Introduction Of Telemedicine Research Articles

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services. Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities. Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P =.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P =.014). The introduction of telemedicine into rural communities is associated with increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.

Telemedizin in der Pädiatrischen Onkologie - Ergebnisse einer Fragebogenaktion des Kompetenznetzes Pädiatrische Onkologie -

The telemedicine project of the Competence Net Pediatric Oncology of the German/Austrian Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) has as an initial step of its work-programme sent out a questionnaire to the 54 largest pediatric hematology/oncology units in Germany. Institutions were asked for their experience, motivation, existing infrastructure, and anticipated benefits and obstacles regarding the implementation of telemedicine in patient care and research. Of the 54 largest German Pediatric Oncology institutions asked, 46 completed the questionnaire (85 %).1. The need for further detailed information on implementation and for help in technical realization of telemedicine applications was expressed by all participants. 2. The majority expected practical advantages from telemedicine communication and anticipated that telemedicine will increase quality in treating children with cancer. 3. Expert consultation (study chairman, reference radiologists) is stated as to be most important. 4. Thirty-three of 46 physicians (72 %) believe that telemedicine will reduce costs in medical care within the next years. 5. It is anticipated that the introduction of telemedicine is time consuming. 6. The lack of available medical informatics competence and manpower was regarded as the most important obstacle. 7. Data security and standardization, transfer speed and transmission quality are considered most important. 8. Most of the institutions (91 %) use computers in the management of patients. Fourty-four (96 %) are connected to the Internet. 9. Thirty-seven of 46 institutions were prepared to invest in the implementation of telemedicine. This analysis demonstrates that the use of telemedicine is expected to become standard in pediatric oncology, while the existing infrastructure and status of information regarding this subject at present are insufficient. The most pressing practical need for telemedicine applications is seen in the field of electronic expert consultation. Hence, the Telemedicine-Project of the GPOH Competence Net will focus on this aspect first.

The Ministry of Public Health telemedicine network of Thailand

The concept of telemedicine is rather new in Thailand and initially, the introduction of telemedicine into the country was hampered by technological limitations. The problem was further aggravated by the inadequacy of telecommunications infrastructures in the rural areas. However, recent rapid advances in info-communications technology, together with the launch of Thailand's first communication satellite, THAICOM I in December 1993, have made it possible for health care to be delivered to remote areas of the country via telemedicine. This paper documents the experience of implementing Thailand's nationwide Telemedicine Network by the Ministry of Public Health (MOPH), beginning with a pilot project in 1994 to the current system, launched in January 1998, that links the Information Technology Office of the MOPH and 19 hospitals with health facilities all over the country via satellite and computer networks.

The changes patients expect to result from telemedicine.

A focus group of 12 persons who had been the subject of telemedical consultations met four times to discuss what changes to the health service they expected to result from the widespread introduction of telemedicine. There was general agreement about four main themes. First, rationalization of care would occur. For example, health-care spending would have to take into account the need for local care and there would be more primary care, with telemedicine providing easy access to specialists. The implementation of home care would be facilitated. Second, there was an expectation that costs would be controlled, for example by the use of multi-skilled personnel and by having fewer, smaller, newer and different hospitals. Third, quality control would be introduced (e.g. the widespread use of evidence-based medicine). Fourth, it was agreed that a change of professional attitudes would be needed, particularly among doctors (e.g. more openness, less bluster and less hierarchy). Telemedicine is likely to be a great driver of change in the health service. The changes relating to the location and type of work are fairly predictable, but the changes in relationships are likely to be profound.

Telemedicine and the organization of the health sector.

The widespread introduction of telemedicine would have organizational consequences for the health sector. However, the problem of health-sector organization is complex. A general framework for analysis of organizational consequences has been developed and consists of eight points. These are: (1) the starting point; (2) mapping of applications of telemedicine where organizational consequences are possible; (3) characterizing the nature of larger organizational consequences; (4) the consequences for the health sector in the chosen area; (5) possible consequences for the number and placement of geographical subunits of the health sector; (6) possible consequences for health sector organizational types; (7) the consequences for the tools of health policy; and (8) design of the change process towards a new organization.