Regional Telemedicine Research Articles

Clinical applications of telemedicine services using a regional telemedicine platform for cancer treatment: a cross-sectional study

BackgroundTelemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine.MethodsWe collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations.ResultsFrom 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration.ConclusionsIn China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital.

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.

From the Editors.

From the Editors.

The Clinical Resource Hub Initiative: First-Year Implementation of the Veterans Health Administration Regional Telehealth Contingency Staffing Program.

Health care systems face challenges providing accessible health care across geographically disparate sites. The Veterans Health Administration (VHA) developed regional telemedicine service focusing initially on primary care and mental health services. The objective of this study is to describe the program and progress during the early implementation. In its first year, the Clinical Resource Hub program provided 244 515 encounters to 95 684 Veterans at 475 sites. All 18 regions met or exceeded minimum implementation requirements. The regionally based telehealth contingency staffing hub met early implementation goals. Further evaluation to review sustainability and impact on provider experience and patient outcomes is needed.

Мониторинг медицинской помощи пациентам с тяжелой пневмонией с использованием региональной телемедицинской системы

Мониторинг медицинской помощи пациентам с тяжелой пневмонией с использованием региональной телемедицинской системы

The Italian investment in telemedicine: a breakthrough model of care in primary care

Abstract Issue/Problem Aging populations, worsening burden of chronic disease and recent pandemic has accelerated awareness and the importance of telemedicine in providing continuity of healthcare. Description of the problem AGENAS is the public body responsible for the implementation of telemedicine investment (€1 billion) in the context of the NextGenerationEU plan. AGENAS has built up a working group expert panel to define the technical and informatics features of the investment. The project consists of the realization of the national telemedicine platform and the regional telemedicine services. Italian regions will implement telemedicine services based on the national guidelines defined by AGENAS, that will also monitor it through key performance indicators outlined on the basis of best practices and scientific evidence of multidimensional evaluation. Results National telemedicine platform will improve, optimise and standardise telemedicine services throughout the Country, considering what may already be available in regional and local healthcare contexts. Regarding telemedicine services in regional context, that will be implemented within the NextGenerationEU, they will be focused on the telemonitoring of high prevalence conditions (i.e. cardiological, respiratory, diabetes, neurological and oncological) as well as other services such as televisit, teleconsultation and teleassistance. Connecting patient's home with healthcare system provide benefits for patients and their families, who will be able to interact with healthcare professionals, obtaining consultation and monitoring of their health. Lessons The implementation of the investment, aiming at improving equity and integration of care, will contribute to provide real world evidence about usage, benefits and potential risk of the telemedicine in primary care for the management of chronic diseases. Key messages • The investment under the Next Generation EU plan it is the lifetime chance to transform Italian healthcare service and draw a new framework to cope with the high demand in telemedicine. • Improving telemedicine services will determine a breakthrough in management of patient with chronic diseases in the Italian primary care sector.

Telemedicine Is Becoming an Increasingly Popular Way to Resolve the Unequal Distribution of Healthcare Resources: Evidence From China.

BackgroundFew studies focused on the general situation of telemedicine in China.ObjectivesThe purpose of this review is to investigate telemedicine in China, from the aspects of necessity, history, scale, and operation procedure, to improve the further development and implementation of telemedicine service.MethodsA literature search for peer-reviewed studies was conducted using the primary electronic databases. Additional documents from the official websites of Chinese government departments involved telemedicine was also collected. We extracted telemedicine related information focused on China from the final retrieved materials, and the general situation of telemedicine was drawn.ResultsIn China, telemedicine offers a feasible solution to the unequal allocation of healthcare resources, which makes telemedicine increasingly become an important alternative to close the gap between rural and urban in the capability and quality of medical services. China initiated telemedicine in the late 1980s. In 2018, China's telemedicine network has covered more than 3,000 hospitals across the country. As of 2019, almost all of the 31 provinces and municipalities in mainland have established regional telemedicine centers, and the market size of telemedicine reached about USD 2.68 billion. Based on the telemedicine network, remote rural patients can apply for healthcare services of top-tier urban hospitals through local county-level medical institutions.ConclusionsThrough improving the capacity, quality, and efficiency of healthcare in underserved areas, and reducing the unequal distribution of medical resources, telemedicine can help solve the problems of the difficulty and high cost to access to medical services in China.

Long-term visual outcomes of children screened for retinopathy of prematurity with telemedicine in New Zealand

ABSTRACT Clinical Relevance Children with a history of regressed retinopathy of prematurity (ROP) are at increased risk of peripheral avascular retina. Wide-field digital retinal imaging and telemedicine is an effective tool for ROP screening. Ophthalmologists and Optometrists should have a high level of clinical suspicion for peripheral retinal changes in children screened for ROP. Background Retinopathy of prematurity, a vaso-proliferative disorder of the pre-term retina, is a preventable cause of childhood visual impairment. The Auckland Regional Telemedicine ROP (ART-ROP) network, established in 2006, utilises wide-field digital imaging and telemedicine to screen at-risk infants for ROP. This prospective observational study reports the long-term ocular outcomes of ART-ROP network infants. Methods A comprehensive paediatric eye examination including cycloplegic autorefraction and wide-field retinal imaging was completed on all participants. Participants had been screened for ROP by the ART-ROP network between May 2008 and October 2011. Results A total of 69 children, with a mean age of 5 to 8 years old were assessed and divided into two groups: those with or without a history of ROP, 44 and 25 children, respectively. Infants with a history of ROP had significantly lower gestational age (26.6 ± 1.9 vs. 29.1 ± 1.6 weeks, p < 0.001) and birth weight (937 ± 237 vs. 1177 ± 311 grams, p = 0.001). No significant differences were detected between the two groups for visual acuity (p = 0.596), stereopsis (p = 0.219), refractive error (p = 0.472), or strabismus. Clinically significant refractive error was noted in 10 participants; none with moderate or high myopia. Retinal imaging exposed asymptomatic, persistent, peripheral avascular retina in four children, all of whom had a history of regressed ROP. Conclusion Visual and ocular outcomes did not vary based on history of ROP, with no participant having reduced vision as a result of undetected or untreated ROP. Further research is required into the long-term implication of persistent avascular retina in regressed ROP.

Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary-Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study.

BackgroundInequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children’s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site.ObjectiveThe aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model.MethodsThis study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately.ResultsOur study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary–regional relationships.ConclusionsThis systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers’ and family members’ perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond.International Registered Report Identifier (IRRID)RR2-10.1186/s12913-018-3859-2

Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis.

BackgroundTelemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field.ObjectiveOur work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China.MethodsWe collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method.ResultsThe regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness.ConclusionsThe development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services.

Role of regional telemedicine center in medical care

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ деятельности регионального телемедицинского центра за период с 2018 по 2020 г., в том числе в условиях пандемии новой коронавирусной инфекции. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Исследование осуществлялось сплошным методом с 2018 по 2020 г. Проанализировано 13 444 случая оказанных телемедицинских консультаций, из них 2296 в отношении высокотехнологичной медицинской помощи населению Астраханской области. Применялись следующие методы: монографический, статистический, логический и системный анализ. В работе использованы абсолютные величины, экстенсивные показатели, моделирующие структуру, и методы построения динамических рядов с последующим анализом. <h3>РЕЗУЛЬТАТЫ</h3> Наблюдается существенный рост количества телеконсультаций пациентов (с 1529 до 5759, в 3,8 раза) за период с 2018 по 2020 г. На федеральном уровне количество телемедицинских консультаций выросло в 6 раз, с 208 в 2018 г. до 1265 в 2020 г. В 2020 г. снизилось количество консультаций, организованных относительно высокотехнологичной медицинской помощи, что связано с перепрофилированием ведущего медицинского учреждения региона в специализированный госпиталь для лечения пациентов с новой коронавирусной инфекцией и резким снижением количества консультаций во время ограничительных мероприятий. <h3>ВЫВОДЫ</h3> Телемедицинские технологии способны обеспечить более безопасный доступ пациентов к лечению, снизить риск медицинских ошибок и способствовать раннему выявлению проблем со здоровьем.

Retrospective evaluation of regional telemedicine team meetings for multiple sclerosis (MS) patients: Experience from the Caen MS expert center in Normandy, France.

Multiple sclerosis (MS) is a demyelinating disease requiring multidisciplinary care coordination. Recent development of diagnosis criteria and disease modifying treatments have encouraged the setup of regional team meetings by MS expert centers, known as CRC Sep, to improve the quality of care provided to patients with complex cases. The CRC Sep in Caen initiated regional telemedicine meetings named Télé-SEP, operating since 2016. The objective of this study was to evaluate the Télé-SEP used by neurologists, on MS patient care management in Normandy. An internal ex-itinere evaluation was conducted with a retrospective descriptive observational study from July 2016 to June 2018. The Télé-SEP meetings were organized with 41 neurologists using a regional telemedicine platform (Therap-e). Data were collected from online records and a declarative voluntary survey. Twenty indicators were classified in the categories: volume of activity, clinical profile, quality and impact. Fifteen meetings were organized with a median of 13 senior neurologists. One hundred forty MS cases were discussed and there was a 33% increase in the second year of Télé-SEP. Median patient age was 44 years with a 72-month median length of disease. Most patient cases required second-line treatment. Relapsing remitting MS was diagnosed in 51.4% of cases. Télé-SEP satisfaction rate was 4.5/5 and 96% of neurologists applied the medical decisions and recommendations given in the meetings. Without Télé-SEP, 54.5% of patients would have been referred to a physical expert consultation in the CRC Sep. This study showed the feasibility and relevance of regional telemedicine team meetings for MS cases in the Normandy region.

Using of telemedicine in treatment of severe community-acquired pneumonia in Krasnoyarsk state

Introducrion. Due to the peculiarities of the Krasnoyarsk krai (a huge territory, low population density, different levels of health development in the districts, personnel shortage), there is a need to increase the availability and quality of medical care to district patients. For this purpose, since 2016, the Regional telemedicine system has started functioning online monitoring for patients with severe pneumonia, which provides full-fledged curation of patients from all over the region.Objective. To evaluate the results of RTS monitoring of patients with severe pneumonia.Materials and methods. 770 cases of severe community-acquired pneumonia registered in RTS from 2016 to 2018 were analyzed. Statistical data processing was performed using variational statistics using the “Excel-7” software package. For all values, the minimum significance level (p) of 0.05 was taken into account.Results. The risk factor for severe flow was male. Among comorbid diseases, cardiovascular and bronchopulmonary diseases, diabetes, alcoholism and HIV infection prevailed. The lack of flu vaccination in 97% of patients increased the number of deaths by 4.5 times. The greatest need for consultation arose in the Central district hospitals of low capacity. The majority of patients are registered in the system on the first day of hospitalization and are consulted by a pulmonologist of the Regional clinical hospital within 2 hours. Air ambulance of the Regional clinical hospital evacuated 174 patients, the need for flights decreased by 3.5 times. The main mistakes of district hospitals in the management of patients were the irrational selection of antibacterial drugs, the volume of detoxification therapy, the late start of antiviral therapy and ventilators, and the lack of prescription of anticoagulants.Conclusions. Along with the presence of comorbidities, the outcome of the EAP is affected by the quality of medical care, which depends on the professional training of medical workers, continuity in the work of regional medical institutions and air ambulance, which causes difficulties, given the specifics of the region. RTS allows you to solve this problem at minimal cost.

Auckland regional telemedicine retinopathy of prematurity screening network: A 10-year review.

Retinopathy of prematurity (ROP) is a potentially blinding condition affecting the retinae of premature infants. Effective screening is necessary for timely treatment. The Auckland Regional Telemedicine ROP (ART-ROP) network, utilizes wide-field digital imaging for ROP screening. This study reviews the ART-ROP network. Retrospective analysis of the ART-ROP database. Files of infants in ART-ROP from 2006 to 2015. Data on infant demographics, ROP stage, treatment and outcome was collected. The efficacy of ART-ROP in the management of ROP. A review of 1181 infants across three neonatal intensive care units, was completed. Infants had a mean of four screening sessions with no infants who met ROP screening criteria being missed. Type 1 ROP was present in 83 infants, who had significantly lower average birth weight 786 ± 191 g compared to 1077 ± 285 g (P < .001), and gestational age 25.3 ± 1.7 weeks compared to 27.8 ± 2.2 weeks (P < .001) than the screened cohort. The number of infants requiring screening increased (R2 = .7993), yet treatment rates decreased (R2 = .9205) across the time period. Out-patient clinic follow-up was attended by 75.10% of infants screened and there was no missed ROP in those infants seen. ART-ROP solely uses wide-field digital imaging for ROP diagnosis, and management, including discharge, of infants. This detailed review of ART-ROP indicates an increase in screening demand, but a decrease in the rate of type 1 ROP. The ART-ROP telemedicine model demonstrates real potential to address workforce shortage in ROP screening.

PHP69 - A REVIEW OF FUNDING PATHS FOR E-HEALTH SOLUTIONS IN THE EU5, US AND CANADA

Limited healthcare resources and rising demand impose a significant burden for healthcare systems sustainability. The digital revolution represents an opportunity to enhance healthcare delivery and reduce costs. The aim of this study was to identify current funding pathways of eHealth solutions in France, Germany, Italy, Spain and the United Kingdom, United States (US) and Canada. A targeted literature review was performed in Medline and Embase, complemented by ad-hoc and primary search with eHealth country experts and payers. Few sustainable paths dedicated to eHealth solutions are available. Funding options include existing paths for health technologies and services, individual arrangements with payers, temporary pilot programs or experiments with innovative care delivery and payment models. Despite various funding sources, current level of pathways implementation is rated 2 to 3 in 6-point scale. In countries with decentralised healthcare systems (Canada, Spain, Italy), funding decisions are made at regional or local levels with differences in eHealth implementation among regions. In the UK, funding decisions are usually made by regional authorities, but central funding is also possible, however it requires evidence from prior local or regional pilots. In France, a legal framework supporting regional telemedicine pilots was defined in 2009 and sustainable national funding was recently introduced for teleconsultation and tele-expertise. National paths for various health technologies and services exist in Germany, but eHealth is usually funded through selective contracts. Coverage by private health insurance companies and out-of-pocket payments represents eHealth funding opportunity in the US and Canada but private payers require an individualized approach. Funding paths for eHealth solutions are still immature. More experience is needed to assess its potential impact on healthcare organisations. Local or regional funding is most frequently observed, usually provided under temporary programs. Positive pilot outcomes may provide grounds for expanding to other regions or applying for national funding.

Design and Implementation of a Message-Based Regional Telemedicine System to Achieve High Availability and Scalability.

Different levels of telemedicine systems have been built across China. To share high-quality medical resources and conduct centralized management of telemedicine systems, a regional telemedicine system (RTS) (such as a provincial level system) has been developed to integrate with small-scale telemedicine systems. Although the established systems offer integration services, they are tightly coupled systems, and not easily integrated with new systems. Meanwhile, with the increasing of input/output, it is difficult for them to run with high scalability, considering the cost of architecture redesign and further development. This article presents the design and implementation of regional integration system through a study in Henan, China, mainly aimed to integrate with heterogeneous small-scale telemedicine systems and provide high efficiency. A provincial telemedicine system and some city-level telemedicine systems have already been established. The provincial system has been built to act as a regional integration system to connect city-level systems. Adopting message-based technology, the provincial system achieves high availability and high scalability, respectively, through LevelDB + ZooKeeper and multicast. The system achieved the centralized management of established telemedicine systems without restructuring their framework, improving high availability of RTS when one ActiveMQ service node in a group failed, and it did not negatively influence normal business logic when adding a new service node. At the same time, two "Master" state ActiveMQ service nodes provided services simultaneously, which enable the RTS to achieve high scalability. The message-based regional integration system enriched the RTS with high availability, easy extensibility, and provided a convenient way to integrate new small-scale telemedicine systems.

Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study.

Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers. Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France. We prospectively obtained data from all patients consecutively admitted to emergency care departments in the region and who received medical or neurosurgical expertise by telemedicine from January 2002 to December 2015. The reasons for requesting expertise, number of requested neurological opinions, and interhospital patient transfers were analyzed. Economic savings were determined by estimating the cost of avoided transfers. A total of 23,710 patients had telemedicine consultations in the region. The network was used by every community hospital (independently of the existence of local neurological teams). These consultations were overwhelmingly for cases of stroke (30%) and head or spinal injuries (36%). Cerebral tumors represented 9% of teleconsultations. In 2015, 75% of patients admitted to the remote hospitals that did not have onsite neurological expertise nevertheless received neurovascular tele-expertise. The rate of thrombolyzed patients dramatically increased within 13 years regionally (9.9%) and 33.5% of thrombolyses were performed by telemedicine. The number of patients examined by telemedicine and admitted for head or spinal injuries also increased over the 13-year period (12% vs. 21%). Secondary interhospital transfers were halved for both pathologies. The estimated saving is ∼€3.5 million. Telemedicine networks facilitate acute-phase neurological assessment and prevent unnecessary secondary interhospital transfers.

Prerequisites for the creation of an oncology segment of a regional telemedicine network

Prerequisites for the creation of an oncology segment of a regional telemedicine network

Telemedicine between a rehabilitation center and home nurses or home: Organization and results after 500 teleconsultations for patients with disabilities suffering from chronic wounds

In 2014, our Rehabilitation Center (Pôle MPR, Saint-Hélier, Rennes) has been selected for a regional telemedicine project about chronic wounds. The aim was to improve the care access for patients with disabilities suffering from chronic wounds in nursing homes or at home. Material/patients and methods Targeted population is constituted by patients: whose access to care is decreased due to moving difficulties, of which the health care team is struggling in the care (wound care but also disability, nutrition…). The members of our telemedicine team are specialist doctors and nurses for wounds. On request the occupational therapist or dietician is involved in the consultation (multidisciplinary approach). Our project is integrated into the regional health policy with other regional telemedicine projects to create a single global regional project for deployment of telemedicine in Brittany named STERENN (secure regional videoconference and files). Since July 2014, over 500 tele-consultations have been done. Fifty percent of requests come from the nursing home, 50% from nurses at home people (pressure ulcers stages 3 and 4, arterial ulcers, venous or mixed). The mean age was 74 years (20–101 years). Duration of consultations is on average 25 minutes. In 30% of cases, the teleconsultation is extended by a real live training time for the nurse at home guided by the expert nurses of the team (learning organization). Without teleconsultation, in 83% of cases, transportation request for consultation would have been made, in 10% hospitalization. In 7%, no request would have been done. More than 70% of followed wounds in 2016 were cured or improved, 20,000 km were already avoided. These organization leads to an improvement of the quality of care by promoting access to care, by providing expertise directly to the home (multidisciplinary), by assisting the nurse at home to redo the dressing (training). Telemedicine could help us to mitigate the effects of ageing population or the dependence of disabled people with difficulties to move. It could help us to guaranty the access to care for all despite difficult economic conditions. These are challenges for the health policy.

Abstract 221: Environmental Scan of Telemedicine Networks With Services for Hypertension Management, 2016

One of the barriers affecting continuity of hypertension care is access to health care, especially in low-income and rural areas. Telemedicine (TM) provides consultation and specialized treatment remotely, and reduces barriers of access to appropriate, high quality care. Common barriers include limited affordable transportation, job or other time constraints, and geographic isolation. TM use has increased, but there is limited information about the ease of finding TM networks and programs (TMNPs) by the general public. To address this gap, we conducted an environmental scan, during Sept.-Nov. 2016, assessing the ease of identifying existing TMNPs in the United States using simple internet searches (e.g., Google, Bing, Yahoo). First, we used the American Telemedicine Association’s 2015 Gap Analysis, Health Resources &amp; Services Administration (HRSA) funded programs and 2013 Maryland telemedicine matrix as our template. After identifying the TMNPs, we assessed TM services provided, especially for hypertension (HTN). After compiling a consensus list of TMNPs in the US, we categorized the TMNPs based on their website’s list of services. Of the 50 states and District of Columbia (DC), we found 36 networks and 17 programs. Of these 53 TMNPs, only 1.9% (n=1) indicated that they provide TM services specifically for the management of HTN. However, there were 18 (34.0%) TMNPs that listed cardiology services. The only TMNP specifically focused on hypertension control was in the southeast, an area with a high burden of HTN. This TMNP was called the “Smartphone Medication Adherence Stops Hypertension” (SMASH), and was funded by the National Institutes of Health. The program has reported 95% control among their patient population with HTN in rural areas, including Hispanic and black adults. Other related programs included those focused on heart failure (5.7% (n=3) and diabetes management 9.4% (n=5). This initial environmental scan found most programs presented limited information about their population of interest. For example, 86.7% (n=46) did not provide information about the number of patients, area(s) served and number of partners and providers on their websites. Our results suggest common methods of obtaining information about TMNPs lack important information on TM services for HTN patients, and/or challenges in identifying existing services for patients to access. Using data collected from this environmental scan, our group will develop an exhaustive collection of data on existing TMNPs’ services (including how to participate), working directly with HRSA’s Telemedicine Resource Centers. The information from our environmental scan may produce regional and county-level telemedicine mapping to inform not only patients and their healthcare providers, but also clinicians, researchers, program managers, and decision makers on existing TMNPs that remotely provide effective HTN management.