Telemedical Applications Research Articles

The Use of Static Telecytology Applications for Accreditational Purposes

This study aims to examine the feasibility of developing a proficiency testing scheme for cytology labs wishing to be accredited according to ISO 15189:2012, by using low cost telemedical applications. Two hundred forty-eight fine-needle aspiration specimens from patients preoperatively aspirated under ultrasonographic guidance and 208 pap smears with histological confirmation were retrospectively selected from the department's registry. Three diagnostic categories of cytological reports were used. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides.

Printed Flexible Microelectrode for Application of Nanosecond Pulsed Electric Fields on Cells.

Medical treatment is increasingly benefiting from biomedical microsystems, especially the trending telemedical application. A promising modality for tumor therapy showed the application of nanosecond pulsed electric fields (nsPEF) on cells to achieve nanoporation, cell death, and other cell reactions. A key technology for this method is the generation of pulsed fields in the nanosecond range with high-field strengths in the range of several kilovolts per centimeter. For further biomedical applications, state-of-the-art setups need to decrease in size and improve their capability of integration into microsystems. Due to demanding electronic requirements, i.e., using high voltages and fast pulses, miniaturization and low-cost fabrication of the electrode is first considered. This paper proposes a proof-of-concept for a miniaturized printed flexible electrode that can apply nsPEF on adherent fibroblast cells. The interdigital gold electrode was printed on polyimide with line-width of about 10 µm using an electrohydrodynamic inkjet printer. Furthermore, an electrical circuit was developed to generate both electrical pulses in the nano-second range and voltages up to 180 V. The electrode was integrated into an experimental setup for in-vitro application to human fibroblasts. Field strengths up to 100 kV/cm with 45 ns pulse duration were applied, depending on the degree of cell confluence. The cells show contraction, detachment from the electrode, and lethal reactions after the nsPEF treatment. Furthermore, this printed miniaturized electrode was found to be suitable for subsequent microsystem integration and further cell experiments to optimize pulse parameters for control of cell reaction and behavior.

Diabetes treatment2.0: telemedicine

The prevalence of diabetes mellitus in Germany is between 5.8% and 9.5%. Telemedical applications (TA) can provide meaningful approaches in diabetes care. So far, however, TA have seldom undergone astructured research evaluation. This deficiency is considered to be one of the reasons why TA have rarely been implemented in routine care as yet. What information about research evaluation can be identified in current TA that address diabetes therapy? In order to identify the accompanying evaluation approaches of telemedical diabetes projects, the "vesta" information portal of the German Society for Telematics Applications for the Health Card (Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH), the websites of the Innovation Fund at the Federal Joint Committee, PubMed, and gray literature were searched. Prevention projects were not included. Twelve projects were identified. For four of the projects, data from the accompanying research could be found, which refers to parameters such as HbA1c, quality of life and economic aspects. One of these four projects stated that it was based on an established model for the evaluation of TA. No information on accompanying evaluations was found for the other eight projects, but three of these are still in the data collection phase. As the results suggest, most of the telemedically supported diabetes projects are not being evaluated in astructured way as yet. Established instruments for the accompanying evaluation of TA are now being used.

Data protection in telemedicine

The lawfulness of telemedical applications themselves is beyond question from the point of view of data protection. However demands have to be met in two respects to make the procedures legitimate: On the one hand, the informed consent of the participating patients is necessary, on which high demands have to be made. On the other hand, ahigh level of data security has to be ensured, especially if providers who are not professionals subject to professional secrecy partake in the application.

A Proxy-Based Solution for Asynchronous Telemedical Systems

Asynchronous telemedicine systems face many challenges related to information security as the patient's sensitive information and data on medicine dosage is transmitted over a network when monitoring patients and controlling asynchronous telemedical IoT devices. This information may be modified or spied on by a malicious adversary. To make asynchronous telemedicine systems more secure, the authors present a proxy-based solution against data modification and spying attacks in web-based telemedical applications. By obfuscating the executable code of a web application and by continuously dynamically changing obfuscation, the authors' solution makes it more difficult for a piece of malware to attack its target. They use a constructive research approach. They characterize the threat and present an outline of a proposed solution. The benefits and limitations of the proposed solution are discussed. Cyber-attacks targeted at the information related to patient's care are a serious threat in today's telemedicine. If disregarded, these attacks have negative implications on patient safety and quality of care.

MobileHeart, a mobile smartphone-based application that supports and monitors coronary artery disease patients during rehabilitation.

Conventional center-based cardiac rehabilitation adherence is poor, adversely affecting long-term efficacy. Innovative strategies such as telerehabilitation are perceived as promising alternatives to improve care delivery. This paper presents the results of prior and ongoing work on the design and development of MobileHeart, a telemedical smartphone-based application to be used in secondary prevention for ischemic heart disease patients. Its constituent components are discussed separately, the minimal necessary cardiovascular monitoring requirements are elaborated in more detail. The results are offered starting from a clinical perspective to stress its relevance in the establishment of scientifically/medically sound programs.

Improved technical performance of a multifunctional prehospital telemedicine system between the research phase and the routine use phase – an observational study

Introduction Telemedical concepts in emergency medical services (EMS) lead to improved process times and patient outcomes, but their technical performance has thus far been insufficient; nevertheless, the concept was transferred into EMS routine care in Aachen, Germany. This study evaluated the system’s technical performance and compared it to a precursor system. Methods The telemedicine system was implemented on seven ambulances and a teleconsultation centre staffed with experienced EMS physicians was established in April 2014. Telemedical applications included mobile vital data, 12-lead, picture transmission and video streaming from inside the ambulances. The tele-EMS physician filled in a questionnaire regarding the technical performance of the applications, background noise and assessed clinical values of the transmitted pictures and videos after each mission between 15 May 2014–15 October 2014. Results Teleconsultation was established during 539 emergency cases. In 83% of the cases (n = 447), only the paramedics and the tele-EMS physician were involved. Transmission success rates ranged from 98% (audio connection) to 93% (12-lead electrocardiogram (ECG) transmission). All functionalities, except video transmission, were significantly better than the pilot project (p < 0.05). Severe background noise was detected to a lesser extent (p = 0.0004) and the clinical value of the pictures and videos were considered significantly more valuable. Discussion The multifunctional system is now sufficient for routine use and is the most reliable mobile emergency telemedicine system compared to other published projects. Dropouts were due to user errors and network coverage problems. These findings enable widespread use of this system in the future, reducing the critical time intervals until medical therapy is started.

A Study of Telemedical Applications Based on User Experience

Abstract The popularity of telemedical applications has been increasing noticeably in recent years. Easy access to a variety of software products makes contemporary users concentrate not only on functionalities but also on the design of the Graphical User Interface (GUI) – its usefulness, ease of use, and intuitiveness. The objective of this study was to evaluate the GUI quality of selected telemedical applications dedicated to depressed patients and doctors providing medical care for this group of patients. Another aim of the paper was to propose and check assessment criteria applied to the evaluation experiment. To achieve this objective, the case study was based on two methods: expert analysis and cognitive walkthrough. The expert analysis study was conducted on three groups of users: user experience specialists, patients, and clinicians. Although the expert analysis method is usually dedicated to GUI design specialists, in this study, we also applied it to patient and physician groups. The results showed that there were no statistical differences between assessments carried out by those three groups of users. Applied testing criteria were revised with Nielsen’s heuristics. The proposed criteria helped to uncover many usability problems in several different areas during user tests. Further studies might be performed in order to strengthen accuracy and for completion of the proposed expert analysis evaluation criteria. However, our results show that the criteria we used seem to be robust enough to apply to both expert and end-user evaluations. Furthermore, multiple evaluation based on two different methods presented with better results, allowing not only problem identification but also verification.

Advancing therapy-oriented telemedicine- Does Europe have an answer?

Despite a large number of existing telemedical applications as well as numerous issues in the current implementations, the desire for intensified integration of IT solutions for the health sector is unanimous amongst all actors involved (patients, practitioners, software and hardware developers, insurers, services, etc.). This reflects the state of digital systems in use in medicine today which have yet to arrive in the 21st century and operate well below the technologically possible. Telemedica/ methods remain mainly associated to flagship projects with often limited mid- or long termimpact on patient care practicesror scientific research. Supraregional or national standards are far from being defined. The register EUSTAR under patronage of the ESH is designed to fill gaps in the current IT solutions by utilization of the innovative software system SCITIM 0 to enable broad application of telemedicine and thereby provide evidence for its scientific and economical feasibility. For this the utilization of interventional decentralised telemonitoring (idTM 0 } is suitable as it preserves clear and direct patient practitioner bonds and communication. The fundamental measure of idTM 0 - to judge the quality of the te/emedica/ application by the medical quality of the consequent actions -is rarely considered by the majority of smaller projects where other tetemedical applications and methods are established.

Development of telemedical solutions based on the electronic case record (EFA)

Efficient communication among doctors who cooperatively support their patients is a prerequisite for implementing effective intersectoral treatment processes. In order to achieve this, IT is becoming increasingly important. With IT systems doctors want to exchange information concerning a patient's case (e.g. doctors' letters, medication prescriptions, etc.). Furthermore, more and more IT-based applications that support the treatment process between patient and doctor (e.g. telemedicine solutions) are being developed. The development of the electronic case record (elektronische FallAkte) has yielded concepts and solutions for a structured case-based information exchange. Furthermore, it has led to infrastructure solutions that support service-based applications for telemedical applications. The "elektronische FallAkte" is an initiative of health institutions that have been organized into the association "Verein elektronische FallAkte". In this paper, concepts and realizations of the "elektronische FallAkte", as well as service-based applications on that infrastructure are described.

Current capabilities of telemedicine in anaesthesiology

Because of an ageing population and a relative lack of professionals, the German health system is under great pressure. In rural regions in particular, anesthesiology is also affected - nursing staff, anesthetists, intensive care physicians, and emergency physicians often have to be supported by freelancers from other regions and from abroad - at least periodically. In addition to the increasing number of treatments, the potential quality of therapy is also increasing owing to progress in medical research. Against this background the need for resources is increasing to ensure the optimal quality of treatment. This applies to all clinical disciplines, including all sections of anesthesiology - especially in economically underdeveloped regions where highly qualified experts are lacking. In various cases it is not the physical attendance or manual skills of experts that is primarily requested on-site, but rather their medical expertise and experience. Therefore, telemedicine systems are suitable for closing these gaps very effectively and efficiently. In the various anesthesiological sub-sections the number of scientific papers published to date varies. For anesthesia and pain therapy only a few telemedical applications or concepts have been reported in the literature. However, in tele-intensive care medicine and tele-emergency medicine several national and international research projects have successfully been carried out, leading to established routine systems in some cases.

Assessment and Comparison of Functionalities of Telemedical Applications

services on the Internet are modern alternative to traditional medical care supporting many functions of healthcare process. In order to improve quality and usability of upcoming tools, evaluation of existing solutions may provide valuable insight for further developments. Therefore the objective of this study was to analyze functionalities of selected telemedical applications. Our analysis provided overview of most widely- used tools and their functionalities. We discriminated three important groups of telemedical applications which were further characterized by ascribing specific functionalities considering also main and supporting role of these functionalities in each group. Our analysis resulted in extensive yet non-exhaustive list of functionalities. Based on data ontology commonly used in medical applications we distinguish three main groups of applications: Communication and social networks, Self-observation, monitoring and diagnosis, Support for medical professionals. Functional analysis for each group of medical applications was performed based on selected cases. According to the findings from our study the major criterion that allows to disentangle the heterogeneity of medical application functionalities is professionalization of the medical application. It is plausible that in future different groups of applications will become even less distinguishable due to increasing applicability of social network features in web applications but also because of increasing popularity of e- health add-ons and tools which are becoming increasingly integrated with complementary solutions. We also identified some unexplored potential of medical applications in the field of disease prevention. General Terms Information Personalization, Data modeling, Data ontology Keywordsmedical application, ontology, functionalities, disease monitoring, telecare

Evaluating the effect of centralization on routing convergence on a hybrid BGP-SDN emulation framework

No abstract available.

The Implementation of Cloud-Based Telemedical Applications for External Quality Control Purposes in the Field of Cytopathology

The aim of this study was to analyze in details the implementation of an accredited proficiency testing scheme by cytopathology labs wishing to establish external quality control measures according to ISO 15189:2012. The proficiency testing scheme was based on simple Cloud-based telemedical applications and was enthusiastically accepted by all colleagues due to its simplicity and its low cost. Six major cytopathology laboratories contributed fifty conventional pap smears with histological confirmation from their registries voluntarily. Twenty board-certified cytopathologists reviewed the smears voluntarily and recorded their diagnoses. Four major diagnostic categories of cytological reports were used for statistical purposes. In addition to diagnosis, reviewers also commented on overall smears quality. Ten smears in which diagnostic interobserver accordance was almost perfect were selected for further study. A characteristic video from each one of the 10 selected smears was transferred via a simple cloud application to password-protected accounts for remote review by independent cytopathologists. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. The statistical evaluation of each participation' s results were a valuable external quality control tool for each participating laboratory and its members.

Interventionelles dezentrales Telemonitoring: Mögliche Indikationen und Perspektiven einer neuen Methode in der Telemedizin

Telemedicine comprises different concepts aiming to close a spatial distance between practitioner, medical staff and patient. Its functionality can include mere data transmission but extend as well to triggering alarms or enable consultation and therapy suggestions. A special form of telemedicinal application is interventional decentralized telemonitoring. Here practitioner-patient communication is characterized by telemedicinal data collection driven therapy-control and -optimization. To identify feasible indications for the employment of telemonitoring a detailed definition of communicated parameters, alarm rules and algorithms of intervention are required as well as a benefit-cost analysis. The quality of the telemedical application is determined by the medical quality of the resulting actions.

21st century telemetry

Despite having been around in one incarnation or another since the early 20th century, as recently as 1995 the full potential of telemedicine—electronic dissemination of medical information over a distance—was still very much underappreciated. A Lancet editorial on the topic asked the question whether this was a fad or the future, and opined on what effect, if any, telemedicine would have on medical practice in the year 2000.1The LancetTelemedicine: fad or future?.Lancet. 1995; 345: 73-74Crossref PubMed Scopus (91) Google Scholar Of course, such discussions could not have even begun to factor in the incalculable boost to be gained from improvements in telecommunications networks and computer-based applications that were just around the corner, leading to an expansion of the landscape of teleconsultation, tele-education, and even telediagnosis, that would be unrecognisable to even the most techno-savvy commentator back then.2Larner AJ Teleneurology: an overview of current status.Pract Neurol. 2011; 11: 283-288Crossref PubMed Scopus (41) Google Scholar Some specialties and more visual disciplines, such as radiology and pathology, lend themselves better to telemedicine than others; accordingly, neurology is a natural fit with the advantages of telemedicine and has even coined its own subspecialty: teleneurology. While teleneurology has been applied to many neurological disorders, such as headache, dementia, movement disorders, and multiple sclerosis, it is in stroke that teleneurological applications have predominated;2Larner AJ Teleneurology: an overview of current status.Pract Neurol. 2011; 11: 283-288Crossref PubMed Scopus (41) Google Scholar, 3Fassbender K Balucani C Walter S Levine SR Haas A Grotta J Streamlining of prehospital stroke management: the golden hour.Lancet Neurol. 2013; 12: 585-596Summary Full Text Full Text PDF PubMed Scopus (194) Google Scholar however, with new interface technologies comes more potential for telemedical applications in epilepsy.4Holmes D Can technology reveal the ecology of epilepsy?.Lancet Neurol. 2014; 13: 347-348Summary Full Text Full Text PDF Scopus (3) Google Scholar But as the initial problems based on the limitations of the technology platforms have been negated, a whole new tranche of obstacles to the wider adoption of telemedicine seem to have supplanted them, including the questions about the standards used to assess the economic benefits, the socioeconomic effects, the factors that promote uptake, the qualitative methods used, and the design of some of the reported studies.5Ekelend AG Bowes A Flottorp S Methodologies for assessing telemedicine: a systematic review of reviews.Int J Med Inform. 2013; 81: 1-11Summary Full Text Full Text PDF Scopus (121) Google Scholar However, reiteration of the requirements still needed can only be for the good and make the wider integration of telemedicine achievable.

Communication architecture for AAL. Supporting patient care by health care providers in AAL-enhanced living quarters.

This article is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". Concepts of Ambient Assisted Living (AAL) support a long-term health monitoring and further medical and other services for multi-morbid patients with chronic diseases. In Germany many AAL and telemedical applications exist. Synergy effects by common agreements for essential application components and standards are not achieved. It is necessary to define a communication architecture which is based on common definitions of communication scenarios, application components and communication standards. The development of a communication architecture requires different steps. To gain a reference model for the problem area different AAL and telemedicine projects were compared and relevant data elements were generalized. The derived reference model defines standardized communication links. As a result the authors present an approach towards a reference architecture for AAL-communication. The focus of the architecture lays on the communication layer. The necessary application components are identified and a communication based on standards and their extensions is highlighted. The exchange of patient individual events supported by an event classification model, raw and aggregated data from the personal home area over a telemedicine center to health care providers is possible.

Effectiveness of Telemedical Applications in Postoperative Follow-Up After Total Joint Arthroplasty

We hypothesized that a postoperative clinical telemedicine tool will be effective in reducing the total number of unscheduled postoperative clinic visits and calls while increasing patient satisfaction. The medical charts of 34 patients who underwent telemedicine follow-up during their postoperative care were compared to that of 44 patients who did undergo telemedicine follow-up. There were 14 unscheduled clinic visits in the non-telemedicine follow-up group compared to only 3 in the telemedicine follow-up group (P=0.01). There were 40 in-clinic calls made by patients in the non-telemedicine follow-up group compared to only 6 made by patients in the telemedicine group (P<0.01). In addition, patients who underwent telemedicine follow-up rated their postoperative satisfaction higher than those who did not undergo telemedicine follow-up.

Lossless Medical Image Compression by Integer Wavelet and Predictive Coding

The future of healthcare delivery systems and telemedical applications will undergo a radical change due to the developments in wearable technologies, medical sensors, mobile computing, and communication techniques. When dealing with applications of collecting, sorting and transferring medical data from distant locations for performing remote medical collaborations and diagnosis we required to considered many parameters for telemedical application. E-health was born with the integration of networks and telecommunications. In recent years, healthcare systems rely on images acquired in two-dimensional domains in the case of still images or three-dimensional domains for volumetric video sequences and images. Images are acquired by many modalities including X-ray, magnetic resonance imaging, ultrasound, positron emission tomography, and computed axial tomography (Sapkal and Bairagi, 2011). Medical information is either in multidimensional or multiresolution form, which creates enormous amount of data. Retrieval, efficient storage, management, and transmission of these voluminous data are highly complex. One of the solutions to reduce this complex problem is to compress the medical data without any loss (i.e., lossless). Since the diagnostics capabilities are not compromised, this technique combines integer transforms and predictive coding to enhance the performance of lossless compression. The proposed techniques can be evaluated for performance using compression quality measures.

The Use of Static Telemedical Applications of Cytopathology for Proficiency Testing

The purpose of this study was to examine the feasibility of developing an external quality control program for cytopathology labs wishing to be accredited according to ISO 15189:2007, by using low cost telemedical applications and solutions. One hundred twenty four fine-needle aspiration specimens from patients preoperatively aspirated under ultrasonographic guidance and on 104 pap smears with histological confirmation were retrospectively selected from the department’s registry. Three diagnostic categories of cytological reports were used. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for re-mote review by five independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides.