ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.1

年代:1995

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.3

年代:1995

数据来源: MAL

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.5

年代:1995

数据来源: MAL

摘要:

OBJECTIVETo implement and evaluate a practice model for telepathology.METHODSA case triage practice model was devised in which general pathologists review all cases and refer them to subspecialists only when necessary. In 1993, the Arizona-International Telemedicine Network (AITN), a high-resolution static imaging telepathology diagnostic network, linking six sites to the University of Arizona in Tucson, began testing the model. Work flow through the network was analyzed, and diagnostic concordance was assessed in 150 surgical cases by comparing the diagnoses of the referring (transmitting) pathologists with diagnoses of the consulting (receiving) telepathologists as well as by comparing the referring pathologists' diagnoses with the consensus diagnoses reached by an independent review panel. Data analysis was controlled for subspecialty case type. Telepathologists had access to the referring pathologists' preliminary diagnoses, and the review panel had access to the original glass slides and the surgical pathology reports prior to rendering their respective diagnoses.RESULTSThe triage pathologist completed the telepathology consultation without the assistance of a subspecialty pathologist in 66% of the cases. The review panel examined the original glass slides from 134 cases by light microscopy. Concordance rates of the telepathologists' or review panel's diagnoses with the referring pathologists' diagnoses were not statistically different (93.1% v 83.6%, respectively;P>0.05).CONCLUSIONThe case triage model is suitable for the practice of telepathology. It significantly reduces the need for subspecialty pathologists. Static imaging telepathology is useful and reasonably efficient for rendering diagnostic opinions in the majority of referred cases. Tissue sampling limitations imposed by static imaging occasionally resulted in diagnostic errors.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.9

年代:1995

数据来源: MAL

摘要:

Issues related to the definition and evaluation of telemedicine are articulated as a basis for conducting theoretically based, empirically sound, and policy-relevant evaluation. This paper includes a proposed operational definition of telemedicine, a discussion of the role of telemedicine in the healthcare system and economic analysis of telemedicine, an analysis of the basic approaches and requirements for telemedicine evaluation, and an identification of basic issues for evaluation. Telemedicine is conceived of as an integrated system of healthcare delivery that employs telecommunications and computer technology as a substitute for face-to-face contact between provider and client. It has the potential for ameliorating seemingly intractable problems in healthcare such as limited access to care among segments in the population—especially the geographically disadvantaged—uneven quality of care, and cost inflation. Its true merit has yet to be determined by systematic empirical study. Such study should include a clear and precise identification of inputs and outputs and the nature of the relations between them, an assessment of the changes that might occur in the process of care as a consequence to telemedicine, and, ultimately, an evaluation of the effects of telemedicine on the healthcare system in terms of cost, quality, and accessibility. Several basic questions regarding the effects of telemedicine are posed as potential hypotheses for future resea

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.19

年代:1995

数据来源: MAL

摘要:

This paper discusses two conceptual models intended to facilitate research on the effects and effectiveness of telemedicine. The first is a conceptual framework to study the efficacy of telemedicine as a diagnostic medium. Using conditions that are carefully chosen to serve as indicators of effectiveness, we recommended the analysis of sensitivity and specificity to establish the accuracy of telemedicine in relation to conventional health care delivery. Suggested guidelines for interpretation of the results are discussed. The second model is a scheme for classification of telemedicine applications that is based on processes of care rather than on specialties or disorders. The purpose of this classification scheme is to facilitate research on such variables as costs, access, acceptability, and effects on practice patterns.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.31

年代:1995

数据来源: MAL

摘要:

OBJECTIVETo assess levels of satisfaction among rural cancer patients being seen for clinic visits by their remote university-based oncologist, using interactive videoconferencing (IAVC).METHODSA 12-item survey instrument assessing satisfaction with the patient—physician clinical interaction was administered to 39 cancer patients who were seen using IAVC. A similar survey, comprised of 9 of the 12 items used in the initial survey, was administered to 21 of these patients after a subsequent on-site clinical interaction. All items were responded to on a five-point Likert scale. Levels of satisfaction with the two consultation modes (IAVC mediated and on-site) were compared.RESULTSRelatively high levels of patient satisfaction with the telemedicine encounter were recorded both at the time of the initial IAVC-mediated clinical visit, as well as at the follow-up on-site visit. With one exception, for each of the survey items, both initially and on follow-up, mean score was above 3.0 (i.e., positive).CONCLUSIONThis small pilot study suggests that rural cancer patients may be satisfied with seeing their oncologist via telemedicine, at least on an occasional basis. Although the accrual numbers are too small to allow the results to be generalizable, the results suggest that patient acceptance is high enough to warrant further investigation of this modality in the care of rural cancer patients with limited access to cancer specialist

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.41

年代:1995

数据来源: MAL

摘要:

OBJECTIVEModern telecommunications and computer technologies enable the delivery of expert consultations and remote diagnoses that previously required transportation of patients or medical specialists. The purpose of this study was to determine whether patients are satisfied with one form of telemedicine consultation.METHODSA general practitioner was trained to perform endoscopie otorhinolaryngological examinations. After the training period, he examined patients at a local health center in Alta, 250 km from Tromso. Images from the endoscopie examination were transmitted to the otorhinolaryngologist at the University Hospital of Tromso for real-time consultation. Twenty-six patients, on a randomly selected day, were asked to complete a questionnaire after the tele-endoscopic examination. The questionnaire was returned anonymously by 24 of the patients.RESULTSAlthough patients interacted with the specialist only via videoconferencing, the results show that most (23/24) were satisfied with this type of consultation, and they reported more advantages than disadvantages. Twenty-one patients indicated that they would accept another tele-endoscopic consultation if they required examination by an otorhinolaryngologist in the future.CONCLUSIONAlthough the sample is limited, the results justify continued investigation of this and other types of telemedicine consultations.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.47

年代:1995

数据来源: MAL

摘要:

A large-scale teleradiology project is under way to link a Florida imaging center to the UCLA Department of Radiology. The initial goal is to provide Florida patients in a routine clinical practice environment with subspecialty consultation by academic radiologists. The plan then calls for the addition of other domestic and international sites. Technical issues in planning to establish the necessary teleradiology infrastructure include wide area network design, image compression, distributed archiving, and special viewing station features. Special emphasis is placed on archive design that makes intelligent use of information, such as triggering events from the radiological information system (RIS) for image prefetching and visual cues from photo-icons for full-size image retrieval. Concepts such as teleconsultation and remote procedure monitoring are aimed at providing the same level of services at distant sites that would be available in-house. This article highlights the system design parameters that must be considered to engineer a scalable distributed teleradiology system.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.53

年代:1995

数据来源: MAL

摘要:

In spite of the many advances in technology, complex problems must be addressed in establishing and maintaining a telemedicine system. Although most such systems are built around interactive videoconferencing (IAVC) equipment, clinical requirements dictate that these systems offer more than traditional IAVC systems. Input from system users should be obtained early in the design process to ensure the functionality necessary to achieve maximum utilization. Surprisingly, audio, rather than video, signals may present the greatest challenge to achieving consistent, high-quality videoconferencing encounters. Audio technical problems can be frustrating for patients and providers alike and can undermine user confidence in IAVC as a vehicle for healthcare delivery. A capability for remote access and control of components at distant sites seems essential to providing cost-effective and technically reliable service.

ISSN:1078-3024    

DOI:10.1089/tmj.1.1995.1.67

年代:1995

数据来源: MAL