bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of case-based pricing on length of stay for common surgical procedures
Authors: Mikkola Hennamari , Häkkinen Unto
Published: October 2002

Objectives: Finland's state subsidy reform of 1993 encouraged hospital districts to adopt case-based pricing of their services. The revenues of most hospitals have since depended on the volume and price of services produced. Information on the incentive effects of this method of funding is needed to further develop pricing systems in public hospitals. This study focuses on identifying the effects of case-based prices on length of stay (LOS) for lumbar discectomies and hip and knee replacements.

Method: The effects of case-based pricing were estimated using count data models. Data from 1994-1998 on 17 767 lumbar disc patients and 19 039 hip and 15 174 knee replacement patients treated in public hospitals were used. Patient characteristics and hospital and hospital district characteristics, as well as accessibility of care and the time trend were taken into account in the modelling.

Results: Use of case-based pricing shortened the LOS by 0.49 days for hip replacements and 0.55 days for knee replacements, but did not shorten LOS for lumbar discectomies.

Conclusions: The use of case-based prices would make possible about 400 extra knee and hip replacements yearly, resources (e.g. orthopaedists) permitting. The effects of hospital pricing reform on LOS in Finland compared with countries such as the USA and Sweden have been relatively modest. Overall, measures to reduce differences in clinical practice would probably have a greater impact on LOS or the number of cases treated than case-based pricing.
Policy and profession: Elite perspectives on redefining general practice in Australia and England
Authors: Lewis Jenny
Published: October 2002

Objectives

To understand how general (family) practice is being redefined and is redefining itself, from the perspective of policy elites, and to build an analytical framework.

Methods

Politicians, senior bureaucrats and executives of professional organisations were interviewed (1998-2000) about the impact of general practice reforms on the profession. The information gathered was thematically coded and used to advance an understanding of profession from an elite perspective.

Results

Four main aspects of profession were discussed by interviewees. These were cultural authority, profession&s authority, social authority and professional autonomy. The elites interviewed reported a potential challenge to the cultural authority of general practice in both countries through moves to redefine it as something broader. The profession&s authority was seen as having shifted, especially in Australia where new forms of representation for the profession have been established. Medicine was viewed variously as having its social authority challenged, maintained, or extended in the granting of expertise in health, and professional autonomy was regarded as having been restructured through policy change.

Conclusions

Policy elites perceive that the authority and autonomy of general practitioners has changed but reform has not resulted in generalised losses for the profession. The framework developedhere, which employed aspects of profession that arose as major themes, proved useful for examining the redefinition of profession and for generating policy insights in regard to possibilities for change and likely impacts.
Reform and counter reform: How sustainable is New Zealand&s latest health system restructuring?
Authors: Cumming Jackie , Mays Nicholas
Published: October 2002

New Zealand's health care sector has undergone almost continual restructuring since the early 1980s. In the latest set of reforms, 21 district health boards (DHBs) have been established with responsibility for promoting health, purchasing services for their populations and delivering publicly owned health services. Boards will be governed by a mix of elected and appointed members, will be responsible for arranging the delivery of primary and community health services, and will own and run public hospitals and related facilities.

We clarify the differences and continuities between earlier reforms and the 2000/01 structures, as well as the current reforms’ potential strengths and weaknesses. The paper discusses whether the DHB model was the only feasible option for restructuring and whether the dynamics of the new system may lead to further changes, particularly on the purchaser side of the system. Given that DHBs face potential conflict between their purchasing and provision roles, and given the potential advantages that primary care organisations may have as purchasers, we conclude that it is possible that all or part of the purchasing function of DHBs might eventually shift to primary care organisations, leaving the DHBs as hospital-based provider organisations.
Variations in practice admission rates: the policy relevance of regression standardisation
Authors: Ferguson Brian , Gravelle Hugh , Dusheiko Mark , Sutton Matthew , Johns Rachel
Published: October 2002

Objectives: To explore variations in general practice admission rates, comparing standardisation by regression with direct standardisation of the data to identify explained and unexplained variation.

Methods: Data from hospital episode statistics and the attribution dataset on 8048 cataract admissions from 109 practices in an English health district (North Yorkshire) between 1995 and 1998. Multiple regression was used to estimate the effect of practice characteristics, socio-economic factors, waiting times and distance on practice admission rates. Rankings of practices by the residuals from the regression were compared with rankings by directly standardised admission rates.

Results: The regression model yielded intuitively plausible results and explained 35% of the cross-practice variation in directly standardised admission rates. Standardisation by regression, compared with direct standardisation, made as least as much difference to the ranking of practices as direct standardisation compared with crude admission rates. Regression standardisation suggested that 10 practices not identified as 'unusual' by comparison of their rates to the district mean were in fact 'unusual', and that six practices identified as unusual by comparison with the district mean were not unusual once allowing for the explanatory factors used in the regression model.

Conclusions: Given the increasing importance of systematic performance assessment to support quality improvement, care must be taken when interpreting variations in health care activity even after conventional standardisation of the data. If significant variations are detected, regression analysis can assist in explaining some of it, which is the starting point in informing discussions about whether variations are justified or unjustified.
A randomized controlled trial to assess the clinical effectiveness of both realtime and store-and-forward teledermatology compared with conventional care
Authors: Loane M A , Bloomer S E , Corbett R , Eedy D J , Hicks N , Lotery H E , Mathews C , Paisley J , Steele K , Wootton R
Published: October 2002

The clinical effectiveness of realtime teledermatology, store-and-forward teledermatology and conventional outpatient dermatological care were evaluated in a randomized control trial. A total of 204 patients took part – 102 patients were randomized to the realtime teledermatology consultation, 96 of whose cases were also referred using a store-and-forward technique, and 102 to the conventional outpatient consultation. There were no differences in the reported clinical outcomes of realtime teledermatology and conventional dermatology. Of those randomized to the realtime teledermatology consultation, 46% required at least one subsequent hospital appointment compared with 45% of those randomized to the conventional outpatient consultation. In contrast, the dermatologist requested a subsequent hospital appointment for 69% of those seen by store-and-forward teledermatology. An analysis of costs showed that realtime teledermatology was clinically feasible but more expensive than conventional care, while the store-and-forward teledermatology consultation was less expensive but its clinical usefulness was limited. Sensitivity analysis indicated that realtime teledermatology was as economical as conventional care when less artificial assumptions were made about equipment utilization, costs and travel distances to hospital.
Telemedicine use in two nurse-led minor injuries units
Authors: Salmon S , Brint G , Marshall D , Bradley A
Published: October 2002

Telemedicine links were established between two nurse-led minor injuries units (MIUs) located in community hospitals and an accident and emergency department in a district general hospital. Telemedicine consultations were logged. During the first year of operation, telemedicine use was surprisingly constant, there being an average of 36 calls a month from one MIU and 16 from the other. Possible reasons for this include the clinical protocols under which nurses could refer patients to hospital. The average duration of teleconsultations was 3.5 min. Although the MIUs dealt with roughly similar numbers of patients, approximately 600–700 per month, the proportion for whom telemedicine was used was very different, at 5.2% and 2.3%.
An Internet-based telediagnosis system for Chinese medicine
Authors: Al-Taei Mohammad Kassab , Pan Yunhe , Lu Dong Ming
Published: October 2002

The Internet is becoming an increasingly popular medium for communication and is being used more and more for telemedicine. Telediagnosis is one of the most developed components of telemedicine. We have designed and partly implemented a telediagnostic system, using the Internet as the means of communication, to enhance access to specialists and health providers in Chinese medicine.
An assessment of the potential effect of a teledermatology system
Authors: Taylor Paul
Published: October 2002

The potential effect of a commercial teledermatology system was assessed. The system allowed general practitioners to send dermatologists a set of digital images, accompanied by a short patient history. Patients were seen, in the normal way, by consultant dermatologists. The system was then used to capture a set of images. These were viewed by two dermatologists, 13 months later. Reasonably high levels of agreement were found between the dermatologist seeing the patient and the dermatologist using the telemedicine system (77%). The two dermatologists were also asked to indicate whether, had the system been in use, the patient would have been seen urgently or routinely, or whether the general practitioner would have been advised that an outpatient appointment was not required. The results showed that fewer patients would have been called for urgent appointments (32% compared with 64%) and that 31% of cases could have been managed by the general practitioner. Assuming that the introduction of the system would have had no effect on the overall number of referrals, nor on the number of follow-up appointments, these figures suggest that the total number of appointments could be cut by 13%. It took approximately an hour to view 20 cases and it would be necessary to devote one consultant session a week to viewing images. This system would therefore not lead to significant savings, nor reduce the waiting list for outpatient appointments. The idea would have potential if the review of images could be made as easy as the triage of referral letters.
Telemedicine services to a county jail
Authors: Zaylor Charles , Whitten Pamela , Kingsley Charles
Published: October 2002

Local and county jails rarely offer telepsychiatry services to their inmates. We have established a telepsychiatry pilot project between the Kansas University Medical Center and the Lyon County Jail in Emporia, Kansas. A total of 264 telepsychiatry consultations were conducted with jail inmates. Of these, 70 were initial evaluations and 194 were follow-up visits; only one inmate refused to be seen. Approximately one-third of all inmates were seen for psychiatric consultation within one week of their incarceration and 68% were seen within one month of incarceration. Among lessons learned during the first year of service were: the monthly demand for consultations was five times greater than projected; moderately to severely ill inmates with a broad range of psychiatric illness can be seen and treated effectively using videoconferencing; and the technology was accepted by the jail personnel and the inmates alike and integrated into the jail's routine in terms of the delivery of psychiatric care.
Tele-ophthalmology screening for retinal and anterior segment diseases
Authors: Yogesan K , Cuypers M , Barry C J , Constable I J , Jitskaia L
Published: October 2002

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera were used as gold standards. Images (390 × 300 pixels × 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup–disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.
Putting the ‘tele’ into health-care effectively
Authors: Birch Katherine , Rigby Michael , Roberts Ruth
Published: October 2002

Although the introduction of new technologies has been successful and become accepted practice in many areas of industry, traditional methods have tended to prevail in health-care. Telemedicine has been adopted by enthusiasts who recognize the potential benefits of a ‘global health service’. However, the more widespread introduction of telemedicine requires considerable organizational change in the way health-care is delivered. More evaluation is required of clinical outcomes, organizational effects, benefits to health-care providers and users, and quality assurance.
Telepsychiatry evaluation in the north-west of England: Preliminary results of a qualitative study
Authors: May Carl , Gask Linda , Ellis Nicola , Atkinson Theresa , Mair Frances , Smith Craig , Pidd Sally , Esmail Aneez
Published: October 2002

A telepsychiatry referral service for patients suffering from anxiety and depression was evaluated from a user perspective. Low-cost video-phones linked a psychiatrist to two general practices in the north-west of England. Quantitative data were collected using a semistructured interview schedule. Twenty-two patients and 13 doctors were interviewed after a video-link consultation. Some users were very positive about the service and recognized its potential benefits, while others were more ambivalent. Patients saw the service as a means of obtaining additional ‘expert’ advice. General practitioners felt that the service might adversely affect the doctor–patient relationship in psychiatry. Both patients and clinicians recognized that the video-link modified normal interaction. Users need to adapt to this form of communication. An induction session is recommended for both patients and clinicians.
Training for surgeons using digital satellite television and videoconferencing
Authors: Kingsnorth Andrew , Vranch Adrian , Campbell James
Published: October 2002

The TETRASUR project (TELematics TRAining for SURgeons) has investigated the effectiveness of distance-learning technologies in the delivery of training for doctors who are studying for membership of the Royal College of Surgeons. Digital satellite television receivers and ISDN videoconferencing equipment have been installed in hospitals to deliver the course modules, including a series of live television programmes transmitted by satellite. ISDN videoconferencing was integrated, live, into the satellite broadcasts to bring in guest lecturers and for interactive discussions with the trainee doctors. Videoconferencing was also used for seminars and discussion groups. These methods proved to be effective and popular with the doctors, although there was some dissatisfaction with the visual quality of the ISDN videoconferencing at 128 kbit/s. Efforts are now being made to improve the quality of the video feed from remote sites using ISDN at 384 kbit/s.
Patient cost-benefits of realtime teledermatology-a comparison of data from Northern Ireland and New Zealand
Authors: Oakley A M M , Kerr P , Duffill M , Rademaker M , Fleischl P , Bradford N
Published: October 2002

As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology 24 as after a hospital appointment 26 and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.
Transtelephonic transmission of electrocardiograms in Slovenia
Authors: Gorjup Vojka , Jazbec Anja , Gersak Borut
Published: October 2002

The transtelephonic transmission of electrocardiograms (ECGs) was introduced in Slovenia in 1996 and has been used regularly since September 1997 by health institutions and patients with cardiovascular diseases. Portable 12-channel ECG equipment weighing less than 200 g is generally used. The diagnostic centre is located in the intensive-care unit at the University Medical Centre Ljubljana. In the first 12 months of regular operation we received 463 calls, 213 of which were diagnostic. The most common reasons for calling were: ischaemic chest pain, atypical chest pain, palpitations and dyspnoea. The most common diagnoses made on the basis of history and the ECG were: acute myocardial infarction, angina pectoris, paroxysmal tachycardias and atypical chest pain. In 40% of cases the cardiologist's advice sufficed; 38% of patients were referred to the emergency room, 29% immediately and 9% only if a suggested therapy did not prove successful; and in 21% of cases new medication or a change of dosage of current medication was suggested. Transtelephonic ECG transmission enables direct communication between general practitioner or patient and cardiologist. With its use, time from onset of symptoms to initiation of treatment is shortened, which reduces disability and mortality due to cardiovascular diseases and improves cost-benefit.
The length of time necessary to break even after converting to digital mammography
Authors: Hiatt Mark D , Carr J Jeffrey , Manning Richard L
Published: October 2002

The cost differences between film-based mammography (FBM) and digital mammography (DM) were estimated after discussions with hospital personnel and industry representatives. Human resource costs were not included. The fixed cost of FBM per machine was estimated to be $50,000 and the variable cost $4.60 per examination. The fixed cost of DM per machine was estimated to be $102,000 and the variable cost $0.10 per examination. The total number of examinations required to break even was therefore 11,556. At a rate of 15 examinations per machine per day and with 251 working days per year, it would take 3.1 years to break even. In the first year after the break-even point had been attained, $16,943 would be saved for every 3765 examinations performed. Extrapolating to the USA as a whole, in which 23 million mammographic examinations are performed each year, suggests that the annual savings from going filmless would be more than $103 million.
Video-capture teleradiology for the after-hours reading of computerized tomography scans
Authors: Kroeker Karen I , Diamond Robert , Jennett Penny A , Johnston Robert V
Published: October 2002

We evaluated the after-hours support that radiologists could provide from their homes to an urban hospital for reading emergency computerized tomography (CT) scans. During a six-month study period, 36 CT scans were acquired using a video-capture card in a PC and transmitted via an ordinary telephone line. The teleradiology interpretation and the formal report (from the hard copy) were compared with a reference or gold standard interpretation made by a radiologist and an emergency physician for 31 of the 36 cases. In comparison with the gold standard, there were 26 correct diagnoses by teleradiology (84%) and five incorrect (16%). Head CT scans accounted for 74% of the transmitted scans and all five of the cases with discrepant diagnoses. The cause of the single clinically relevant discrepancy was found to be unrelated to the use of teleradiology. In comparison with the formal report, the accuracy of the teleradiologist was not significantly different for all categories combined or for head CT scans alone. Video-capture technology provided a reliable means of transmitting CT scans for after-hours interpretation in emergency cases.
Telehealth in speech pathology: Applications to the treatment of stuttering
Authors: Kully Deborah
Published: October 2002

The potential value of telecommunications systems in treating communication disorders is being increasingly recognized. This mode of service delivery shows particular promise in giving patients access to specialist services for problems like stuttering, which are difficult to manage and often require long-term follow-up support. The Institute for Stuttering Treatment and Research at the University of Alberta has used videoconferencing to provide follow-up support to geographically remote adults who have undergone intensive treatment on site.
Managing the ‘fit‘ of information and communication technology in community health: A framework for decision making
Authors: Cardno E Jayne
Published: October 2002

The ‘fit‘ of information and communication technologies (ICT) in community health is important in meeting the needs of patients, carers, staff and organizations in the delivery of services. A good fit leads to greater efficiencies and effectiveness in ICT use. A multi-step research project was conducted to look not only at the role of ICT but at how to manage ICT and make a good ICT fit to enhance community health services. Telehealth was identified as the application of ICT to enhance population health, health promotion and health-service delivery. A participatory process was identified as critical to determining needs and potential uses as well as to the successful design and implementation of ICT in health. There was additional value in ensuring a diversity of desired outcomes which balance costs and benefits while fostering capacity and technical sustainability.
Japanese occupational therapy in community mental health and telehealth
Authors: Tsuchisawa K , Ono K , Kanda T , Kelly G
Published: October 2002

Help for people with mental health problems in Japan has traditionally centred on inpatient medical care. In a revision of the Mental Health Welfare Law planned for 2001, responsibility for the support of people with mental health problems will be transferred from central government to local government. Furthermore, local government will, in turn, delegate administrative tasks to a ‘community life support centre‘. We believe that such a centre could be linked to a university with a telehealth network. Connection to the network could benefit people with mental health problems living at home. We also believe that occupational therapists are ideally positioned to play a significant role in community life support centres. With the expected sustained growth in Japanese occupational therapy, it could become a key profession in the rehabilitation of people with mental health problems.
Current developments in Canadian privacy and information law: Implications for telehealth
Authors: Tigerstrom Barbara Von
Published: October 2002

An appropriate legal regime protecting privacy of personal information is an important element in assuring public confidence in telehealth initiatives while at the same time avoiding undue restrictions or difficulties for those implementing these technologies. In Canada there are several sources of legal protection of personal information but there is increasing emphasis on legislation. A bill recently passed by the Canadian House of Commons is expected have a significant impact on the way personal information, including health information, is handled in the private sector.
Super-high-definition image systems for telemedicine
Authors: Wada Minoru , Suzuki Ryuta , Murakami Tokumichi
Published: October 2002

Super-high-definition (SHD) images are those with more than 2048 pixels x 2048 lines. They are of interest in the medical field because of their very high quality. We have developed a new SHD system for still pictures which is based on an SHD card that can be installed in a PC. We think that certain telemedicine applications will be facilitated by the use of SHD images.
Interactive telemedicine in the operating theatre of the future
Authors: Graschew Georgi , Rakowsky Stefan , Balanou Panagiota , Schlag Peter M
Published: October 2002

An experimental stereoscopic system has been established in the Robert-Rössle-Klinik, including four operating theatres and the surgical research unit OP 2000. The system allows local three-dimensional image acquisition, local stereoscopic video display, in-house stereoscopic video transmission and stereoscopic links to external partners. The goal is to make high-quality patient data available in a medical centre or over a collaborative network of medical experts. In future the requirements of teleconsultation in terms of image quality and bandwidth will be heterogeneous. A sophisticated medical telecommunication system for second opinions is needed that can take advantage of intelligent compression approaches (e.g. wavelet compression) to archive, to search for image content and to transmit medical data such as images.
Telemedicine to improve patients' self-efficacy in managing diabetes
Authors: Po Yip Mei
Published: October 2002

Diabetes mellitus is becoming a major public health problem. Despite enormous efforts to change the delivery of diabetes care, the outcome has not been entirely positive. In ignoring the role of assisting patients to improve their self-management, the effectiveness of diabetes care is likely to be compromised. However, telecommunication can improve the quality of diabetes care by altering the caring environment and care delivery process. Telemedicine has various applications in diabetes care, including as a method of increasing the efficacy of patients' self-management, which could lead to better control of glycaemia.
A cost-minimization analysis of a realtime teledermatology service in northern Norway
Authors: Bergmo T S
Published: October 2002

Realtime teledermatology has been a routine service provided by the University Hospital of Tromso to a primary-care centre in Kirkenes since 1989. The cost of the teledermatology service was compared with the costs of three alternative methods of treatment for the patients. The first was a combination of a visiting service and patient travel to hospital. The second was patient travel to the nearest secondary-care centre. The third was a locally employed dermatologist. At the actual 1998 workload of 375 patients, the total cost of teledermatology was NKr470,780, while the three alternatives cost NKr880,530, NKr1,635,075 and NKr958,660, respectively. Analysis of the unit costs showed that the realtime teledermatology service, including local phototherapy, was less costly than the three alternatives for annual workloads above 195 patients per year. A sensitivity analysis showed that the results were robust to changes in the assumptions about the cost structure.
The need for still-image transfer during home nursing visits
Authors: Lamminen Heikki , Ruohonen Keijo
Published: October 2002

We investigated home-care needs in Ikaalinen, a small Finnish town. Two nurses completed questionnaires during all their home visits. During the 17 weeks of the study, the two nurses made 313 home visits, most to people aged 70-90 years. According to the questionnaire results, a visit by a general practitioner (GP) to the patient's house could not have been replaced by still-image transmission from a digital camera in any of the cases. Thus there was no need for image transfer by email between nurse and GP. The nurses did take pictures and showed them to the GP during their weekly meetings, but they nonetheless felt that they did not need to transfer them from the patient's home. When the reasons for the visits were classified as service delivery (no nursing required), check-up visit or drug service (no nursing required), blood test or other treatment test (nurse required) or nursing work, it became apparent that 38% of the visits would not have required someone with nursing skills. If these visits had been made by the home-help service instead, the annual saving for the Ikaalinen district would have been nearly FM240,000.
An Internet-based blood pressure monitoring system for patients
Authors: Aris Ishak Bin , Wagie A A E , Mariun Norman Bin , Jammal A B E
Published: October 2002

We developed a personal blood pressure monitoring system for patients with hypertension or hypotension. The system can be used to measure a patient's blood pressure at home and to transmit the data automatically to a hospital database via the Internet. The accuracy of blood pressure readings using the system was assessed by comparison with readings from a standard digital sphygmomanometer in four subjects. The measurement error for the systolic readings was 1.7-2.7% and for the diastolic readings 2.7-3.2%. The system therefore appears to be a promising means of assessing blood pressure remotely.
An attributable cost model for a telecare system using advanced community alarms
Authors: Brownsell S J , Bradley D A , Bragg R , Catling P , Carlier J
Published: October 2002

We have developed an attributable cost model for a city-based telecare scheme involving 11,618 community alarm users. The equipment was assumed to cost 500-1000 per installation, compared with 175 for the current system. Because of the significant additional capital cost of the proposed system, it would be necessary to borrow to finance it. For example, if the home equipment cost 500 per unit, an additional 2.2 million would be required. Nonetheless, it would be possible to achieve a return on the investment after 10 years. The principal savings would arise from reduced hospital bed costs and reduced residential care. The model suggests that the financial benefits of the proposed system would occur in the ratio of 4% to the local authority housing department, 43% to the National Health Service and 53% to the residential care provider.
Neurological teleconsultation for general practitioners
Authors: Paiva Teresa , Coelho Helena , Araújo Madalena Teles , Rodrigues Ricardo , Almeida António , Navarro Teresa , Cruz Manuela , Carneiro Graça , Belo Carlos
Published: October 2002

A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.
The potential of telemedicine for home nursing in Queensland
Authors: Black S , Andersen K , Loane M A , Wootton R
Published: October 2002

The potential for telemedicine in home nursing was examined by retrospectively reviewing the case-notes relating to home visits made by nurses in Queensland. The case-notes of 166 clients were randomly selected from 10 domiciliary nursing centres run by the Blue Care nursing organization in south-east Queensland. Two experienced community registered nurses independently undertook a retrospective review of the case-notes. Each reviewer made an independent judgement as to whether any of the home nursing visits in the episode of care could have been conducted by telemedicine. Visits requiring hands-on care were deemed to be unsuitable for telemedicine. A total of 12,630 home visits were reviewed. The median number of visits per client was 27 (range 1–722). The mean age of the clients was 72 years (range 2–93 years). A total of 1521 home visits (12%) were judged suitable for telemedicine. There was no significant difference in suitability between males (13%) and females (12%). Care interventions suitable for telemedicine were more likely to be those of a supportive, educational or review nature. Forty per cent of clients lived up to 5 km from the home nursing centre, 33% lived 5–10 km from the centre and 27% lived over 10 km from the centre. The results of the present study confirm the potential for telemedicine in home nursing in Australia.
Eighteen months' experience with remote diagnosis, management and education in congenital heart disease
Authors: Tsilimigaki Amalia , Maraka Sophia , Tsekoura Theofani , Agelakou Vasiliki , Vekiou Athina , Paphitis Chris , Thanopoulos Vasilis
Published: October 2002

In July 1998, a telemedicine link was established between the Venizelio General Hospital in Crete and the Paediatric Cardiology Department of the Aghia Sophia Children's Hospital in Athens. The telemedicine link used ISDN at 384 kbit/s for diagnosis, management and education in congenital heart disease. Over 18 months, a total of 39 teleconsultations were carried out, concerning 93 children with haemodynamically significant cardiac abnormalities. Forty-four children (47%) were managed locally after teleconsultation, while three children with transposition of the great arteries (3%) were transported as emergency cases to Athens in the first days of life. The other 46 children (50%) had a scheduled appointment at a tertiary centre for cardiac catheterization, angiocardiography, operative treatment or surgical repair. The telemedicine link brought a number of benefits, such as better access to the tertiary centre and the avoidance of patient transportation.
Telephone advice nursing — callers' experiences
Authors: Wahlberg Anna Carin , Wredling Regina
Published: October 2002

We studied telephone callers' experiences of contacting a medical call centre. A questionnaire was administered to 203 persons. It was completed by 144 (71%), of whom 81 (56%) chose to comment on their experience in the space provided. The comments were analysed using a qualitative method and were categorized as relating to either the practical or the emotional aspects of the call. Sixty-nine per cent of comments described a satisfactory experience. The unsatisfactory comments mostly concerned access problems. The callers emphasized the importance of receiving appropriate advice and being treated in a kindly manner. In addition, there were dimensions of security and insecurity in nearly all the categories. The findings highlight the telephone nurses' communication skills and their ability to deal with callers as individuals, to make them feel more secure. The selection, education and training of telephone nurses should place more emphasis on their supportive and communicative roles.
An analysis of why telehealth systems in Australia have not always succeeded
Authors: Yellowlees Peter
Published: October 2002

Telehealth programmes are rather similar to humans in the way that they are planned, develop, grow and ultimately die or disappear. To achieve good life expectancy for a telehealth programme there appear to be three major needs: nurturing, which includes the provision of money, ideas, education, training and innovation; experience, which involves an integrated management process, the achievement of long and wide patterns of usage, the development of updated policies and procedures and the involvement of multiple disciplines; success, which involves evidence of outcomes, evaluation and research, and, most important, the sharing of information through scientific and popular press publications, and conferences and collaborations with internal and external groups. The future of telehealth in Australia is at a watershed. There are now a substantial number of programmes, and there has been a large amount of financial and human investment in telehealth around the nation. There is, however, no forum for national leadership, no national association and little support at federal government level.
Teledermatology in the Waikato region of New Zealand
Authors: Oakley Amanda , Rademaker Marius , Duffill Mark
Published: October 2002

Teledermatology consultations over a video-link began at Health Waikato in 1995. Clinical trials involving about 500 patients have demonstrated the diagnostic accuracy and economic gains of these teleconsultations, and patient satisfaction with them. Yet, six years on, out-of-date equipment remains under-used. There has been no expansion of the network and no additional clinical teleconsultation services. Possible reasons include the excessive capital cost of videoconferencing equipment, clinician overwork, inconvenience, lack of reimbursement, administrative and governmental inertia, and little demand from patients and their doctors. To widen our referral base without the inconvenience of videoconferencing, we decided to offer a secure browser-based dermatology tele-advice service to referring general practitioners who owned digital cameras. With the increase in online health information and electronic communication, we assumed it would be popular. But, despite up to six-month waits for patients to be seen in the dermatology outpatient clinic, few patients have been referred to the service. Explanations have included time constraints, unavailability of a camera, no Internet access at the time of consultation and lack of reimbursement. Can we look forward to a future in which all doctors have high-speed access to the Internet at their desktop through their practice management systems? Who will pay? Will they continue to prefer conventional referral?
Some successes and limitations with telehealth in Canada
Authors: Hailey David
Published: October 2002

Canada has taken important steps towards establishing telehealth within its health-care system. However, in many areas telehealth in Canada has yet to progress beyond the stage of testing feasibility. A recent survey of eight Canadian telehealth programmes that are using videoconferencing indicated that there is little evidence of either clinical or economic benefits compared with conventional care. There are examples of sustainable, routine telehealth services in Canada. However, overall, the number of patients seen by telehealth is still very small in comparison with the number of face-to-face visits. ‘People-related’ factors seem dominant in determining the degree of success of telehealth applications.
The point-of-referral barrier—a factor in the success of telehealth
Authors: Smith Anthony C , Isles Alan , Mccrossin Robert , Westhuyzen Jasper Van Der , Williams Michael , Woollett Helen , Wootton Richard
Published: October 2002

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.
Patient satisfaction with telemedicine: A comparison study of geriatric patients
Authors: Bratton Robert L , Short Tina M
Published: October 2002

Studies of patient satisfaction are continually needed to provide feedback to the medical community about rapidly changing telemedicine technology. We accumulated data during 1998 from geriatric patients living in a retirement community based on their experience with telemedicine (one encounter a week for eight weeks). Responses to the items on a Likert scale were generally positive. A similar study was conducted with random patients at the same site two and a half years later. The results were once again positive and appeared to show an even better response than those obtained in the previous study. Thus, although the pilot study was small (20 patients, 18 reporting), this trend may reflect an increased acceptance of telemedicine applications among geriatric patients. Larger studies are needed to substantiate this claim.
Realtime fetal ultrasound by telemedicine in Queensland. A successful venture?
Authors: Chan Fung Yee , Soong Barbara , Watson David , Whitehall John
Published: October 2002

We have established a realtime fetal tele-ultrasound consultation service in Queensland, which has been integrated into our routine clinical practice. The service, which uses ISDN transmission at 384 kbit/s, allows patients in Townsville to be examined by subspecialists in Brisbane, 1500 km away. For the 90 tele-ultrasound consultations performed for the first 71 patients, 90% of the babies have been delivered, and outcome data have been received on all the pregnancies. All significant anomalies and diagnoses have been confirmed. The referring clinicians would have physically referred 24 of the 71 patients to Brisbane in the absence of telemedicine. A crude cost–benefit calculation suggests that the tele-ultrasound service resulted in a net saving of A$6340, and at the same time enabled almost four times the number of consultations to be carried out.
Administrator and provider perceptions of the factors relating to programme effectiveness in implementing telemedicine to provide end-of-life care
Authors: Cook David J , Doolittle Gary C , Whitten Pamela S
Published: October 2002

Two large hospice organizations in Kansas and Michigan began a telehospice project with the goal of improving care at the end of life using telemedicine. Hospice nurses provided services using video directly to the homes of hospice patients. The telemedicine equipment operated over ordinary telephone lines. Nursing services included symptom assessment and psychospiritual evaluations. Patients lived in both urban and rural settings. Studies were designed to evaluate utilization patterns, access to care, patient/carer acceptance, medical outcomes and cost. During the first year of the project, tele-hospice care was initiated at five rural sites (two in Michigan and three in Kansas) and three urban sites (two in Michigan and one in Kansas). There was greater telehospice activity in Michigan than in Kansas, with 118 and 44 patients served, respectively. The urban site in Kansas withdrew from the study after participating for only nine months. In an effort to understand the difference in utilization patterns and reasons for withdrawing from the project, in-depth interviews of key study participants, including hospice administrators, nurses and research personnel, were conducted. Human factors appear to be important in the adoption of novel telemedicine applications.
Randomized comparison of the quality of realtime fetal ultrasound images transmitted by ISDN and by IP videoconferencing
Authors: Chan F Y , Taylor A , Soong B , Martin B , Clark J , Timothy P , Lee-Tannock A , Begg L , Cincotta R , Wootton R
Published: October 2002

We compared the quality of realtime fetal ultrasound images transmitted using ISDN and IP networks. Four experienced obstetric ultrasound specialists viewed standard recordings in a randomized trial and rated the appearance of 30 fetal anatomical landmarks, each on a seven-point scale. A total of 12 evaluations were performed for various combinations of bandwidths (128, 384 or 768 kbit/s) and networks (ISDN or IP). The intraobserver coefficient of variation was 2.9%, 5.0%, 12.7% and 14.7% for the four observers. The mean overall ratings by each of the four observers were 4.6, 4.8, 5.0 and 5.3, respectively (a rating of 4 indicated satisfactory visualization and 7 indicated as good as the original recording). Analysis of variance showed that there were no significant interobserver variations nor significant differences in the mean scores for the different types of videoconferencing machines used. The most significant variable affecting the mean score was the bandwidth used. For ISDN, the mean score was 3.7 at 128 kbit/s, which was significantly worse than the mean score of 4.9 at 384 kbit/s, which was in turn significantly worse than the mean score of 5.9 at 768 kbit/s. The mean score for transmission using IP was about 0.5 points lower than that using ISDN across all the different bandwidths, but the differences were not significant. It appears that IP transmission in a private (non-shared) network is an acceptable alternative to ISDN for fetal tele-ultrasound and one deserving further study.