The sonographer on site and the remote radiologists agreed on the quality of the images. The information required for diagnosis was available from the sonographer's study in the majority of cases, with second-look scanning by the on-site radiologist or videoconferencing by the remote radiologist providing a major new diagnosis in only 1% of patients.

Conclusion: Teleultrasound service to High Level could be provided reliably with remote supervision, comparable to direct on-site supervision.

Understanding the full financial effects of telemedicine systems on payers, providers, and patients has been hampered by the lack of data from full-fidelity systems operating at a steady state. The vast majority of telemedicine systems in the United States have yet to achieve their full potential in serving their target populations and are operating well below capacity. The purposes of this research are two-fold: (1) to develop a methodology that compensates for the limited availability of empirical data on the financial effects of telemedicine; and (2) to test this methodology in a comprehensive telemedicine system in West Virginia. The proposed methodology utilizes simulation modeling techniques for evaluating the financial performance of a mature telemedicine system. It is particularly suitable for analyzing large, complex systems that have not yet achieved steady-state operation. Although complex, the methodology can be described simply as consisting of two major steps. The first is the identification of all of the relevant variables and parameters for modeling. The second consists of simulating "real world" decision situations involving all relevant variables and parameters. The relation among the variables and parameters are described in terms of mathematical equations. The ability of the researcher to estimate the financial effects of a given telemedicine system is a function of the extent to which the resulting model approximates conditions of the real world; i.e., the fit between model and reality.

Objective: Telemedicine technology has the ability to project highly specialized medical and dental expertise anywhere in the world. This is particularly important to many small, isolated communities that do not have access to medical and dental specialists. Telemedicine also has the potential to reduce unnecessary travel, time away from work, and unneeded hospital admissions. For this technology to be successful, however, clinicians need to have confidence in its capabilities. This study was conducted to determine the accuracy of an orthognathic evaluation using telemedicine.

Materials and methods: Thirteen patients were randomly selected for review by two surgeons each using telemedicine and clinical examinations. Clinically acceptable differences were established, and the results of the two examination methods were compared.

Results: A main effect of the examination method was observed in 7 of the 18 continuous measurements taken. Examination of the absolute value of the within-subject difference between the two examination methods demonstrated that the mean absolute difference was statistically different from zero for 13 of 18 measurements taken.

Conclusions: These data demonstrate that a relatively accurate orthognathic examination can be performed with this technology. With this in mind, clinicians may feel comfortable using this technology for other clinical applications.

Objective: The Kyushu area of southwestern Japan has several mountains and 157 inhabited islands. We assessed the feasibility of implementing a desktop conference (DTC) system to improve medical care in this area. TELECOMMUNICATIONS TECHNOLOGY AND EQUIPMENT: The Phoenix DTC system (NTT Corporation, Tokyo, Japan) for personal computers includes a microphone, speaker, color CCD camera, and appropriate software. We used a digital camera for still pictures and image-analysis software for radiographs and CT and MRI films. The system was installed on a Pentium 133 MHz computer, which was connected by ISDN line at a 128 kbps data rate to a clinic on a small island where one physician cares for 1000 residents, two small nursing offices where each nurse tends 100 residents, two nursing homes, a hospital in a mountainous area, and the residence of a patient with atopic dermatitis. Connections were made once a week for a period of 6 months.

Results: The transmitted still pictures; e.g., senile nevus, atopic dermatitis, chickenpox, and a radiograph of a suspected fracture, were useful for diagnosis and clinical decision making. We received and responded to inquiries from residents of the participating nursing homes on nutrition, senile depression, nevus, decubitus ulcers, urinary tract infection, and protection against Legionella infection. We also used the system to deliver lectures on pediatrics to nurses; provided case discussions on diaphragmatic herniation and subtentorial tumor; and had on-line presentation of a patient with beta-thalassemia using presentation software.

Conclusion: The DTC system used in the present study seemed technically satisfactory and useful in improving medical care in remote sites of Japan.

Memorial University of Newfoundland has been continuously involved in telemedicine activities since 1975. Unlike most early telemedicine programs, which did not continue after grant funding ended, Memorial made the transition to create a self-sufficient Telemedicine Centre. Key to its success was the vision and drive of its founder, Dr. Max House, and adherence to the following principles: (1) all activities were based on a legitimate need; (2) the simplest, least expensive technology was used to meet the need; (3) the network was shared by a variety of users; and (4) users were given proper training and support. Over the years, Memorial has been involved in 30 telemedicine projects, many of which became ongoing services. Although most initial activity was health related, educational activities have played an increasingly important role. In 1997, the Telemedicine Centre delivered approximately 7000 hours of programming and administered a network of 247 dedicated audioconference sites in 161 communities (168 of the sites had telewriter workstations and 75 had multimedia workstations) and eight videoconferencing sites. Approximately 70% of all programming was distant high school and university education, 20% health education, 5% clinical activities, and 5% other uses. Current clinical activities include tele-electroencephalograms, tele-ultrasonography, tele-nuclear medicine, child telepsychiatry, general teleconsultation from a remote nursing station, and general teleconsultation from an offshore oil platform. Lessons learned from more than 20 years of telemedicine experience are presented.

Objective: Needs assessment is a critical part of the design and implementation of telehealth projects. This study assessed the need for a telehealth link between a local community and a tertiary-care medical center.

Methods: The assessment was conducted using multiple focus groups in a remote community and at a tertiary-care pediatric and women's medical center. Participants were physicians and allied health professionals at both sites and the parents of pediatric patients. Data were analyzed for comment categories and thematic items.

Results: The focus groups revealed a number of important positive and negative attitudes regarding telehealth and priorities for implementation. Uncertainty and trust were two themes that emerged from all groups. The resulting design of the telehealth program incorporated these responses.

Conclusion: Qualitative methods, including focus groups, can yield useful data on complex behavior and explore attitudes toward new and unfamiliar technology.

Objectives: To determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy.

Materials and methods: Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina.

Results: The two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis.

Conclusion: The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.