Telemedicine Center Research Articles

Coronavirus disease 2019 pandemic: Time to optimize the potential of telepsychiatric aftercare clinic to ensure the continuity of care.

Coronavirus disease 2019 pandemic: Time to optimize the potential of telepsychiatric aftercare clinic to ensure the continuity of care.

A Collaborative Tele-Neurology Outpatient Consulation Service in Karnataka: Seven Years of Experience From a Tele-Medicine Center.

Neurology services in rural and semi-urban part of India are very limited, due to poor infrastructure, resources, and manpower. Tele-neurology consultations at a non-urban setup can be considered as an alternative and innovative approach and have been quite successful in developed countries. Therefore, an initiative to bridge this health gap through Tele-Medicine has been taken by the Government of India. To study the sociodemographic and clinical profiles of patients who have received collaborative Tele-Neurology consultations from the Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru. We reviewed case files of such patients between December 2010 and March 2017. A total 189 collaborative tele-neurology outpatient consultations were provided through the Tele-Medicine Centre, located at a tertiary hospital-based research centre in southern India. The mean age of the patients was 39.6 (±19) years and 65.6% were aged between 19 to 60 years; 50.8% were male. The most common diagnosis was a seizure disorder in 17.5%, followed by cerebrovascular accident/stroke in 14.8%. Interestingly, 87.3% were found to benefit from tele-neurology consultations using interventions such as a change of medications in 30.1%, referral to a specialist for review in 15.8%, and further evaluation of illness and inpatient care for 7.93%. This study has demonstrated the successful implementation of outpatient-based collaborative tele neurology consultation in Karnataka.

Implementation of International Telemedicine Network with Rapid Coronavirus Registration by Resonant Technology to Neutralize the Pandemic

The World Health Organization calls for better use of evidence and information from COVID-19 surveillance systems to optimize the only approach at our disposal to minimize transmission: to identify, isolate, test and treat each case of the disease. Track and quarantine each contact. Digital technologies play a leading role in contact tracking. Digital technology and artificial intelligence are well established in the fight against the pandemic. In many countries, telemedicine is used alongside traditional care, especially in rural areas, and is now actively used in the context of COVID-19. Telemedicine has proved to be a very effective tool for combating telemedicine to counter the virus. We have not yet realized the full potential of telemedicine. It should open up opportunities for all people to develop an international culture of health and neutralize the pandemic. COVID-19 Various technologies are used to identify COVID-19. Researchers from George Washington University have created a miniature device that allows you to almost instantly detect the presence of COVID-19 (MedicalXpress) in human blood. The operation of the device is based on the color spectroscopy method, and the analysis results can be obtained using a mobile application. The author of the article proposes to use resonant technology for detecting COVID-19. Resonance technology is implemented by a micro-device, designed in the form of a pendant, which is convenient to wear to everyone. The micro-device for detecting COVID-19 is connected to the telemedicine center, which promptly fixes the morbid patient and provides him with the necessary services. Telemedicine centres of various countries are connected to the international medical network for the prompt registration of coronavirus, the exchange of information, decision-making and the provision of services to foreign citizens.

Innovative Technology of Mathematical Modeling of Regulatory Mechanisms Medical Informatization

The article is devoted to modeling the regulatory mechanisms of the health care informatization process and analyzing the risk of the telemedicine business depending on the resource supply, availability and quality of IT technologies, highly qualified specialists, etc. Studies show that interconnected telemedicine centers have the following modes of functioning: stable functional activity, the possibility of oscillatory modes of functioning, irregular fluctuations (chaotic uncontrolled activities) and the black hole effect (collapse of projects)

Experience in consulting with the use of telemedicine technologies in psychiatry and narcology

The results of the telemedicine advisory center, organized on the basis of the Bekhterev Psychoneurological Research Institute, for the semi-annual period (from October 2018 to March 2019). The center provides scheduled consultations on the profiles of «psychiatry» and «psychiatry - narcology». Consultations are organized through the circulation of documents in the system developed by the Ministry of Health of Russia and the All-Russian Center for Disaster Medicine «Protection». For half a year of work of the telemedicine center from the subordinate regions (Southern, North-Western, North-Caucasian and Volga federal districts) 76 requests for consultations were received. More than half (57,9%) of patients requiring telemedicine consultation were women. The largest number of requests for telemedicine consultations came in February 2019. It has been established that the Southern Federal District showed the greatest interest in consultations with the use of telemedicine technologies, the number of their requests was 35,5%, and the smallest number of requests came from the North-West Federal District. 88,2% of all complaints were in the «psychiatry» profile, 11,8% - «psychiatry - narcology». 90,9% of women and84.4% of men received counseling on the «psychiatry» profile. 30,2% of requests were returned to doctors for revision, due to the lack of completeness of the documents provided. At the end of the consultation, a medical report is sent to the attending physician, which indicates recommendations for the further management of the patient. Recommendations on the need for additional examinations and the appointment of drug therapy received 52,8% of patients, respectively.

Compression and encryption for ECG biomedical signal in healthcare system

The ECG data needs large memory storage device due to continuous heart rate logs and vital parameter storage. Thus, efficient compression schemes are applied to it before sending it to the telemedicine center for monitoring and analysis. Proper compression mechanisms can not only improve the storage efficiency but also help in faster porting of data from one device to another due to its compact size. Also, the collected ECG signals are processed through various filtering techniques to remove unnecessary noise and then compressed. In our scheme, we propose use of buffer blocks, which is quite novel in this field. Usage of highly efficient methods for peak detection, noise removal, compression and encryption enable seamless and secure transmission of ECG signal from sensor to the monitor. This work further makes use of AES 256 CBC mode, which is barely used in embedded devices, proves to be very strong and efficient in ciphering of the information. The PRD outcome of proposed work comes as 0.41% and CR as 0.35%, which is quite better than existing schemes. Experimental results prove the efficiency of proposed schemes on five distinct signal records from MIT-BIH arrhythmia datasets.

Establishment of Centre of competence “Leonardo Da Vinci” in Medical University of Pleven, Bulgaria

Abstract Issue/problem In 2016 Ministry of education and science initiated a call for projects for establishment of centres of competence aiming to increase the level and market orientation of the research activities in Bulgaria and to support the development of innovation capacity. The center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery in Medical University of Pleven is to be developed from 2018 to 2023. Description of the problem The objectives are: 1) To create a high-tech research and educational product with long-lasting tendencies to improve the community’s scientific development and level of public health; 2) To set up research teams of young researchers to write modern PhD theses and publications in high impact scientific journals; 3) ТÐ3/4 integrate research results into the business. Methods classical and virtual microscopy, computer-assisted morphometry, clinical-genealogical method, functional endoscopic sinus surgery, laparoscopic transanal total mesorectal excision, hysteroscopic morcellation and others. Results About 2500 patients will be treated in the centre for 5 years. Diagnostic panels will be developed for different cancer types and the most common hereditary diseases within Bulgarian population. Individual orthotics suitable for 3D printing will be developed and patented. Tissue transplants will be created for body models that will be used for training on robotic surgical simulator. The telemedicine center will allow distant consultations with other centers, specialized training and research in virtual reality. The teams are experienced in the genetic testing and robotic surgery. Till 2015 all robotic surgeries in Bulgaria were performed in Pleven. The proportion for 2016, 2017 and 2018 was respectively 81.1%, 71.5% and 32% due to the increase of number of robotic surgery centres. Pleven’s centre has strong training traditions to guarantee the high quality of planned 72 workshops and seminars. Key messages The introduction of new technologies requires new models of training of health professionals to develop the necessary skills to take full advantage of their benefits. Better dissemination of innovations increases the access of population to health care of good quality and the achievement of highest attainable standard of physical health.

P5237Continued financial benefits of LATIN telemedicine program from avoiding unnecessary transfer of patients

Abstract Background Latin America Telemedicine Infarct Network (LATIN) employed telemedicine to construct a population-based AMI program in Brazil, Colombia, Mexico, and Argentina. It increased access, accuracy and guidelines-based care and addressed fiscal issues. Previously, we demonstrated a cost and benefit analysis (CBA) of LATIN based upon avoiding unnecessary transfers and hospitalization. We have performed a scrupulous follow up of this initial observation with a long-term follow up from all expanded LATIN sites. Purpose To demonstrate that telemedicine avoids unnecessary transfer of patients. Methods 784,947 patients at LATIN spokes (small clinics in remote areas) were screened and CBA measured at hubs, spokes and telemedicine centers. Technology, transfer, inpatient, and procedure-related costs were included. A sensitivity analysis was performed for worst and best scenarios of costs, revenues, and savings. A comparison with Avera e-Emergency (Sioux Falls, SD) Telemedicine program, involving 85 rural hospitals in 7 states, is provided (13% transfer avoidance). Results Of 784,947 screened patients, 8,448 had STEMI (1.08%); 3,911 (46.3%) were urgently reperfused, 3,049 (78%) with PPCI. Time to Telemedicine Diagnosis was 3 min. With efficient triage, costs for non-AMI patients was controlled. LATIN expenses, including for IT and experts, were $272, and for transfer and indirect care, $1,068. Net savings/patient were $796. Savings, till date, range between $187.4 million and $62.4 million (Best scenario −30% transfer avoidance; Worse scenario −10% transfer avoidance). Conclusions Longitudinal analysis firms the trend of enormous cost savings with LATIN. Telemedicine avoids unnecessary transfers and hospitalization and it is a cost-effective strategy for population-based AMI programs.

77 Virtual Reality Trauma Simulation: An Immersive Method to Enhance Medical Personnel Training and Readiness

Immersive virtual reality (IVR) can be highly effective as a medical simulation training platform. Given recent advancements this technology has become increasingly portable and visually realistic. While IVR technology appears to hold promise, there is a great deal to learn about the best way to functionally develop, implement, and share these training resources. Several groups have created models that recreate current simulation lab environments with instructor input. While these systems increase training opportunities, decrease equipment needs, and offer broad potential, they still require a skilled trainer to ‘prompt the system.’ Removing this limitation seems like a potential way to increase scalability. We are currently in the process of creating, to our knowledge, the only simulator that would offer immediate autonomous feedback to users through both real-time patient physiologic responses and overall grading. We created a working group of 10 active duty or former military emergency physicians and 2 technical experts. We hosted 15 meetings to facilitate the development process. The program was developed with financial support from the Telemedicine and Advanced Technology Research Center (TATRC), through the primary vendor Exonicus, Inc, with support from Anatomy Next Inc, and Kitware, Inc. Development was completed using an agile project management style, which allowed our team to review progress and provide immediate feedback on previous milestones throughout its completion. The working group completed the resulting 4 simulation scenarios to evaluate perceived realism and training potential. Finally, while one member of the team was deployed, testing of the technology platform off the network in a deployed role 3/tent environment was conducted. Upon completion we created four IVR scenarios based on the highest mortality battlefield injuries: hemorrhage, tension pneumothorax, and airway obstruction. The working group unanimously indicated a high level of realism and potential training usefulness. Throughout this process there have been a number of lessons learned and we present those here to show what we have created as well as provide guidance to others creating IVR training solutions. Our team developed trauma scenarios that, to our knowledge, are the only IVR trauma scenarios to run autonomously without instructor input. Furthermore, we provide a potential template for the creation of future autonomous IVR training programs. This framework may offer a dynamic starting point as more teams seek to leverage the capabilities IVR offers.

Telestroke in Chile: 1 year experience at 7 hospitals

Acute ischemic stroke (AIS) is one of the leading causes of death in Chile. Intravenous thrombolysis (IVT) is an effective treatment. Geographical barriers and lack of specialists limit its application. Telemedicine can overcome some of these pitfalls. To describe the implementation and results of AIS treatment by telemedicine at the TeleStroke Unit (TeleACV) of the Southern Metropolitan Health Service, connected with seven hospitals in Chile. Descriptive analysis of a prospective tele-thrombolysis data-base that covers from 2016 to 2018, with an emphasis in the last year. During the analyzed period, seven remote telemedicine centers were activated as far as 830 kilometers on a continental level from the reference center and up to 3,700 kilometers on an island level. There were 1,024 telemedicine consultations, 144 (14%) of them resulted in an IVT treatment. During 2018, 597 tele-consultations were made, thrombolysis was done in 115 (19%) patients aged 66+-13 years; 54 (46.6%) being female. The median admission National Institute of Health Stroke Scale was 8 (interquartile range (IQR) 5-14). The median door-to-needle time was 56.5 (IQR 44.8-73.3) minutes; 60% of patients were treated within 60 minutes. Eight patients (7%) were referred for a subsequent mechanical thrombectomy to a center of greater complexity. Symptomatic intra-cranial hemorrhages occurred in four treated patients (4%). One patient had a systemic bleeding. The Telestroke Unit achieved a high rate of IVT and good door-to-needle times. This may help to overcome some of the geographic barriers and the specialist availability gap in our country.

Telemedicine: an ICT based healthcare approach to ensure health service for all

Background: Despite enormous efforts, healthcare service is still a daunting challenge area of Bangladesh healthcare systems. Bangladesh suffers from both a shortage of and geographic mal-distribution of human resource for health, as well as inadequate resources. Considering the challenges, telemedicine can be a blessing especially to the people living in hard-to-reach and rural areas. The current study was conducted on to measure the outcomes of providing telemedicine service at the field level.Methods: The study was conducted in Nagarkanda Upazilla of Faridpur district. Mixed method approaches including user experience and perception survey, case study and in-depth interview were adopted in order to bring a comprehensive scenario.Results: Around 50% of the users used to visit telemedicine center frequently. For quality of service provided from telemedicine service point, there were few benchmarks like service provider’s behavior, waiting time, accessibility, distance, cost of treatment, willingness to pay and referral mechanism. Telemedicine service centers were found situated within the reach of people (within 1-2 km of 83.30% km). 97% participants rated service provider’s behavior as good. Cost of treatment including diagnosis, prescription and medication was found within 501-3000 BDT for 60% of participants.Conclusions: Although the studied telemedicine service was not comprehensive in nature, it still helped to save time, reduce cost and most of all increased access to healthcare services.

Design and Application of a Telemedicine System Jointly Driven by Videoconferencing and Data Exchange: Practical Experience from Henan Province, China

Background and Objectives: There are a few problems restraining the effective operation of telemedicine in China. On the basis of practices of the Henan Province Telemedicine Center of China (HTCC), the purpose of this study was to design a telemedicine system jointly driven by videoconferencing and data exchange to address the issues limiting the further development and implementation of telemedicine. Methods: Based on service-oriented architecture, the organizational design of the telemedicine system was gradually refined from top to bottom to complete its hierarchical layout. Technologies including multiprotocol stack adaptation, self-adaptive multilink network transmission, information exchange of heterogeneous medical systems, and open application system architecture were also used to construct the system. Results: The telemedicine system realizes the integration of videoconferencing, data acquisition and exchange of heterogeneous medical information systems, and the actual applications and expansion of telemedicine services. The HTCC currently covers more than 500 telemedicine centers, workstations, and service points, forming a five-level "province-city-county-township-village" telemedicine network linkage. The HTCC handles nearly 30,000 teleconsultation cases per year, helping patients save about ¥120 million Chinese Yuan RMB (approximately US $17.5 million). Conclusions: The proposed telemedicine system achieves satisfactory operation effects, along with social and economic benefits. It has the potential to increase the coverage of medical resources in remote regions, and it can play a role in solving other problems facing telemedicine development in China. The findings also inform measures for further improvement in telemedicine's implementation effects, service quality, and application scope in China and globally.

Optimization of Teleconsultation Using Discrete-Event Simulation from a Data-Driven Perspective.

Background: Teleconsultation plays an increasingly important role to solve the health care problem in rural areas around the world. Teleconsultation resource optimization has become a new research topic. Materials and Methods: Given the complex teleconsultation process was difficult to be described by mathematical methods, a queuing simulation model was developed based on the data and teleconsultation empirical flow of Henan Telemedicine Center of China (HTCC) and we used kernel density estimation to solve the problem of arrival rate and service rate of teleconsultation. The data obtained from HTCC included 21,295 teleconsultation records over a 1-year period (February 27, 2016-March 25, 2017). Results: The average waiting time (WT) that primary hospitals requested for teleconsultation was obtained by simulation and compared with empirical average WT to verify this model. We found that Department of Internal Medicine (DIM) WT was the highest and we searched the optimized combination of teleconsultation rooms and DIM experts by sensitivity analyses. Conclusions: The existing resource allocation was not optimal and the hospital managers can improve it to reduce the hospitals' operating costs and the patients' waiting costs. We suggested that the teleconsultation rooms needed at least four and the DIM experts could increase from three to four.

Teledermatology in Switzerland : Set-up for and examples of dermatological treatment from a telemedicine center

In Switzerland, telemedicine has been an integral part of the health care system for many years and plays asignificant role in basic medical care. Telemedicine is particularly suitable for skin diseases, thanks to the possibility of diagnostic imaging. The aim of this article is to point to services and structures needed using the example of asuccessful telemedicine center (Medgate Tele Clinic, Basel, Switzerland) and to illustrate the wide range of applications of telemedicine available in Switzerland based on examples from teledermatology. This article describes how atelemedicine center functions, with particular emphasis on teledermatology. As examples, some of the dermatological disorders that have been treated only using teledermatology will be presented. In about half of all cases, physicians working at the above-mentioned telemedicine center can complete treatment of their patients over the phone or video, so that no further appointment with adoctor is necessary. Many dermatological problems (such as pityriasis versicolor, perioral dermatitis or rosacea without eye involvement) can be treated particularly well with telemedicine.

Telemedicine in heart failure

Improved outpatient care of heart failure patients is considered crucial to avoiding unplanned cardiovascular hospitalizations and reducing mortality. Making up for regional and rural differences in heart failure care poses a further challenge. Telemedical care as a supplement to outpatient point-of-care medicine by the general practitioner and medical specialist is considered relevant to implementing this goal. This article presents the technical and organizational basics of telemedical methods in outpatient heart failure care. Current evidence on the efficacy of telemedical co-management is also explained based on the results from the nine most important randomized studies on telemedicine in heart failure. Particular attention is paid to the TIM-HF2 study published in 2018, which showed the superiority of telemedical co-management in terms of mortality and morbidity following recent hospitalization for heart failure. Pre-stratified subgroup analysis revealed no significant interactions in terms of the primary endpoint between urban and rural regions. Scalability is required in order to translate the telemedical study concept from TIM-HF2 to a nationwide care program for all patients in Germany. Telemed5000 is the first project to set its goal as the development of a telemedicine center for the telemedical co-management of up to 5000 patients using artificial intelligence. It is being funded by the Federal Ministry of Economics and Technology for the period 2019-2022.

Collaborative Tele-Neuropsychiatry Consultation Services for Patients in Central Prisons.

Background:Tele-medicine helps to provide clinical care comparable to in-person treatment in various clinical settings. It is a novel system of healthcare delivery in both low-resource settings and sites where adequate medical care continues to pose greatest challenge like in prison's in India and worldwide.Aim:To study the sociodemographic and clinical profile of patients from Central Prisons, having received collaborative Tele-Neuropsychiatric Care.Methodology:Psychiatry, neurology, and neurosurgery specialists provided tele-neuropsychiatry consultation through Specialist–Doctor–Patient model as part of the state-run program for the two central prisons from July 1, 2014, to June 30, 2016. A retrospective file review was done of the tele-neuropsychiatry case records at Tele-Medicine Centre, Located at Tertiary Neuro Psychiatric centre of South India.Results:A total of 53 patients were provided tele-neuropsychiatric consultation over 2-year period. Of these, 48 (90.6%) were male and 34 (64.1%) were aged more than 30 years. In total, 20.7% of them had severe mental illness, i.e., schizophrenia and mood disorders, 20.7% with substance use disorder (alcohol and cannabis), 17% had anxiety disorders while 17% with seizure disorder. Nearly 81.1% of patients (inmates) were advised pharmacotherapy while 18.9% were suggested further evaluation of illness and inpatient care at the higher center.Conclusion:The collaborative care was successful in delivering psychiatry, neurology, and neurosurgery consultation with a Specialist–Doctor–Patient model to prison inmates.

Feasibility and Utility of Tele-Neurorehabilitation Service in India: Experience from a Quaternary Center.

Background:Neurological rehabilitation service in developing countries like India is a great challenge in view of limited resources and manpower. Currently, neurological rehabilitation with a multidisciplinary team is limited to a few major cities in the country. Tele-neurorehabilitation (TNR) is considered as an alternative and innovative approach in health care. It connects the needy patients with the health-care providers with minimum inconvenience and yields cost-effective health care.Aim:The aim of this study was to study the socioclinical parameters, feasibility, and utility of TNR services in India.Methodology:A retrospective file review of TNR consultations provided through Telemedicine Center at a quaternary hospital-based research center in south India between August 2012 and January 2016.Results:A total of 37 consultations were provided to the patients belonging to four districts of Karnataka. The mean age of the patients was 34.7 (±19.5) years, 23 (62.1%) were aged between 19 and 60 years, and 31 (83.8%) were male. Thirty-one patients (83.8%) had central nervous system-related disorders such as stroke, cerebral palsy, and tubercular meningitis with sequelae or neuromuscular disorders such as Guillain–Barre Syndrome and Duchenne muscular dystrophy. Twelve patients (32.4%) were advised to consult higher centers in the vicinity, and the rest was referred to the district hospital.Conclusion:The findings suggest that TNR services are feasible, effective, and less resource intensive in delivering quality telemedicine care in India. More clinical studies are required to elucidate its full utility at different levels and in different parts of the country.

Avances recientes en dermatología comunitaria 2016-2017. Teledermatología, un modelo de enseñanza y asistencia en atención primaria a la salud

Community dermatology (CD) is integrated by dermatologists, epidemiologists and interested people. It has 27 years of experience at the Guerrero State. Due to unsafety issues, the teaching and medical attention model had to be changed from presential to virtual trough telemedicine. Transversal, descriptive, observational and analytic study, in which results from teaching-learning of the health personal that was capacitated throughout the telemedicine network at the Guerrero State were evaluated, during nine courses that reached 35 telemedicine centers. 2465 health workers were capacitated in basic dermatology, which were evaluated in their general knowledge of dermatology before and after every course. The utility of this modality of teaching was statistically evaluated with a random simple in 611 attendees with satisfactory results. Teaching through telemedicine network, represents an improvement for CD by reaching a higher number of attendees to several reception centers simultaneously, minimizing transportation expenses and improving the safety of the participants at the activities, with the advantage of allowing continuity of the CD purposes.

Medication safety in a German telemedicine centre: Implementation of a telepharmaceutical expert consultation in addition to existing tele-intensive care unit services

Introduction Tele-intensive care unit (tele-ICU) services offer the possibility to provide specialized medical care in remote areas and to improve patient outcomes. The aim of this study was to implement and evaluate an additional telepharmaceutical expert consultation as part of tele-ICU services. Methods This is a prospective observational study conducted in the telemedicine centre of the University Hospital RWTH Aachen, Germany. Between March and July 2015, all tele-ICU patients of one internal and two remote ICUs received telepharmaceutical consultation. Number and type of drug related problems (DRPs) were identified in a comprehensive medication safety check. Implementation of DRPs was discussed interdisciplinarily by tele-ICU pharmacist, tele-ICU physician and remote ICU physician. Special focus was on drug–drug interactions (DDIs) and dosage adjustment in renal and liver failure. Results A total of 210 DRPs in 103 patients were identified and discussed. On average, 2.0 (range 0–17) DRPs per patient were found. At least one DRP was found in 62% of patients. Antibacterials for systemic use were most involved in DRPs. A total of 1129 DDI-alerts were generated by ID PHARMA CHECK®. Fifty-six DDIs (5%) were discussed in tele-ICU rounds. The tele-ICU team discussed 28 cases of dosage adjustment in organ failure. Discussion Telepharmaceutical consultation as part of tele-ICU services was successfully implemented and can improve medication safety. Telemedicine infrastructure provides the possibility to implement guidelines recommending pharmaceutical service in the ICU in remote hospitals not having access to clinical pharmacists. Thus, quality of care can be improved.

Role of pre-hospital and hospital emergency services in the management of stroke

Any out-of-hospital neurological deficit of less than 24hours should prompt a call for emergency medical help Urgent Medical Aid Service. Early identification of signs of stroke or transient ischaemic attack allows to guide the therapeutic approach towards intravenous thrombolysis or other alternatives. Telemedicine centres complement the network of neurovascular units.