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State of the Art Telemedicine/Telehealth
Abstract
The symposium was organized into a progressive series of formal presentations, panel discussions, workshops, and a summary plenary session. Workshop participants were assigned on the basis of their respective interest and expertise, and included those who made formal presentations and participated in panel discussions on the selected topics. Reports were derived for the following topics: network organizational models, technology development and application, clinical applications, public health, disease surveillance and personal health, education, and telemedicine diffusion. It is hoped that the symposium's organization, focus, and agenda make it unique and, more importantly, make this report critical to a well-conceived advancement of telemedicine based on the best information available. More specifically, the symposium had several related objectives. The first was to convene an international gathering based on invited position papers prepared and presented by leading experts in the field of telemedicine. A second objective involved examining and assessing the "state-of-the-art" of telemedicine. Based on these first two objectives, the third objective was to achieve a consensus on the major issues facing the development and diffusion of telemedicine. The fourth and, perhaps most critical, objective was to propose recommendations for research agendas and action plans directed toward moving telemedicine forward in the service of improving health and medical care at regional, national, and international levels.
The telemedicine and medical remote monitoring in particular, today represents an effective solution to the health professional shortcomings facing to the increasing older population. In addition to the comfort of being at home, this system decreases the cost of long hospitalization. The proposed system achieves the home medical telesurveillance by means of microphones and medical sensors to detect a distress situation. This system is designed for elderly people at home or for the patient with chronic illness. The experimental apartment is equipped with medical sensors (tensiometer, oxymeter, balance, etc.), infrared position sensors, and acoustic sensors (1 microphone/room). The originality of the system comes from the replacement of the video surveillance with a sound surveillance. The sound analysis system is divided in two stages: firstly, the detection/extraction of the sounds is operated and secondly, a classification of these sounds in known classes takes place. A wavelet-based algorithm with good performance when applied in noisy environments is proposed. The acoustical classification step uses a Gaussian Mixture Models to classify the sounds according to the 7 predefined classes. The detection algorithm allows an equal error rate of 0% for the signal to noise ratio superior or equal to 10 dB and 4% for the 0 dB. The proposed system coupled with a classical medical telesurveillance system will bring extra information needed for the reliability of the global system.
To evaluate an Internet-based telemedicine program designed to reduce the costs of care, to provide enhanced medical, informational, and emotional support to families of very low birth weight (VLBW) infants during and after their neonatal intensive care unit (NICU) stay.
Baby CareLink is a multifaceted telemedicine program that incorporates videoconferencing and World Wide Web (WWW) technologies to enhance interactions between families, staff, and community providers. The videoconferencing module allows virtual visits and distance learning from a family's home during an infant's hospitalization as well as virtual house calls and remote monitoring after discharge. Baby CareLink's WWW site contains information on issues that confront these families. In addition, its security architecture allows efficient and confidential sharing of patient-based data and communications among authorized hospital and community users.
A randomized trial of Baby CareLink was conducted in a cohort of VLBW infants born between November 1997 and April 1999. Eligible infants were randomized within 10 days of birth. Families of intervention group infants were given access to the Baby CareLink telemedicine application. A multimedia computer with WWW browser and videoconferencing equipment was installed in their home within 3 weeks of birth. The control group received care as usually practiced in this NICU. Quality of care was assessed using a standardized family satisfaction survey administered after discharge. In addition, the effect of Baby CareLink on hospital length of stay as well as family visitation and interactions with infant and staff were measured.
Of the 176 VLBW infants admitted during the study period, 30 control and 26 study patients were enrolled. The groups were similar in patient and family characteristics as well as rates of inpatient morbidity. The CareLink group reported higher overall quality of care. Families in the CareLink group reported significantly fewer problems with the overall quality of care received by their family (mean problem score: 3% vs 13%). In addition, CareLink families also reported greater satisfaction with the unit's physical environment and visitation policies (mean problem score: 13% vs 50%). The frequency of family visits, telephone calls to the NICU, and holding of the infant did not differ between groups. The duration of hospitalization until ultimate discharge home was similar in the 2 groups (68.5 +/- 28.3 vs 70.6 +/- 35.6 days). Among infants born weighing <1000 g (n = 31) there was a tendency toward shorter lengths of stay (77.4 +/- 26.2 vs 93.1 +/- 35.6 days). All infants in the CareLink group were discharged directly to home whereas 6/30 (20%) of control infants were transferred to community hospitals before ultimate discharge home.
CareLink significantly improves family satisfaction with inpatient VLBW care and definitively lowers costs associated with hospital to hospital transfer. Our data suggest the use of telemedicine and the Internet support the educational and emotional needs of families facilitating earlier discharge to home of VLBW infants. We believe that further extension of the Baby CareLink model to the postdischarge period will significantly improve the coordination and efficiency of care.
The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We report on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists.
A total of 129 diabetic inpatients were screened for diabetic retinopathy by slit-lamp biomicroscopy performed by an ophthalmologist and by two-field 50 degrees non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the reference method for detection of diabetic retinopathy. Slit-lamp biomicroscopy was the reference method for the detection of macular edema.
The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sight-threatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-threatening diabetic retinopathy. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading reports. An additional seven reports referred the patients for further investigation because of concurrent diabetic retinopathy.
Telescreening for diabetic retinopathy by an assessment of two-field 50 degrees non-stereo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed.
This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns accounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments.
“ What is new and significant must always be connected with old roots, the truly vital roots that are chosen with great care from the ones that merely survive .” Bela Bartok
The explicit use of health information technology (HIT) to enable threshold improvements in the delivery of health care services is beginning to emerge as a serious objective for health care organisations and systems. Many readers who are very knowledgeable of quality measurement are relatively uninformed about health informatics and the converse is also true. It is for these readers that this paper is written. Specifically, the objective of this review of HIT in the UK and USA will focus upon salient features, deployment, and related policy issues. Particular attention will be given to areas in which threshold improvements in quality now exist or are likely to be forthcoming. Comments are organised to relate at the level of the individual, teams or microsystems, organisations, and larger systems, including national information infrastructures.
Health care information technology is a broader phenomenon than it is deep. Over the past 30 years the information technology revolution developed slowly from roots in Turing's military intelligence machines of World War II to DARPA and the present day Internet when the pace picked up. While the telephone took 40 years to reach 10 million people, it only took 4–5 years for the Internet to reach 100 million. Despite successes being clouded by hype and hope, the Internet consumer health market is projected to reach $1.7 billion by 2003.
Randomised trials now confirm the early evidence that health care quality can be significantly improved through health informatics.1 Evidence of improved access and cost effectiveness should soon follow.2 Over the next two decades e-health could deliver patient, provider, and planner/manager interactions for all aspects of health …
A 3-D display system for medical imaging by computer-generated integral photography (IP) has been developed. Real 3-D images are generated from 3-D medical images and displayed by simple structure. Each point in 3-D space is reconstructed by the convergence of rays from many pixels on the computer display through the lens array. Only the coordinate of the best point is computed for each pixel on the display. The locations of images projected within 40mm from the display were found to be less than 2.0mm in error. Projected images could be observed with motion parallax within 10 degrees from the front of the display.
This paper empirically examines the relationship between HMO market share and the diffusion of magnetic resonance imaging (MRI) equipment. Across markets, increases in HMO market share are associated with slower diffusion of MRI into hospitals between 1983 and 1993, and with substantially lower overall MRI availability in the mid- and later 1990s. High managed care areas also had markedly lower rates of MRI procedure use. These results suggest that technology adoption in health care can respond to changes in financial and other incentives associated with managed care, which may have implications for health care costs and patient welfare.