Telemedicine Studies Research Articles

Research Implications for future telemedicine studies and innovations

Abstract Despite the increasing application of information and communication technologies (ICT) in health care, robust data on the effectiveness and implementation of digital health solutions is lacking. Therefore, the objective of this analysis is to identify and categorise implications for future research in order to inform policy and practice decisions. Systematic reviews and meta-analyses of RCTs evaluating the effectiveness of telemedicine in chronic diseases, all identified via a recent umbrella review, were used as primary sources of information. Qualitative content analysis following Mayring (2000) was used to categorize future research topics mentioned in the discussion sections and conclusions of included research published after 2015. Parallel, independent data extraction and coding using inductive category development was performed by two researchers with previous coding experience. Any disagreements were solved by discussion. Of the 25 included systematic reviews and meta analyses, 23 reported on future research implications. They were categorised as follows: (1) Need for high quality studies including specific outcome measures; (2) Need for comprehensive technology assessment; (3) Need for in-depth considerations of patients’ characteristics & more diverse study populations; (4) Ethics & Safety; and (5) Translation & implementation strategies. A codebook comprising descriptions and examples of those categories and sub-categories was developed. Results show a need for larger and more rigorous studies with longer intervention durations, mid- to long-term follow-ups as well as more heterogeneous study populations. More pragmatic study designs to evaluate multimodal and tailored interventions like telemedicine solutions are needed to develop an improved understanding on mechanisms and target-group specific effectiveness. Key messages We need a stronger focus on relevant and well-designed studies to improve the impact of telemedicine trials. Identified needs have the potential to inform future guidelines for the use of telemedicine.

New- and Next-Generation of Telemedicine Projects and Studies in Chronic Heart Failure, with the Example of TIM-HF2 and E-Care

Since the beginning of the 2000’s, several telemedicine projects and studies that focused on chronic heart failure have been developed with various clinical results. Numerous new and next-generation telemedicine projects have emerged in Europe over the last five years or are still under development as for computer science heart failure, especially in Europe. TIM-HF2 is the first positive prospective randomized study in regards of evidence-based medicine with positive significant clinical benefit, in terms of unplanned cardiovascular hospital admissions and all-cause deaths. The E-care telemonitoring project fits within the telemedicine 2.0 framework, based on connected objects, new Information and Communication Technologies (ICT) and Web 2.0 technologies. E-care is the first telemedicine project including Artificial Intelligence (AI). In this setting, the potential contribution of new- and next-generation telemedicine projects in terms of mortality, morbidity, and number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions had previously been validated by the first-born telemedicine projects.

What do Cochrane systematic reviews say about telemedicine for healthcare?

Telemedicine has emerged as a tool for overcoming the challenges of healthcare systems and is likely to become increasingly viable, since information and communication technologies have become more sophisticated and user-friendly. We aimed to identify all Cochrane systematic reviews (CSRs) on telemedicine within healthcare and to summarize the current evidence regarding its use. Review of CSRs, developed at the Discipline of Emergency and Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. We searched for studies that compared use of telemedicine with conventional treatment or management of diseases within healthcare. Diagnostic telemedicine studies or studies using automatic text, voice-text or even self-managed care were excluded. The main characteristics and the certainty of evidence were synthetized and critically discussed by all authors. We included 10 CSRs that investigated a broad range of diseases. There is still insufficient evidence to determine what types of telemedicine interventions are effective, for which patients and in which settings, and whether such interventions can be used as a replacement for the standard treatment. Harm relating to telemedicine technologies needs to be better investigated and addressed. Telemedicine might be an excellent way to facilitate access to treatment, monitoring and dissemination of important clinical knowledge. However, given the recognition of systematic reviews as the best evidence resource available for decision-making, further randomized controlled trials with stricter methods are necessary to reduce the uncertainties in evidence-based use of telemedicine.

MHealth resources for asthma and pregnancy care: Methodological issues and social media recruitment. A discussion paper.

A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care. Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them. A Phase I or modelling study. A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources. Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2. We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment.

Diagnostic Accuracy of Ophthalmoscopy vs Telemedicine in Examinations for Retinopathy of Prematurity

ImportanceExaminations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine.ObjectiveTo directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard.Design, Setting, and ParticipantsThis multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP.ExposuresEach examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders.Main Outcomes and MeasuresResults of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics.ResultsAmong the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%-84%] vs 78% [95% CI, 73%-83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%-87%] vs 79% [95% CI, 72%-86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%-92%] vs 79% [95% CI, 75%-83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%-91%] vs 73% [95% CI, 67%-78%]; P = .004 [n = 136]).Conclusions and RelevanceNo difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.

Validity of the Model for Assessment of Telemedicine: A Delphi study

Introduction In 2009, the Model for Assessment of Telemedicine (MAST) was developed within the MethoTelemed project as a framework for description of the effectiveness of telemedicine applications. The goal was for the assessments to be used as basis for decision-making in healthcare systems. Since then, MAST has been used in many European telemedicine studies and is now the most widely used model for assessment of telemedicine. The aim of this study was to assess the face validity of MAST. Methods A modified Delphi process was carried out and included a workshop with a sample of healthcare decision makers. A total of 56 decision makers and experts in telemedicine were invited and 19 persons participated in the two Delphi rounds. Thirteen hospitals or regional health authorities from 12 European countries and six research organisations were represented in the final sample. The participants were asked to assess the importance of the different domains and topics in MAST on a 0–3 Likert scale. Results All respondents completed the two rounds. Based on the answers, the face validity of all MAST domains was confirmed, since all domains were considered moderately or highly important by more than 80% of the respondents. Discussion Even though the study confirmed the validity of MAST, a number of supplements and improvements regarding study design and data collection were suggested. When considering the results it should be noticed that the sample size was small and larger studies are needed to confirm the results.

Review of high quality economic evaluations of telemedicine

Introduction: Telemedicine has been suggested as solution to the demographic challenges that the health care sector in many European countries are facing. The basis of this suggestion is reviews of studies of tele- medicine interventions, and these reviews often find that telemedicine is able to reduce the costs per patient. However, a large proportion of the economic studies of telemedicine suffering from methodological weaknesses making them inadequate for drawing conclusions about the economic potential of telemedicine solutions. The objective of this study was therefore to examine the results from high quality economic evaluation of home monitoring for patients with chronic diseases in order to identify the true costs of tele-medicine applications.Methods: High quality economic evaluations are here defined as economic evaluations based on randomised controlled trials that include description of data collection, mean use of resources per patient, prices and costs in accordance with the Drummond et al. (2005) guideline for economic evaluation. Economic evaluations published before August 2010 was collected from a systematic review of telemedicine studies by Wootton (2012). Economic evaluations published after August 2010 was identified by a systematic literature search in the PubMed database. Inclusion criteria were economic evaluation of telemedicine based on randomized controlled trials. The results with regard to the estimated costs per patient were synthetized qualitatively and quantitatively by meta-analyses.Results: 26 economic evaluations were found by Wootton et al. (2012) and in the Pubmed search 58 studies were identified. Of these nine economic evaluations of high quality of home monitoring for patients with chronic diseases were identified. Six of the nine studies (67%) found higher costs when telemedicine in used, and meta-analysis showed a statistical significant increase in total costs per patient of DKK 907 (p value = 0.04). No clear tendency was observed with regard to the types of costs that was reduced or increased when a telemedicine intervention was introduced. However, meta-analysis showed significant cost savings for emergency department visits of DKK 121 per patient (p value = 0.02). Investment costs were found to comprise 41 to 65% of the total intervention costs.Discussion: This review is focusing on the estimated costs from high quality economic evaluations of home monitoring for patients with chronic diseases. The study shows that telemedicine is often associated with higher costs per patient, mainly because of high costs of investment in telemedicine devices. This indicates that more attention should be given to costs and price of the telemedicine devices.Notice that the study was not designed to address questions of cost-effectiveness as only the cost side was studied. Thus, studies showing an increase in the costs per patient can still be describing a cost-effective technology if the intervention is effective. In addition the definition of high quality economic evaluations can be discussed.The literature search identified relatively few studies of high quality indicating a continuing need for more and better economic evaluations of telemedicine based on randomized controlled trials - not to forget the need for clear and transparent reporting of results. A concluding point to be noted is that statements of the economic potential of telemedicine must be based on methodological sound studies.

MHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process

ABSTRACTObjectives: Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%–75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals.Methods: The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal.Results: Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00).Conclusion: We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.

Telemedicine - a scientometric and density equalizing analysis.

BackgroundAs a result of the various telemedicine projects in the past years a large number of studies were recently published in this field. However, a precise bibliometric analysis of telemedicine publications does not exist so far.MethodsThe present study was conducted to establish a data base of the existing approaches. Density-equalizing algorithms were used and data was retrieved from the Thomson Reuters database Web of Science.ResultsDuring the period from 1900 to 2006 a number of 3290 filed items were connected to telemedicine, with the first being published in 1964. The studies originate from 101 countries, with the USA, Great Britain and Canada being the most productive suppliers participating in 56.08 % of all published items. Analyzing the average citation per item for countries with more than 10 publications, Ireland ranked first (10.19/item), New Zealand ranked second (9.5/item) followed by Finland (9.04/item). The citation rate can be assumed as an indicator for research quality. The ten most productive journals include three journals with the main focus telemedicine and another five with the main focus “Information/Informatics”. In all subject categories examined for published items related to telemedicine, “Health Care Sciences & Services” ranked first by far. More than 36 % of all publications are assigned to this category, followed by “Medical Informatics” with 9.72 % and “Medicine, General & Internal” with 8.84 % of all publications.ConclusionIn summary it can be concluded that the data shows clearly a strong increase in research productivity. Using science citation analysis it can be assumed that there is a large rise in the interest in telemedicine studies.

Telemedicine in care homes in Airedale, Wharfedale and Craven

Purpose – The purpose of this paper is to observe and analyse the effects of the use of telemedicine in care homes on the use of acute hospital resources. Design/methodology/approach – The study was an uncontrolled retrospective observational review of data on emergency hospital admissions and Emergency Department (ED) visits for care home residents in Airedale, Wharfedale and Craven. Acute hospital activity for residents was observed before and after the installation of telemedicine in 27 care homes. Data from a further 21 care homes that did not use telemedicine were used as a control group, using the median date of telemedicine installation for the “before and after” period. Patient outcomes were not considered. Findings – Care homes with telemedicine showed a 39 per cent reduction in the costs of emergency admissions and a 45 per cent reduction in ED attendances after telemedicine installation. In the control group reductions were 31 and 31 per cent, respectively. The incremental difference in costs between the two groups of care homes was almost £1.2 million. The cost of telemedicine to care commissioners was £177,000, giving a return on investment over a 20-month period of £6.74 per £1 spent. Research limitations/implications – The results should be interpreted carefully. There is inherent bias as telemedicine was deployed in care homes with the highest use of acute hospital resources and there were some methodological limitations due to poor data. Nevertheless, controlling the data as much as possible and adopting a cautious approach to interpretation, it can be concluded that the use of telemedicine in these care homes was cost-effective. Originality/value – There are very few telemedicine studies focused on care homes.

Critical appraisal of published systematic reviews assessing the cost-effectiveness of telemedicine studies.

Over the last 10 years several systematic reviews have been published on the cost-effectiveness of telemedicine studies. Most reviews have concluded that there is not much difference in the cost-effectiveness when delivering health services via telemedicine or by conventional means. We are not aware of any systematic review looking at the systematic reviews of cost-effectiveness of telemedicine. This study was designed to identify published systematic reviews on the cost-effectiveness of telemedicine studies and to undertake a quality assessment of the identified systematic reviews. We searched six electronic databases, including Medline, Embase, and the NHS Economic Evaluation Database, combining "review" terms with "telemedicine" terms to identify systematic reviews. We identified 4,116 potential abstracts. Nine systematic reviews met the inclusion criteria, which looked at the cost-effectiveness of telemedicine in general. All reviews were similar in terms of their stated purpose, and the objectives were clear. Three of the reviews did not use a checklist for the economic evaluation studies included in their review. The quality assessment found that five of the nine reviews had minimal flaws. Even though the general quality of reporting of the reviews was fine, we have found that conclusions cannot be drawn on the cost-effectiveness of telemedicine applications based on the methodological flaws in the economic analysis of the studies included in the reviews. Over time, reporting of cost-effectiveness has generally improved; however, there is still room for improvement, and authors need to use the recommended checklists for economic evaluations.

Progress on retinal image analysis for age related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of vision loss in those over the age of 50 years in the developed countries. The number is expected to increase by ∼1.5 fold over the next ten years due to an increase in aging population. One of the main measures of AMD severity is the analysis of drusen, pigmentary abnormalities, geographic atrophy (GA) and choroidal neovascularization (CNV) from imaging based on color fundus photograph, optical coherence tomography (OCT) and other imaging modalities. Each of these imaging modalities has strengths and weaknesses for extracting individual AMD pathology and different imaging techniques are used in combination for capturing and/or quantification of different pathologies. Current dry AMD treatments cannot cure or reverse vision loss. However, the Age-Related Eye Disease Study (AREDS) showed that specific anti-oxidant vitamin supplementation reduces the risk of progression from intermediate stages (defined as the presence of either many medium-sized drusen or one or more large drusen) to late AMD which allows for preventative strategies in properly identified patients. Thus identification of people with early stage AMD is important to design and implement preventative strategies for late AMD, and determine their cost-effectiveness. A mass screening facility with teleophthalmology or telemedicine in combination with computer-aided analysis for large rural-based communities may identify more individuals suitable for early stage AMD prevention. In this review, we discuss different imaging modalities that are currently being considered or used for screening AMD. In addition, we look into various automated and semi-automated computer-aided grading systems and related retinal image analysis techniques for drusen, geographic atrophy and choroidal neovascularization detection and/or quantification for measurement of AMD severity using these imaging modalities. We also review the existing telemedicine studies which include diagnosis and management of AMD, and how automated disease grading could benefit telemedicine. As there is no treatment for dry AMD and only early intervention can prevent the late AMD, we emphasize mass screening through a telemedicine platform to enable early detection of AMD. We also provide a comparative study between the imaging modalities and identify potential study areas for further improvement and future research direction in automated AMD grading and screening.

Systematic Review of Telestroke for Post-Stroke Care and Rehabilitation

Telemedicine for acute stroke care is supported by a literature base. It remains unclear whether or not the use of telemedicine for other phases of stroke care is beneficial. The authors conducted a systematic review of the published literature on telemedicine for the purposes of providing post-stroke care. Studies were included if the title or abstract expressed use of two-way audio/video communication for post-stroke care. From an initial yield of 1,405 potentially eligible hits, two reviewers ultimately identified 24 unique manuscripts to undergo functionality, application, technology, and evaluative (F.A.T.E.) scoring. Each article was classified using a scoring rubric to assess the functionality, application, technology, and evaluative stage. It was found that most post-stroke telemedicine studies evaluated rehabilitation of adults. All primary data manuscripts were small and preliminary in scope and evaluative phase, and median F.A.T.E. score for primary data was 2. The use of telemedicine for post-stroke care is nascent and is primarily focused on post-stroke rehabilitation.

Trends in telemedicine assessment indicate neglect of key criteria for predicting success

This innovative analysis aims to quantify the use of evaluation criteria in telemedicine and to identify current trends in metric adoption. The focus is to determine the frequency of actual performance metric reporting in telemedicine evaluation, in contrast to systematic reviews where assessment of study quality is the goal. Automated literature search identified telemedicine studies reporting quantitative performance metrics. Studies were classified by telemedicine class; store-and-forward (SAF), real-time consultation (RTC) and telecare (TC), and study stage. Studies were scanned for evaluation metric reporting, i.e. clinical outcomes, satisfaction, patient quality and cost measures. Evaluation metric use was compared among telemedicine classes, and between pilot and routine use stages. Diagnostic accuracy was reported significantly more frequently in pilots for RTC and TC. Cost measures were more frequently reported in routine use for TC. Clinical effectiveness and hospital attendance were better reported in routine use for SAF. Comparison also revealed different evaluation strategies. In pilots, SAF favoured diagnostic accuracy, compared to RTC and TC. TC preferred clinical effectiveness evaluations and TC more frequently assessed patient satisfaction. Cost was only reported in less than 20 per cent of studies, but most frequently in RTC. Routine use led to increased reporting of all metrics, except diagnostic accuracy. Clinical effectiveness reporting increased significantly with routine use for RTC and SAF, but declined for TC. Clinical outcomes and patient satisfaction were reported frequently in telemedicine studies, but reporting of other performance metrics was rare. Understanding current trends in metric reporting will facilitate better design of future telemedicine evaluations.

Incorporating remote visits into an outpatient clinic

Most telemedicine studies are concerned with either the technological or diagnostic comparisons, rather than assessing the impact on clinic management. This has attributed to the retrospective nature of the studies, with lack of data being the main cause for not using simulation for prospective analysis. This article demonstrates the use of simulation to assess the impact of prospective systems by utilising data generated from clinical trials. The example used here is the introduction of remote consultations into an outpatient's clinic. The article addresses the issues of using secondary data, in terms of the differences between the trial, the model and future reality. The result of running the simulation model show that exchanging the mode of service delivery does not improve patient wait times as expected, and that a protocol change in association with the introduction of remote visits is necessary to provide a substantial reduction in patient wait times.

Differences in diagnosis for cognitive assessment following an in-person physical examination versus a telegeriatric evaluation

Background: Telehealth services such as video consultation enable access to specialist advice for patients in rural and regional areas. The significance of the in-person physical examination as a part of a telegeriatric memory disorder clinic is unexplored. This research project aims to examine the degree to which the physical examination of the patient contributes to the diagnosis of dementia in older adults. Results: Telegeriatric consultation resulted in excellent intraobserver agreement (weighted kappa = 0.94). These results correlate with other telemedicine studies involving physical examination and intra-observer agreement. To place this result in perspective, the intra-observer agreement for conventional consultation was also excellent (weighted kappa = 1.0). Conclusions: We conclude that in the majority of cases, for the diagnosis of dementia via video consultation, the additional information gleaned from a physical examination does not lead to a change in the diagnosis that has been established as a result of an interview with the patient and carer. Journal compilation © 2007 COTA

An Overview and Analysis of Theories Employed in Telemedicine Studies

This study asks: What theories are employed in telemedicine studies? How might they be categorized in ways that help distinguish the knowledge base of telemedicine? Theories in use were identified from a database of telemedicine-related publications between 1990 and 2005. Eighty-three (5% of 1615) articles referred to a theoretical concept. Grounded Theory procedures were used to analyze and categorize theories, while descriptive statistics were used for supplementary information. The proportion of studies with theory was 3% in 1999 and 7% in 2005. The 83 articles were dispersed among 48 of the in total 795 different journals in the original sample. Identified theories were grouped into two main categories; 'shared' (used in two or more studies) and 'lone ranger'. All of the shared theories are social science theories employed without notable adjustments to any uniquely defining features of telemedicine; diffusion, technology acceptance, health behavior, science and technology studies (STS), and economics. Theoretical concepts within the lone ranger category may well address unique features of telemedicine, but have yet to attract the attention of colleagues. The theories identified as 'shared' play an important role, but are inadequate in illuminating any unique features of telemedicine. The future of telemedicine as a field will need to identify its underlying theoretical components. Frameworks employed in the field of evaluation may aid in identifying the types of theories worth articulating in telemedicine.

A systematic review of research methodology in telemedicine studies

We conducted a systematic review of 15 relevant databases for articles about telemedicine. After eliminating articles that did not meet the inclusion criteria, 1615 remained for analysis. Three raters coded the articles to assess various theoretical and methodological variables. Only 5% (n = 85) of the telemedicine articles made mention of any theory or paradigmatic approach. Studies commonly reported the objectives (96%) but rarely stated a research question or hypothesis (11%). Randomized selection of the subjects was reported in 11% of patient studies and 4% of studies where providers were the subject. There was a wide range in the number of subjects employed, although the majority of studies were based on sample sizes of less than 100. Only 26% of the studies reported a time frame. Until the telemedicine field adheres to agreed standards of reporting methodological details it will be difficult to draw firm conclusions from review studies.

Preadmission anesthesia consultation using telemedicine technology: a pilot study.

TELEMEDICINE has been defined as the delivery of healthcare and sharing of medical knowledge over a distance using telecommunications systems. 1 It uses modern high-speed telecommunication systems that allow interactive video-mediated clinical consultations. Telemedicine enables the delivery of healthcare irrespective of geographic location or ability to travel to tertiary healthcare centers. 2 In Canada, a significant population lives in remote regions away from tertiary care centers. At Toronto Western Hospital, 15% of patients are referred from remote regions. Telemedicine can potentially reduce travel costs and improve accessibility to health care. Although telemedicine has been used by other medical and surgical specialties, there have been no reports in the literature evaluating telemedicine technology for anesthesia consultations. 3-5 We report the technical aspects and implementation of telemedicine anesthesia consultation, the first 10 patients interviewed, and their satisfaction regarding telemedicine consultations.

Teleotolaryngology: a retrospective review at a military tertiary treatment facility

Objective/ hypothesis The use of real-time telemedicine in providing quality health-care in multiple specialties has been demonstrated in several small studies; however, a review of the literature reveals no large-scale prospective or retrospective telemedicine studies in otolaryngology. The telemedicine office at Naval Medical Center San Diego (NMCSD) acquired a large otolaryngology telemedicine patient database, and this study reviews the otolaryngology telemedicine experience at NMCSD over an 18-month period. Study design We conducted a retrospective and reviewed new patient consults for the NMCSD otolaryngology telemedicine clinic from April 1, 2001, until November 6, 2002. Results During the study period, a total of 883 patients received new patient evaluations. Of 883 patients, 568 (64.3%) received a preliminary diagnosis and were treated accordingly. Telemedicine resulted in the avoidance of 22.7% consults. Only 115 (13.0%) of 883 patients required traditional face-to-face otolaryngology consultation. In addition, only 30 (4.3%) of 705 patients who underwent flexible nasopharyngoscopy, otomicroscopy, or nasal endoscopy received incomplete examinations. Conclusions Our study demonstrates the ability of telemedicine to function in an general otolaryngology setting.