Provide Telemedicine Services Research Articles

Provision of telemedicine services by community health centers.

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers.

Telemedicine Networks of EHAS Foundation in Latin America.

Rural areas in developing countries are characterized by lack of resources, low population density, and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate health-care services. This paper explains research results achieved by Enlace Hispano Americano de Salud – Hispano American Health Link (EHAS) and how they have contributed to improve healthcare in isolated areas of developing countries through the use of information and communication technologies (ICT). As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the health-care services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system) have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned.

AMA Approves Recommendations for Telemedicine

AMA Approves Recommendations for Telemedicine

SATMED: Legal Aspects of the Physical Layer of Satellite-Telemedicine

Significant disparities exist between the availability of physicians and health care specialists in urban and rural areas, particularly in developing countries. Emerging telemedicine technologies would enable doctors located in urban areas and elsewhere around the globe to serve rural patients. However, the limited availability of telecommunications infrastructure and technology necessary for telemedicine in rural areas inhibits the deployment of such health care applications. Satellites' ability to bridge gaps in telecommunications infrastructure gives them a unique capacity to also bridge the urban-rural health care divide by making telemedicine applications available to rural patients and medical professionals worldwide. However, international law provides an expansive grant of national sovereignty over electromagnetic spectrum that supersedes state obligations to provide access to health care. As a result, the physical equipment necessary to provide telemedicine services to rural patients is subject to national regulatory regimes that prevent the widespread and cost-effective availability of life-saving technology.This paper identifies the body of international law governing satellite telemedicine including conventions governing economic, social and cultural rights and the right to health care; and international telecommunications law including the ITU Constitution, Tampere Convention, and the Global Mobile Personal Communication by Satellite Memorandum of Understanding. It then concludes that an additional international undertaking to eliminate national barriers to entry for satellite telemedicine technology is necessary.

Using Health Information Technology to Prevent and Treat Diabetes

Using Health Information Technology to Prevent and Treat Diabetes

A systematic review of telemedicine projects in Colombia

A systematic review of telemedicine projects in Colombia was conducted. We searched electronic databases, and also searched for relevant Internet websites. Each project manager was contacted by telephone to identify projects which had not actually been carried out. They were interviewed to request information about the projects they were managing, and whether they knew of other projects in Colombia. The search process identified 43 different projects, which were classified into two groups: telemedicine research initiatives and projects for providing health-care services via telemedicine. There were 32 projects which provided telemedicine services, of which 14 had been finished, 11 remained active, 4 were being implemented and no data were available about the state of the other 3. Health-care services had been provided using telemedicine to at least 550,000 patients. The projects had connected more than 650 health-care institutions, mainly in deprived areas of the country. Unfortunately, although many projects seem to have had a positive effect, none of them had been rigorously evaluated, and therefore in the absence of scientific evidence no general recommendations can be made. However, the methodology of the present study appears suitable for similar reviews of telemedicine in other developing countries.

Providing telemedicine services in an infrastructure-based cognitive radio network

Compared to traditional wireless networks, a cognitive radio network (CRN) can be built with much more flexibility. In this article we study the performance of supporting telemedicine traffic in a CRN. We first introduce an infrastructure-based CRN for telemedicine, where cognitive base stations sense available spectrum and forward data for associated healthcare stations. We then present strategies and performance for supporting urgent and real-time periodic telemonitoring traffic in the network. Our results show that satisfactory real-time performance can be achieved for telemedicine traffic.

Space technology: a new frontier for public health

When former UN secretary-general Kofi Annan was seen leaving conference in Geneva in November 2005 clutching maps of the south Asia earthquake disaster, it was evidence that satellites--as key weapon in humanitarian emergencies--had arrived. In the hours and days after the October 8 quake struck killing more than 73 000 people and injuring some 150 000, experts from France, Germany, the United Kingdom and the United Nations scrambled gather and interpret images data from satellites assist rescue workers on the ground from local authorities nongovernmental organizations (NGO), like Telecoms Sans Frontieres. The maps (which can be seen at http://www.disasterscharter.orgl disasters/CALLID_110_e.html) compare the terrain before and after the disaster, and pinpoint the location and impact of landslides. Such photos, says Maarten Meerman, satellite designer at MacDonald Dettwiler in Vancouver, Canada, would be detailed enough to spot flooded roads, burning forests, washed out railways, etc. [ILLUSTRATION OMITTED] These relief crews and aid workers--with their boots knee-deep in mud and their laptops under plastic bags for protection from the rain--got the damage maps and reported that the information was useful, recalls Philippe Bally, an earth observation specialist from the European Agency (ESA) and member of the secretariat of the International Charter Space and Major Disasters, seven-year-old commitment by 10 space agencies provide satellite-based data countries affected by disaster. This vote of confidence, he concluded, was a clear message when it comes from the end user. But it was the sight of Annan emerging with maps of the disaster that struck home for Bally, who through the Charter helped coordinate obtaining the images and their interpretation by experts from an ESA project called GMES RESPOND. Those maps, says Bally, the results of huge effort from the Charter alongside value-adding partners working on satellite data extract thematic Great advances have been made in space technology in the past decade, and these advances have become useful for addressing humanitarian crises. The chief of these, as the Pakistan earthquake illustrates, is using satellites obtain images of disaster zone quickly, so that rescue workers can focus their efforts where they are needed. But there are other uses of satellites: as way predict and monitor the spread of communicable diseases; as simple means of communication when land-based systems have failed; and as location and navigation aids when Global Positioning System--GPS--units locate and track public health information. In the outbreak of Rift Valley fever in Kenya (2006-2007), for example, GPS units were used link surveys an actual place on the earth, according Carl Kinkade, enterprise Geographic Information System (GIS) coordinator for the United States Centers for Disease Control and Prevention (CDC). ESA is collaborating with the World Health Organization (WHO) establish European user-driven Telemedicine via Satellite programme. Telemedicine is the use of information technology deliver medical services or information from one location another. The programme will aim provide telemedicine services, such as delivering medical care and treatment via satellite, and, for WHO, key element is training health workers in how use such health technologies in their work. WHO has already trained health workers in how use satellite images in 20 countries. The Satellites For Epidemiology (SAFE) pilot project, for example, is part of that collaboration. According SAFE coordinator Audrey Berthier, of the Institut de Medecine et de Physiologie Spatiales (MEDES) in Toulouse, France, the SAFE project attempts answer the question: how good are satellites for providing early warning of disease outbreaks? To explore this, SAFE conducted training exercise in November 2007 on the Greek island of Crete (http://www. …

Perspectives from the Veterans Health Administration about opportunities and barriers in telemedicine

We used qualitative interviews to examine the perceptions of direct providers of telemedicine services, primary care providers (PCPs) and hospital administrators about opportunities and barriers to the implementation of telemedicine services in a network of Veterans Health Administration hospitals. A total of 37 interviews were conducted (response rate of 28%) with 17 direct telemedicine providers, nine PCPs and 11 administrators. The overall inter-coder reliability across all themes was high (Scott's pi = 0.94). Direct telemedicine providers generally agreed that telemedicine improved rapport with patients, and respondents in all three groups generally agreed that telemedicine improves access, productivity, and the quality and coordination of care. Respondents mentioned several benefits to home telemedicine, including the ability to better manage chronic diseases, provide frequent clinician contact, facilitate quick responses to patient needs and provide care in patient's homes. Most respondents anticipated future growth in telemedicine services. Barriers to telemedicine implementation included technical challenges, the need for more education and training for patients and staff, preferences for in-person care, the need for programme improvement and the need for additional staff time to provide telemedicine services.

Evolving Pediatrician Perceptions of a Telemedicine Program

This study addresses pediatrician perceptions of a telemedicine program as it developed from 1998 to 2000. The researchers completed structured interviews with ten pediatricians who provided telemedicine services between a university medical center and an urban school district. The results describe how pediatricians understood the telemedicine program, including technology, consult process, and relationships. This understanding of how pediatricians “make sense” of telemedicine allows optimal planning for the program's future and may inform other telemedicine initiatives about challenges in the pediatric setting.

Providers' Acceptance of Telehospice

This research was conducted as part of a telehospice study conducted by researchers at Michigan State University, in a partnership with Hospice of Michigan. The study took place from March 2000 through December 2002. One of the primary objectives of the study was to learn more about how providers feel about the provision of telemedicine services, in this case telehospice. Of particular importance was learning more about how providers' perceptions of services could change over the course of the project as they became more familiar and comfortable with providing telehospice services. Finally, researchers were interested in how the providers' perceptions of telehospice system might influence utilization. Four Hospice of Michigan offices took part in this telehospice study, two in rural areas and two in urban settings with a total of 187 patients receiving telehospice care. Health providers who offered telehospice services were recruited to share information about their perceptions of the technology. Providers were surveyed at the beginning and end of the project to track their perceptions of telehospice services. Five focus groups with providers were also conducted over the course of the project to allow providers to elaborate their thoughts and perceptions in greater detail. Actual utilization of the telehospice system did not have a significant impact on perceptions of services; for the most part, providers began the project with pre-conceived notions about the technology and these perceptions held over the course of the project. Even providers who praised the level of training and technical support and who were able to cite success stories did not display a significant change in attitudes toward telehospice. Providers did express concern regarding how telehospice would impact current aspects of their job such as autonomy or mileage reimbursement. Study results indicate that providers serve as gatekeepers to a new technology and manner of providing care. Telehospice services in this project were primarily provided by a handful of enthusiastic adopters. The results of this study provide important implications if telehospice care is to disseminate for general use among hospice recipients.

Contracting with health-care customers and specialists for the provision of telemedicine services across European borders: the TEN-Telemed Legal Project.

Two generic contract models have been developed to resolve the legal and ethical issues that arise when contracting for telemedicine services across Europe. Model 1 relates to the risks and responsibilities of the expert providing and specialist opinion and the telemedicine service organization, while model 2 outlines the risks and responsibilities from the perspective of the client seeking the advice and (again) the telemedicine service organization. These contracts express the legal rights and responsibilities of each of the parties involved.

The sustainability of telemedicine projects.

Although there are instances where the provision of health care is successfully driven by the profit motive, in most countries it is considered a public service. The provision of telemedicine services assuredly meets an important social need to extend health care to remote and rural areas in developing countries. While there are potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. Telemedicine undoubtedly yields cost savings in certain circumstances, but few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. With their low expenditures per person, developing countries face a daunting challenge in making such public services sustainable. Pilot projects should be a first step in demonstrating the cost-effectiveness and benefits of telemedicine, but such projects should also be sustainable. Sponsors of such pilot projects must have a clear plan from the start about how the project can continue after the sponsorship comes to an end. This paper examines ways in which telemedicine services can be made sustainable.

Telemedicine in practice

Telemedicine is defined as the "delivery of health care and sharing of medical knowledge over a distance using telecommunication systems." The concept of telemedicine is not new. Beyond the use of the telephone, there were numerous attempts to develop telemedicine programs in the 1960s mostly based on interactive television. The early experience was conceptionally encouraging but suffered inadequate technology. With a few notable exceptions such as the telemetry of medical data in the space program, there was very little advancement of telemedicine in the 1970s and 1980s. Interest in telemedicine has exploded in the 1990s with the development of medical devices suited to capturing images and other data in digital electronic form and the development and installation of high speed, high bandwidth telecommunication systems around the world. Clinical applications of telemedicine are now found in virtually every specialty. Teleradiology is the most common application followed by cardiology, dermatology, psychiatry, emergency medicine, home health care, pathology, and oncology. The technological basis and the practical issues are highly variable from one clinical application to another. Teleradiology, including telenuclear medicine, is one of the more well-defined telemedicine services. Techniques have been developed for the acquisition and digitization of images, image compression, image transmission, and image interpretation. The American College of Radiology has promulgated standards for teleradiology, including the requirement for the use of high resolution 2000 x 2000 pixel workstations for the interpretation of plain films. Other elements of the standard address image annotation, patient confidentiality, workstation functionality, cathode ray tube brightness, and image compression. Teleradiology systems are now widely deployed in clinical practice. Applications include providing service from larger to smaller institutions, coverage of outpatient clinics, imaging centers, and nursing homes. Teleradiology is also being used in international applications. Unresolved issues in telemedicine include licensure, the development of standards, reimbursement for services, patient confidentiality, and telecommunications infrastructure and cost. A number of states and medical boards have instituted policies and regulations to prevent physicians who are not licensed in the respective state to provide telemedicine services. This is a major impediment to the delivery of telemedicine between states. Telemedicine, including teleradiology, is here to stay and is changing the practice of medicine dramatically. National and international communications networks are being created that enable the sharing of information and knowledge at a distance. Technological barriers are being overcome leaving organizational, legal, financial, and special interest issues as the major impediments to the further development of telemedicine and realization of its benefits.

Does products liability litigation threaten picture archiving and communication systems and/or telemedicine?

Numerous writers have commented on barriers to the growth and progress of telemedicine. Among these barriers are reimbursement concerns, professional liability exposure, licensing restrictions, hospital credentialing questions, and other problems. A legal threat not generally described in the literature to date is the possibility that products liability claims could be brought against manufacturers and distributors of hardware, software, and peripherals used in providing telemedicine services. Several of these concerns extend to picture archiving and communication systems (PACS), including, of course, teleradiology. This article considers that possibility in the context of several potential plaintiffs' theories, discusses currently applicable law, and proposes approaches to diminishing the magnitude and severity of this potential threat.

Remote management of haemodialysis patients: Design and implementation of a telemedicine network

Summary. Telemedicine applications have been implemented in many clinical specialties. Some, like teleradiology, are now established applications with specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Project Phoenix, a National Library of Medicine funded project set up to look at the access, cost and quality implications of telemedicine in a renal dialysis setting, we are establishing such protocols and standards. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and Information Systems (ISIS) Center of the Department of Radiology, the Clinical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a remote outpatient dialysis clinic, and a nephrologist's home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. This paper shows that the first step in establishing standards and operational protocols for various clinical applications is to start with specific clinical needs assessment followed by an iterative process of reassessment and evaluation. This allows flexibility and a dynamic approach in the optimal system design.

Towards a general purpose, scaleable workstation for remote medical consultations. Experiences from use of VIDA–a still image system for the provision of low-cost telemedicine

Telemedicine is a way of providing medical services to patients, no matter where the patient or relevant information is located. A low-cost still image system for the provision of telemedicine services has been implemented and has been subject to field trials within several medical disciplines. The objective has been two-fold. Through our work we have aimed to bring forward a tool for remote medical consultations. Furthermore, we have earned experiences from these trials relative to the long-term task of designing a general-purpose, telemedicine workstation. We describe the objective for the work, the VIDA still image system, experiences from user trials, and discuss how these should influence the design and technical requirements for such a workstation.