Practical evaluation of telemedicine systems in the real world

Navy Telemedicine: A Review of Current and Emerging Research Models

With extended deployments of military telemedicine to remote, austere, and high-risk settings, there is a danger that implementation will outrun the research designed to assess it. A review of existing research evaluates current assessment models and indicates gaps around which future research may be designed. A review of models for evaluating telemedicine was conducted in September, 2001. Seven areas of assessment recurred that could be subsumed under the framework of "interoperability." A follow-up search was conducted during September, 2003, to ascertain the degree to which assessments of interoperability were being advocated. Although extensive deployments of telemedicine systems in high-risk settings make it imperative to know that human, organizational, and technical components are integrating productively (i.e., interoperating), current research does not evaluate telemedicine as a system. The structure and functioning of telemedicine systems should be assessed empirically and systemically to avoid subjective or limited assessments.

A needs assessment of the potential users of a South Pacific telehealth service

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure.

The effect of nuclear medicine telediagnosis on diagnostic pathways and management in rural and remote regions of Western Australia

Limited accessibility to certain medical imaging services in regional and rural centres has led to the use of alternative modalities, which may not be best practice or which require patients to travel considerable distances for diagnosis. Data collected over three years were examined to determine the clinical effect of nuclear medicine teleradiology (NMT) and its effect on diagnostic patterns for the investigation of cardiovascular disease, radio-occult musculoskeletal injury and oncology. In comparison with two other rural, non-NMT areas of similar demographic profile, there was a significant shift in the delivery of care in terms of diagnostic work-up. NMT input led to the detection of disease and a change to therapeutic management in 122 cases and eliminated the need to transfer patients to another facility for unnecessary and expensive examinations in 38 cases. While NMT is more costly than conventional nuclear medicine services, it permits faster access to specialist consultation, provides for better management and is likely to reduce overall health costs by reducing the volume of inappropriate tests and treatment practice.

Telemedicine and developing countries--successful implementation will require a shared approach

Telemedicine is often proposed as a solution to certain health-care problems in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of which only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educational in nature, and there has been little clinical experience. It seems probable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the organization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding whether scarce resources should be devoted to telemedicine in developing countries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.

Utilization and practical aspects of tele-ophthalmology between South Africa and the UK

A tele-ophthalmology service was established between a regional hospital in South Africa and a specialist eye hospital in the UK. The aim of the service was to provide secondary specialist advice in the diagnosis and treatment of difficult ophthalmology cases in South Africa. Over 12 months, the South African medical officers saw 16,458 ophthalmology patients and would have liked a second opinion in 5.7% of these cases. Case discussions conducted by videoconferencing at 384 kbit/s were carried out in 0.5% of cases. No significant connection problems were experienced during the 12-month study period. On 4% of occasions, the case discussions were conducted at a bandwidth of 256 kbit/s, but this did not affect the quality of the still images. The South African medical officers valued the educational benefits gained from the case discussions with the UK specialists.

Utility of real-time video teleconferencing in conducting family mental health sessions: two case reports

Due to the worldwide mission of the military, service members often find themselves isolated from their families and other important people in their lives. Historically, this has been especially problematic during periods of illness, as the isolation has precluded the meaningful involvement of families in patient care. With the increased availability of real-time video teleconferences (VTCs), however, providers may now gain access to family members. The Inpatient Psychiatry Department at Tripler has conducted therapeutic trials of family meetings using real time VTCs. These meetings are used to facilitate social support and mend family disconnections. The high clarity images offered through this system were instrumental in developing a virtual interactive social presence among the participants. Despite the potential benefits of VTC in gaining accessing to family support, there is little mention of such clinical family meetings in the medical literature. This report describes two case examples of the application of real-time family VTC in the management of mental illness.