Hospital Telemedicine Research Articles

Remote Monitoring in Heart Failure Patient: A Review of Non-invasive Approach

Remote monitoring (RM) has been actively developed in recent years, including in of patients with chronic heart failure. Unlike invasive methods, non-invasive methods do not involve surgical risks and offer a wide range of management options: telemonitoring, virtual visits, forward triage, hospital telemedicine, telerehabilitation, psychological support. The first RM was performed by a multidisciplinary team of healthcare providers from different specialties and showed effectiveness. Unfortunately, attempts to use modern technology to reduce human involvement have often been unsuccessful. However, the COVID-19 pandemic triggered a dramatic development of mHealth. Today, there is a huge variety of methods available, but it is still impossible to give a definitive answer about the effectiveness of non-invasive RM due to the lack of uniform standards, imperfect legislation, regional, social and economic differences in the availability of technology. Nevertheless, it was included in the European Society of Cardiology clinical guidelines for the diagnosis and treatment of acute and chronic heart failure in 2021 (IIb). This review focuses on the history of development, current and potentially effective methods, the problems they aim to solve, and the challenges society needs to overcome to use them effectively.

The Relationship between Accessibility of Telemedicine Services and Decisions on Use: A Cross-Sectional Study at X General Hospital Malang

As many as 65% of patients interviewed about telemedicine at Outpatient Hospital X in Malang Regency admitted that they were only aware of telemedicine services like Halodoc, Alodokter, Klikdokter, and the hospital's telemedicine applications, but had never directly used them. The patient acknowledges that the application menu service on several telemedicine platforms is overly complicated and challenging to navigate, particularly for patients over the age of 45. The aim of this study was to determine the relationship between the accessibility of telemedicine service applications and the decision to use them. In January 2023, we conducted this research at the outpatient facility of one of the hospitals in Malang Regency. This study had a total sample size of 67 patients. Researchers gathered the data through a questionnaire utilising a Likert scale, concentrating on the accessibility of telemedicine and the choices made concerning it. Researchers conducted statistical analyses using Pearson correlation. The findings revealed a significant correlation between telemedicine service accessibility and utilisation, with a significance level of 0.000, thereby validating the hypothesis. The decision to employ the telemedicine application for outpatient care is made. The hospital in Malang Regency is influenced by factors such as the ease of communication with health care providers, the clarity of their voices, the provision of diagnoses based on the patient's condition, the patient's ability to clearly see the health care provider or health worker, and the ease of using the telemedicine application itself.

Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts.

The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.

A pediatric telecardiology system that facilitates integration between hospital-based services and community-based primary care

IntroductionTelecardiology has emerged as a vital field within telemedicine, fostering collaboration between hospital and community medicine. This pilot study introduces an innovative pediatric telecardiology system, comprising a telecardiology system seamlessly integrated with a hospital telemedicine platform. A smooth flow of ECG execution, transmission, and reporting between Primary Care Pediatrician clinics and the hospital was tested as the primary objective. User experience surveys were also considered. MethodsThe study involved three Primary Care Pediatrician clinics, and the enrollment of children took place consecutively from January to July 2023. We integrated a digital electrocardiographic signal acquisition unit and online information transmission-capable tablets, that were provided to the pediatricians, with a telemedicine multitenant platform that facilitated the transmission of the patient's ECG data from the community to the Hospital Pediatric Cardiologist. ResultsA total of 158 children (80 M/78F, 8.9 ± 2.8 yrs) underwent ECG recording (78.5 % medical certificates, 21.5 % presence of symptoms) The transmission and reporting of ECGs were successfully completed in all cases, without technical issues. Normal findings on the ECG were demonstrated in 94.9 % of children. 70.8 % of respondents completed all parts of the survey. Respondents had a high level of education (90 %) and demonstrated excellent or good competence in using digital technologies (89 %). 51 % of respondents were not familiar with the term “Telemedicine” and 81 % of the cases had no previous telemedicine experience. 90 % of users were very satisfied or satisfied with the service. Connection problems (2.8 %) and concerns about the service's reliability compared to standard care (3.7 %) were mentioned as possible limitations of the telecardiology. ConclusionsOur pediatric telecardiology system offers a valuable diagnostic tool to enhance patient management in the community.

Remote management of worsening heart failure to avoid hospitalization in a real-world setting.

From a patient and health system perspective, managing worsening heart failure (WHF) as an outpatient has become a priority. Remote management allows early detection of WHF, enabling timely intervention with the aim of preventing hospitalization. The objective of the study was to evaluate the feasibility and safety of remotely managing WHF events using a multiparametric platform. All patients enrolled in the heart failure remote management programme of the Bordeaux University Hospital Telemedicine Center between 1 January and 31 December 2021 were included in the study. Follow-up data were collected until 1 March 2022. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II symptoms and an elevated B-type natriuretic peptide (BNP>100pg/mL or N-terminal-pro-BNP>1000pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. In total, 161 patients (71±11years old, 79% male) were followed for a mean of 291±66days with a mean adherence to the remote monitoring system of 80±20%. Over this period, 52 (32.3%) patients had 105 WHF events, of which 66 (63%) were successfully managed remotely, the remaining requiring hospitalization. Freedom from WHF events and hospitalization at 300days were 66% and 85%, respectively (P<0.001 for the difference). Increased level of BNP was associated with an increased risk of WHF event [hazard ratio (HR) per unit increase in BNP: 1.001; 95% confidence interval (CI) 1-1.002; P=0.001] and hospitalization (HR 1.002; 95% CI 1.002-1.003; P=0.002). A decrease in the level of glomerular filtration rate was associated with an increased risk of hospitalization (HR per unit decrease in estimated glomerular filtration rate: 0.946; 95% CI 0.906-0.989; P=0.014). WHF event recurrence and (re)hospitalization rates at 1-month were similar among patients managed remotely (18% and 12%, respectively) and those requiring hospitalization (21% and 10%, respectively). Iatrogenic complications occurred more often during hospitalization than remote management (26% vs. 3%, P<0.001). Our study suggests that remote management of WHF events based on a multiparametric approach led by a telemedical centre is feasible and safe. Adopting such a strategy for patients with chronic HF could reduce HF-related hospitalizations with expected benefits for patients, care providers, and health care systems.

Antecedents of Online Patient Experience of the Hospital Telemedicine Application and Its Consequences

Hospitals had to adjust by offering telemedicine services in response to the COVID-19 outbreak. In contrast to telemedicine, which is developed independently, telemedicine used to have adequate resources. Unfortunately, few studies have been conducted to capture online patient experience from hospital telemedicine services. Therefore, this study attempts to analyze factors that can affect Online Patient Experience (OPX) and assess the impact on Continue Usage Intention (CUI) and Intention to Recommend (ITR). The independent variables that become the antecedents of OPX are Professional Knowledge (PKL), Physician Rank (PRK), Physician Image (PIM), Response Speed (RSP), Service Commitment (SCM), Service Attitude (SAT), and Communication Efforts (CEF). This study is a quantitative survey with cross-sectional data obtained by questionnaire instrument. Respondents were taken purposively using judgment sampling to get those who had received telemedicine services managed by a large group of hospitals in Jakarta. Based on the result, 172 respondents were eligible. The result indicated that all the antecedents studied had a positive and significant relation (p-value &lt; 0,05) with OPX. The results also found that RSP (β = 0.317), SCM (β = 0.216), and PIM (β = 0,186) are the three constructs that play the dominant role. Thus, it is important to create a positive online patient experience so that patients can continue to use teleconsultation services and recommend them to others.

Abstract WMP44: Feasibility Of Monitoring Door-in-door-out Across A Fourteen Hospital Telemedicine Supported Stroke System Of Care

Background: Door-In-Door-Out (DIDO) times are crucial to help improve outcomes for patients presenting to Primary Stroke Centers (PSCs) needing urgent endovascular therapy. However, DIDO is often a difficult measure to track and improve due to relatively low volumes at a single stroke program. Healthcare networks hold a significant advantage through standardization of processes which then allow for aggregate data collection. Methods: We designed a system that went live 1/2021 using PowerBI™ and Microsoft Suite™ products to monitor DIDO across 13 PSCs. Data queries from existing centralized stroke data were modeled together with internal transport team data into one report resulting in an interactive chart used to track DIDO and its related performance measures including: door to transfer center contact time (DTCC), door to ambulance arrival time (DAA), ambulance arrival to ambulance departure Time (AAAD) and reasons for delayed transfer. Data was analyzed using Wilcoxon Rank Sum test. Results: Metrics were assessed pre (1/1/2021-3/31/2021) and post (4/1/2021-12/31/2021) implementation of a dashboard guided process improvement. There were 32 transfers pre vs. 86 post-implementation. Median DIDO improved: (Pre: 120 min {IQR:82-146} vs. post: 86 min {IQR: 62-108} p=0.004). Other sub-metrics of DIDO all improved: Median DTCC (Pre: 55 min {IQR:32-76} vs. post: 38 min {IQR: 22-53} p=0.032); median DAA (Pre: 89 min {IQR:68-126} vs. post: 67 min {IQR: 43-84} p=0.041). There was a trend to improvement for the median AAAD: (Pre: 24 min {IQR:12-36} vs. post: 19 min {IQR: 10-24} p=0.054). Conclusion: Relatively low volume but high-risk events like DIDO transfers can be improved by leveraging the use of modern data display and analysis software solutions that process the collective data aggregate generated from standardized workflows across a health care network.

Digital health in medicine: Important considerations in evaluating health economic analysis

Digital health in medicine: Important considerations in evaluating health economic analysis

The arrangement of medical records in implementation of Telemedicine in Hospitals

Legal research methods are procedures or steps that are considered effective and efficient. Based on the discussion, it is concluded as follows 1)The legal principles of hospital telemedicine include prprinciples of Information and Communication Technology (ICT) utilization, the principle of state and community responsibility, the principle of competence, integrity, and quality, the principle of equality, good faith, independence, and volunteerism as well as legal certainty and the principle of data security and confidentiality as well as standardization, the principle of patient autonomy and freedom to choose technology or technology neutral and the principle of patient interest is prioritized, data protection, IT forensics, best practices, and legal audit standards as well as justice and legal protection principles 2) medical record regulation different countries, namely Indonesia and America. Indonesia does not yet have a law that specifically regulates electronic medical records. Apart from the ITE Law.

ANALISIS PENGARUH PANDEMI COVID-19 SEBAGAI KATALIS DALAM PERKEMBANGAN TELEMEDICINE DI INDONESIA: SEBUAH NARRATIVE REVIEW

Telemedicine is one of the health services that is widely used in the world along with the development of information and communication technology. Indonesia has formulated Telemedicine service regulation in “Peraturan Menteri Kesehatan Number 90 Year 2015”. However, the existing guidelines are not comprehensive to cover Telemedicine in Indonesia, especially during Covid-19 pandemic. This study aim is to analyze the effect of Covid-19 pandemic in accelerating the development of Telemedicine in Indonesia. This review process is carried out through a systematic review from supporting sources. The result shows that during Covid-19 pandemic, Indonesia Government facilitated Telemedicine service program for non-emergency health cases, meanwhile researches related to the implementation of Telemedicine in hospitals are started. The data obtained demonstrates the Covid-19 pandemic has a role as catalyst in the development of Telemedicine in Indonesia.

Indonesian hospital telemedicine acceptance model: the influence of user behavior and technological dimensions

Since the COVID-19 pandemic hit, several hospitals in Indonesia have started to develop teleconsultation services to expand the reach of health services and prevent the spread of the COVID-19 virus. Therefore, this study was conducted with the aim of analyzing the influence of user and technological dimensions on the acceptance of the use of hospital teleconsultation applications by users. The research was conducted using quantitative methods with data from questionnaires distributed online. The respondent criteria for this study were Indonesians aged 17 years and over who knew about or had used a hospital's teleconsultation application, and this resulted in 534 respondents. Data processing was carried out using the covariance-based structural equation modeling method with the AMOS 24 application. The user behavior and technology dimensions are influence intention to use telemedicine applications. Furthermore, the results showed that contamination avoidance, safety, reliability, professionalism, perceived ease of use, perceived usefulness, and information quality have a significant positive influence on the behavioral intention to use hospital telemedicine applications. Meanwhile, facilitating conditions and social influence were not shown to have a significant positive effect on the behavioral intention to use such applications. Finally, behavioral intention to use significantly and positively influences actual use. This research can help hospitals and the government in providing guidance in terms of developing telemedicine applications.

TELEMEDICINE AS AN OPTION FOR HEALTH SERVICE LIMITATIONS IN COVID-19 PANDEMIC ERA

Coronavirus disease 2019 (COVID-19) pandemic era provides a new habit in form of self-quarantine or physical distancing. The recommendation is to delay visits to health facilities if it is not in the emergency condition to slow down the spread of COVID-19 transmission. This study aims to develop a telemedicine system that integrates three main components, namely doctors, patients, and hospital management in Gotong Royong Hospital Surabaya to minimize the transmission of COVID-19 while still provides comprehensive health services. The development of telemedicine service is divided into 3 stages. In the first stage, emergency screening was carried out by developing Frequently Asked Questions (FAQs). The second stage was continued with prototype testing and the last part was improving the system to create a better referral system. Gotong Royong Hospital telemedicine has been active since June 2021, within 2 months, 45 patients are willing to use telemedicine services. The results showed that telemedicine was easily accepted by patients in internal medicine clinic services (p<0,005). In addition, there are no differences in acute and chronic diseases conditions as well as COVID and non-COVID so that telemedicine can be recommended for all aspects of patient care. In the ease of obtaining related to treatment or length of treatment and interpretation of laboratory result, a significant difference was obtained (p = 0,01). Based on this result, the development of telemedicine services during the COVID-19 pandemic makes it easier for patients to gather information related to health care.

Healthcare Economics: Financial Impact and Limitations of Telemedicine

In 2020, the US government spent over 4 trillion dollars on healthcare, accounting for over 17 percent of the nation’s gross domestic product (GDP) [1]. Despite this spending, the United States has the lowest life expectancy of the eleven developed nations in the Organization for Economic Co-operation and Development (OECD), and over 30 million Americans remain uninsured [2,3]. There have been significant efforts by healthcare policymakers and administrators, politicians, and insurance companies to try and reduce national healthcare expenditure. One area that has received significant attention (especially during the COVID-19 pandemic) has been the increase in the utilization of telemedicine in hospitals and medical practices across the US. Telemedicine is the use of remote video conferencing to communicate and distribute medical services, interventions, education, and health administration to patients [4]. Research has found these methods to be cost-effective in several medical settings and specialties. Additionally, telehealth can expand healthcare coverage to rural Americans who are otherwise effectively excluded from regular health services. With the potential to improve costs, efficiency, and access, telemedicine is integral to the future of the US healthcare system. There are, however, important roadblocks and limitations of telemedicine that need to be addressed before a digitalized future of patient-provider interactions can become a reality.

The hospital telemedicine TELEMED database: Providing information on evidence-based telemedicine services to hospital managers and healthcare professionals

Background Increased use of telemedicine in the healthcare system is a political goal in Denmark. Although the number of hospital patients using interventions such as the video consultation has increased in recent years only a small proportion of the outpatient and inpatient visits involve telemedicine. The TELEMED database (https://telemedicine.cimt.dk/) has been launched at the Center for Innovative Medical Technology in Denmark to ensure that hospital managers and healthcare professionals have access to information about telemedicine services and their effectiveness. This article describes the development and the content of the TELEMED database. Methods A structured literature search was made in the PubMed Database for randomised controlled trials or observational studies with a control group that investigated the effect of telemedicine interventions for hospital patients. Data were extracted from each article on the clinical effectiveness, patient perceptions, economic effects and implementation challenges. As the database should only provide inspiration to healthcare professionals regarding possibilities for use of telemedicine, the risk of bias in the studies was not assessed. Results The literature search resulted in 2825 hits. Based on full text assessment, 331 articles were included for data extraction and assessment. These articles present telemedicine services used in 22 different medical specialities. Forty-eight percent of the studies found a positive, statistically significant clinical effect, while 47% showed no statistically significant difference. In 48% of the studies, patients’ experiences were examined and of these 68% found positive patient experiences. Fifty-four percent of the articles included information on the economic effects and, of these, 51% found reduction in healthcare utilization. In the majority of studies between two and four types of implementation challenges were found. Conclusions and recommendations: The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services for use by hospital managers and health professionals, who whish to to implement telemedicine. The database is freely available and expected to be continuously improved and broadened over time.

Abstract WP345: Feasibility of Monitoring Door in Door Out Times Across a 14 Hospital Telemedicine Supported Stroke System of Care

Background: Door-in-door-out time (DIDO) is an established driver of outcome in ischemic stroke patients who initially present to a Primay Stroke Center (PSC) and require transfer for endovascular intervention. In 2019, the Joint Commission required monitoring of DIDO as part of its STK-OP measure. Given the importance of rapidly transferring ischemic stroke patients, we embarked to create a monitoring tool to help assess the areas of delay in a 14 hospital telemedicine supported stroke system. Methods: A monitoring system was designed using PowerBI™ and Microsoft Suite™ products that models various data sources for consumption and action. Separate data queries from various sources were entered into one report using the Office365™ suite and Power Query Editor™ in PowerBI™. The resulting data model was then reorganized and programmed into a PowerBI™ report that can be shared throughout the organization. Results: The report allowed region-wide or hospital specific evaluation of several time based transfer metrics, including: door to initial call to transfer center, transfer center contact to neurointerventional physician accept time, accept time to ambulance arrival, ambulance arrival to ambulance departure and travel time to thrombectomy center. The largest areas of delays identified were door to initial call to transfer center and time of ambulance arrival to spoke to departure from spoke. The tool also allowed the separation of the STK-OP measure into ischemic stroke, intracerebral hemorrhage or sub-arachnoid hemorrhage. The assessment of these time metrics at a regional and individual hospital level permitted us to create a plan to focus on the greatest areas of delay to further decrease our transfer times. Conclusion: Modern data software may be leveraged by stroke programs to help assess the specific time metrics causing delay in DIDO, which could then further assist in focused quality improvement of these metrics.

Assessment of children and adolescent presenting to the dermatology outpatient clinic in Turkey during the coronavirus disease-2019 pandemic.

OBJECTIVE:The coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. During the partial curfews implemented in the pandemic period, the pediatric patients presenting to the dermatology clinic of our hospital were examined taking the necessary precautions. We aimed to identify children and adolescent cases requiring dermatology services and their urgency when the number of COVID-19 cases was rapidly increasing and partial curfews were being imposed in Turkey.METHODS:The study was conducted with pediatric patients that presented to our hospital dermatology outpatient clinic, a tertiary health care institution between March 11, 2020, and May 29, 2020, and their differences according to age groups and presentation period were evaluated.RESULTS:The most common reason for a dermatology clinic visit was acneiform diseases (n=103, 33.3%). According to age groups, the most common diagnosis was eczema diseases in both the 0–2 and 3–6 years groups (n=10 [55.6%] and n=11 [47.8%]), respectively), infectious diseases in the 7–12 years group (n=19, 31.10%), and acneiform diseases in the 13–18 years group (n=100, 48.3%). While 144 patients visited the clinic within the first 15 days after the declaration of pandemic, the number of patients presenting in the following month decreased by more than 80% (n=23 for the second 15-day period and n=14 for the third 15-day period). There was a moderate increase in the number of pediatric dermatology patients 45 days after the declaration of pandemic (n=57 for the fourth 15-day period and n=71 for the fifth 15-day period). A correlation was observed between the number of newly diagnosed COVID-19 cases in Turkey and the number of pediatric patients presenting to our outpatient clinicCONCLUSION:Considering that non-urgent and follow-up pediatric patients continue to present to dermatology outpatient clinics during the pandemic process, it is necessary to encourage the implementation of patient care methods, such as telemedicine in hospitals as part of the health system.

The Perceptual Differences of Hospital Employees on the Use and Adoption of Electronic Health Records and Telemedicine

Abstract Technological innovation is one of the key factors in improving healthcare services. It is necessary to examine the perceptions of hospital employees of the adoption of electronic health records and telemedicine in hospitals. Because of the fact that the perception of the usage of technology differs from one employee to another, this study determines the perceptual differences of hospital employees on the usage of electronic health records and telemedicine in hospitals of Vellore district. By employing the unified theory of acceptance and use of technology model, the study determines the purpose. A total of 770 doctors, 770 nurses, and 770 clinical staff were contacted and asked to elucidate their responses; of those contacted, 537 doctors, 580 nurses, and 568 clinical staff willingly filled up the questionnaire after filling the missing values. The mean series of all the respondents have been chosen for the final study. The findings, implications, limitations, and future research are suggested and delineated.

Pilot of a Home Telehealth Platform in a Pediatric OPAT Program

BackgroundPatients discharged with outpatient parenteral or prolonged oral antibiotic (OPAT) require monitoring to ensure optimal clinical outcomes. Advances in technology have allowed novel approaches for clinical interactions. We sought to develop a new home telehealth platform for a subsection of pediatric OPAT patients.MethodsWe used an existing infrastructure developed by our hospital telemedicine program to pilot the electronic home visit. A process was established to create a virtual connection at a pre-designated time using a HIPPA-secured web-based platform. Clinic staff performed a pre-visit technology check. Electronic Medical Record (EMR) scheduling platforms were created and the parent was coached on how to download and execute the necessary software. A virtual clinic was established between provider and family. Documentation occurred in the EMR with specific language and modifier codes for billing accuracy identified by the telemedicine team. Patients were selected based on medical complexity and travel time greater than 2 hours to our institution.ResultsTwo pediatric OPAT patients completed the pilot in Spring 2017 for treatment of 1) CLABSI with retained line and 2) chronic ulcer with osteomyelitis. Three visits between the OPAT ID provider, located in her office, and the patient, located at home, were successfully piloted with video and voice. A routine clinic visit was conducted with a parent-driven physical exam. A clinical note was documented in the EMR with specific telemedicine templates. This platform also allowed for multi-disciplinary visits with a hospitalist and home health nurse to address a central line related issue with ID provider present. Total time for each visit was under 20 minutes.ConclusionWe were able to demonstrate feasibility and functionality of this novel platform to conduct a billable OPAT clinic visit in a patient’s home. Health system infrastructure was a necessary and vital component to execution of the virtual clinic. Specific patient groups may benefit from this provider-patient interface. The use of telemedicine in OPAT may serve as a new platform for improving provider efficiency, lowering health system costs, and achieving greater patient satisfaction.Disclosures All authors: No reported disclosures.

Energy Optimization of ZigBee Based WBAN for Patient Monitoring

This paper proposes an energy efficient wireless telemonitoring scenario of cardiac patients through ZigBee, based on variable duty cycle being rendered to sensors. In an intra hospital telemedicine scenario, Electrocardiogram (ECG) signals of patients are acquired through ECG sensor nodes having transmission capability and these ECG signals are received by Personal Digital Assistant (PDA) kept at nursing station through ZigBee network. ECG signals are further transmitted to Doctor's PDA. If the duty cycle is varied as per the load or number of active sensors, total energy consumed in idle mode can be avoided and total energy consumed by sensors is reduced hence increasing total network lifetime. This paper, comparatively analyzes the energy efficiency of ZigBee sensors with different percentage of duty cycle on the basis of energy consumption parameter under variable load conditions. The matrices used in performance evaluation are energy consumption in transmit mode, energy consumption in received mode and energy consumption in idle mode using Qualnet 5.0.2 simulator.

New Hospital Telemedicine Services: Potential Market for a Nighttime Telehospitalist Service

A critical shortage in the supply of physicians in the United States has necessitated innovative approaches to physician service delivery. Telemedicine is a viable service delivery model for a variety of physician and health services. Telemedicine is most effective when applied where physician resources are scarce, patient care is time sensitive, and service volume may be distributed across a network. Shortages in critical care and neurology specialists have led to the use of tele-intensive care unit and telestroke services in hospital settings. These hospital-based telemedicine services have gained acceptance and recommendation. Hospitalist staffing shortages may provide an opportunity to apply similar telemedicine models to hospitalist medicine. This study assesses the potential market for a nighttime telehospitalist service. An analysis of the Florida state hospital discharge dataset investigated the potential market for a new nighttime telehospitalist service. Admissions were filtered and stratified for common hospitalist metrics, time of day, and age of patients. Admissions were further expressed by hour of day and location. Nineteen percent of common hospitalist admissions occurred between 7:00 p.m. and 7:00 a.m., with a range of 17%-27% or 0.23-10.09 admissions per night per facility. Eighty percent of admissions occurred prior to midnight. Nonrural facilities averaged 6.69 hospitalist admissions per night, whereas rural facilities averaged 1.35 admissions per night. The low volume of nighttime admissions indicates an opportunity to leverage a telehospitalist physician service to deliver inpatient medical admission services across a network. Lower volumes of nighttime admissions in rural facilities may indicate a market for telehospitalist solutions to address the dilemma of hospitalist staffing shortages.