Telehealth Network Research Articles

Undergraduate Psychology Students’ Perceptions About the Use of ICT for Health Purposes

Objective: Information and communication technologies (ICT) have great potential for health care. In this study we explore undergraduate psychology students’ perceptions about different specific uses of ICT for health (i.e. online interventions, health information websites, telehealth and online social networks). A total of 113 students answered an online survey designed to gather their perceptions about the use of these four types of interventions for health purposes. Results: Results showed that online interventions and telehealth were assessed as the best ways of using ICT for health, while the worst way was using social networks for health. The most frequently mentioned advantages were related to the fact that ICT can help with access to information and/or treatments, and that they are comfortable. The most frequently mentioned disadvantages were related to the quality of the information (for social networks and health information websites) and the fact that they were considered impersonal (for telehealth and online interventions). Conclusions: Students were not very enthusiastic about the use of ICT for health. Education is needed to change these perceptions and increase the likelihood that they will incorporate ICT in their future practice.

A Primer on Medicaid Telepractice Reimbursement

A Primer on Medicaid Telepractice Reimbursement

Prevalence of normal electrocardiograms in primary care patients.

Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. All digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. During the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. The prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.

A piecewise geometry method for optimizing the motion planning of data mule in tele-health wireless sensor networks

In tele-health wireless sensor networks (WSNs), data mules (DMs) can be despatched to collect and deliver distributed healthcare data via wireless communication. However, to improve the delivery ef...

Teleneurology: Successful Delivery of Chronic Neurologic Care to 354 Patients Living Remotely in a Rural State

Delivery of specialty healthcare to rural citizens in the United States remains largely unmet. The Veterans Health Administration is in a unique position to deliver specialty care to rural Veterans because it is mandated to deliver medical care to all eligible Veterans regardless of residence. To accomplish this, the VHA developed large national telehealth networks that provided over 1 million episodes of care in 2012. We investigated whether clinical video telehealth technologies can provide quality efficient neurologic follow-up care to Veterans living in the rural southwest United States. Veterans with chronic neurologic conditions living remotely in New Mexico, southern Colorado, eastern Arizona, and western Texas were offered follow-up teleneurology care at 11 rural community-based outpatient clinics following initial evaluation at the Albuquerque, NM, neurology outpatient clinic. Over a 2-year period, 87% of 354 consecutive patients returned a performance improvement satisfaction questionnaire. Ninety percent of the patients were fully satisfied with their visit, and 92% felt teleneurology saved them time and money. We calculated an average time savings of 5 h and 325 miles driven, plus at least $48,000 total cost savings. Ninety-five percent reported they wanted to continue their neurologic care by teleneurology. Our study confirms earlier pilot studies of successful follow-up care through telemedicine. Our patients were highly satisfied with the convenience and quality of their teleneurology visit, and the neurology providers were convinced that neurologic care to both teleneurology and clinic follow-up patients was equivalent. Teleneurology to rural Veterans can provide quality neurologic care and overwhelming patient satisfaction and save considerable time and money.

PT021 The effects of Cilostazol on the ion Channels in rat right ventricular myocyte

Introduction: Chest pain is a common presentation in primary care. Although coronary artery disease is an infrequent etiology in this setting, it should be ruled out. In this context, the electrocardiogram (ECG) is very useful to assess patients with chest pain. Objectives: To assess the prevalence of ECG abnormalities in primary care patients with chest pain. Methods: This is an observational retrospective study. All ECGs performed by the Telehealth Network of Minas Gerais, a Brazilian public telehealth service, from January to December 2011, were analyzed. This service attends 660 cities in the state of Minas Gerais. The prevalence of ECG abnormalities was assessed. Results: During the study period, 197,101 ECGs were performed in patients with chest pain (mean age 50 19 years, 59.4% women). Hypertension was the most frequent comorbidity (26.8%). Family history of coronary artery disease was reported in 13.1%, smoking in 6.3% and diabetes in 4.6%. Regarding the ECGs, 61.7% had no abnormalities. The prevalence of abnormalities suggestive of ischemia was 4.4%: 2.5% poor R wave progression, 1.5% abnormalities suggestive of acute ischemia; 0.4% pathological Q waves. First degree atrioventricular block as observed in 1.8%, left bundle branch block in 1.6%, right bundle branch block in 2.8%, atrial fibrillation 1.7%, left ventricular or atrial hypertrophy in 6.5%, premature beats in 4.2% and nonspecific repolarization abnormalities in 17.4%. Although the percentage of patients with abnormalities suggestive of acute ischemia is low, primary care physicians should have in mind that a normal ECG does not rule out coronary artery disease, and a careful clinical assessment should be performed in all patients. Conclusion: In this study in a large sample of primary care patients with chest pain, the prevalence of exams with no abnormalities is higher than 50%, and a minority of patients has abnormalities suggestive of myocardial ischemia. Disclosure of Interest: None Declared

Democratizing telehealth with Scalable Video Conferencing

Videoconferencing has been around for more than 20 years in healthcare. But it never took off in scale. We are at an inflection point today. The inhibitors for widespread adoption in healthcare have been so far expensive endpoints and infrastructure, required quality of service in the transmission path, standard’s based smallest common denominator quality, enterprise architecture, no presence information and no integration into the workflow. Scalable Video Coding (SVC) addresses all these inhibitors by standardizing a new annex in the ITU H.264 standardization with the definition of the H.264 SVC (Scalable Video Coding) standard. This standard allows to increase the quality of the video signal with higher image resolution, higher framerates and lower delays in order to create a natural interaction between people, to adapt to the network rather than expecting guarantees from the network, to add resiliency to the system by introduction of scalable video coding, so that video can be transported over lossy network such as wireless and low-bandwidth networks, to give each participant the best quality based on his/her available bandwidth, end system and screen resolution, to leverage the processing power of the desktop/laptops, tablets and smart phones rather than building a heavy centralized infrastructure, to provide the system across many different existing compute platforms to enable BYOD in video conferencing – rather than buying expensive endpoints, to provide interoperability with the H.264 AVC standard and existing room systems. The practicality, scalability, financial sustainability and usability of this approach is being demonstrated by major telehealth projects such as the Ontario Telehealth Network, the Massachusetts General Hospital, Royal Flying Doctors of Australia, SmokeFreeLife and some others.

Lessons on the road to an urban/rural community telehealth network

Lessons on the road to an urban/rural community telehealth network

The Design, Implementation, and Operational Management of a Comprehensive Quality Management Program to Support National Telehealth Networks

The Veterans Health Administration (VHA) is a large integrated healthcare system with a mission to care for over 5.6 million Veteran patients annually. VHA, like other healthcare organizations, is challenged with providing access to care to those it serves when they live at a distance from a physical site of care. VHA has embraced telehealth as a way of delivering care at a distance and increase access to specialty care services. Since 2003 VHA has developed large national telehealth networks that provided care to 497,342 patients in fiscal year 2012, who received 1,429,424 episodes of care, and is recognized as a national leader in this field. To ensure the safety and effectiveness of its telehealth networks in their delivery of care VHA has implemented a dedicated quality management (QM) program for telehealth. QM data for telehealth are reviewed at 3-month intervals, and the procedures and processes in place to support telehealth in VHA are assessed biannually in an internal accreditation process called "Telehealth Conditions of Participation." This collegial, nonadversarial process has ensured that all designated telehealth programs meet minimal standards and disseminate best practice. As a result of VHA's QM program, telehealth services in VHA meet consistently high clinical outcomes and have received no adverse Joint Commission citations. The Joint Commission regularly assesses patients managed via telehealth under its tracer methodology reviews.

A Rede de Teleassistência de Minas Gerais e suas contribuições para atingir os princípios de universalidade, equidade e integralidade do SUS - relato de experiência.

Brazilian have unequal access to specialized health care services, especially in remote municipalities. Telehealth is a strategy to support primary health care professionals in such municipalities. The objective for this study was to report a successful experience from the Telehealth Network of Minas Gerais (Rede de Teleassistencia de Minas Gerais - RTMG), which highlights the contribution of this service to the Brazilian Unified Health System principles (Sistema Unico de Saude – SUS). The methodology used includes empirical observations, which compose a retrospective observational study that evaluates teleconsultations and cost-effectiveness. In 2005, public funds from the state government and research development agencies financed RTMG construction, which was intended to connect hospitals from six public universities to primary health caregivers in remote municipalities. In 2006, 82 municipalities were served. The service was expanded several times, and it has reached 660 municipalities since 2012. As of February 2013, 1,165,410 electrocardiograms and 48,680 teleconsultations had been conducted (6.1 activities/municipality/week mean). The teleconsultations averted potential referrals for specialized health care services by 80%. The return on investment was R$ 3.75 for every R$ invested. In conclusion, the RTMG facilitates universality, equality and integrality in the Minas Gerais public health care system as well as contributes to improved care quality.

Building a Telehealth Network Through Collaboration

With the recent governmental focus on increasing broadband capabilities throughout the nation, with rapid advances in technology, and with other regulatory and reimbursement barriers falling, a great number of sites across the United States are in the process of either initiating or expanding their Telehealth capabilities. The Nebraska Statewide Telehealth Network, one of the most comprehensive networks in the nation, is no exception. Built through a collaborative effort of hospitals, health departments, the Nebraska Hospital Association, and other organizations, the Network's members include nearly every hospital and health department in the State. The Nebraska Statewide Telehealth Network has been awarded more than $1.4 million in grant funding since 2008 and, last year, provided 3633 clinical consultations to rural residents across the State.Among its many benefits, Telehealth increases access to specialty care for patients in rural areas; decreases travel time and saves money for patients and caretakers alike; provides the potential for earlier disease intervention; enhances clinical support between specialists and primary care providers; and serves as a medium for easy access to professional education, training, and collaboration. And, now, this technology is becoming increasingly mobile, allowing practitioners the opportunity to connect anywhere. In a rural state dominated by Health Care Professional Shortage Areas and Medically Underserved Areas, Telehealth has the opportunity to help patients receive care at home.

Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil

The Brazilian population lacks equitable access to specialized health care and diagnostic tests, especially in remote municipalities, where health professionals often feel isolated and staff turnover is high. Telehealth has the potential to improve patients' access to specialized health care, but little is known about it in terms of cost-effectiveness, access to services or user satisfaction. In 2005, the State Government of Minas Gerais, Brazil, funded the establishment of the Telehealth Network, intended to connect university hospitals with the state's remote municipal health departments; support professionals in providing tele-assistance; and perform tele-electrocardiography and teleconsultations. The network uses low-cost equipment and has employed various strategies to overcome the barriers to telehealth use. The Telehealth Network connects specialists in state university hospitals with primary health-care professionals in 608 municipalities of the large state of Minas Gerais, many of them in remote areas. From June 2006 to October 2011, 782,773 electrocardiograms and 30 883 teleconsultations were performed through the network, and 6000 health professionals were trained in its use. Most of these professionals (97%) were satisfied with the system, which was cost-effective, economically viable and averted 81% of potential case referrals to distant centres. To succeed, a telehealth service must be part of a collaborative network, meet the real needs of local health professionals, use simple technology and have at least some face-to-face components. If applied to health problems for which care is in high demand, this type of service can be economically viable and can help to improve patient access to specialized health care.

Patient Safety Considerations in Developing Large Telehealth Networks

Telehealth is an emerging area of healthcare delivery that increases access to care, reduces utilization and offers the potential to improve patient safety, especially in rural and remote areas. The existing telehealthcare environment into which telehealth programmes are being implemented is characterized by its variability. Ensuring telehealth programmes maintain current levels of patient safety, or further improve this, requires standardization of the underlying clinical, technology and business processes. In order to achieve this standardization telehealth must be implemented as part of a ‘systems’ approach to healthcare transformation. Patient safety is an important driver that can help ensure the design, implementation and operational integrity of telehealth programmes conform to this systems approach. It cannot be assumed that existing clinical risk management and patient safety processes within legacy healthcare platforms offer the structure, process and outcomes that are necessary to ensure telehealth programmes are implemented and sustained in a safe, appropriate and effective way.

Abstract 3107: Thrombolysis Using Telehealth Has Comparable Results To Non- Telehealth Thrombolysis Across Northern Alberta: The Alberta Provincial Stroke Strategy (APSS)

Background: Telehealth videoconference technology shows promise in reducing rural-urban disparities in access to acute stroke care but more population-based studies are needed. The APSS has created a province-wide telehealth network (telestroke) centred around northern (University of Alberta Hospital) and southern (University of Calgary) tertiary care hub centres. In the northern half of the province we assessed the hypothesis that thrombolysis outcomes for stroke patients were similar in those treated using telestroke versus those treated without telestroke. Methods: The APSS created a prospective minimum dataset in June 2007 requiring submission of data for all ischemic stroke patients treated with tPA in the province. This dataset captures information on onset, arrival, and treatment times, whether telehealth was used, and occurrence of intracerebral hemorrhage associated with neurological worsening. From 2009 on we were able to differentiate post tPA petechial hemorrhage from intracerebral hematoma (ICH) in the database. Data were available for the northern half of the province. We examined door-to-treatment time using Wilcoxan rank - sum tests, and rate of neurological worsening associated with hemorrhage on brain CT using logistic regression. Results: In the northern half of the province, there were a total of 554 patients treated with tPA from 2007/08 until 2010/11. Telestroke was utilized in 119 of these (21%) from 9 rural Primary Stroke Centres. Of 435 patients who received tPA without telestroke, 318 (73%) were from one Comprehensive Stroke Centre and 117 (27%) were from three Primary Stroke Centres with neurologists or internists on-site. Telestroke patients had a mean age of 70y compared to 71y for non-telestroke patients. Median (Q1, Q3) door to needle time was 84 min (66, 105) in telestroke patients and 83 min (65, 107) in non-telestroke patients (p=0.337). Neurological worsening associated with either petechial hemorrhage or intracerebral hematoma by 36 hours occurred in 5.29% of non-telestroke patients and 8.4% of telestroke patients; this difference was not statistically significant (OR 0.608; p=0.207). The rate of neurological worsening associated with intracerebral hematoma was 3.0% to 7.9% for telestroke patients and 3.6% to 5.6% for non-telestroke patients when we examined 2009-10 and 2010-11 (OR 0.814; p= 0.732). Conclusion: With one hub centre it is feasible to create a telehealth network over a very large geographic area improving access to stroke care for remote rural communities. Door-to-treatment time and rate of hemorrhagic complications are comparable in telestroke-treated versus non telestroke-treated patients in real practice. Investment in telestroke is likely justified for health regions serving a large and scattered rural population.

Using an Established Telehealth Model to Train Urban Primary Care Providers on Hypertension Management

The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers.

A Health Insurance Portability and Accountability Act–Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

The anatomy of a telehealthcare project with point-of-care testing for monitoring chemotherapy; from concept to adoption

A significant proportion of women with breast cancer develop neutropenia whilst receiving chemotherapy. Consequence they may have their dose delayed or reduced, develop febrile neutropenia and sepsis. Neutropenia is invariably only detected immediately prior to the next dose of chemotherapy, or following emergency admission to hospital, with the aid of a laboratory investigation of white blood cell count (WBC). Point-of-care testing (POCT) enables such investigations to be performed in the home, by the patient, with communication of results and subsequent advice being achieved through a secure telehealth network between patient and oncology team. Clinical effectiveness requires demonstration that neutropenia and its consequences are minimised. The evidence requires demonstration that (i) the change in WBC after chemotherapy predicts neutropenia later in the cycle, (ii) the patient can measure WBC reliably, (iii) the clinical intervention following a low WBC minimises the occurrence of adverse events, together with successful trial of the new care pathway. Successful adoption requires identification of the quality management requirements e.g. training of patients, equipment management etc., together with the necessary clinical process change and resource reallocations (both investment and disinvestment). Experience of innovation in health care suggests that the latter might be the greatest challenge.

Enhancing Access to Cancer Education for Rural Healthcare Providers via Telehealth

Healthcare providers serving rural populations face numerous barriers to accessing educational programming. Difficulties accessing continuing professional education contribute to the challenges of providing comprehensive health care in the rural setting. Telehealth can inform and educate rural providers about changes in medicine and evidence-based practices, both of which may help them provide quality care. The Native People for Cancer Control Telehealth Network used telehealth technology to deliver a cancer education series in 2008 and 2009 to Washington and Alaska rural healthcare providers who treated American Indians and Alaska Native people. Customizing presentation content to providers' educational needs encouraged attendance. Evaluation indicated videoconferencing technology was positively received for delivery of the educational sessions. This series demonstrated videoconferencing was a satisfactory means of delivering real-time, interactive cancer educational programming to providers who might not otherwise have access to such programs.

Developing the Native People for Cancer Control Telehealth Network.

We aimed to develop a telehealth network to deliver postdiagnosis cancer care clinical services and education to American Indian and Alaska Native patients, their families, and their healthcare providers. We also sought to identify the challenges and opportunities of implementing such a telehealth-based application for this rural and underserved population. We followed a participatory formative evaluation approach to engage all stakeholders in the telehealth network design and implementation. This approach allowed us to identify and address technical and infrastructure barriers, lack of previous experience with telehealth, and political, legal, and historical challenges. Between September 2006 and August 2009, nine tribal clinics in Washington and 26 clinical sites in Alaska had participated in the telehealth network activities. Network programming included cancer education presentations, case conferences, and cancer survivor support groups. Twenty-seven cancer education presentations were held, with a total provider attendance of 369. Forty-four case conferences were held, with a total of 129 cases discussed. In total, 513 patient encounters took place. Keys to success included gaining provider and community acceptance, working closely with respected tribal members, understanding tribal sovereignty and governance, and working in partnership with cultural liaisons. The telehealth network exceeded expectations in terms of the number of participating sites and the number of patients served. Following a participatory formative evaluation approach contributed to the success of this telehealth network and demonstrated the importance of community involvement in all stages of telehealth system design and implementation.

A Health Insurance Portability and Accountability Act–Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

A Health Insurance Portability and Accountability Act–Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy