National Telemedicine Research Articles

Telemedicine in Alzheimer's disease and other dementias: Where we are?

The prevalence and global health burden of dementia including Alzheimer's disease (AD) is rising, while patients living in remote and underserved areas face significant challenges in reaching specialized care. Telemedicine offers a valuable solution in bridging this widening gap, by providing equal and timely access to tertiary-specialized centers. Accumulating evidence highlights that most parts of the remote neuropsychological and neurological evaluation are feasible, with patients, healthcare professionals and caregivers being generally satisfied with this means of care. Herein, we provide an updated overview of the available evidence on the use of telemedicine for patients with cognitive disorders, focusing on the different applications and settings, the remote, video-based neurological and neuropsychological assessment, current recommendations, non-pharmacological interventions, as well as legal and ethical considerations. Based on the literature review and our three-year experience in the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network" in the Aiginition University Hospital of Athens, we propose a brief guide for assessing patients with cognitive impairment via telemedicine and suggest future research directions for the more effective and appropriate use of telemedicine in dementia assessment and care.

A new digital model for Italian Integrated Home Care: strengths, barriers, and future implications

Abstract Issue/Problem After the COVID-19 pandemic, Italy’s National Health Service (NHS) is transforming by adopting telemedicine through its National Recovery and Resilience Plan, aiming to modernize healthcare delivery and ensure equity. In this plan Territorial Coordination Centers (COT) were designed to improve patient access and continuity of care. However, regulatory challenges hinder the widespread adoption of telemedicine. Our work describes the technical, structural, and operational aspects of the new Italian Integrated Home Care (IHC) digital model, addressing strengths, barriers, and future implications. Description of the problem The implementation of the IHC digital model faces multiple challenges. Italy’s poor technical infrastructure, especially in rural areas, hampers access to critical services. Resistance to change among rural systems and the elderly, coupled with low digital literacy, inhibits telemedicine adoption. Fragmentation in the NHS leads to resource disparities, particularly disadvantaging southern regions. Italy also grapples with a severe shortage of healthcare professionals, posing a threat to the model’s sustainability. Results The National Digital Health Agency enacts the IHC model by overseeing telemedicine services through a cloud-based protocol. Each Region provides “Basic Telemedicine Services”: healthcare professionals’ and patient teleconsultation, telemonitoring, teleassistance. Communication between services, infrastructures, and local health authorities is facilitated by a modular interoperability layer, ensuring data standards and quality. A national telemedicine dissemination portal will contain data on all telemedicine solutions provided. Lessons Clear communication is essential for telemedicine acceptance. COTs enhance coordination and management. Bridging the technology gap for disadvantaged groups, supporting frontline employees and addressing adoption factors is vital to overcome the challenges faced. Key messages • The National Digital Health Agency drives telemedicine services under the IHC model. Each region offers Basic Telemedicine Services, ensuring data standards, quality and interoperability of data. • Italy’s telemedicine adoption faces poor infrastructure, resistance and workforce shortages. Focusing on equity, healthcare workers support and bridging the technology gap will be key.

Pandemic Action Plan: Phase 3-Lessons Learned from Implementation. "What Did We Learn?"

The COVID-19 pandemic created critical challenges for hospitals and health care providers. Suddenly clinics were forced to close; elective procedures were delayed; scheduled visits were canceled; emergency rooms were overcrowded; hospital beds, equipment, and personal protective equipment (PPE) were in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma, and personal risk. To better address challenges of the ongoing COVID-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment Resource Center (TTAC) was asked to develop a Pandemic Response Action Plan that would allow its users to address critical issues with available telemedicine and related technologies. The project was constructed in 3 phases. Phase 1-Develop a Pandemic Response Action Plan and a Pandemic Response Action Plan Policy and Regulatory Summary, which identifies the regulatory challenges as well as policy recommendations. Phase 2-Publish the Action Plan and the Policy and Regulatory Summary. Phase 3-Look at health care providers who used the approaches, tools, and technology in the Pandemic Action Plan and document the results. This document represents Phase 3. This document is Phase 3. In this report we look back at health care providers who used the approaches in the Phase 1 Pandemic Response Action Plan as published in Phase 2. In this document we report on the challenges and results of implementing parts of the Pandemic Action Plan. It records the findings, conclusions, and recommendations resulting from the experience of health care providers and the professional experiences of the team and their organizations in implementing parts or all of the plan. Methods: The same multidisciplinary team that constructed Phase 1 and Phase 2 were engaged to develop this Phase 3 report. The members of the team represent leadership expertise and key stakeholders in health care delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, and information technology) as well as a facilitator. For Phase 3, the group used structured brainstorming to define the findings, issues, and results of their own organizations' digital health response to the pandemic. In addition, eight health care providers (hospitals) identified by the Telemedicine Resource Centers' (TRCs) organizations, who used the Pandemic response Plan (created in Phases 1 and 2), were interviewed. All interviews were conducted by the same facilitator with leaders (CEO, and leaders of the telemedicine programs) in each of the eight programs, using a standard questionnaire created by the team. Current literature references are included in this report to illustrate when findings are known to have broader applicability. Conclusions: The impact of the COVID-19 Pandemic was severe and identified multiple critical challenges and weaknesses. Applying the approaches, tools, and technology outlined in the Pandemic Response Action Plan proved to be effective in addressing critical provider challenges. However, implementing these tools during a crisis was difficult unless the organization had experience with the tools and necessary workflows in advance. Implementing these tools as part of standard workflows and everyday operations increased the capabilities and resilience of these organizations in the provision of care during this and for future pandemics.

TelMedAI

Telemedicine is the practice of technology-enabled remote communication between patient and doctor. This phenomenon in healthcare has the potential to make services affordable and save time and money. Besides telemedicine allows care givers and family members to join conversations with doctors. Indian government initiated the National Telemedicine Network (NTN) to serve remote areas in healthcare by integrating existing healthcare facilities.Literature has revealed that existing works lack in an integrated approach for patient speech translation in language-independent fashion and automatic detection of disease and symptoms based on speech.There is a need for an automated system using Artificial Intelligence (AI) to recognize patient's speech and identify symptoms based on given audio description. We proposed a framework known as TelMedAI which is designed to recognize patient speech to comprehend disease symptoms besides converting the speech text into desired language. The framework is useful for realizing a telemedicine system. Speech to Speech (STS) module takes the patient's audio content into English audio. STS module exploits the Bi-LSTM model with an encoder, decoder and attention mechanism for translation. Then Google Speech API is used to convert English audio into English text. Then the framework exploits Natural Language Processing (NLP) to improve the quality of text. Afterwards, the disease and symptoms miner module eventually recognizes a list of diseases and corresponding symptoms. We proposed an algorithm known as Learning based Disease and Symptom Recognition from Patient Speech (LbDSRPS). This algorithm has the functionality to develop TelMedAI which helps doctors in telemedicine. Our empirical study has revealed that TelMedAI takes technology-driven telemedicine research forward significantly. The highest accuracy achieved by the proposed framework is 68.13% which is much better than the baseline LSTM model used for voice translation.

Association Between Antibiotic Receipt and Provider Rating Within a National Telemedicine Practice.

This retrospective cohort study estimated the association between prescription receipt and provider 5-star rating for adult visits with upper respiratory infections in a national telemedicine practice with active antibiotic stewardship initiatives. The odds of a 5-star rating were higher for visits with an antibiotic or nonantibiotic prescription and longer visits.

National Emergency Tele-Critical Care in a Pandemic: Barriers and Solutions.

The COVID-19 pandemic caused tremendous disruption to the U.S. healthcare system and nearly crippled some hospitals during large patient surges. Limited ICU beds across the country further exacerbated these challenges. Telemedicine, specifically tele-critical care (TCC), can expand a hospital's clinical capabilities through remote expertise and increase capacity by offloading some monitoring to remote teams. Unfortunately, the rapid deployment of telemedicine, especially TCC, is constrained by multiple barriers. In the summer of 2020, to support the National Emergency Tele-Critical Care Network (NETCCN) deployment, more than 50 national leaders in applying telemedicine technologies to critical care assembled to provide their opinions about barriers to NETCCN implementation and strategies to overcome them. Through consensus, these experts developed white papers that formed the basis of this article. Herein, the authors share their experience and propose multiple solutions to barriers presented by laws, local policies and cultures, and individual perspectives according to a minimum, better, best paradigm for TCC delivery in the setting of a national disaster. Cross-state licensure and local privileging of virtual experts were identified as the most significant barriers to rapid deployment of services, whereas refining the model of TCC to achieve the best outcomes and defining the best financial model is the most significant for long-term success. Ultimately, we conclude that a rapidly deployable national telemedicine response system is achievable.

Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study.

Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA's videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit.

Awareness among Pediatricians Regarding National Telemedicine Guidelines during the COVID-19 Pandemic: A Survey.

The success of telemedicine depends on awareness among doctors on how to implement it. We aimed to assess knowledge about national telemedicine guidelines in pediatricians during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study of pediatricians across India was conducted through a structured online questionnaire containing 16 marks. The mean knowledge score (KS) was calculated. Participants were divided into two groups: poor KS (KS <8) and good KS (KS ≥8). The association between factors and KS was assessed using univariate analysis. A total of 503 pediatricians participated (private sector: 80.7% and public sector: 19.3%). Most (61%) belonged to the age group of 31-50 years and were males (75%). The minimum educational qualification was a Doctor of Medicine (MD) in 57% of cases. Despite work experience of more than 5 years in most (70%) of the cases, very few had provided teleconsultation before the pandemic (13.9%). The mean KS was 10.60 ± 2.8, that is, 66.25%. The minimum KS was 1 (6.25%), and the maximum was 16 (100%). Assam, Chandigarh, Himachal Pradesh, Jharkhand, Odisha, Sikkim, and Tamil Nadu showed higher knowledge than other states, although no significant difference was found. The majority (89.1%) had good KS, which is significantly higher among private practitioners as compared to public practitioners. There was no association between KS and age, gender, qualification, and work experience. Pediatricians have good information regarding telemedicine guidelines in India; however, training programs will further empower doctors working in the public sector.

The Steps on the Path of Digital Transformation in Greek Public Healthcare: Challenges and Prospects

Globally, the tremendous growth of Information and Communication Technology (ICT) has led to a great expan- sion of the information produced, emerging new terms such as E-government (EG), Digital Governance (DG), and Digital Transformation (DT) that brought revolutionary changes in public administration and other sectors such as telecommunication, industry, and energy but not enough in public healthcare area. This study set out to explore the level of development of DT of Greek Public Healthcare (GPH) since 2000, focusing on the e-Health and Digital Health (DH) applications and services, and highlighting its accelerated development due to COVID-19 pandemic and its main problems in its application. A review of compara- tive studies published from 2000 to date was conducted. Search was demonstrated on Organisation for Economic Co-operation and Development (OECD), European Com- mission and Open Data Institute (ODI) databases, and Greek Legislation Framework. Keywords we used: «Digital Transformation», “Digital Governance”, “e-Health”, “Digi- tal Health”, “Electronic Health Record”, “e-prescription”, “Health Information Systems”, “Health Atlas”, “m- Health/Mobile Health”, “Telemedicine”, “Telehealth”, “ICT Action Plan”. During the first decade, there were many advances in DG and DT, like the Integrated Health Infor- mation Systems (IHIS), which in the majority of their implementation have not adequately fulfilled their role remaining as isolated HIS. The second decade, marked by the memorandum and the economic crisis, brought many significant changes in the context of the organization and rational administration of the GPH, especially in the field of DT, DG, and e-Health such as e-prescription, ESY.net, e-inventories, e-warehouses, e-invoicing of hospital charges, electronic Statements of Detailed Health Documents (eDAPY), the United4Health project, the National Telemedicine Network and the partially developed Individual Electronic Health Record (IEHR). Taken together, these results suggest that, Greece still lags in the field of e- Health and significant steps are needed to make GPH cost-effective, accessible, and inclusive, such as among others the integration of IEHR and the import of Laboratory Infor- mation System (LIS) and Picture Archiving and Communi- cation System (PACs) data into the IEHR.

Pioneering a Framework for Robust Telemedicine Technology Assessment (Telemechron Study)

The field of technology assessment in telemedicine is garnering increasing attention due to the widespread adoption of this discipline and its complex and heterogeneous system characteristics, making its application complex. As part of a national telemedicine project, the National Center for Innovative Technologies in Public Health at the Italian National Institute of Health played the role of promoting and utilizing technology assessment tools within partnership projects. This study aims to outline the design, development, and application of assessment methodologies within the telemedicine project proposed by the ISS team, utilizing a specific framework developed within the project. The sub-objectives include evaluating the proposed methodology’s effectiveness and feasibility, gathering feedback for improvement, and assessing its impact on various project components. The study emphasizes the multifaceted nature of action domains and underscores the crucial role of technology assessments in telemedicine, highlighting its impact across diverse realms through iterative interaction cycles with project partners. Both the impact and the acceptance of the methodology have been assessed by means of specific computer-aided web interviewing (CAWI) tools. The proposed methodology received significant acceptance, providing valuable insights for refining future frameworks. The impact assessment revealed a consistent quality improvement trend in the project’s products, evident in methodological consolidations. The overall message encourages similar initiatives in this domain, shedding light on the intricacies of technology assessment implementation. In conclusion, the study serves as a comprehensive outcome of the national telemedicine project, witnessing the success and adaptability of the technology assessment methodology and advocating for further exploration and implementation in analogous contexts.

Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project.

Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands. Data were derived from the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network", March 2021-March 2023. The survey included 10 questions (5-point Likert scale). We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information. The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.

The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors.

Our 2019 survey of sleep medicine fellowship program directors (PDs) indicated that fellows' contact with telemedicine was limited. Within months, the coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field. This survey describes fellows' telemedicine exposure, their PDs' attitudes toward it, and their formalized telemedicine training during the pandemic's third year. A 33-item SurveyMonkey questionnaire was developed. Many quantitative (Likert scale) items were identical to items on the 2019 survey for direct comparison. An open-ended question was added for qualitative analyses. All 91 sleep medicine fellowship PDs were invited to participate. The SurveyMonkey platform provided quantitative item descriptive statistics. Qualitative data underwent thematic analyses using codebook methodology. Forty (97.5%) PDs indicated their program offers a telemedicine experience. Thirty-two (80%) PDs observed at least a 10% increase in sleep fellows' telemedicine encounters compared with prepandemic times. Although 27 (67.5%) PDs agreed that a national telemedicine curriculum could be useful, 8 (20%) of them offer a sleep telemedicine curriculum. Qualitative feedback revealed diverging attitudes toward telemedicine's place in sleep medicine practice, fellowship training, and the utility of a national curriculum. Sleep telemedicine utilization during fellowship training was markedly higher on this 2022 survey (97.5%) compared with a similar 2019 survey (33.3%), and most PDs agreed a standardized curriculum could be useful. However, relatively few programs offer formalized telemedicine training. These findings imply that, while most sleep medicine fellows participate in telemedicine, they lack the formalized training that may optimize their utilization of the medium in their postfellowship careers. Fields BG, Kaur K, Dholakia S, Ioachimescu O. The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors. J Clin Sleep Med. 2024;20(2):201-210.

The Experience of Telerehabilitation in Coronavirus Disease 2019 Pandemic: Observations from Physiatrists of an Indian Neurorehabilitation Desk

Abstract Context: The coronavirus disease pandemic heralded a global ‘new normal’. India responded with a complete lockdown. Simultaneously, the release of the Indian National Telemedicine Practice Guidelines led to a surge in telemedicine. The authors share their experience of launching an indigenous telerehabilitation service, a largely unexplored area in India. Aims: This study aimed to determine the socioclinical characteristics of the population availing telerehabilitation. Settings and Design: A retrospective chart review was done in a physiatrist-led neurorehabilitation department of a unispeciality tertiary care hospital. Subjects and Methods: Before the launch, a strategic promotional campaign was designed. Consent forms were structured following the national guidelines with institutional modifications. A combination of the ‘real-time’ and ‘store-and-transfer’ models was used. Teleconsultation by a physiatrist was followed by telerehabilitation by therapists. Satisfaction scales were used for feedback. Statistical Analysis Used: Data are described as frequency and percentages for qualitative data. Results: Between 8 April 2020 and 30 September 2020, there were 561 teleconsultations, of which 224 patients consulted the physiatrist. Stroke (46 patients, 20.53%), low back pain (40 patients, 17.85%) and spinal cord injury (27 patients, 12.05%) were the most common diagnosis. A majority of 93 patients belonged to the age group of 40–60 years. A comparable number of patients within and outside the city availed of the service. Conclusions: Telerehabilitation with simply available resources is feasible and useful. The digital divide, security concerns and restrictions in the execution of treatment are its imitations. Technology and creativity can be combined to develop further viable telerehabilitation models.

Implementation, service effectiveness and satisfaction with teleconsultation services in China during the COVID-19 pandemic: from the Perspective of Primary Health Care Professionals

ObjectiveThis study aims to evaluate satisfaction and service effectiveness of primary hospital physicians participating in the National Telemedicine Center of China during the COVID-19 period, and to identify potential improvement suggestions. MethodsAn online questionnaire was developed to assess the impact and satisfaction of teleconsultation services. A teleconsultation manager from each of the 98 hospitals randomly invited the medical staff involved in teleconsultation to complete the online questionnaire. ResultsA total of 379 health care professionals responded to the online questionnaire, with a mean age of 36.74 years. Out of these respondents, 95.5% had a positive attitude towards teleconsultation during the epidemic. Only 6.6% believed that teleconsultation systems were not useful in preventing and controlling the COVID-19 pandemic. Those respondents who were very satisfied with teleconsultation participated in it 1.81 times per week averagely. Factors related to satisfaction included weekly participation frequency（P=.003）, patient data quality(P=.023), equipment operation proficiency（P=.006）, audio and video clarity and smoothness（P=.004, P=.020）, environmental satisfaction（P=.032）, and incentive measures of title promotion（P=.003）. The main challenges in teleconsultation were the lack of understanding of medical staff and the public, insufficiently advanced software and hardware equipment, and the lack of optimization of service processes. ConclusionsPrimary hospital doctors demonstrate high satisfaction levels, suggesting that teleconsultation could be an effective tool for patients seeking medical care in areas under lockdown during the COVID-19 pandemic. The primary barriers to teleconsultation include lack of public understanding and unadvanced equipment. These findings should inform future efforts to establish regional telemedicine programs in the post-COVID-19 era.

Optimization of teleconsultation appointment scheduling in National Telemedicine Center of China

Teleconsultation service plays an important role in the Chinese healthcare service provision especially during the period of the COVID-19 pandemic. We propose a two-stage distributionally robust optimization model in teleconsultation appointment scheduling to minimize the total cost considering doctors’ and an inpatient’s waiting for appointments in a neurology department. This approach suits well with unique type of patients, expert doctor’s mobility and primary doctors’ time-anxiety of teleconsultation in the National Telemedicine Center of China. Given the ambiguity set based on the estimated mean and covariance matrix of the distribution, an approximate semidefinite programming model is reformulated, which can be solved by a standard solver due to special structures of constraints. In this paper, we have compared the performance of the strategy with and without considering primary doctors’ time-anxiety. We have used real-world data to conduct numerical experiments to determine the sensitivity of the results with respect to the changes in the parameters such as ambiguity set parameters, the risk level of overtime and waiting cost. Finally, managerial recommendations are provided for decision-makers to achieve better performance in the case of teleconsultation systems.

Home NIV treatment quality in patients with chronic respiratory failure having participated to the French nationwide telemonitoring experimental program (The TELVENT study)

BackgroundThe ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeutic education and NIV telemonitoring with data processed by an algorithm generating alerts. The TELVENT study objective was to analyze the evolution of ventilation quality in patients included in the ETAPES program. MethodsMulticentric cohort study on patients undergoing long-term NIV included in the ETAPES program between September 2018 and December 2020 and who did not refuse the use of their data for this research. Data were obtained from homecare provider databases. The primary endpoint was to attain successful NIV treatment, which was determined by a combination of daily NIV usage for > 4 h per day, low leaks, and a low apnea-hypopnea index (AHI) identified by the NIV device. Respiratory disability was assessed using the DIRECT questionnaire. Results329 patients were included in the study of which 145 had COPD and 83 had started NIV and ETAPES within one-month delay. Approximately 25% of patients did not achieve the criteria for successful NIV at ETAPES entry. The proportion of patients with successful NIV treatment increased to 86.8% at six months (p = 0.003, Cochran-Armitage trend test) regardless of NIV history and continued to increase at 12 months in newly equipped NIV patients (93.8%, at month 12, p = 0.0026 for trend test). Over time, a significant increase in NIV use and compliance was observed, while AHI significantly decreased in the overall population. No significant decrease was observed for non-intentional leaks. Approximately 4.9 alerts were generated per patient per 6 months. Their number and type (low NIV use, high AHI or leaks) differed among patients based on their NIV history. Respiratory disability score decreased over time compared with baseline. ConclusionThe TELVENT study highlights the importance of remote NIV monitoring to rapidly identify patients with unsuccessful ventilation. The combination of remote monitoring and therapeutic education may improve the quality of home NIV, especially in the first months of treatment.

Feasibility and Acceptability of a US National Telemedicine Curriculum for Medical Students and Residents: Multi-institutional Cross-sectional Study

Telemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels. This study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies. A total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70%) medical students and 359 (30%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses. A total of 92% (1101/1203) of learners completed the entire curriculum. Across the modules, 78% (SD 3%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87% (SD 4%) reported that the information presented was at the right level for them; 80% (SD 2%) reported that the structure of the modules was effective; and 78% (SD 3%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants' responses and their institution's geographic region, setting, or previous experience with a telemedicine curriculum. Both undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective.

User’s perceived service quality of national telemedicine services during COVID-19 pandemic in Bangladesh: Cross-sectional study (Preprint)

User’s perceived service quality of national telemedicine services during COVID-19 pandemic in Bangladesh: Cross-sectional study (Preprint)

Abstract TP65: An Automated Algorithm For The Nih Stroke Scale Assessment

The NIH Stroke Scale (NIHSS) is widely adopted in clinical practice. Despite being originally designed for research use, the NIHSS is a valued resource for communication and prognostication, and it is useful for the decision-making process regarding reperfusion therapies and prophylaxis. However, its assessment can be laborious and complex among even certified healthcare providers. In the context of increasing telemedicine use, an accurate assessment of the NIHSS may be crucial in acute stroke management We aimed to create and validate an automated tool for the NIHSS (SPOKES) in a national telemedicine service. A board of five certified vascular neurologists created an NIHSS algorithm based on a tree decision, including tips and hints in the main questions and auxiliary boxes. We randomized 22 spoke hospitals using an automated tool to invite emergency physicians not certified in the NIHSS to use or not the SPOKES. NIHSS-certified and blinded neurologists from a hub hospital performed a double-check of each item of the NIHSS. From June to August 2022, we included 144 cases from 10 spoke hospitals. Our algorithm was fully adopted in 27 cases (19%). The median of reported NIHSS was 3 [1, 5] and 3 [2, 7] points among users and non-users, p=0.38. The general difference between the reported and the double-checked score was 0 [0, 1] points – there was no difference between those who used or did not the SPOKES (p=0.12). A complete concordant score was achieved at 66.7% (n=18/27) and 45.3% (n=53/117), χ 2 =0.036, among users and non-users, respectively. In a bivariate regression analysis, the SPOKES increased the chance of complete agreement [OR 2.4, 95%CI 1-5.8, p=0.049]. There was no difference regarding discrepant scores (≥4 points), χ 2 =0.46. Among SPOKES cases, treatment with tPA was indicated in 11.1%, versus 12.7% among non-users (p=0.59). Despite the small number of included cases, our algorithm seems to be a promising tool for the NIHSS assessment in a national telemedicine service, increasing the chance of a complete agreement with certified neurologists. The tool is free and available at www.spokes-nihss.com

AI telemedicine screening in ophthalmology: health economic considerations

AI telemedicine screening in ophthalmology: health economic considerations