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Review of guidelines and standards for telemedicine
Abstract
We conducted a review to establish the range and scope of current telemedicine guidelines and standards. Published guidelines were identified by searching the Medline and Telemedicine Information Exchange (TIE) databases, and by performing a Google search using the term 'telemedicine guidelines'. Three types of guidelines were identified, namely clinical, operational and technical. Clinical guidelines included those for teleradiology, telepsychiatry, home telenursing, minor injuries telemedicine, surgical telemedicine, teledermatology and telepathology. Operational guidelines included those for email communication, Internet access and videoconferencing. Technical guidelines included those from the American Telemedicine Association and the US Office for the Advancement of Telehealth. The main standards relevant to telemedicine include those of the International Telecommunication Union and the DICOM standard. The scarcity of guidelines and standards suggests that telemedicine is not yet near to routine use. If an international telemedicine organization were to take responsibility for defining guidelines, under the direction of clinicians with appropriate telemedicine experience, this might speed up their development.
... In its purest form, telemedicine refers to treatment by a physician who is professionally responsible for providing this service remotely to a patient without face-to-face contact [9][10][11]. Other medical services that do not necessarily include direct interaction with a physician are generally referred to as telehealth or eHealth [12][13][14]. Telehealth includes health services in the form of various applications [15]. An operational definition of telemedicine stimulates the discussion of its role in the healthcare system and the global economy [16]. ...
... In addition to the telecommunications infrastructure, an important background factor for the development of telemedicine is the emergence of very influential organizations and initiatives focused on telemedicine, often with a global dimension, including the National Telemedicine Initiatives initiated by the National Medical Library (NLM) [53], the Telemedicine Information Exchange (TIE) [54], ATSP-Association of Telehealth Service Providers [55] and ATA-American Telemedicine Association [14,56,57]. ...
... Adapting to telemedicine solutions and constantly training physicians to use new telemedicine technologies for further development is necessary. Telemedicine networks [6,14,90,91] can provide services in the one-to-one (point-to-point), one-to-many (point-to-multipoint) and many-to-many (multipoint-to-multipoint) models. Initially, the telemedicine system was adopted to allow the patient to interact with a single physician, and the benefits cover many fields of teleradiology, teleneurology and others. ...
The progress in telemedicine can be observed globally and locally. Technological changes in telecommunications systems are intertwined with developments in telemedicine. The recent COVID-19 pandemic has expanded the potential of teleconsultations and telediagnosis solutions in all areas of medicine. This article presents: (1) an overview of milestones in the development of telecommunications systems that allow progress in telemedicine and (2) an analysis of the experiences of the last seven conferences of telemedicine and eHealth in Poland. The telemedicine and eHealth conferences have grown steadily in Poland since their inception in the late 1990s. An exemplary conference program content was used to assess the scientific maturity of the conference, measured by the indices of research dissemination and the impact of publications. The overview presents progress in selected areas of telemedicine, looking at local developments and broader changes. The growing interest in telemedicine in the world’s medical sciences is demonstrated by visibility metrics in Google Scholar, Pubmed, Scopus and Web of Science. National scientific events are assumed to raise interest in the population and influence the creation of general policies. As seen in the example of Poland, the activity of the scientific community gathered around the Polish Telemedicine Society led to novel legal acts that allowed the general practice of telemedicine during the SARS-CoV-2 pandemic. Local scientific conferences focusing on telemedicine research can be a catalyst for changes in attitudes and regulations and the preparation of recommendations for the practice of telemedicine and electronic health. On the basis of the results of this study, it can be concluded that the progress in telemedicine cannot be analyzed in isolation from the ubiquitous developments in technology and telecommunications. More research is needed to assess the cumulative impact of long-standing scientific conferences in telemedicine, as exemplified by the telemedicine and eHealth conferences in Poland.
... Information and communication technology is valuable for exchange of valid information for diagnosis, treatment, and prevention of diseases. [28][29][30] In this study, the use and effectiveness of telemedicine among doctors of a tertiary institution was evaluated and the mean age of the participants seen was 41 ± 9.9 years. An earlier similar study done in the same institution showed a mean age of 25.8 ± 5.4 years. ...
... [35] The remote delivery of health care to a patient through information technology has been used in improving quality and accessibility of medical care by allowing distant counseling, diagnosing, treating, and providing follow-up. [28,[36][37][38] In this present study, counseling stands out as the most treatment provided using telemedicine followed by review of medication. This is similar to the experience of Song et al. [11] where patients were counseled using online consulting clinic on their medical conditions. ...
... [43][44][45] The importance of legal and ethical considerations to ensure patient's privacy and confidentiality ensured and preserved has also been stressed. [27,28] Cross-border legalities are also concern in developing countries when communicating with health professionals in more than one country. [44] CONCLUSION This study established telemedicine as a useful tool in managing patients during the lockdown period. ...
Background: Telemedicine has been documented as a viable option in attending to patient’s
need where distance is a critical factor. The Federal Government of Nigeria on March 27, 2020,
imposed a total lockdown in Lagos state in order to curb the spread of the coronavirus disease
2019 (COVID‑19) pandemic. The restriction in movement prevented many patients from
attending their regular clinics and physical consultations. The aim of this study was to evaluate
the use and effectiveness of telemedicine among the hospital health professionals during the
lockdown period. Methods: This was an online cross‑sectional study among doctors at a
tertiary health facility in Lagos. Ethical approval was obtained from the institutional ethical
committee. A list of the telephone and WhatsApp contacts of doctors were obtained from
the hospital directory; the SurveyMonkey tool was used as an online web‑based structured
questionnaire for data collection. The information obtained was analyzed to find means and
averages. Results: A total of 104 doctors completed the survey. The proportion of participants
who used telemedicine was 93.3%, with the most commonly used telemedicine option being
phone call (27.1%) and WhatsApp video call (27.1%). The main management provided during
this period was counseling (56.6%). Seventy‑nine percent of the participants were satisfied with
the result of the management provided through telemedicine options, but the major concern
was that of ethical issues (36.2%). Majority (44.2%) of the respondents agree that telemedicine
was effective during the COVID‑19 lockdown period. There was no association found between
gender, age, designation, and perceived effectiveness of telemedicine by respondents in this
study (P = 0.88, 0.4, and 0.07, respectively). Conclusion: Telemedicine was found to be a
useful tool for effective patient’s management during the lockdown period although there
exist ethical concerns. The formulation of policies guiding its use will ensure the security of
information and patient’s confidentiality.Background: Telemedicine has been documented as a viable option in attending to patient’s
need where distance is a critical factor. The Federal Government of Nigeria on March 27, 2020,
imposed a total lockdown in Lagos state in order to curb the spread of the coronavirus disease
2019 (COVID‑19) pandemic. The restriction in movement prevented many patients from
attending their regular clinics and physical consultations. The aim of this study was to evaluate
the use and effectiveness of telemedicine among the hospital health professionals during the
lockdown period. Methods: This was an online cross‑sectional study among doctors at a
tertiary health facility in Lagos. Ethical approval was obtained from the institutional ethical
committee. A list of the telephone and WhatsApp contacts of doctors were obtained from
the hospital directory; the SurveyMonkey tool was used as an online web‑based structured
questionnaire for data collection. The information obtained was analyzed to find means and
averages. Results: A total of 104 doctors completed the survey. The proportion of participants
who used telemedicine was 93.3%, with the most commonly used telemedicine option being
phone call (27.1%) and WhatsApp video call (27.1%). The main management provided during
this period was counseling (56.6%). Seventy‑nine percent of the participants were satisfied with
the result of the management provided through telemedicine options, but the major concern
was that of ethical issues (36.2%). Majority (44.2%) of the respondents agree that telemedicine
was effective during the COVID‑19 lockdown period. There was no association found between
gender, age, designation, and perceived effectiveness of telemedicine by respondents in this
study (P = 0.88, 0.4, and 0.07, respectively). Conclusion: Telemedicine was found to be a
useful tool for effective patient’s management during the lockdown period although there
exist ethical concerns. The formulation of policies guiding its use will ensure the security of
information and patient’s confidentiality.
... There are currently no formalised standards or guidelines that exists for the telemedicine sector of healthcare. The literature points loosely to guidelines and standards which can be followed when implementing telemedicine systems as stated by Loane & Wooten [3]. Standards may be defined as technical compliance with rigid and defined criteria whilst guidelines indicate adherence to recommended and flexible practices. ...
... Through research conducted by Loane & Wootton [3], three types of guidelines were identified; clinical, operational and technical. Guidelines tend to focus on various types of telemedicine, as such they are often specific to a sub-speciality within the medical field [4]. ...
... General guidelines regarding telemedicine as a whole are concerned with ethical issues. These issues cover categories such as doctor-patient relationships, consent and communication and security and confidentiality (Loane & Wootton, 2002;Jack, 2008) For the purposes of this article, guidelines for best practices have been adapted from the mHealth (mobile health) sector. This is due to the lack of established guidelines and standards for telemedicine in an intensive care setting. ...
Patient care and monitoring in the intensive care unit (ICU) is a complex process, which requires a team of highly specialized nursing staff to provide the necessary one-on-one assistance. Specialist nurses in South Africa are scarce which often lead to shortfalls in patient monitoring. Doctors rely on reports by the nursing staff to provide a drug management schedule and patient care instructions. In many cases, issues that arise with the patient slip by unnoticed due to the shortage of nurses and are onlyaddressed by the doctor at a later stage. Many of these issues can be prevented if the doctor has access to a platform, which will allow for continuous monitoring of the patient's vital sign parameters.
This project involved the design of a telemedicine system for monitoring intensive care patients as well as the development of a prototype of the system. This telemedicine system directly assists medical professionals in remotely monitoring intensive care patients while helping to ease the burden on a limited nursing staff with the primary aim of increasing the consistency, efficiency and quality of patient care.
The Systems Development Life Cycle in conjunction with Agile Methodologies was used to design the system and build a prototype. Systems modelling tools were employed to analyse the current process and design the telemedicine system. The design of the system included modelling of the processes to be executed (using data flow diagrams) and the databases to be implemented (using an extended entity relationship diagram and a data dictionary). A non-operational prototype was further developed to test the feasibility of the design.
... Telemedicine has been chosen as the topic for this research because, although it is still in its early stage, it is gaining considerable interest due to the use of many new telemedicine applications as its services expand. Much of the previous research in the area referred to situations in which the potential of telemedicine is undermined by such concerns as policies (Anderson, 2000;Courtright, 2004;Darkins and Cary, 2000;Fidler, 2001;Fujimoto et al., 2000;Scott et al., 2002), security and privacy (Blobel and Roger-Frace, 2001;Gilbert, 1997;Kumekawa et al., 1997a;Magennis and Mitchell, 1996;Sandberg, 1995;Stanberry, 2006;Tulu and Chatterjee, 2003), standards (Kumekawa et al., 1997b;Loane and Wootton 2002;Wachter, 2000;Williams and Singh, 1996), ICT infrastructure (Carbajal and Honea, 1999;Collen, 1999;, lack of interest or resistance of physicians (Chau and Hu 2001, 2002a, 2002bCroteau and Vieru, 2002;Kifle et al., 2005b;Friedma, 1997), reimbursement (Brady, 2005;Doolittle et al., 2004;Johnston et al., 2004;Whitten, 2002;Whitten et al., 2000a), organization and environment (Aas, 2001;Hu et al., 2000;Iacovou, 1995;Rogers, 1983;Whitten and Allen, 1995) and cultural situations (Hofstede, 2000;Leidner and Kayworth, 2006;McCoy et al., 2003a;Straub et al., 2002 ). ...
... Many telemedicine publications address the need to develop security and standards polices, but very little literature about privacy, confidentiality, standards, and security is actually to be found in SSA countries. Standards and security policies are new and relatively few in developing countries (Casmir, 2005) In industrialized countries, telemedicine technology brings with it concerns about privacy, security, and confidentiality for a long period, more than security issues in other sectors (Loane and Wootton, 2002;Nagle, 1995). These issues necessitate initiating a process to address risks specifically associated with their application to Information Systems (telemedicine). ...
... However, telemedicine is different from other technologies in terms of both continuity and standards. Considering the wide range of technologies and applications used, standards need to be developed for the management of a national committee for telemedicine (Berler et al., 2006;Loane and Wootton, 2002). Continuity is needed for the delivery of a reliable, efficient, safe and quality level of healthcare, as well as a reliable telephone and electrical power system. ...
... As a thumb rule, prescribing medicines for chronic diseases (such as asthma, diabetes or hypertension) should be avoided during teleconsultation, unless it is an add-on or refill of an earlier prescription obtained during an in-person consultation less than six months ago. If a prescription for chronic diseases is to be issued, then the teleconsultation should be done strictly via video [8]. These guidelines are in place to monitor the patient's progress before issuing them the prescriptions. ...
... These guidelines are in place to monitor the patient's progress before issuing them the prescriptions. A prescription can be sent through any electronic medium such as email, WhatsApp etc. as a photo/scan / digital copy of a signed prescription or an e-prescription [8]. Some practical suggestions based on the study's findings are Doctors must establish a good rapport with patients and their attenders They must practice good communication skills in daily clinical practice, treating a teleconsultation like a direct physical consultation Effective time management & solving network issues before each call must be ensured. ...
Background: A doctor's communication and interpersonal skills encompass gathering information to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. While face-to-face consultations have been the norm, tele-consultations and enrolment in telemedicine apps have become necessary. Tele-consultations have been on the rise significantly during the COVID-19 lockdown. This study aims to assess the barriers to tele-consultations among doctors in Chennai. Methodology: This study uses a cross-sectional design to assess the barriers to tele-consultations among doctors in Chennai using a convenience sampling technique. Data was entered in Microsoft Excel and analyzed using SPSS software version 23. Results: 81.6% of the participants feel that teleconsultations have reduced face-to-face consultations. Only about 6% of the study participants preferred teleconsultation in the future. About a third of the doctors in the study could not treat/manage chronically ill patients through teleconsultations. About 70% of the doctors could follow up with their patients through telecommunication, but 70% failed to follow up. Conclusion: From this study, we conclude that only about 6% of the study participants would prefer teleconsultation in the future. Treating medical emergencies and assessment of surgical patients were considered as top 2 important barriers in this study with about half of them facing this barrier during their telecommunication.
... So, commonly the telemedicine industry uses high-level health care guidelines and technical standards developed for various technology sectors including multimedia conferencing, information technology, data communications, and security. In this context, basically, three types of guidelines can be identified: clinical, operational and technical (Loane and Wootton, 2002). Clinical guidelines address specific medical specialities, e.g., teleradiology or teledermatology. ...
... All these initiatives demonstrate the need for tailoring quality guidelines to the specific characteristics and needs in the telemedicine context. However, the existing guidelines and standards are still not comprehensive for the development of routine telemedicine products or services (Loane and Wootton, 2002). Especially software process capability/maturity models, which guide the assessment and improvement of a maturing software process for the development and maintenance of telemedicine systems and services are, basically, non-existent. ...
Developing high-quality asynchronous store-and-forward telemedicine systems (ASFTSs) remains a challenge. However, there is no accepted understanding as to what are the important quality characteristics for this type of software system and/or what defines a mature software process for producing high-quality ASTFSs. Through adopting a multi-step research methodology, we define a quality model for ASFTSs indicating relevant quality characteristics and their priority for this specific type of software system based upon ISO/IEC 25010. We, then, propose an extended software process capability/maturity model based on ISO/IEC 15504 and ISO/IEC 12207 to meet these particular quality requirements. The resulting model can be used to both guide the development and the evaluation of such systems. We expect that the availability of such a customized model will facilitate the development of high-quality ASFTSs, reducing related risks and improving the quality of telemedicine services.
... The above raises an important aspect of sensitizing telemedicine professionals and their users to cultural issues where the adoption of standard definitions and protocols could help overcome these issues [16][17][18][19][20][21][22]. Notwithstanding that in 2002, Loane raised concerns regarding the scarcity of guidelines and standards in telemedicine, the selected studies did not assess the issue [23]. ...
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
... 45 There is therefore the need for formulation of standard guidelines. [44][45][51][52][53] In spite of the pandemic, there is the need to maintain the delivery of safe, effective health care services and this would require the establishment of telemedicine guidelines and standards. 49 There is also a need for training of health-care providers, commitment to regular funding, and long-term sustenance plans to be made by the stakeholders. ...
Background: COVID-19 remains a major public health threat globally, and has challenged healthcare systems and services including oral health Objective: This study examines the key public health challenges posed by the COVID-19 pandemic in low resource settings. While healthcare services are learning to cope with the COVID-19 pandemic, dental care services, in particular restorative dental practice have been adversely impacted because of the closeness of caregivers to the patient’s mouth as well as the generation of aerosols during most restorative procedures. This presents a challenge for low-and-middle-income countries (LMICs) such as Nigeria where weak and poor governance structures characterize healthcare systems in addition to paucity of economic resources. Another challenge in the form of COVID-19 conspiracy theories has threatened to undermine public health efforts designed to control the pandemic. Conclusion: The implementation of optimal guidelines and safety protocols for effective COVID -19 infection prevention and control is a major challenge for restorative dental care practice in low resource settings owing to paucity of key material resources and inappropriate behaviour associated with lingering doubts about COVID-19 reality among the majority of the populace. The Safer Aerosol-Free Emergent Dentistry concept offers a viable practical approach for restorative dental practice in LMICs during and in the post COVID-19 pandemic era. There is a need to deploy all resources, human and material, in the education and enlightenment of the populace regarding the reality of COVID-19. , COVID-19 pandemic
... W pierwszej kolumnie Tabeli 1 przedstawiono przeglądową klasyfikację zagadnień telemedycyny i e-zdrowia. Istnieje wiele opracowań przeglądowych zawierającychklasyfikacje zagadnień podlegających regulacjom w telemedycynie[38,39,40,41]. Jako podstawę analizy wybrano omówioną wcześniej klasyfikację zaproponowaną przez Intan Sabrina i Defi, w artykule opublikowanym w styczniu 2021[41]. ...
... In the absence of professional standards and guidelines, the clinical information obtained online may be incomplete, resulting in missed diagnosis or misjudgment. Some guidelines for telemedicine are available in some disciplines (9), and experts in pediatric nephrology in China have started to focus on the exploration and creation of clinical practice guidelines for online medical consultation systems, providing a model for other disciplines (10,11). In addition, the construction of a structured online medical information system is warranted, to facilitate quality control of online medicine and the application and management of big medical data. ...
Background:
Telemedicine is becoming an emerging innovative supplement to the traditional medical system in China. In the present study, we described the rapid implementation of the telemedicine in pediatrics during the coronavirus disease 2019 (COVID-19) outbreak and explored its value in response to the demand for pediatric medical services during the epidemic.
Methods:
An Internet-based platform for multidisciplinary online medical consultation was established on February 8, 2020, by a national children's medical center in China. The medical data of the traditional hospital visits and novel online visits from the first two months (February 8 to March 31) after the establishment of the platform were collected and analyzed. The demographic features, changes in the disease spectrum and characteristics of online medical services were described.
Results:
The total number of visits was significantly lower (by 75.3%) than that of in the same period in the previous year. The disease spectrum was different with a significant decrease of >95% in the number of patients with infectious or contagious diseases. The online visits accounted for 14.7% of all visits. Online patients came from all over the country, covering 91% of the administrative regions of China, and the largest proportion of inquiries were for infants (33.7%) (P<0.01). The response rate of experts to requests for online consultations was 100%. During the study period, 266 experts from 25 pediatric specialties completed 12,318 effective consultations, proving different degrees of online supplementation for various specialties (4.3-168.4%). Online consultations mainly addressed two types of problems: (I) accessibility of the traditional hospital visits and (II) consultations regarding an illness. Data from pediatric nephrology showed that 96% of the patients with stable chronic kidney disease successfully received follow-up medication adjustment guidance through the online platform.
Conclusions:
The traditional hospital medical services have been affected by the COVID-19 outbreak. The multidisciplinary online medical consultation system is a strategy to actively respond to the medical needs of children during unique periods.
... 4,5,[49][50][51][52][53] Psychiatry and chronic disease follow-up consults rely less on physical examinations and are suitable for telemedicine. The current suitability criteria will need to be slowly expanded in future, along with standards and guidelines 54 to be more permissive so that VC will benefit more than the 10% we encountered in the pilot study. Although there is limited use for general practice VC, portable and digitally connected instruments via a smartphone can harness otoscopy, 55 flexible laryngoscopy 56,57 and fundoscopy 58-60 for specialist teleconsults. ...
Introduction:
The Singapore Armed Forces (SAF) recognises the potential benefits and looks to harnessing telemedicine for primary health care services. In this prospective self-controlled pilot study, we aimed to evaluate the safety, efficiency and user satisfaction outcomes of virtual care (VC) at a military medical centre.
Methods:
Out of 320 patients seen during the study period, 28 were enrolled in this study and underwent on-premises VC, comprising digital symptoms collection and telemedicine in addition to the usual in-person physician consultation. Safety outcomes were measured based on the diagnostic concordance between physicians. Efficiency was measured based on consultation times, and user satisfaction was evaluated using a standard questionnaire.
Results:
There was a higher caseload of both upper respiratory infections and dermatological conditions in our population, in which telemedicine performed well. In terms of safety, telemedicine achieved a mean diagnostic concordance of 92.8% compared to in-person consultations. In terms of efficiency, consultation times were 26.2% - or 2 minutes and 15 seconds - shorter on average with telemedicine (p = 0.0488). User satisfaction was favourable, with 85.5% of patients satisfied with the VC experience.
Discussion:
This study has been invaluable in showing that on-premises telemedicine is a safe, efficient and effective means to extend and increase our surge capacity for primary health care. Our results have given us reasonable confidence to explore a larger-scale implementation in our network of military medical centres in the future.
... Some of these clinical guidelines have been developed by professional organizations to provide up-to-date quality and specific evidence to assist clinicians in making decisions, better treatment options, and designing optimal care pathways for patients with breast cancer (19,20). Therefore, it seems appropriate to employ the relevant identified clinical guidelines when a telemedicine system is used (21). ...
Background: Teleoncology refers to the use of telemedicine for remotely providing multiple specialized services in clinical oncology processes, including screening, diagnosis, treatment planning, consultation, supportive care, pathology, surgery, and follow-up services. Objectives: The aim of this study was to identify the required data elements and elicitation of requirements for developing a telemedicine system that aims at providing treatment plans for patients with breast cancer. Methods: In this study, the required data elements for the teleoncology system were identified through both the investigation of clinical guidelines and review of patients' medical records. Identified data elements were determined by breast cancer specialists through the questionnaire. Besides, an interview method was applied to elicit the requirements of this system. Results: The identified data elements were categorized into 20 groups (e.g., clinical data, breast physical examinations, pathological results, tests, imaging results, etc.). From the 182 data elements included within the questionnaire, 125 were recognized to be necessary (n = 32, 100%). The lowest mean percentage were observed in magnesium blood test (Mg) (n = 21, 65.63%) and protein test (Pr) (n = 21, 65.63%). Other data elements with a minimum mean of 71.87% and a maximum mean of 100% were recognized necessary. In general, 2 major themes, 9 categories, and 45 related sub-categories were extracted from analyzing the findings of the interviews related to the system requirements. Conclusions: The findings of the present study can be used as a basis for developing teleoncology systems that aim at providing treatment plans for patients with breast cancer.
... Telemedicine refers to a practice of prescribing, health education, and counseling through the utilization of communication technology. 1 The Telemedicine Practice Guidelines recognize text and audio modes of consultation. 2 Usually, may find it extremely difficult to arrange for, train personnel for, or derive satisfaction from, offering video-based services. ...
Telemedicine has been quickly and widely been adopted as a feasible and effective health care delivery method during the COVID-19 pandemic. Though telemedicine was being practised in India, the clinical practice guidelines, and the operational guidelines for telepsychiatry were published in 2020. Telemedicine is of particular relevance to psychiatry and can be an effective tool for the delivery of psychiatric services than thought otherwise.
The existing guidelines do not elaborate on telemedicine through email. This article aims to fill these lacunae by offering guidelines for telepsychiatry through email.
... World health Organization (WHO) and government bodies impose policies on standardizing medical transmission. According to [2,3], telemedicine communication is vulnerable on communication channel and henceforth a set of standardization is proposed for establishing telecommunication. ...
Tele-Medical data communication via general purpose networking protocols and techniques are major set-back under low line channels and adequate resources such as bandwidth, frequency, power spectrum for transmission and impacts the Quality of Data (QoD) on transmission line. In this paper, a heterogeneous multi-input multi-out (MIMO) based dynamic user clustering technique is proposed and the protocol is termed as TelMED. The proposed technique introduces machine learning terminology on networking nodes for dynamic user grouping and classification resulting in the formation of clusters with reflective similarity indexing ratio. The dynamic clustered users of TelMED protocol are allocated with resources for the transmission of Multi-Objective Optimized Medical datasets resulting in creation of virtual telemedicine networking environment with a given typical network space. The technique is designed on clustered user grouping size of maximum 32 users for reliable results over a fixed networking space and optimized resources for low line transmission channels of rural or remote networks. The resulting technique proves an efficiency of 92.3% over dynamic MIMO user grouping.
... 6,7] . Par ailleurs, l'usage de la télémédecine est encadré par de multiples recommandations [8] de sociétés savantes ou gouvernementales depuis plusieurs années, comme celles de l'American Telemedicine Association [9] . Technique L'évaluation de la surface cutanée brûlée est aujourd'hui facilitée, autant pour l'adulte que l'enfant, en utilisant des applications sur téléphone portable telle E-burn [10] ( Figures 1 et 2 ) Aujourd'hui, les systèmes de télémédecine sont simples et fi ables, par l'usage d'un téléphone portable et l'envoi de fl ux multimodaux, synchrones ou non (audio, vidéo, photo), et de qualité [11] . ...
The evaluation of the patient and his burned body surface is one of the fundamental prerequisites for his care on site as well as for the initiation of his care journey. New tools such as the E-burn application and telemedicine improve this assessment and remote medical assistance management by reducing the risk of under-sorting or over-sorting. Telemedicine limits inappropriate secondary inter-hospital transfers and the resulting increased mortality. It is carried out according to standards that ensure safety and confidentiality for the patient and caregivers.
Copyright © 2019. Publié par Elsevier Masson SAS.
... In Telemedicine, important medical information is exchanged between two medical experts or between client and medical experts [22]. There are two types of interaction occur in telemedicine one is the pre-recorded or asynchronous class in which transmission of images is done by using email, internet access etc. and another one is real-time or synchronous class in which telephone or video conferencing are used [17]. ...
... However, communication in FTF and telemedicine consultations differs significantly, partly due to the presence of a number of health-care professionals from diverse levels of care in the consultation and partly because of the presence of new technology (22). To optimize the use of telemedicine, new normative standards of behavior and interpersonal communication need to be developed to support important functions of the medical consultation, such as history taking, physical examination, diagnosis, and decision-making (30). There is a long list of arguments in the literature whether the available video link technologies facilitate or hinder communication between distant sites (31,32), and several researchers have called for more and rigorous studies examining the effect of telemedicine on patient-provider communication, relations, and outcomes (22,29,32). ...
This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
... The e-Health system, when developed, has to secure the following functionality and comply with following main requirements: -Information exchange between the systems performing e-Health functions and between the participants of the e-Health system (e.g. health care institutions); -Nationwide functionality of accessibility to registries; -Implementation of the following unified principles and procedures for full functionality of the e-Health system: access to private, medical, administrative and other System information; nationwide identification of patients, health care specialists and administrative staff; and system interfaces and internal information exchange and information exchange with external objects; and -Support of the development, implementation and usage of the standards and regulations relevant to e-Health System (Loane, and Wootton, 2002). This is a challenging time for the public health in the UAE, and particularly for the fragile health of populations in developing countries. ...
... There is evidence in the literature showing that telemedicine is useful in developing countries for educational and clinical purposes, and in remote areas there is a chronic lack of specialists. 1 Dermatology relies on visual clues that are easily captured by imaging technologies, making it ideally suited for this care model known as teledermatology (TD). 2 Numerous TD-related studies have demonstrated high levels of concordance in diagnosis and management plans compared with face-to-face consultation. 3 This raised interest in TD in addition to its ability to provide specialized consultations for remote communities and for primary health care facilities lacking dermatologists. 4 Moreover, it has been shown that TD affords educational benefits to primary care providers and junior dermatologists, and it cuts down the costs of medical service through eliminating the necessity of the patient or physician traveling. ...
Introduction:
The paucity of studies evaluating teledermatology (TD) in developing countries was the impetus behind conducting this work. We aimed to evaluate the feasibility and reliability of TD in remote areas where medical facilities and consultant dermatologists are not available, through measurement of diagnostic concordance rates between face-to-face diagnosis and store-and-forward (SAF) TD diagnosis.
Methods:
A total of 600 patients with dermatological ailments who attended Abshway Hospital were recruited into the study, examined by an on-site dermatology resident, and offered a diagnosis. The clinical images and patients' history were collected and transferred (through the Dropbox application) to two remote consultant dermatologists. The reliability of the three physicians' agreement rates was assessed.
Results:
Diagnostic agreement rates between the face-to-face dermatologist and the two teledermatologists were 86.7% and 87% respectively. Of the cases, 97% had complete or partial agreement and 81.3% of cases showed complete agreement between the three physicians. The reliability of the three physicians' agreement rates was assessed statistically using Cohen's kappa coefficient (κ) and this showed a range of 0.46-0.52.
Conclusion:
This study might aid in enhancing the utilization of this tool in our country, especially in remote areas with a lack of a proper dermatological service. The simplicity and low cost of the adopted technique might facilitate its use over large sectors. It opens the door for gaining the benefit of this technology in other aspects such as teaching and monitoring health care providers.
... The encrypted tunnel provides a secure path for network applications and requires no changes to the application (www.csm.oml.gov). Store-and-forward, including its simplest form (e-mail), will require similar protection [24]. HIPAA affects the privacy of health information in all formats (eg, paper, electronic, fax, voice) and therefore has likely already been addressed in many otolaryngology practices. ...
... A comprehensive review of guidelines and standards for telemedicine (Loane and Wootton, 2002) concluded that many telemedicine reports cite the need to develop guidelines, but few actually Computer-Based Technology and Caregiving for Older Adults exist in practice, particularly at an international level. Furthermore, the report states, "the formulation of such guidelines does not necessarily guarantee improved patient outcomes, and continual monitoring of the effect of guidelines will be required." ...
... The application collected and saved data from the questionnaire and sends it to a server via a secure wireless Sana Mobile platform. It was then analyzed by The system performance and data transmission times were also analyzed, as low data transmission rates are known to be an important issue in resource poor areas (29,30) . However, Brazil has a very fa vorable geography for data transmission and even remote areas have good cellphone coverage. ...
To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient's condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation.
A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of São Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. RESULTS were then compared to the gold standard diagnosis provided at the hospital.
The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations.
This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.
... Regarding the technological aspects and standards of telemedicine (13) , there has been variation in the Tele-ICU model across several studies (14)(15)(16)(17)(18)(19) . In terms of the intensity of Tele-ICU coverage, some centers have used an active Tele-ICU model. ...
Health information technology (IT) has become an important part of current medical practice, especially in critical care services. One significant advance is the use of telemedicine which was initiated in Thailand nearly two decades ago. Telemedicine is also used in the intensive care unit or what has been termed the "Tele-ICU". It has evolved as an alternate paradigm linking the intensivist and critical care specialists to critically ill patients in remote areas. In this article, the author has reviewed the evidence of health IT on critical care services in Thailand, focusing on telemedicine, as well as the concept of the 'Tele-ICU' and its challenges. These factors may assist intensivists to reach more critically ill patients in remote areas.
... Psychiatrists do not agree on clinical criteria for telepsychiatry (Aas 2001). In general we find a need for developing criteria and guidelines for telemedicine (Loane & Wootton 2002;Stanberry 2006). Information about telemedicine work can be stored in computers and payment occurs when decided criteria are satisfied. ...
... Existem três formas distintas de interação via telemedicina: a forma síncrona ou interativa (sistemas em tempo real), a forma assíncrona (sistemas de armazenamento e envio) e a híbrida 5,6,7 . ...
PURPOSE: The purpose of this study was to evaluate the efficacy of teleophthalmology as an auxiliary approach for diagnosis of infectious and inflammatory ocular diseases and to study the main problems associated with the conclusion reached by consultation. METHODS: Two hundred and thirty three 35 mm slides (retinography or biomicroscopy photos) were digitalized and stored in a Compact Disc to be later analyzed in a computer monitor by two consultants, specialists in uveitis. The consultants filled out a form and a questionnaire, indicating the diagnosis and probable treatment for the analyzed cases also the main difficulties found to reach a conclusion of the consultation. The Kappa statistic, an assessment of the change-corrected agreement (reproducibility) among consultants, was calculated. Kappa values of > 0.7 indicated excellent agreement; values between 0.4 and 0.7 indicated fair to good agreement and values of
The passage of the Universal Health Care Law in 2019 offers an opportunity to scale up the implementation of telehealth solutions. However, to fully realize the integration of telehealth in healthcare provider networks (HCPNs), an evaluation framework and tool is indispensable. This paper proposes a telehealth solution assessment tool (TSAT), which can potentially be used to assess programs on telehealth both in the public and private sectors.
The development of TSAT proceeded in two phases. In the first phase, the authors reviewed existing telehealth implementation models and frameworks. The result of this review, more broadly, emphasized the value of simultaneously considering factors related to technology, telehealth users, organizational priorities, financing, policies, and the broader socio-economic environment in defining the readiness of the telehealth implementers and the maturity of the implementation.
Following the first phase, the authors then reviewed available national and international telehealth implementation guidelines that reflect, in many ways, the lessons found in the conceptual review of telehealth implementation models and frameworks. The authors' review highlight the following concepts (i.e., indicators) in assessing telehealth solution implementation: Leadership and governance, Standards, Infrastructure, Financing, Health workforce, Prioritizing underserved areas, Healthcare provider network, Coordination and continuity of care, People-oriented healthcare, Public-private coordination in HCPN, and Monitoring of outcomes. While the current version of the TSAT has limitations, the authors argue that this paper has advanced this assessment tool's conceptual component, which can be adopted by policy makers and program implementers as guide.
In this chapter, I review the literature of guidelines, frameworks and theories used in telehealth service implementation, operation and evaluation. Guidelines contain instructions written by health professionals on what to do or what not to do when operating telehealth services. Through examining such guidelines, I uncovered some of the processes and practices applied to telehealth services. Policymakers advocate visions for improvement of healthcare access and increased system efficiency arising from telehealth services. Providers seek to ensure that healthcare is effective and safe. Issues raised in this literature about the application of telehealth services include aspects such as quality and safety, responsibilities of clinicians and ethical considerations such as privacy and confidentiality and management of liability or risk. Hitherto, the norms of medical practice have been place-based. This chapter charts how these norms have responded to the introduction of separated care using telehealth services.
Increase in population is causing further increase in senior population which is the major cost factor in health care. Health information technology has been cited as one of the tools to help reduce this cost for this group of patients. Therefore, our study explores strategies and policies helping reduce the barriers for the adoption of a health information technology – teleconsultation – for senior population. The objective of this research is to develop a model to evaluate alternative solutions to increase the adoption of Remote Patient Monitoring (RPM) for the senior population. The research leverages hierarchical decision modeling (HDM) to build a hierarchical multi criteria assessment model. The model elements are derived through literature and validated by an expert panel.
Telemedicine has seen a rapid expansion lately, with virtual visits ushering in telediagnosis. Given the shift in the interpersonal and technical aspects of communications in a virtual visit, it is prudent to understand its effect on the patient-provider relationships. A range of interpersonal and communication skills can be utilized during telemedicine consultations in establishing relationships, and reaching a diagnosis. We propose a construct of "webside manner," a structured approach to ensure the core elements of bedside etiquette are translated into the virtual encounter. This approach entails the totality of any interpersonal exchange on a virtual platform, to ensure a clinician's presence, empathy and compassion is translated through this medium.
The COVID-19 pandemic has obstructed the classical practices of psychological assessment and intervention via face-to-face interaction. Patients and all health professionals have been forced to isolate and become innovative to continue receiving and providing exceptional healthcare services while minimizing the risk of exposure to, or transmission of, COVID-19.
Aim
This document is proposed initially as a guide to the extraordinary implementation of telepsychology in the context of the COVID-19 pandemic and to extend its implementation to use fundamentally as the main guideline for telepsychology services in Saudi Arabia and other Arabic communities.
Method
A professional task force representing different areas of professional psychology reviewed, summarized, and documented methods, policies, procedures, and other resources to ensure that the recommendations and evidence reviews were valid and consistent with best practices.
Results
The practice of telepsychology involves the consideration of legal and professional requirements. This paper provides a guideline and recommendations for procedural changes that are necessary to address psychological services as we transition to telepsychology, as well as elucidates and demonstrates practical telepsychology frameworks, procedures, and proper recommendations for the provision of services during COVID-19. It adds a focused examination and discussion related to factors that could influence the telemedicine guideline, such as culture, religion, legal matters, and how clinical psychologists could expand their telepsychology practice during COVID-19 and after, seeking to produce broadly applicable guidelines for the practice of telepsychology. Professional steps in practical telemedicine were illustrated in tables and examples.
Conclusion
Telepsychology is not a luxury or a temporary response. Rather, it should be considered part of a proactive governance model to secure a continuity of mental health care services. Arabic communities could benefit from this guideline to telepsychology as an essential protocol for providing mental health services during and after the COVID-19 pandemic.
Advances in telemedicine technologies have offered clinicians greater levels of real-time guidance and technical assistance for diagnoses, monitoring, operations or interventions from colleagues based in remote locations. The topic includes the use of videoconferencing, mentorship during surgical procedures, or machine-to-machine communication to process data from one location by programmes running in another. This edited book presents a variety of technologies with applications in telemedicine, originating from the fields of biomedical sensors, wireless sensor networking, computer-aided diagnosis methods, signal and image processing and analysis, automation and control, virtual and augmented reality, multivariate analysis, and data acquisition devices. The Internet of Medical Things (IoMT), surgical robots, telemonitoring, and teleoperation systems are also explored, as well as the associated security and privacy concerns in this field. Topics covered include critical factors in the development, implementation and evaluation of telemedicine; surgical tele-mentoring; technologies in medical information processing; recent advances of signal/image processing techniques in healthcare; a real-time ECG processing platform for telemedicine applications; data mining in telemedicine; social work and tele-mental health services for rural and remote communities; applying telemedicine to social work practice and education; advanced telemedicine systems for remote healthcare monitoring; the impact of tone-mapping operators and viewing devices on visual quality of experience of colour and grey-scale HDR images; modelling the relationships between changes in EEG features and subjective quality of HDR images; IoMT and healthcare delivery in chronic diseases; and transform domain robust watermarking method using Riesz wavelet transform for medical data security and privacy. Demographic shifts in populations trigger opportunities for innovations in e-Health, m-Health, precision and personalized medicine, robotics, sensing, the Internet of Things, cloud computing, Big Data, Software Defined Networks, and network function virtualization. The integration of these technologies is however associated with many technological, ethical, legal, and social issues. This book series aims to disseminate recent advances in the e-Health Technology field to help improve healthcare and wellbeing.
Objective
To report on results from a new tele-urology pathway for managing hematuria consults, including a survey of patient attitudes and satisfaction with such a program. Recent guideline changes have relaxed the definition of microscopic hematuria and may have significantly increased the number of hematuria evaluations.
Materials and Methods
Patients referred to the Atlanta Veterans Administration Medical Center with hematuria were scheduled for a tele-urology clinic encounter utilizing a telephone call to obtain hematuria-related clinical information via a standardized algorithm. At subsequent cystoscopy, patients were evaluated with a 29-question survey regarding overall acceptance and satisfaction of the clinic (8 questions) and impact factors (21 questions).
Results
One hundred fifty veterans participated in the survey. Median time from consult request to appointment was 12 days and thereafter to cystoscopy was 16 days. Patients reported high acceptance and overall satisfaction with telephone evaluation; mean scores exceeded 9 out of 10 for overall satisfaction, efficiency, convenience, friendliness, care quality, understandability, privacy, and professionalism. When presented with a choice, nearly all patients (98%) preferred telephone-based encounters to face-to-face clinic visits. Underlying negative factors responsible for patients' preferences included transportation-related issues (97%) and logistical clinic issues (65%). Ninety-seven percent of patients reported high-quality evaluation.
Conclusion
Patients report high acceptance and satisfaction with telephone clinics as a mechanism for expedited hematuria evaluation, primarily due to avoiding barriers related to transportation and clinical operations, as well as a perceived high quality of evaluation. Telephone appointments have potential to positively impact healthcare access and productivity.
It is of vital importance to clarify legal issues and ensure that teledermatology services are performed within the relevant health care legislation. Information processing in telemedicine and e-health must ensure confi dentiality, privacy and be secured by information security regimes.
While the heart disease patient perception and needs for telecare services has been extensively investigated, the patient safety is relatively unexplored. The research focuses on randomly sampled 500 patients diagnosed with heart disease located in New Taipei City. This study extended
Technology Acceptance Model (TAM) to explain and predict heart disease patient acceptance of telecare technology. It was examined using structural equation model. The result shows that patient perceived patient safety had an indirect effect, through the mediating perceived usefulness, on intention
to use, with a resulting total effect of 0.028. Perceived ease of use had an indirect effect, through the mediating perceived usefulness, on intention to use, with a resulting total effect of 0.124. Perceived usefulness had a direct as well as an indirect effect, through the mediating attitude,
on intention to use, with a resulting total effect of 0.426. In order to raise individual intentions to use a technology, it is important to encourage a positive attitude about patient safety toward using the technology. Emphasizing devising effective means to communicate the clinical utility
(patient safety) of the technology to heart disease patients should be the high priority task for the healthcare organization management.
Telemedicine can be applied in two major settings: high end setting such as space station and transatlantic robotic surgery or to bring better quality care to developing regions of the world. We aimed to develop a low cost, flexible, open source telemedicine platform, HaceTTele. We have experienced some difficulties as well as certain facilities regarding open source technology and we discuss these in this paper.
A revised version of Ohio Psychological Association's Telepsychology Guidelines originally adopted in April 2008.
DICOM standard (Digital Imaging and Communication in Medicine) is a non-proprietary protocol for the medical exchange information. DICOM represents and defines the information of real world objects like a magnetic resonance image (MRI), a computerized axial tomography and a digital medical photography (VL photographic), through information object definitions called IOD. The present article describes a methodology to represent the IOD of a digital medical photography of visible light (VL Photographic Image) through XML Schema documents. These documents were used in the creation and validation of XML documents to represent digital medical photographies compiling clinical and technical information for their later implementation in a teledermatology application.
We analysed the most highly cited articles in two specialist telemedicine journals, the Journal of Telemedicine and Telecare (JTT) and Telemedicine Journal and E-health (TJEH). Articles were extracted from the Science Citation Index Expanded in September 2012. A total of 1810 articles were listed for the JTT and 1550 for TJEH. In the JTT, the mean number of citations was 43 (SD 13); in TJEH the mean number of citations was 30 (SD 11). The average number of citations for the JTT was significantly higher than for TJEH (P < 0.001). In each journal, the 60 articles which had the most citations were identified as highly cited publications (HCPs). The 60 HCPs in the JTT originated from 16 countries; the 60 HCPs in TJEH originated from 10 countries. Considering both journals together, the majority of HCPs came from the US, UK, Australia and Canada. In the JTT, the mean number of authors for each HCP was 4.6 (SD = 3.1); in TJEH, the mean number of authors for each HCP was 4.5 (SD = 2.3). There was no difference between the two journals (P = 0.84) and the characteristics of the HCPs published in the JTT and TJEH were broadly similar. Although HCPs are not a direct method of measuring quality, they are an indicator of the scientific impact of the articles.
Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations.
In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes.
Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients’ history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients’ history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes.
It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.
Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.
The organizational consequences of telemedicine have frequently been mentioned in the telemedicine community, but there are few empirical studies. A study was therefore carried out of what happens in organizations when telemedicine is implemented. Qualitative interviews were undertaken with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. Almost all respondents reported numerous organizational changes, some important. Changes in work processes were the most common. Examples of the organizational consequences of telemedicine were organizational restructuring, new organizational units, changed mechanisms for internal coordination, different flows of patients through the health-care system, improved coordination of care, new job descriptions, relocation of the place of work, employment of personnel living far away from the workplace, effects on employees not directly involved in telemedicine, sharing of experiences, minor staffing changes, clinical teamwork independent of co-location, administrative meetings arranged by telemedicine, merger of organizations independent of location, less travel by staff (and patients), a possible beneficial effect on the quality of care, and limited opposition to the adoption of the technology. Telemedicine may be important in the future organization of the disciplines studied and in health-care generally. The infrastructure of electronic networks may play an important role for organizations as the volume of telemedicine activity increases and economies of scale are realized.
Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.
We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384 kbit/s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 degrees. The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.
Telemedicine has evolved to become an integral part of the South Australian Rural and Remote Mental Health Service. The resulting telemedicine service is one of only a few telepsychiatry services around the world that is firmly embedded in normal clinical practice and can be regarded as sustainable. The telepsychiatry service has been operational in Adelaide since January 1994 and more than 2000 clinical consultations have been performed since that time. In contrast to other telepsychiatry systems internationally, more than 80% of the usage of the South Australian system has been for clinical purposes. The benefits and limitations of telepsychiatry are reviewed, as are factors that have affected the success of the project.
A retrospective review of patient records comparing clinical outcomes of patients seen by interactive television (IATV) and those seen in person was carried out to determine whether IATV reduced the quality of psychiatric care. A Global Assessment of Functioning (GAF) score was determined for each patient in both the study and control groups at the initial visit, and at subsequent visits. Forty-nine patients with either major depression or schizoaffective disorder were studied. No significant difference was found in the percentage change in GAF scores between the two groups, which suggests that clinical outcomes were not affected by the use of IATV. Patients seen by IATV had a greater attendance rate and follow-up visits took less than half the time compared with in-person visits, indicating that IATV was an acceptable and efficient method of providing psychiatric services.
Protocols are essential in a nurse-led minor injuries unit. They allow the identification of agreed steps that need to occur in a sequential and timely fashion for a given process. Protocols fall into four categories: (1) for the management of specific clinical conditions; (2) for ordering and interpreting radiographs; (3) for prescribing and dispensing medications; (4) for conducting the teleconsultation itself. Current examples are given which offer a clear demonstration of the types of protocol that are in use in the UK for minor injuries telemedicine and how they are presented.