Technical dependability of obstetric ultrasound transmission via ISDN

Outcomes and Methods in Telemedicine Evaluation

One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.

Telemedical support using real-time ultrasonography and endoscopy images

We developed a telecommunications apparatus (TMS-6101, NIHON KOHDEN WELLNESS CORPORATION, Tokyo, Japan) and evaluated its clinical utility as a telemedical support system. It is capable of transmitting on a real-time basis such vital signs as blood pressure, arterial O2 saturation and ECG recordings, which are measured at bedside using the Life-Mate monitor (NIHON KOHDEN WELLNESS Co.). It is also capable of transmitting moving video-camera pictures in real time. In this study we assessed its application for telemedical supports with particular emphasis on ultrasonography and endoscopy images since reports of such applications are lacking. Employing this system, several kinds of technically demanding endoscopic procedures were supported successfully under the supervision of at least one off-site specialist physician. The system proved to be a very useful medical resource, since it facilitated high quality medical care and specialist consultation at any location without those specialists traveling to the scene.