Assessment Of Telemedicine Research Articles

Assessing Cross-Border Telemedicine Data Exchange in the European Union: A Call to Action.

Background: Telemedicine offers potential benefits for health care delivery. However, evidence of cross-border telemedicine data exchange within the European Union (EU) remains limited. The objective of this communication provides a brief outline of the regulatory framework, initiatives, and challenges associated with cross-border telemedicine data exchange in the EU, setting the stage for a comprehensive evidence assessment. Methods: We explore the current regulatory landscape (European Health Data Space), existing initiatives (the European Electronic Health Record Exchange Format), and interoperability challenges (e.g., legal, technical, semantic) facing EU cross-border telemedicine data exchange. Results: There is a need for thorough evidence assessment of cross-border telemedicine and related data movements. Conclusion: Understanding the current landscape of cross-border telemedicine is crucial. This article highlights the need for evidence assessment through a formal review to inform future research and policy initiatives in this domain.

Telemedicine in Acute Trauma Care: A Review of Quantitative Evaluations on the Impact of Remote Consultation.

There is extensive literature describing the application of telemedicine techniques to trauma care. However, there is a paucity of articles showing quantitative assessment of its safety and efficacy. This structured review examines articles with quantitative assessment of telemedicine's impact in acute trauma care. Medline and CINAHL databases were searched for peer-reviewed articles that quantitatively assess the impact of telemedicine on diagnostic accuracy, clinical decision-making, emergency department length of stay, transfer rates, and mortality in initial trauma management. Only 9 of the 408 screened articles met the criteria for quantitative assessment. Telemedicine appears to be preferentially used for more severely injured patients. Limited quality evidence supports procedural interventions at remote sites. Telemedicine may help abbreviate pre-transfer length of stay. However, its impact on diagnosis and mortality remains unclear. Telemedicine's potential to enhance the quality and efficiency of trauma care, especially for resource-scarce areas, warrants continued quantitative research.

Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence.

Ocular surface squamous neoplasia (OSSN) is a common eye surface tumour, characterized by the growth of abnormal cells on the ocular surface. OSSN includes invasive squamous cell carcinoma (SCC), in which tumour cells penetrate the basement membrane and infiltrate the stroma, as well as non-invasive conjunctival intraepithelial neoplasia, dysplasia, and SCC in-situ thereby presenting a challenge in early detection and diagnosis. Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments, such as topical medicines, whereas advanced invasive lesions may need orbital exenteration, which carries a risk of death. Artificial intelligence (AI) has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management. AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN, aiding ophthalmologists in early detection and diagnosis. AI can also track and monitor lesion progression over time, providing objective measurements to guide treatment decisions. Furthermore, AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response. This manuscript highlights the role of AI in OSSN, specifically focusing on its contributions in early detection and diagnosis, assessment of lesion progression, treatment planning, telemedicine and remote monitoring, and research and data analysis.

Telemedicine applied to neurology, a syndromic approach

Introduction: Telemedicine has proven invaluable, especially in cases like stroke, where it expedites accurate diagnosis and thrombolytic treatment initiation, thereby reducing mortality rates. Objectives: Evaluate the efficacy of telemedicine in diagnosing neurological syndromes among patients receiving outpatient care through teleneurology. Methodology:A systematic literature review was conducted using a qualitative and descriptive approach, guided by the "PICO" search and analysis strategy. The study population comprised patients seeking outpatient neurological care, with the primary interest being the assessment of telemedicine's efficiency in diagnosing neurological syndromes. Data were collected from PubMed, Scopus, and BVS databases using predefined inclusion and exclusion criteria. Results: Several studies demonstrated the successful application of telemedicine in neurological care. For instance, teleconsultations with patients diagnosed with cognitive impairment yielded positive outcomes, reducing demands while delaying symptom progression. However, the feasibility of telemedicine varied across different regions and patient demographics, highlighting socio-economic factors as determinants of accessibility and acceptance. Additionally, telemedicine showed promise in managing complex neurological conditions such as cerebellar ataxia, Parkinson's disease, and myasthenia gravis, albeit with certain limitations in physical examination capabilities. Conclusion: In conclusion, telemedicine has emerged as a crucial tool in neurology, overcoming geographical barriers and enhancing access to specialized care. Despite its widespread adoption, challenges persist, particularly in ensuring equitable access across diverse populations. Moving forward, addressing these challenges and advancing telemedicine infrastructure will be paramount in optimizing neurological care delivery and improving patient outcomes.

Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review.

Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. PROSPERO CRD42022347366; https://osf.io/pxedm/.

Patient satisfaction with telemedicine for substance-related disorders.

Telemedicine has been shown to be an effective approach for people with substance-related disorders. Analyzing patient satisfaction with telemedicine is necessary for improving treatment outcomes. This study aims to assess patient satisfaction with telemedicine for substance-related disorders at the Centro Asistencial Córdoba in Argentina. A cross-sectional, descriptive, and correlational design was carried out. A patient satisfaction survey was created, consisting of eight questions and a quality-of-life question, which was administered to N = 115 patients. The results showed that more than 90% agreed with the ease of use of virtual consultations, 82% felt they received the same level of care as if the consultation had been in person, 86% agreed with the adequacy of time utilized during the virtual session, and over 85% agreed to repeat their telemedicine treatment. Regarding the composite variable "users' assessment of telemedicine," we found an average of 17.41 ± 2.80. Concerning satisfaction with virtual care and the previous use of telemedicine, 95.7% were satisfied, and nearly 61.7% reported not having used virtual care previously. In terms of money and time saved, 93.9% saved money with virtual consultations, 66.1% saved more than two hours per week, 23.5% saved more than one hour per week, and 10.4% saved less than one hour per week. Overall, there is significant approval of telemedicine among users of substance-related disorders services. In particular, they were satisfied with the time employed, the benefits of saving time and money, and the ease of use of telemedicine; furthermore, they were positive about undergoing telemedicine treatment in the future.

Aligning practitioner's perception: Empowering MAST framework for evaluating telemedicine services.

Telemedicine is a digital substitute for in-person healthcare service delivery systems that has gained popularity amid the global COVID-19 pandemic. The objective of this study was to evaluate telemedicine compatibility from the perspective of healthcare practitioners to enhance the effectiveness and spectrum of the Model for Assessment of Telemedicine. Primary and Secondary Healthcare and King Edward Medical University extended their respective telemedicine services in 2020 where 24,516 patients were benefited from the telemedicine services provided by 1273 doctors from different specializations. A cross-sectional survey via online questionnaire was conducted among purposively sampled 248 healthcare practitioners designated at telemedicine portals in the public sector; further analysed by descriptive analysis and Monte Carlo Feature Selection. Healthcare practitioner perception was analysed explicitly and found significant in addition to the existing domains under multidisciplinary assessment in the Model for Assessment of Telemedicine model. The variables of subdomains integration with healthcare system, patient facilitation, technology ease, capacity building, ethical integrity, outcome assessment and communication gap under proposed healthcare practitioner perception domain were found interdependent. The variables of patient satisfaction, resource preservation, healthcare practitioner satisfaction, digital connectivity, user-friendliness, and patient safety were found to be of higher importance (RI values). However, the compatibility of telemedicine with the healthcare system was also influenced by interdependencies (RI plot) and multifaceted interactions of variables derived from the healthcare practitioner perception. The variables of healthcare practitioner perception were exhibiting various weightages of importance and interdependencies in determining the compatibility of telemedicine within the healthcare system and recommended to be considered in the Model for Assessment of Telemedicine framework.

ContactDoctor app: Video-consultations between citizens, municipality health or social care employees and general practitioners.

Introduction: The ContactDoctor app enables citizen-centric, interdisciplinary and cross-sector video-consultations to improve quality and integration of care and provide equitable access to healthcare.
 Background: Video-consultations with healthcare professionals, incl. general practitioners (GP), accelerated in 2020-2021 to limit the spread of Covid-19. During that time, the app ContactDoctor was rapidly developed in a successful public-private collaboration.
 A national project was initiated to support wider implementation of ContactDoctor, where the goal is 60/98 municipalities and 700/1600 GP clinics. 
 The project is financed by the Danish Ministry of Health. The ContactDoctor-app is owned by the Organisation of General Practitioners in Denmark.
 Target group: ContactDoctor is intended for elderly and vulnerable citizens, e.g., people with social, psychological, physical problems, in nursing homes, homecare, rehabilitation, emergency teams and living-arrangement offers, who are not able to conduct a video-consultation with their GP without support. In Denmark, these welfare and healthcare areas are decentralised to municipalities. Municipality employees facilitate video-consultations between citizens and GPs and support citizens during the conversation. Citizens’ relatives can participate in the video-consultation too. 
 The project collaborates with interested municipalities concerning implementation. A User Group, consisting of representatives from 10 municipalities and a data-consultant from each region, is closely involved in the development of ContactDoctor and in preparing guidelines and implementation-material. 
 Results: The evaluation design is ‘Model for Assessment of Telemedicine’. Four evaluation reports are published between November 2021-February 2023 and collect different learnings and results from the implementation process or target groups. 
 The following results are derived from two published reports and based on statistical data, 10 different questionnaires and 7 focus-group interviews targeted municipality employees, GPs, and project managers.
 
 By September 2022, the total number of video-consultation via ContactDoctor is 1614. The data is showing a continuous increase, albeit with large differences between the municipalities. Currently, 36 municipalities and 203 clinics is using ContactDoctor.
 Users report great potential in ContactDoctor due to the flexible and integrated format and user-friendliness. ContactDoctor has been used in many different situations: acute, follow-up, medication assessment, physical problems, preparation for doctor's visit. 
 ContactDoctor has the potential to improve quality of care, enable better integrated care and provide equitable access to healthcare services. Users agree that ContactDoctor can lead to faster and more efficient treatment, fewer inconveniences for vulnerable citizens who, due to e.g., anxiety, reduced mobility, find it difficult getting to their GP. 
 Conclusion and learnings: The use of video-consultations is voluntary and the implementation of ContactDoctor is progressing, however slowly despite users reporting it a beneficial supplement to physical consultations. During the pandemic, ContactDoctor was essential, but now several municipality employees recognize that they forget to use it during a busy workday. It requires great awareness and continuous implementation focus before the app is a standard work tool and its full potential in an integrated care approach is reached. This applies to both GPs and municipalities. Without local initiatives in regions and municipalities, including management support and implementation follow-up, the initiative can result in a low degree of use and distribution.

Consumers' experiences, preferences, and perceptions of effectiveness in using telehealth for cancer care in Australia.

COVID-19 accelerated telehealth (video and telephone) use for cancer care to reduce disease exposure and transmission. Understanding consumers' health service delivery needs is required to sustain telehealth activity and develop new models of care. We explored consumers' experiences of telehealth in cancer care and their perspectives on improving and sustaining telehealth uptake in the future. Exploratory design mixed-methods study using the Model for Assessment of Telemedicine (MAST) framework. Consumers affected by cancer completed an online survey and semistructured interviews. Quantitative data were analyzed using descriptive statistics and chi-square. Qualitative data from the MAST consumer domain were thematically analyzed. There were 1162 survey respondents and 18 interview participants. Video and telephone were used in cancer care with various providers. Telephone was used more frequently. Most respondents (85%) had reliable internet connections for video, however, 36% were not offered a video consultation. Video compared with telephone users were statistically significantly more likely to be satisfied with the quality of their treatment and perceived their consultation achieved as much as an in-person consultation. Telephone users (51%) compared with video users (31%) were more likely to perceive their concerns would have been better understood by their care provider if they were seen in person. Five themes emerged from the qualitative data. Consumers want modality choice, video provides superior experiences versus telephone, consultation mode preference is fluid, and consultation scheduling and administration need further consideration. Consumers support telehealth in cancer care. Consumers want consultation mode choices based on their needs and purpose of consultation.

Quality analysis of telemedicine studies in sleep apnea: applications of the model of assessment telemedicine as a methodological tool

INTRODUCTION: Our study aimed to verify the usefulness of the Model for Assessment of Telemedicine (MAST) to select quality studies on the use of telemedicine in patients with sleep apnea syndrome.EVIDENCE ACQUISITION: We carried out a bibliographic search with the Pubmed search engine. We selected all the articles published in the last ten years, written in English or Spanish, that included only an adult patient. The type of study accepted was the clinical trial, meta-analysis, systematic reviews, and observational studies. The user Medical Subject Headings (MesH) were “telemedicine,” “telehealth” and, “sleep apnea syndrome.”EVIDENCE SYNTHESIS: We included a total of 20 studies, 70% of which were conducted in Europe. We identified three studies considered “high quality” and detected a significant association between domains 3 and 5 of the MAST with the higher quality of the manuscript. Non-compliance of several domains of the MAST method is systematic, especially in order of frequency, domains 2 (95% non-compliance), 5 (55%), 4 (50%) and 3 (30%).CONCLUSIONS: The MAST is an easy-to-use tool that allows the design, analysis and selection of the highest quality telemedicine studies. In our opinion, a new domain to assess health professionals’ opinion should be considered that allows detection parameters that may eventually interfere with the acceptance and use of the telemedicine program.

A review of questionnaires used for the assessment of telemedicine

Introduction Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. Methods We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. Results and Discussion We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

Assessment of Pediatric Telemedicine Using Remote Physical Examinations With a Mobile Medical Device

The number of innovations in health care based on the use of platforms, digital devices, apps, and artificial intelligence has grown exponentially in recent years. When used correctly, these technologies allow inequities in access to health care to be addressed by optimizing care and reducing social and geographic barriers. However, most of the technological health care solutions proposed have not undergone rigorous clinical studies. To assess the concordance between measurements from a remote physical examination using a mobile medical device and measurements from a conventional in-person physical examination. This nonrandomized controlled trial was conducted from January 1 to December 31, 2020. The clinical parameters compared were heart rate; body temperature; heart, lung, and abdominal auscultation; otoscopy; throat and oral examination; and skin examination. A total of 690 patients with clinical stability and various symptoms who were seen in the emergency department of 2 Brazilian pediatric hospitals were eligible to enter this study. The primary outcome was concordance between measurements from a telemedicine physical examination using a mobile medical device and measurements from a conventional in-person physical examination. The secondary outcome was the specificity and sensitivity of the digital device, considering the conventional in-person consultation as the gold standard. Among 690 patients, the median (IQR) age at study entry was 5 (1-9) years; 348 (50.4%) were female, and 331 (48.0%) presented with a chronic disease. Regarding the primary outcome, the concordance values were 90% or greater for skin examination (94% for rash, 100% for hemorrhagic suffusion, and 95% for signs of secondary infection), characteristics of the mucosa (98% for hydration and 97% for coloring), and heart (95% for murmur, 97% for rhythms, and 98% for sounds), lung (91% for adventitious sounds, 97% for vesicular sounds, and 90% for fever), and abdominal (92% for abdominal sounds) auscultations. Concordance values were lower for otoscopy (72% for the ear canal and 86% for the tympanic membrane), throat and oral examination (72%), and rhinoscopy (79% for mucosa and 81% for secretion). The specificity was greater than 70% (ranging from 74.5% for the ear canal to 99.7% for hemorrhagic suffusion) for all variables. The sensitivity was greater than 52% for skin examination (58.0% for rash and 54.8% for signs of secondary infection), throat and oral examination (52.7%), and otoscopy (66.1% for the ear canal and 64.4% for the tympanic membrane). In this study, measurements from remote physical examination with a mobile medical device had satisfactory concordance with measurements from in-person physical examination for otoscopy, throat and oral examination, skin examination, and heart and lung auscultation, with limitations regarding heart and lung auscultation in infants and abdominal auscultation in children of all ages. Measurements from remote physical examination via a mobile medical device were comparable with those from in-person physical examination in children older than 2 years. These findings suggest that telemedicine may be an alternative to in-person examination in certain contexts and may help to optimize access to health care services and reduce social and geographic barriers. Brazilian Registry of Clinical Trials Identifier: RBR-346ymn.

Assessment of telemedicine versus in-person care in managing abdominal pain in children during the COVID-19 pandemic

Objectives The COVID-19 pandemic has led to a dramatic increase in telemedicine care delivery. This raises the question of whether the visit type affects the care provided to patients in the pediatric gastroenterology clinic. The aim of this study is to assess whether diagnostic, treatment, and outcome measures differ between telemedicine and in-person visits in patients seen in pediatric gastroenterology clinics for the chief complaint of abdominal pain. Methods We conducted a retrospective analysis of patients aged 0–22 who underwent their initial pediatric gastroenterology clinic visit, for abdominal pain, between March and September 2020 (n = 1769). The patients were divided into two groups: in-person or telemedicine. Clinical outcome measures were compared from the initial gastroenterology visit and followed for a total of 3 months. Results There was an increase number of images (M = 0.52 vs. 0.36, p < 0.001), labs (M = 4.87 vs. 4.05; p = 0.001), medications (M = 2.24 vs. 1.67; p < 0.001), and referrals (M = 0.70 vs. 0.54; p < 0.001) performed per visit in the in-person group. Electronic communications (3.97 vs. 5.12 p <0.003) was less frequent after in-person visits. There was no difference in number of procedures (M = 0.128 vs. 0.122, p = 0.718), emergency room visits (M = 0.037 vs. 0.017 p = 0.61), follow-up visits (M = 1.21 vs. 1.21 p = 0.922), or telephone encounters (M = 1.21 vs. 1.12 p = 0.35) between the two groups. Conclusion Telemedicine utilizes less resources while having comparable outcome measurements in children with a chief complaint of abdominal pain.

Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians

BackgroundIn the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany.MethodsThe anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians.ResultsThe use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients.ConclusionThe COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician’s and patient’s barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.

Optimising specialist geriatric medicine services by telehealth

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.

Facilitators and barriers for the implementation of telemedicine from a local government point of view - a cross-sectional survey in Germany

BackgroundTelemedicine offers additional ways of delivering medical care, e.g., in primary care in rural areas. During the last decades, projects including telemedicine are being implemented worldwide. However, implementation of telemedicine is in some countries, e.g., Germany somewhat slower compared to northern European countries. One important part of successful implementation is to include the citizen perspective. The aims of this study were to explore the perception of representatives of the local government regarding telemedicine in the context of a perceived GP shortage and to tailor future telemedicine offers according to these perceived needs.MethodsConsidering the multidisciplinary assessment suggested by the Model for Assessment of Telemedicine a questionnaire with 19 questions was developed by identifying determinants of telemedicine out the literature. After pre-testing, the questionnaire was sent to all 2199 mayors from the federal states of Schleswig-Holstein (North Germany) and Baden-Württemberg (South Germany) as representatives of the citizens (cross- sectional study; full population survey). The final questionnaire contained sections for socio-demographic data, telemedicine and perceived GP shortage. All responses from November 2018 until 2019 were included and analyzed descriptively.ResultsThe response rate was 32% (N = 699), of which 605 were included in the analysis. A majority of the participants stated they live in a rural area and 46% were in the office for up to 8 years. The mayors had predominantly a positive perception about telemedicine (60%) and 76% of them stated, their community would benefit from telemedicine. A GP shortage was reported by 39% of the participants. The highest risk of telemedicine was seen in misdiagnosing. In case of an emergency situation 291 (45%) of the participants considered data privacy as not as relevant. Mayors from a community with a perceived GP shortage had a more negative perception regarding telemedicine.ConclusionThe acceptance of telemedicine is rapidly rising compared to former studies. Communities with a perceived GP shortage had a more negative perception. Barriers like data security concerns were seen as less important in case of an emergency. The highest risk of telemedicine was seen in misdiagnosing. These findings need to be considered in designing future telemedicine offers.

Feasibility, Outcomes, and Safety of Telehepatology Services During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID‐19) has hampered health care delivery globally. We evaluated the feasibility, outcomes, and safety of telehepatology in delivering quality care amid the pandemic. A telemedicine setup using smartphones by hepatologists was organized at our tertiary‐care center after pilot testing. Consecutive patients availing telehepatology services were recruited between March and July 2020. An adapted model for assessment of telemedicine was used after validity and reliability testing, to evaluate services 7‐21 days after index teleconsultation. Of the 1,419 registrations, 1,281 (90.3%) consultations were completed. From 245 randomly surveyed patients, 210 (85.7%) responded (age [years, interquartile range]: 46 [35‐56]; 32.3% females). Seventy percent of patients belonged to the middle or lower socio‐economic class, whereas 61% were from rural areas. Modes of teleconsultation were audio (54.3%) or hybrid video call (45.7%). Teleconsultation alone was deemed suitable in 88.6% of patients. Diagnosis and compliance rates were 94% and 82.4%, respectively. Patients’ convenience rate, satisfaction rate, improvement rate, success rate, and net promoter scores were 99.0%, 85.2%, 49.5%, 46.2% and 70, respectively. Physical and mental quality of life improved in 67.1% and 82.8% of patients, respectively, following index teleconsultation. Person‐hours and money spent by patients were significantly lower with teleconsultation (P < 0.001); however, person‐hours spent by hospital per teleconsultation were higher than in physical outpatient services (P < 0.001). Dissatisfied patients were more likely to have lower diagnosis rate, unsuitability for teleconsultation, noncompliance, poorer understanding, and uncomfortable conversation during teleconsultation. Connectivity issues (22.9%) were the most common barrier. Three patients, all of whom were advised emergency care during teleconsultation, succumbed to their illness. Conclusion: Telehepatology is a feasible and reasonably effective tool for rendering health care services using smartphones during the COVID‐19 pandemic. Systematic implementation, possible integration into routine health care delivery, and formal cost‐effectiveness of telehepatology services need further exploration.

Children with congenital colorectal malformations during the UK Sars-CoV-2 pandemic lockdown: an assessment of telemedicine and impact on health

PurposeThis pilot study was designed to assess bowel function and quality of life (QoL) in children and adolescents with congenital colorectal malformations (CCM) during the first UK COVID lockdown period.MethodsChanges in health were assessed through semi-structured interviews, gastrointestinal functional outcomes using Krickenbeck scoring and QoL by the modified disease-specific HAQL (Hirschsprung’s disease anorectal malformation quality of life questionnaire). The State-Trait Anxiety Inventory (STAI)™ for adults was used to assess parental anxiety.ResultsThirty-two families were interviewed; 19 (59%) reported no change in their child’s health during the lockdown, 5 (16%) a deterioration and 8 (25%) an improvement. Neither the severity of the CCM, nor the degree of bowel dysfunction, correlated with any deterioration. The HAQL score was not correlated to a change in health. Anxiety scores ranged from no anxiety to clinical concerns. Telemedicine was well accepted by 28/32 parents (88%); however, in-person appointments were preferred if there were clinical concerns.ConclusionIn the follow-up of children and adolescents with CCM during the first UK lockdown using telemedicine we found that over half had stable health conditions. Patients needing additional care could not be predicted by the severity of their disease or their bowel function alone.

Health technology assessment of telemedicine applications in Northern borders of India

BackgroundEconomic evaluations of health technology help to decide which interventions are to be continued and which are to be terminated. In the Armed Forces, the provision of efficient medical services requires meticulous planning for optimal utilization of scarce resources. We report a cost analysis of telemedicine and air transportation of casualties, and attempt to identify the strengths, weaknesses, opportunities and threats of telemedicine services. MethodsThe costs incurred in telemedicine were compared with the cost of air evacuation. A qualitative assessment of telemedicine was undertaken through in-depth interviews with the hospital authorities and focused group discussions with medical officers and paramedical staff. Results34.2% of casualties could successfully be stabilized on-site using available healthcare resources with the peripheral hospitals. 18 casualties were managed at the periphery on-site by teleconsultations each year, averting air-transportation efforts. Estimated cost savings achieved in the initial management of casualty by teleconsultation was Rs. 146,111 per case. The strengths of telemedicine are knowledge updation, faster decision making, improved pre-hospital care and improved confidence in case management. ConclusionThe reduction in air efforts and remote management of casualties make a substantive case for scaling up telemedicine interventions.

26.C. Workshop: How to evaluate digital health: three examples based on the model of Continuous eHealth Evaluation

Abstract Despite the common advantages of digital health, such as the increase of quality of care and the decrease in healthcare costs, the implementation of these innovations into public health are lacking. A positive impact in daily clinical practice is important for the successful implementation of digital health [1, 2]. Still it is difficult to assess the true impact of digital health in a real-life setting as proper evaluation studies are challenging [3-5]. Within a clinical setting the focus of these evaluations are mainly on clinical effectiveness or quality of care. But these kinds of evaluations are only feasible when the technology is mature and no further development is needed. This is also indicated by the most popular method for the evaluation of digital health, based on the Health Technology Assessment (HTA) model. This method, the Model for Assessment of Telemedicine (MAST) [6-8], is only applicable for fully mature technologies. Unfortunately, MAST does not specify when a technology is mature enough. Resulting in evaluations of immature technologies in clinical trials. In our opinion, the maturity of the technology can be assessed based on the Technology Readiness Levels (TRLs). With TRLs we can clearly communicate whether a technology, such as a digital health intervention, is ready for use in daily clinical practice. An understanding of both the performance and the intended use of the technology is required to establish TRL and should be the starting point for every evaluation. The objective of this workshop is to present our model for continuous eHealth evaluation [9] and to demonstrate it based on three evaluation studies of new developed digital health innovations for public health. All three innovations are still under development and have different TRLs. This will help other researchers to plan their evaluation studies with health technologies in an early phase of development. In our opinion the evaluation of digital health should be a continuous and iterative process, aligned to the progress in the development process itself. The presentations will each focus on the evaluation of a new digital innovation with real end-users and in a real-life setting. These evaluations are based on our model for continuous eHealth evaluation and will be presented as three separate cases. We will conduct a 60-minutes interactive workshop, which starts with an overview presentation (15 minutes) of our model for continuous eHealth evaluation. Next, three presentations (3x 10 minutes) on the evaluation of the three new digital health innovation will follow. The workshop ends with a plenary discussion (15 minutes) to discuss our view on the evaluation of digital health (model for continuous eHealth evaluation) and the development of the digital health innovations with the attendees. Key messages The evaluation of digital health is challenging but the maturity of the technology must be the starting point of every digital health evaluation. The evaluation of digital health should be a continuous and iterative process, aligned to the progress in the development process itself.