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

Objective: This project identified telelearning projects associated with the 13 established Canadian telehealth centers in order to describe the nature of their activities, outline enablers and barriers to these activities, and present key action plans to move the Canadian agenda on telelearning in health forward.

Materials and methods: Data were collected by a one-page questionnaire sent to the Canadian telehealth centers. Recipients were asked to identify current partners in such activities and to indicate if such partners should complete a separate questionnaire. Forty-nine questionnaires were distributed. Reported enablers, barriers, and action plans were placed in categories and analyzed. Data from 37 questionnaires, referencing 101 projects, formed the basis of the analysis.

Results: More than half of the telelearning programs were developed for health providers, approximately one third for undergraduate or graduate students, and a small percentage for patients or the private sector. The most frequently used communication mode was two-way audio/video conferencing. Enabling conditions were grouped into four categories: Canada as a country, timing, infrastructure, and collaboration and support. Five categories of barriers were cited: lack of sustainable funding, insufficient infrastructure and resources for sustainable programs, absence of the required culture change, lack of standardization and defined policies, and unavailability of valid and reliable evaluation frameworks. Eight broad constructive action steps were suggested.

Conclusions: The reported enablers can create momentum to carry telelearning into a position of prominence. The Canadian telehealth community recommends action steps that could facilitate the removal of barriers and maximize current opportunities.

The National Aeronautics and Space Administration (NASA) has been a pioneer in telemedicine since the beginning of the human spaceflight program in the early 1960s. With the rapid evolution in computer technology and equally rapid development of computer networks, NASA and the Department of Surgery in Yale University's School of Medicine created a telemedicine testbed with the Russia Space Agency, the Spacebridge to Russia Project, using multimedia computers connected via the Internet. Clinical consultations were evaluated in a store-and-forward mode using a variety of electronic media, packaged as digital files, and transmitted using Internet and World Wide Web tools. These systems allow real-time Internet video teleconferencing between remotely located users over computer systems. This report describes the project and the evaluation methods utilized for monitoring effectiveness of the communications. The Spacebridge to Russia Project is a testbed for Internet-based telemedicine. The Internet and current computer technologies (hardware and software) make telemedicine readily accessible and affordable for most health care providers. Internet-based telemedicine is a communication tool that should become integral to global health care.

Objective: This is an evaluation of a telemedicine system for the rapid interpretation of neonatal echocardiograms from a regional, level III neonatal intensive care unit (NICU). The use of telemedicine to support the cardiology needs of NICUs is increasing. However, there is very little published objective information regarding health outcomes or costs resulting from such telemedicine systems. The primary hypothesis tested was that the utilization of a telemedicine system for the interpretation of neonatal echocardiograms reduces the intensive care length of stay of low birthweight (LBW) infants.

Study design: All infants who were admitted to neonatal intensive care at New Hanover Regional Medical Center during the first six months of the system were studied by the use of echocardiograms. They were compared with infants who were born in the same period of the previous year. The outcome measures were the intensive care length of stay, rate of transfer to academic medical centers, and mortality rate.

Results: A statistically non-significant reduction of 5.4 days in the intensive care length of stay (LOS) of low birthweight infants was observed (p = 0.37). The cost per echocardiogram transmitted was calculated at $33 compared to previous method of sending videotapes via overnight courier.

Conclusions: While the sample size was inadequate to demonstrate improvements in health outcomes, the magnitude of the change and the low costs of the system suggest that this intervention is practical for obtaining rapid diagnostic and treatment support. Larger studies are warranted to confirm these findings and determine whether faster diagnosis and earlier initiation of treatment improve health outcomes of newborn infants.

Objective: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients.

Methods: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis.

Results: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction.

Conclusions: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.

Objective: The significance and usefulness of image transmission in laryngology were evaluated retrospectively on the basis of daily clinical practice.

Materials and methods: The subjects consisted of 29 patients with laryngeal disease, whose laryngeal findings had been already recorded on videotape. Patient data were sent to a major hospital by Internet e-mail. Two laryngeal images, during breathing at rest and phonation, were transmitted as an attached file. Using a rigid or flexible endoscope coupled with a one-chip CCD camera, laryngeal images were recorded. Pictures of these laryngeal images were printed by a video printer, digitized by a compact print scanner, and saved as JPEG files.

Results: The diagnosis made by the three specialists in laryngology (receivers), who referred to the transmitted images and text files of the patient's history, was identical to the diagnosis made by the general otolaryngologist (sender), who referred to the original pictures and patient data. All images were displayed with sufficient quality to evaluate morphologic abnormalities, and the disturbance of cordal movements was detectable by comparing images during breathing at rest with those obtained during phonation.

Conclusion: The image-transmitting system was a useful tool for consultation between otolaryngologists and for referrals from general practitioners to otolaryngologists.

Purpose: To determine if current telemedicine technology can support real-time telementoring to teach ophthalmologic surgical procedures in remote areas.

Method: Using an integrated systems digital network (ISDN) line conveying information at a rate of 128 kbps, an endoscopic laser-assisted dacryocystorhinostomy (ELA-DCR) procedure was transmitted in real time from the Saint Francis Medical Center in Honolulu, Hawaii, to ophthalmologists at the Makati Medical Center in Manila, Philippines, more than 5000 miles away. Live surgical and endoscopic images were sent real time with explanations by the surgeon and with interactive questions and answers during and after the procedure.

Results: The ELA-DCR procedure was transmitted in real time from Honolulu to more than 100 ophthalmologists at the Makati Medical Center in the Philippines.

Conclusion: Current technology in telemedicine can support the use of real-time surgical telementoring to teach complex ophthalmologic procedures.

Use of the Internet for patient-specific consultation across international boundaries has been demonstrated. This report describes the efforts of Baylor College of Medicine and NASA to conduct a telemedicine consultation with Moscow, Russia. Consultation between Russian and American physicians was performed over the Internet with a combination of real-time and store-and-forward techniques. The clinical focus involved a 65-year old Russian scientist who had undergone mitral valve replacement in the United States 5 years earlier. Development of new activity-related chest pain, dyspnea, and intermittent atrial fibrillation led to a consultation with his American cardiologist and cardiac surgeon. Real-time video was supplemented with telephone voice communication to overcome bandwidth limitations. Prior to the video link, the patient's recent history and clinical data were made available via the Internet using file transfer protocol (FTP). The patient's medications, new electrocardiographic findings, and activity status were reviewed. Specific clinical recommendations were made as a result of this telemedicine consultation. This case illustrates the technical factors, clinical implications, and confidentiality issues related to using the Internet for telemedicine consultations and demonstrates that the Internet may provide an alternative means for long-term clinical follow-up of patients.

Health care must be understood in a way that facilitates a rational, consistent coverage and payment policy. Telephone care, telemedicine care, and in-person consultation are all useful ways of providing health care services. Because improved health and reasonable costs are the universally desired outcomes of medical consultations, reimbursement policies should favor the most efficient means of providing care. This view suggests that health care reimbursement should be made technologically neutral. That is, a covered service should produce the best clinical outcome at the lowest possible cost, irrespective of the technology used. The logic and implications of technological neutrality and its application to telemedicine are discussed.