Internet-based Telemedicine System Research Articles

A telediagnosis assistance system for multiple-lead electrocardiography.

The diffusion of telemedicine opens-up a new perspective for the development of technologies furthered by Biomedical Engineering. In particular, herein we deal with those related to telediagnosis through multiple-lead electrocardiographic signals. This study focuses on the proof-of-concept of an internet-based telemedicine system as a use case that attests to the feasibility for the development, within the university environment, of techniques for remote processing of biomedical signals for adjustable detection of myocardial ischemia episodes. At each signal lead, QRS complexes are detected and delimited with the J-point marking. The same procedure to detect the complex is used to identify the respective T wave, then the area over the ST segment is applied to detect ischemia-related elevations. The entire system is designed on web-based telemedicine services using multiuser, remote access technologies, and database. The measurements for sensitivity and precision had their respective averages calculated at 11.79 and 24.21% for the leads of lower noise. The evaluations regarding the aspects of user friendliness and the usefulness of the application, resulted in 88.57 and 89.28% of broad or total acceptance, respectively. They are robust enough to enable scalability and can be offered by cloud computing, besides enabling the development of new biomedical signal processing techniques within the concept of distance services, using a modular architecture with collaborative bias.

Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus.

Health information technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to examine the impact of an enhanced telemedicine system on glucose control and pregnancy outcomes in women with gestational diabetes mellitus (GDM). We used an Internet-based telemedicine system to also allow interactive voice response phone communication between patients and providers and to provide automated reminders to transmit data. Women with GDM were randomized to either the telemedicine group (n=40) or the control group (n=40) and asked to monitor their blood glucose levels four times a day. Women in the intervention group transmitted those values via the telemedicine system, whereas women in the control group maintained paper logbooks, which were reviewed at prenatal visits. Primary outcomes were infant birth weight and maternal glucose control. Data collection included blood glucose records, transmission rates for the intervention group, and chart review. There were no significant differences between the two groups (telemedicine vs. controls) in regard to maternal blood glucose values or infant birth weight. However, adding telephone access and reminders increased transmission rates of data in the intervention group compared with the intervention group in our previous study (35.6±32.3 sets of data vs.17.4±16.9 sets of data; P<0.01). Our enhanced telemedicine monitoring system increased system utilization and contact between women with GDM and their healthcare providers but did not impact upon pregnancy outcomes.

A suggestion for future research on interface design of an internet-based telemedicine system for the elderly

Telemedicine has emerged as an effective tool for providing high quality healthcare service and health-related information, especially in rural areas. Rural areas often have a larger elderly population with greater rates of preventable disease. These areas also have fewer medical resources and specialists, and have limited access to health services, all of which can influence overall health. An Internet-based telemedicine system can be one solution to provide the rural elderly with the proper health information when needed. The elderly obviously have limited capabilities compared with younger adults in the use of internet technology. However, the interfaces of the currently existing Internet-based telemedicine systems are not specifically developed for elderly users. This paper suggests future interface design research for an Internet-based telemedicine system specifically for the elderly.

A usability gap between older adults and younger adults on interface design of an Internet-based telemedicine system

Internet-based telemedicine is becoming an effective tool to deliver home-healthcare services and health information on demand, especially in rural areas, where there is often a large elderly population with greater rates of preventable chronic diseases. However, the designs of current interfaces for these internet-based telemedicine systems do not take elderly user characteristics into consideration. This study conducted usability testing on the interface of an internet-based telemedicine system using two different age groups, young adults and older adults. Differences in overall performance and satisfaction between the two groups were identified. Based on these results, a future direction is suggested for the interfaces of Internet-based telemedicine systems.

Accuracy of Blood Pressure Measurements Transmitted Through a Telemedicine System in Underserved Populations

In underserved populations, inadequate surveillance and treatment allows hypertension to persist until actual cardiovascular events occur. Thus, we developed an Internet-based telemedicine system to address the suboptimal control of hypertension and other modifiable risk factors. To minimize cost, the subjects used home monitors for blood pressure (BP) measurements and entered these values into the telemedicine system. We hypothesized that patients could accurately measure their BP and transmit these values via a telemedicine system. Inner city and rural subjects (N = 464; 42% African-American or Hispanic) with 10% or greater 10-year risk of cardiovascular disease and with treatable risk factors were randomized into two groups, control group (CG) and telemedicine group (TG). Each subject received a home sphygmomanometer with memory. The TG recorded and entered BP at least weekly. During office visits, the BP meters were downloaded and recorded BP compared to BP values transmitted via telemedicine. The telemedicine (T) BP values were similar to the meter recorded (R) values (T: systolic/diastolic BP 133.4 +/- 11.1/77.5 +/- 6.8 mm Hg, and R: systolic/diastolic BP 136.4 +/- 11.9.4/79.7 +/- 7.5 mm Hg). The percent error was <1% for both systolic (-0.02 +/- 0.04%) and diastolic (-0.03 +/- 0.04%) BP. Lastly, the telemedicine BP values were similar to the office (O) BP values for systolic and diastolic BP (T: systolic/diastolic BP 133.4 +/- 11.1/77.5 +/- 6.8 mm Hg, and O: systolic/diastolic BP 136.3 +/- 20.5/78.1 +/- 10.5 mm Hg). In underserved populations, this inexpensive approach of patients using a home monitor and entering these values into a telemedicine system provided accurate BP data.

Managing Heart Failure Care Using an Internet-Based Telemedicine System

Background Managing patients with heart failure (HF) is labor intensive, and follow-up is often inadequate to detect day-to-day changes that ultimately lead to decompensation. We tested the effect of an Internet-based telemedicine (T) system that provides frequent surveillance and increased communicate between HF patients and their provider on frequency of hospitalization in a cohort of patients with advanced HF. Methods and Results HF patients in NYHA Class II-IV were randomized to usual care (UC, n = 24) or T (T plus UC, n = 24) and followed for 1 year. Office visits, emergency department visits, hospitalizations, telephone calls, and number of Internet communications were measured over the 1-year period. Left ventricular ejection fraction (EF) was assessed by echocardiography in both groups. For T, mean age was 53.2 ± 2.0 years (72% male, 61% Caucasian, 39% African American). For UC, mean age was 54.1 ± 2.6 years (76% male, 72% Caucasian, 14% African American, and 14% Hispanic). HF etiologies and EF were similar in both groups. During the 12-month period, UC had 74 total phone calls to the practice, whereas T had 88 telephone calls plus 1887 telemedicine data messages (6.5 messages/patient/month). ER visits were lower in the T group (T 5, UC 12; P < .05). Hospital admissions (T 24, C 40; P = .025) and total hospital days (T 84, UC 226 days; P < .005) were lower in T. Unscheduled clinic visits (T 13, UC 13; P = NS) and scheduled clinic visits (T 78, UC 94; P = NS) were similar in both groups. Conclusions Frequent monitoring and patient management using a telemedicine system may help to reduce hospitalizations, hospital days, and emergency department visits.

Use of Telemedicine To Follow Symptoms and Disease Course in Patients with Gastroparesis: A Pilot Study

Purpose: Chronic disease care, such as in gastroparesis, requires ongoing communication between patient and physician. Telemedicine eliminates geographic constraints and allows convenient access between patients and physicians. Remote patient monitoring through telemedicine has improved outcomes in disorders such as diabetes, heart failure and hypertension; but has not been used to any great extent in GI disorders. Aims: 1) To set up an operational Internet-based telemedicine system for convenient patient reporting of symptoms. 2) To evaluate the feasibility of monitoring symptoms of patients with gastroparesis. Methods: In this pilot longitudinal study of patients with gastroparesis, a HIPAA compliant Internet-based telemedicine system was devised and used to follow patients’ symptoms. Symptoms of gastroparesis were monitored using 9 symptoms modified from the Gastroparesis Cardinal Symptom Index (GCSI). Patients rated their symptoms – none, very mild, mild, moderate, severe, very severe. In addition, diabetic patients could report blood glucose levels. Selected patients were asked to participate and given a short instructional session on how to use the internet-based telemedicine system. They were asked to enter their symptoms on a frequent basis, at least 3 times a week. Results: Ten patients with symptoms of gastroparesis were recruited to participate (9 idiopathic gastroparesis, 1 diabetic gastroparesis). During the 2-month monitoring period, 8 of the 10 patients reported their symptoms using this Internet-based telemedicine system. The number of days the patients entered their symptoms averaged 18 ± 16 [mean ± SD] with a range of 2 to 48 sessions per patient. Interestingly, some patients had stable symptoms, whereas other patients had periods of symptom exacerbations. Increases in symptom scores were seen prior to patient visits to emergency rooms and hospitalizations. In addition, decreases in symptom scores were seen with instituting new treatments in some patients. Conclusion: This pilot study shows that an Internet-based telemedicine system can be used to follow patients’ symptoms. Use of telemedicine may be useful to follow individual patient symptoms – both monitoring for symptom exacerbations and symptom response to treatments. This discrete data compiled on a regular basis over a long period provides a unique insight into the disease course of patients with gastroparesis.

Use of an Internet-Based Telemedicine System to Manage Underserved Women with Gestational Diabetes Mellitus

Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet. Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25). Patients in the Internet group were provided with computers and/or Internet access if needed. A website was established for documentation of glucose values and communication between the patient and the health care team. Women in the control group maintained paper logbooks, which were reviewed at each prenatal visit. Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery. Women in the Internet group accessed the system and sent on average 21.8 (+/- 16.9) sets of data. There was no difference between the two groups in regards either fasting or post-prandial blood glucose values, although more women in the Internet group received insulin therapy (31% vs. 4%; P <0.05). There were also no significant differences in pregnancy and neonatal outcomes between the two groups. Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study's end. The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system. Although system use was not associated with improved pregnancy outcomes, women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy.

A feasibility study of an Internet-based telemedicine system for consultation in an ophthalmic emergency room

We examined the feasibility of a low-bandwidth, Internet-based tele-ophthalmology system for consultation in an ophthalmic emergency room. Forty-nine patients (98 eyes) with complicated cases were seen during night shifts in the ophthalmic emergency room. Ocular images were taken using a slit-lamp connected to a video camera, processed and transmitted to a senior physician by email. A telephone was used for real-time audio communication. Each case was re-examined by the same senior physician the following day. The time needed to capture and to process the images was 5 min (SD 2). Each case was given a feasibility score (0-100%), which was defined as the contribution made by the transmitted images in presenting clinical details which could not have been described verbally. High feasibility scores (mean scores ranging from 85 to 90) were found for the following images: ocular surface, anterior chamber, anterior chamber angle, pupils, lens, optic nerve and macula. In contrast, images of vitreous and peripheral retina received low feasibility scores (mean score 65). There was 100% agreement between the diagnosis made during consultation and the on-site examination made by the senior ophthalmologist later on. Ninety-eight percent of the patients stated that they would prefer being examined under the telemedicine system on their next emergency room visit, rather than the traditional resident on-site examination.

Web-Based Internet Telemedicine Management of Patients with Heart Failure

An Internet-based store-and-retrieval telemedicine system to communicate between patients and their healthcare provider was tested. The system requires no specialized equipment, is Web-based, and allows frequent surveillance of the health status of the patients with heart failure (HF). Thirty six patients were recruited to evaluate a Web-based telemedicine system for reducing care encounters. Eighteen patients were randomized to the telemedicine arm (group T), and 18 were given usual clinical care (group C) in our HF center. Patients in group T reported three times weekly via a secure Internet site for telemedicine intervention. We studied patients with HF with New York Heart Association (NYHA) class 2 to 4 with hospitalization within past 6 months. Mean age was 56.1 +/- 12.6 years (66.7% male; 66.7% Caucasian, 27.8% African American, and 5.6% Hispanic). Mean ejection fraction (EF) was 23.9% +/- 17.6% in group T and 26.6% +/- 16.4% in group C. Over an 8-month period, unscheduled (group T-3; group C-5), and scheduled clinic visits (group T-11, group C-7) were similar (p = NS); one group T patient was transplanted, one group C patient died. Total hospital days were lower with group T (44 days) compared to group C (133 days), p < 0.05. An Internet-based telemedicine system was able to closely monitor patients with HF. Surveillance through Internet-based telemedicine resulted in less hospitalization compared to control patients. This system may be helpful in reducing the cost of HF patient care.

An internet-based telemedicine system in Nigeria

Telemedicine is a very exciting field worldwide. Nigeria has a population of more than 120 million people, a major percentage of which live in the remote rural areas, whereas with the best-equipped hospitals and scarce medical experts are distributed in the urban cities. These people living in remote rural and poorer areas have limited access to basic healthcare. Geographic isolation, the scarcity of physicians and hospitals, and difficulties of travel to larger cities where such care is available are among the factors limiting this access. Governments at federal, state and local levels, have been making healthcare in these remote rural areas their focal point over the years so as to enable citizens in both rural and urban areas to have equal access to medical services and clinical healthcare despite the geographic isolation barriers but this effort has only been partly successful. Therefore, establishment of an Internet-based telemedicine system would be most useful in achieving government's aims of bringing useful healthcare to these remote rural and poorer areas. This among other things would improve the quality of healthcare in rural and outlying areas, lower costs of delivering healthcare and give remotely placed physicians the opportunity to consult over any patient's case. In this paper, an Internet-based telemedicine environment is developed for Nigeria, specifically to support consultations among remotely placed patients, rural health workers and specialists in the urban cities and provide a secure access to remote patient records. The paper further discusses some of the challenges and implementation issues of telemedicine in Nigeria.

Interdisciplinary Treatment of Diabetes Mellitus in a Military Treatment Facility

The American Diabetes Association emphasizes interdisciplinary management as the standard of care for patients with diabetes. Many times, however, interdisciplinary means various health care professionals treating a patient but not necessarily interacting with each other regarding the patient's care. Recently, Tripler Army Medical Center replicated the Joslin Diabetes Center's diabetes outpatient intensive treatment program as part of a Joslin Diabetes Center/Department of Defense/Veteran's Administration research collaboration. Tripler Army Medical Center named this interdisciplinary program Holopono, which is Hawaiian for success. Holopono is a team of health care professionals providing integrated care and education to a group of diabetes patients over 3.5 days. Individual care management, aided by an Internet-based telemedicine system, then continues for 1 year after entry into the program. This article describes the Holopono program, the role of each team member, and how the team functions together to provide comprehensive diabetes care.