Use Of Telecommunication Technologies Research Articles

Using Telerehabilitation to Support Assistive Technology

Telerehabilitation—the use of telecommunications technology to provide rehabilitation and long-term support to people with disabilities—offers exciting possibilities for the delivery and support of assistive technology services. This article describes the experiences of a specialty hospital serving persons with disabilities in exploring telerehabilitation to support assistive technology use in the home. Four case studies are presented to illustrate how telerehabilitation may be used in relation to seating evaluation, evaluation of home accessibility, setup of computer access systems, and training in use of augmentative communication devices.

Reasoning about diabetes and its relationship to the use of telecommunication technology by patients and physicians

Health care is moving toward a team effort, with patients as partners. This requires effective communication between physicians and patients, who have different understandings of health and illness. These understandings in turn guide their decisions about management of health and illness. With the introduction of home-based technology, which provides an efficient way for doctors and patients to communicate, the question of the effectiveness of the decisions being made must be addressed. In this study, we assess the conceptualizations of health and illness related to diabetes and the relationship to the use of communication technology by patients and physicians. Methods: The subjects were interviewed using a semi-structured questionnaire and were then asked to enter information into a telephone-based telecommunications system. Data were audiotaped, transcribed, and analyzed to characterize models of health and illness and for the factors that influence the decision making about diabetes management. Interactions with the system were then examined relative to these findings. Results: Patients used lay concepts in providing explanations of their illness, whereas physicians used biomedical concepts. Use of these differing concepts influenced the use of telecommunication technology, with more errors in the communication of information being made by patients than by physicians. Examination of the organization of information required by the system showed it to be incongruent with the way patients normally reason, but in agreement with the way physicians reason. The paper discusses the implications of these findings for: (a) the nature of evidence used by patients and physicians; and (b) the design of technology to maximize effective doctor–patient communication.

Rural telepsychiatry.

Telepsychiatry is the use of telecommunications technology to connect patients and health care providers, permitting effective diagnosis, education, treatment, consultation, transfer of medical data, research, and other health care activities. Telepsychiatry has been used as a partial solution to the problem of limited psychiatric services for clinics and hospitals in remote areas of areas underserved by psychiatrists and other mental health care specialists. In the United States, eastern Oregon's RodeoNet telepsychiatry program and the telemedicine program of the Kansas University Medical Center, which has a psychiatric component, are excellent models. Telepsychiatric applications can be cost-effective, but careful evaluation is needed.

Editorial

As clinical dermatologists, we are all striving to achieve the highest possible accuracy in our clinical acumen and diagnostic skills. Over the past decade, one relatively simple advance, epiluminescence microscopy with the use of the dermatoscope, has significantly contributed to our diagnostic skills in the detection of benign versus pigmented lesions. In the paper by Kawabata and Tamaki, these authors delineate distinctive dermatoscopic features of acral lentiginous melanoma in situ, and contrast this with melanocytic nevi. The restructuring of healthcare delivery systems by third party payers and governmental programs is impacting on the pattern of our medical practices. In Canada, this has limited access to widespread use of techniques such as Mohs' micrographic surgery. The article by Arlette and colleagues has further supported the well-established studies indicating that Mohs' micrographic surgery for high-risk skin cancers has a dramatic benefit. Healthcare restructuring has also led to a decreased number of trainees in a number of subspecialties, including dermatology. This decrease in manpower has been an impetus to look at alternative forms of care for underserviced areas. Telemedicine, the use of telecommunications technology to provide healthcare services over a distance, has been examined as one attempt at solving this problem. In the Point-Counterpoint articles, we have two distinct views on the future of telemedicine as it applies to dermatology. Over the past decade, there have been dramatic advances in our understanding at a molecular nature of various disease processes. This rapid development has translated into a large number of therapies. Regulatory agencies such as the Food and Drug Administration in the United States, or the Health Protection Branch in Canada, are caught between demands to bring effective therapies to the market in an expedited fashion, and yet establish efficacy and maintain safety of new therapeutic entities. This occurs by a multistaged approval process. During the early phases, exposure is limited in order to accumulate preliminary data on pharmacology and toxicity. In the Critical Appraisal CME series, Muglia and DiGiovanna describe early testing processes in Phase 1 clinical trials. Calciphylaxis is a severe disease associated with calcification of the skin, subcutaneous tissue and potentially, internal organs. While the disease itself is relatively uncommon, the manifestations are quite distinctive. In this issue of the Journal, we have a review of calciphylaxis from Richard Worth, as well as a preamble by Dr. Goodall and a case report by Kalaaji et al. illustrating the consequences of this rare but distinctive entity.

Telemedicine user Network: A Call for Interested Participants

Telemedicine, or the use of telecommunication technologies for the delivery of medical services, has been receiving increasing attention as a possible answer to the tyranny of distance and the scarcity of specialist resources in rural and remote Australia [1,2]. While internationally teleradiology and teledermatology are the most frequent users of the technology, in Australia it is psychiatry that has been quick to recognise the potential of telemedicine and to use it for the delivery of specialist psychiatric support. In Australia telepsychiatry is one of the most common forms of telemedicine with some of the most established and successful tele-psychiatry programmes in the world.

ADVANCED TELECOMMUNICATIONS TECHNOLOGIES IN RURAL COMMUNITIES: FACTORS AFFECTING USE

The role of telecommunications technologies in economic development has received increased focus in recent years. This study assesses the level of use of various telecommunications technologies by rural residents and identifies the community characteristics and individual attributes that are conducive to the adoption and use of these technologies. Data are from surveys of nearly 2,000 residents in 20 communities representing 6 states in the Midwest. The study findings reveal relatively high levels of use of a number of telecommunications technologies -- levels that may rival or even exceed urban rates. The findings also indicate that economic development that involves growth of the service sectors will likely increase the use of telecommunications technologies in rural areas.

The Diffusion of Telemedicine

Telemedicine, the use of telecommunication technologies in the delivery of health services, has literally burst upon the health care scene during this decade. However, no study to date has attempted anything further than a cursory examination of the diffusion of this innovation. This article argues that a linear approach is inadequate to understand the diffusion of decentralized and continually reinvented innovations such as telemedicine. Instead, a communicative focus which privileges the role of participatory conversation is used to examine and explain the invention, diffusion, and reinvention of telemedicine.

Collaborative teaching. A strategy for interactive telecourses.

The use of telecommunication technology in nursing education is increasing dramatically. Interactive television courses are effective and efficient in overcoming barriers of distance and access. Faculty members using the technology find many opportunities for innovation and creativity as courses are implemented. The authors describe a nursing graduate course offered collaboratively between two schools of nursing.

How is telepathology being used to improve patient care?

Telepathology, as a subspecialty of telemedicine, involves the use of telecommunications technologies to transmit images to distant sites for the purpose of communicating diagnostic information or for teaching. Recent advances in technology have greatly increased the feasibility of performing diagnosis by telepathology, but there are still significant obstacles to implementation. In this review, I will discuss the technologies and organizations involved in telepathology, with examples of current practice in the US and abroad.

Strategies for Reducing Energy Consumption and Emissions in Texas Transportation Sector

Texas is the nation's highest energy consumer, and it is the highest emitter of carbon dioxide. Texans consume 23 percent more energy per capita on transportation than the nation as a whole. The state's contribution to global climate stabilization and local environmental quality requires reexamination of its transportation system. In this study, four scenarios were constructed reflecting different energy strategies that Texas could pursue to address these issues. These alternative scenarios were measured against a reference scenario that reflects current trends in transport policy. The first alternative, a “roll-back” scenario, examined the consequences of revoking the current alternative fuels programs. Moderate, aggressive and visionary scenarios were also developed consisting of increasingly aggressive policies to reduce energy consumption and emissions. Included in the analyses are various transportation control measures, employee trip-reduction programs, broader use of telecommunications technologies, accelerated vehicle scrappage, “feebates,” mode shifts from automobile to various public transit alternatives and from truck to rail freight, and fuel taxes. The effects of these measures are discussed to identify the ones that have the greatest impact. Only if very aggressive policies are adopted—such as those modeled in the visionary scenario—will transport energy use and greenhouse gas emissions in Texas stabilize, let alone decline. The major stumbling block to implementing such an aggressive suite of transportation policies is the long time frame required for the impacts to come to fruition; the conclusion is political difficulties in taking a long-term perspective will need to be overcome.

Strategies for Reducing Energy Consumption and Emissions in Texas Transportation Sector

Texas is the nation's highest energy consumer, and it is the highest emitter of carbon dioxide. Texans consume 23 percent more energy per capita on transportation than the nation as a whole. The state's contribution to global climate stabilization and local environmental quality requires reexamination of its transportation system. In this study, four scenarios were constructed reflecting different energy strategies that Texas could pursue to address these issues. These alternative scenarios were measured against a reference scenario that reflects current trends in transport policy. The first alternative, a roll-back scenario, examined the consequences of revoking the current alternative fuels programs. Moderate, aggressive and visionary scenarios were also developed consisting of increasingly aggressive policies to reduce energy consumption and emissions. Included in the analyses are various transportation control measures, employee trip-reduction programs, broader use of telecommunications technologies...

Distance Education Applications in Rural Special Education: Where We've Been and Where We're Going

In the last decade, distance education applications in rural special education have expanded rapidly with the growing use of telecommunications technologies. Distance education has been used in direct service programs for students with special needs in rural school systems, in preservice personnel preparation programs, and in inservice training programs for teachers working in rural areas. State educational agencies, colleges and universities, and regional and local school districts all have implemented distance education efforts to support rural special education using a variety of new technologies. Distance education will continue to offer exciting opportunities in which the needs of pupils, preservice students, and inservice teachers will be met as telecommunications technologies become more widely available and organizational constraints are eliminated.

Health Care Financing Administration (HCFA) and reimbursement in telemedicine

Telemedicine has real potential to improve the availability of services and advice of medical specialists to primary care practitioners and their patients. Use of the term "telemedicine" for the purposes of this article will refer to two-way, interactive video systems over which medical consultation takes place. This does not include the use of telecommunications technology to transport still images, particularly radiologic images, from one site to another. We are quite aware that teleradiology and telepathology is already in common use in many sites. We are currently exploring the question of quality standards for teleradiology in addition to other forms of telemedicine.

Telemedicine Technology and Clinical Applications

TELEMEDICINE can be broadly defined as the use of telecommunications technologies to provide medical information and services. Although this definition includes medical uses of the telephone, facsimile, and distance education,<i>telemedicine</i>is increasingly being used as shorthand for remote electronic clinical consultation. Interest in the field has increased dramatically in the 1990s. State and federal allocations for telemedicine and related technologies are likely to exceed $100 million in fiscal 1994-1995.¹At least 13 federal agencies, including the US Department of Commerce, Health Care Financing Administration (HCFA), Office of Rural Health Policy, and US Department of Defense, have begun telemedicine research and demonstration programs. Many states are using their own resources to build state-of-the-art telemedicine systems, some with capital investments exceeding $50 million. Faith in this technology is not universal, however. Depending on one's viewpoint, telemedicine may be seen as a valuable tool for providing badly needed specialty care services

Telecommunication Technologies

Telecommunication technology enables multinational corporations (MNCs) to efficiently transfer the information necessary for coordinating global operations and remaining internationally competitive. However, few published studies have empirically examined the relationship between the organizational characteristics of MNCs and their use of telecommunication technologies. This study investigated whether use of, and investment in, telecommunication technologies by MNCs is related to firm and industry characteristics. Results from 105 U.S. MNCs reveal that the use of certain telecommunication technologies like teleconferencing networks and messaging systems differ significantly across firms with different degrees of international involvement and size; and, to a limited extent on industry characteristics. However, other technologies like inter-organizational systems and transmission media do not differ based on these characteristics. Moreover, the relative investment in such technologies as a whole differs in terms of a firm’s degree of international involvement and its industry type, but not in terms of its size. Reasons for these differences are explored. The study also highlights the growing importance of building information platforms for integrating organizational systems using a wide variety of computing and communication technologies. Implications for IS/telecommunication executives and researchers are discussed.

Organizational integration and the use of telecommunication technologies for internal links: an empirical investigation

The strategic potential of telecommunications is now widely acknowledged. Telecommunication links can be strategically deployed for internal integration as well as interorganizational systems. However, much of the research on telecommunication use has concentrated on interorganizational systems. Little empirical research has been conducted on internal use of telecommunication and its impact on organizational performance. This paper examines the effects of five key variables—environmental uncertainty, size of the organization, value chain information intensity, product information intensity, and information system (IS) maturity—on organizational integration, internal telecommunication use, and the impact of telecommunication links on organizational performance. Nine hypotheses concerning these relationships are proposed and empirically tested. Data for the study were collected from two mail surveys and some secondary sources. Results show that organizational integration is positively associated with both environmental uncertainty and the size of the organization. Internal telecommunication use was found to be positively related to product information intensity and IS maturity. Finally, the impact of telecommunication links on organizational performance was associated with IS maturity and the interaction of organizational integration and internal telecommunication use. Some implications for future research and practice are examined.

Book Reviews : Competing in Time: Using Telecommunications for Competitive Advantage Peter G. W. Keen Publisher: Ballinger Publishing Company, Cambridge, MA 01238 Year of Publication: 1986 Length: 235 pages Price: $14.95

Competing in Time: Using Telecommunications for Competitive Advantage, as the title implies, explores the technological components, organizational arrangements, and managerial policies necessary to employ telecommunications technology for competitive purposes. Essentially, the book views telecommunications technology as a significant feature of an organization's competitive arsenal. In common with other works on the relationship between information technology and organizational strategy (e.g., Ives &amp; Learmouth, 1984), Keen argues strongly for executives to investigate systematically the nature of telecommunications technology and the role it will play in changing markets and industrial competition. The book's analysis is rooted in the structural functionalist and managerial rationalist paradigms and provides a series of frameworks for management action. In doing so, Keen cautions against complacency. The major contribution of the book is in its clear and understandable primer on telecommunication technology and the frameworks for introducing organizational change and strategic redirection within organizations. The book provides a practical guide for managers who want to explore the competitive use of telecommunications technology.

Telemedicine: an historical perspective

The use of telecommunications technologies to help deliver medical services has increased over the past few decades and is now well accepted. Called telemedicine, it involves medical diagnosis and management with the participants (doctors, nurses and patients) in different places. The practice is not new and follows closely behind technological developments. This paper traces its use from the beginning of the twentieth century to the present day. Topics covered include the major telemedicine projects, their impact and the lessons learned from them. A summary of the characteristics of the various technologies is included.

Telemedicine in the USA: An overview

The authors examine the development and use of telecommunications technology in the provision of health services and in that context discuss policy formulation relating to technological innovation in health care. In the course of their examination, they consider the nature of the major challenges facing health care delivery that are amenable to responses in telecommunications technology, present selected findings from telemedicine studies in the light of these challenges, and offer a set of policy recommendations.

The patient trajectory: A modelling tool for planning rural telemedicine systems

The authors present an analytical tool developed and applied to plan for the use of telecommunications technology to link a non-physician health care provider in a rural satellite clinic to a central source of medical expertise. The principal result obtained is that narrowband technologies appear nearly two- thirds as effective as broadband technologies in averting patient travel.