Telemedicine journal : the official journal of the American Telemedicine Association最新文献

{"title":"Diagnostic accuracy and image quality using a digital camera for teledermatology.","authors":"E A Krupinski,&nbsp;B LeSueur,&nbsp;L Ellsworth,&nbsp;N Levine,&nbsp;R Hansen,&nbsp;N Silvis,&nbsp;P Sarantopoulos,&nbsp;P Hite,&nbsp;J Wurzel,&nbsp;R S Weinstein,&nbsp;A M Lopez","doi":"10.1089/107830299312005","DOIUrl":"https://doi.org/10.1089/107830299312005","url":null,"abstract":"<p><strong>Objective: </strong>The study was designed to evaluate the effectiveness of digital photography for dermatologic diagnoses and compare it with in-person diagnoses.</p><p><strong>Materials and methods: </strong>Patients referred for specialty consultations (n = 308) were recruited from a university dermatology clinic. Patients were examined in-person by one of three board-certified dermatologists who provided clinical diagnoses. Digital photos were obtained on all patients and were evaluated as computer images by a panel of dermatologists.</p><p><strong>Results: </strong>There was 83% concordance between in-person versus digital photo diagnoses. Intradermatologist concordance averaged 84%, and interdermatologist concordance averaged 81%. Decision confidence was rated as \"very definite\" to \"definite\" 62% of the time. Concordance with biopsy results was achieved in 76% of the cases. Image sharpness and color quality were rated \"good\" to \"excellent\" 83% and 93% of the time, respectively.</p><p><strong>Conclusion: </strong>Digital photography for store-and-forward teledermatology produces high-quality images and diagnostic concordance rates that compare favorably with in-person clinical diagnoses.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 3","pages":"257-63"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency analysis of a multi-specialty telemedicine service.","authors":"E Krupinski,&nbsp;P Webster,&nbsp;M Dolliver,&nbsp;R S Weinstein,&nbsp;A M Lopez","doi":"10.1089/107830299312014","DOIUrl":"https://doi.org/10.1089/107830299312014","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this project was to assess case turn-around times for store-and-forward and real-time video consultations in the Arizona Telemedicine Program.</p><p><strong>Materials and methods: </strong>Five components contributing to total case turn-around time were analyzed. Each parameter was submitted to statistical analysis and compared for store-and-forward and real-time sessions.</p><p><strong>Results: </strong>Turn-around for real-time are longer than for store-and-forward sessions. Real-time sessions take longer, from when the consulting clinician is contacted to the time the case is reviewed. This is compounded by the fact that real-time sessions sometimes need to be rescheduled. For both types of consults, the time to deliver the final report is the longest segment of the total turn-around time.</p><p><strong>Conclusion: </strong>Several factors contribute to case turn-around times. By identifying and analyzing each contributing factor, it is possible to revise consult protocols to improve efficiency.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 3","pages":"265-71"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interactive surrogate travel system.","authors":"I Nakajima,&nbsp;A Ichimura,&nbsp;H Juzoji,&nbsp;K Mugita","doi":"10.1089/107830299312159","DOIUrl":"https://doi.org/10.1089/107830299312159","url":null,"abstract":"<p><p>The Interactive Surrogate Travel (IST) system is based on the super-miniaturized system of virtual technology, Cave Automatic Virtual Environment (CAVE). Using bilateral virtual reality (VR-to-VR) communications, IST enables the testing of subjects via interactive communications. It appears that IST will find practical applications in the near future. We examined the utility of IST in medical treatment and psychiatric tests. Psychiatric symptoms reflect human pathos, which in turn are greatly influenced by culture. If these culture-bound symptoms can be adequately communicated between providers and clients of different cultures, we can develop effective telepsychiatric services across different societies and cultures. IST requires high-speed transmission and gigabyte circuits. A pilot project tested the utility of IST (through the use of optical fiber communications on earth) as a basis for experiments via the Gigabit satellite, to be launched in the year 2002.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 2","pages":"187-92"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleoncology in the Department of Defense: a tale of two systems.","authors":"D C Hunter,&nbsp;J E Brustrom,&nbsp;B J Goldsmith,&nbsp;L J Davis,&nbsp;M Carlos,&nbsp;E Ashley,&nbsp;G Gardner,&nbsp;I Gaal","doi":"10.1089/107830299312023","DOIUrl":"https://doi.org/10.1089/107830299312023","url":null,"abstract":"<p><p>Two telemedicine networks were developed for the purpose of conducting multidisciplinary oncology (\"teleoncology\") conferences. The infrastructure of each system differed: one system was Internet-based; the other was delivered via Integrated Services Digital Network (ISDN) lines. The purpose of this study was to describe the infrastructure and cost, consultative process, technical aspects, and conference format of the two teleoncology programs. The two systems' technical aspects, participant satisfaction with the systems, and conference participation were compared qualitatively. Assessment of the technical aspects of the systems suggested that each had distinct advantages. Survey results indicated that provider satisfaction with the technical and logistical aspects of each type of teleoncology conference was high. The present study may prove helpful for individuals who are considering implementing their own teleoncology programs.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 3","pages":"273-82"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A compression and transmission system of ultrasonic image sequence for telemedicine.","authors":"A Matani,&nbsp;H Yagi,&nbsp;T Umeda,&nbsp;K Chihara","doi":"10.1089/107830299311952","DOIUrl":"https://doi.org/10.1089/107830299311952","url":null,"abstract":"<p><strong>Objective: </strong>A newly developed compression and transmission system of ultrasound image sequence for telemedicine is proposed for transmitting ultrasonic image sequence in real time via IP-connected computers for telemedicine.</p><p><strong>Materials and methods: </strong>In the compression method, the characteristics of ultrasound images were taken into account. Only sound data were essential, and the histogram of the images had two narrow distributions around black-and-white areas. The sound data, therefore, were run length encoded and then transmitted. In the transmission, UDP/IP was employed with a time weight insertion among the packets so as not to overflow the data buffers of computers in this system to derive the maximum transmission performance up to the network capacity. The decompression method was the same as the generation of the sector scan images from the sound data, so that natural ultrasound image sequence could be obtained.</p><p><strong>Results: </strong>This system was evaluated by transmitting the ultrasonic image sequence of the heart via ISDN (1. 5 mbps). Although this system completely specialized in compression and transmission of the ultrasound sector scan image sequence, a relatively good performance in the frame rate and the image quality was achieved, compared with the previous systems (H.260, JPEG, and MPEG-1).</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 4","pages":"385-9"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299311952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21749942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine to Iowa's correctional facilities: initial clinical experience and assessment of program costs.","authors":"S Zollo,&nbsp;M Kienzle,&nbsp;P Loeffelholz,&nbsp;S Sebille","doi":"10.1089/107830299312041","DOIUrl":"https://doi.org/10.1089/107830299312041","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the costs and benefits of a prison telemedicine program for the institutions involved and to assess early provider satisfaction.</p><p><strong>Materials and methods: </strong>A survey of primary care and consulting providers from four prisons and an academic tertiary care facility in Iowa was conducted during the first year of telemedicine service linked with the state's correctional facilities, from March, 1997 to February, 1998. Data were evaluated from 247 completed telemedicine encounters. Cost estimates were made for (1) 1997 cost data for the 4,396 Iowa prisoners who were transported to The University of Iowa Hospitals and Clinics (UIHC) for their health care, and (2) the equipment, circuitry, and personnel costs necessary on both ends of the network to provide comparable telemedicine service to remote patients and providers. A formula for estimating the cost of implementing a telemedicine service is presented. It includes a projection for determining at what point the cost of the telemedicine visit approaches the average cost of an on-site visit (breakeven point). There was also a brief survey administered to presenting and consulting physicians to determine their overall satisfaction with the telemedicine system for diagnosis, treatment planning, and follow-up.</p><p><strong>Results: </strong>The average cost to the prisons for an on-site inmate visit to the University of Iowa Hospitals and Clinics (UIHC) was $115 during our study period, from March 1997 to February 1998. Using a formula that specifies a number of fixed and variable costs for implementing telemedicine, we were able to determine that the breakeven point for Iowa's correctional facilities would require 275 teleconsultations per year, per site (total of 1,575 consultations a year). Given the higher equipment investment at the UIHC hub, the breakeven point would be around 2,000 teleconsultations annually. Cost studies did not include medical care, which is assumed to be relatively comparable for both on-site and telemedicine interactions. Overall, referring physicians expressed a higher rate of satisfaction with telemedicine than specialists (4.19 to 3.45, respectively, on a scale of 1 to 5 - 5 representing the highest ranking). Both consulting and referring physicians ranked the quality of transmission the highest among all questions regarding satisfaction with the telemedicine system.</p><p><strong>Conclusions: </strong>No one should anticipate instantaneous cost-effectiveness with telemedicine. However, with careful planning, implementing a telemedicine program can be \"cost-acceptable\" initially. Telemedicine ultimately becomes cost-effective as the volume of teleconsults increases.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 3","pages":"291-301"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspects of human factors engineering in home telemedicine and telerehabilitation systems.","authors":"C E Lathan,&nbsp;A Kinsella,&nbsp;M J Rosen,&nbsp;J Winters,&nbsp;C Trepagnier","doi":"10.1089/107830299312131","DOIUrl":"https://doi.org/10.1089/107830299312131","url":null,"abstract":"<p><p>Human factors engineering and system design are critical elements in the newly developing field of telerehabilitation. Telerehabilitation is the remote delivery of rehabilitative services such as monitoring, training, and long-term care of persons with disabilities using telecommunications technology. This paper describes projects at the Rehabilitation Engineering Research Center (RERC) on Telerehabilitation in the context of three conceptual models: telecounseling and training, telemonitoring and assessment, and teletherapy. Issues pertaining to human factors engineering design are identified, and ongoing challenges are discussed.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 2","pages":"169-75"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299312131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21748925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine surgical telepathology in the Department of Veterans Affairs: experience-related improvements in pathologist performance in 2200 cases.","authors":"B E Dunn,&nbsp;H Choi,&nbsp;U A Almagro,&nbsp;D L Recla,&nbsp;E A Krupinski,&nbsp;R S Weinstein","doi":"10.1089/107830299311899","DOIUrl":"https://doi.org/10.1089/107830299311899","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether diagnostic concordance, case deferral rate, and/or time required to review slides changed significantly as telepathologists gained additional experience using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system on the 2000 cases following an initial 200 consecutive surgical cases, previously reported.</p><p><strong>Materials and methods: </strong>Gross surgical pathology specimens were prepared by specially trained personnel in Iron Mountain, Michigan. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain VAMC (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee, Wisconsin, VAMC (host site). For each case, a telepathologist had the option of either rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated (for nondeferred cases), the slides were transported to Milwaukee, where they were reexamined by the same pathologist, now using LM. When there was disagreement between the TP and LM diagnosis, a supplemental or revised report was issued, and the referring physician was notified by telephone immediately. All supplemental and revised reports were reviewed by a third pathologist in the group. The slides were then reviewed by the pathology group practice or, when there was no consensus, by the Armed Forces Institute of Pathology to establish a \"truth\" diagnosis. To determine changes in telepathologist performance with experience after the initial start-up of the service, their performance in handling 10 consecutive sets of 200 surgical pathology cases was analyzed.</p><p><strong>Results: </strong>Concordance rates for clinically significant TP and LM diagnoses were high for all 10 sets, ranging from 99% to 100%. Comparing the first set (Cases 201-400) with the last set (Cases 2001-2200), viewing times per case were reduced from 10.26 min to 3. 58 min. Viewing times per slide were reduced from 3.44 min to 1.13 min per slide, comparing the first and last sets. Case turnaround times (TAT) decreased from 2.46 days to < or =1.5 days.</p><p><strong>Conclusion: </strong>Thes results demonstrate that improvements in TP services occur over time as the result of additional experience using the TP system. The high diagnostic concordance and low rate of case deferral lend additional support to the proposal that a host-site pathologist using HDSF TP can substitute effectively for an on-site pathologist as a service provider.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 4","pages":"323-37"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299311899","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21749936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Live transmission of neonatal echocardiograms from underserved areas: accuracy, patient care, and cost.","authors":"C Sable,&nbsp;T Roca,&nbsp;J Gold,&nbsp;A Gutierrez,&nbsp;E Gulotta,&nbsp;W Culpepper","doi":"10.1089/107830299311907","DOIUrl":"https://doi.org/10.1089/107830299311907","url":null,"abstract":"<p><strong>Objective: </strong>Echocardiography is an important tool in the diagnosis and management of critically ill neonates. The authors hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from underserved areas would improve management, prevent unnecessary transports, enhance sonographer proficiency, and result in monetary savings.</p><p><strong>Materials and methods: </strong>Using personal computers capable of real-time transmission of echocardiograms over three integrated services digital network (ISDN) telephone lines, pediatric cardiologists interpreted echocardiograms, suggested views to sonographers, and made recommendations to neonatologists 200 miles away. Analyses of accuracy, management, echocardiogram quality, time, and costs were carried out prospectively.</p><p><strong>Results: </strong>Sixty studies were transmitted over 7 months. Indications for echocardiography were suspected congenital heart disease (n = 29), suspected patent ductus arteriosus (PDA) (n = 27), and hemodynamic instability (n = 4). Diagnoses were critical congenital heart disease (n = 4), noncritical heart disease (n = 8), PDA (n = 21), ventricular dysfunction (n = 5), persistent pulmonary hypertension (n = 3), and normal (n = 19). Videotape review confirmed all telemedicine interpretations. The echocardiogram led to immediate change in management in 25 cases (42%), and echocardiogram quality was improved in 53 studies (88%). Time from request to completion of echocardiography was 43+/-30 min. Monetary savings from five avoided transports exceeded all expenses.</p><p><strong>Conclusion: </strong>Live transmission of neonatal echocardiograms over three ISDN lines is diagnostic, improves patient care and echocardiography quality, and is cost effective.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 4","pages":"339-47"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299311907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21749937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sickle cell telemedicine and standard clinical encounters: a comparison of patient satisfaction.","authors":"K F Woods,&nbsp;A Kutlar,&nbsp;J A Johnson,&nbsp;J L Waller,&nbsp;R K Grigsby,&nbsp;M E Stachura,&nbsp;D W Rahn","doi":"10.1089/107830299311916","DOIUrl":"https://doi.org/10.1089/107830299311916","url":null,"abstract":"<p><strong>Objectives: </strong>To determine patient satisfaction with telemedicine encounters among adults with sickle cell disease and compare their scores with SCD patients who have standard medical encounters (as controls).</p><p><strong>Methods: </strong>Adults patients were recruited from a list of participants in sickle cell telemedicine clinics and prospectively at the time of clinic encounter. Patients were assigned to telemedicine or standard encounter groups. Demographic and pertinent clinical data were obtained for all subjects, and the Client Satisfaction Questionnaire (CSQ-8) was administered. Patients were also asked for open-ended comments regarding their satisfaction with the service. Their responses were recorded verbatim.</p><p><strong>Results: </strong>Patients with telemedicine (n = 60) and standard encounters (n = 60) were comparable in gender, genotype, education, employment, and mean number of sickle cell disease-related complications. Patients in the telemedicine group were younger (p< 0.005), more likely to have Medicaid insurance (p = 0.009), and more likely be taking hydroxyurea (p = 0.003) than patients in the control encounter group. Mean CSQ scores for the telemedicine group were high (total: 28.82+/-3.06), and there was no difference for any item between encounter groups (p = 0.389). Patients in the standard encounter group were more likely to provide positive open-ended comments regarding the encounter (95% vs. 70%; p = 0.001). Negative comments were generally in the area of confidentiality.</p><p><strong>Conclusions: </strong>While some patients expressed concern about confidentiality with telemedicine, the benefits of improved access and continuity of care were recognized, and overall satisfaction with telemedicine was high. These findings support the use of telemedicine as an acceptable health care delivery option for rural, underserved populations with sickle cell disease.</p>","PeriodicalId":79734,"journal":{"name":"Telemedicine journal : the official journal of the American Telemedicine Association","volume":"5 4","pages":"349-56"},"PeriodicalIF":0.0,"publicationDate":"1999-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/107830299311916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21749938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}