Index

A

Academic medical centers, 3, 18, 44.

See also individual facilities

Acceptability of telemedicine, 8, 152, 206

Acceptance of telemedicine.

See also Patient and clinician perspectives;

Patient satisfaction data

documented benefits and 80-81

health care restructuring and, 4, 81-82

human factors and, 73-82

patient, 80, 147

payment concerns, 81

professional, 79-80

Access to care

barriers, 173-174

definitions and concepts, 8, 32, 175-176, 205

and development of telemedicine, 2, 53

health information, 174

and quality of care, 192

questions about, 12-13, 176-179, 205

telecommunications rates and, 85

Advanced Research Projects Agency, 120 n.2, 239

Agamemnon, 34

Agency for Health Care Policy and Research, 22, 117

Allina Health care Systems, 52

Ambulatory care clinics, 38-39

American College of Physicians, 22

American College of Radiology, 72

American Medical Association, 98, 103, 106

American Medical Informatics Association, 41

American National Standards Institute, 69

American Society for Testing and Materials, 69

Americans with Disabilities Act, 103

Anesthesiology, 38

Annals of Internal Medicine, 154

Appropriateness of care, 12, 108, 110, 123, 166-167, 175-176, 178

Automated telephone-based services, 45, 129-130

B

Bell, Alexander Graham, 35

Bell Operating Companies, 240



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--> Index A Academic medical centers, 3, 18, 44. See also individual facilities Acceptability of telemedicine, 8, 152, 206 Acceptance of telemedicine. See also Patient and clinician perspectives; Patient satisfaction data documented benefits and 80-81 health care restructuring and, 4, 81-82 human factors and, 73-82 patient, 80, 147 payment concerns, 81 professional, 79-80 Access to care barriers, 173-174 definitions and concepts, 8, 32, 175-176, 205 and development of telemedicine, 2, 53 health information, 174 and quality of care, 192 questions about, 12-13, 176-179, 205 telecommunications rates and, 85 Advanced Research Projects Agency, 120 n.2, 239 Agamemnon, 34 Agency for Health Care Policy and Research, 22, 117 Allina Health care Systems, 52 Ambulatory care clinics, 38-39 American College of Physicians, 22 American College of Radiology, 72 American Medical Association, 98, 103, 106 American Medical Informatics Association, 41 American National Standards Institute, 69 American Society for Testing and Materials, 69 Americans with Disabilities Act, 103 Anesthesiology, 38 Annals of Internal Medicine, 154 Appropriateness of care, 12, 108, 110, 123, 166-167, 175-176, 178 Automated telephone-based services, 45, 129-130 B Bell, Alexander Graham, 35 Bell Operating Companies, 240

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--> Blue Cross and Blue Shield Association, 22, 109 Bowman Gray, 44 Brigham and Women's Hospital, 44 Business plan/project management plan, 3, 6, 148-149, 155, 202-203 C Cable television definition, 240 rates, 85 telemedicine applications, 38-39 California, confidentiality of medical records, 92 Cameras, digital, 50, 56 Center for Devices and Radiological Health, 113-114 Center for Health Policy Research, 122-124, 126, 132 Center for Health Services Research, 122 Cleveland State University, 129-130 Clinical applications of telemedicine. See also specific applications categories, 29-30 central/consulting site, 30, 58-59 definition, 28 diffusion of, 194 and evaluation, 116-117, 141 examples, 29, 31 remote site, 30, 58-59 Clinical decision support systems, 58 Clinical information systems, 58, 241 Clinical practice guidelines, 22, 98 Clinical Telemedicine Cooperative Group, 124, 133, 135-136 Clinicians. See Patient and clinician perspectives Cochrane Collaboration, 22 CODEC, 50, 241 Colorado confidentiality of medical records, 92 prison telemedicine program, 46 teleradiology standards, 100 Columbia University Health Sciences Division (New York), 237 Community effects of telemedicine, 9, 163 Comparison (control) group, 6, 150-151, 198, 203 Compressed video, 42, 241 Computed axial tomography, 42, 56 Computer Aided Diagnosis (CADx) Working Group, 115 Computer conferencing, 241 Computer systems architecture, 239 compatibility issues, 68-69, 72-73, 77, 195 millennium problem, 73 multimedia, 78 peripheral equipment, 50, 246 regulation as medical devices, 114-115 standards, 98, 122-123 workstations, 35, 49, 50, 63, 77, 78, 115, 250 Conferencing. See Computer conferencing; Teleconferencing Confidentiality, 83, 92, 95, 101, 102, 196. See also Privacy Continuous quality improvement, 154-155, 166 Costs and cost-effectiveness of care. See also Economic analyses; Payment for services data transmission technology and, 66 definition, 8 emergency services network, 53 prison telemedicine, 46-47 technology, 68, 78, 182, 186 teleconsultations, 52, 53 transportation issues, 180 Costs of technologies, 2, 39-40 Credentialing, 95-96 Croatia, 131 D Data bits, 66, 240

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--> collection instruments, 133, 161, 171, 178, 187, 188, 207, 240 confidentiality, 102 quality issues, 123 Data security, 102. See also Privacy auditing and tracking programs, 107 authentication procedures, 107, 240 authorization procedures, 107 confidentiality agreements, 101 defined, 102 encryption, 107, 243 firewalls, 107, 243 systems, 101, 106-107 Data transmission asynchronous, 239 bandwidth, 61, 63-65, 240 by coaxial cable, 65-66, 241 compressed, 42, 67, 241, 242 costs, 66 digital/digitizing, 66-67 packet switching, 67, 246 real-time, 65, 76, 129, 246 standards, 72, 123 store-and-forward technologies, 16-17, 50, 65, 77, 247 synchronous, 247 by telephone, 65 T1 (DS1) lines, 62, 63, 242 Demonstration projects. See also specific projects diversity, 41 evaluation, 86, 118, 124, 135, 148 funding, 85, 113 HCFA, 109 policies, 83-84, 85, 197 professional education, 39-40 rural economic development, 86 sustainability, 53, 74, 75, 118, 136, 138-139 Department of Commerce, 86, 117 Department of Defense evaluation of telemedicine, 24, 117, 120-121, 130-131, 142, 204 Hospital Information System, 62, 63 projects, 39, 40; see also Military telemedicine Department of Health and Human Services, 86, 106, 117, 199-200. See also Health Care Financing Administration; National Library of Medicine; Office of Rural Health Policy Department of Health, Education and Welfare, 39 Department of Veterans Affairs, 40, 89, 117,121-122, 204. See also VA facilities and services Dermatology. See Teledermatology Dialysis center, 49, 51 Digital images/imaging conventional images compared to, 127-129 direct, 242 software, 86 store-and-forward technologies, 16-17 Digital Imaging and Communication in Medicine (DICOM) standard, 72, 242 Digital Imaging Network Project, 39 Digitizing, 42, 66-67, 242 Distance medicine, 28 Documentation of methods and results, 6, 154, 191, 202, 203 Drew Health Foundation, 51 E East Carolina University School of Medicine, 47 Eastern Montana Telemedicine Network, 230-231 Eastern Oregon Human Services Consortium, 47-48 Eastern Oregon State College, 48 Economic analyses. See also Costs and cost-effectiveness of care billed charges, 182-183 capital costs, 181-182 conceptual challenges, 183-184 cost-benefit analysis, 181, 192-193 cost-effectiveness analysis, 181 decision rules, 184-186 definitions and concepts, 32, 180-183, 205-206 discounting, 182 dynamic simulation model, 134-135

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--> level and perspective, 179-180 needs, 128, 198 patient vs provider perspectives, 148, 175 principles, 138 productivity assessment, 128 questions about, 13, 184, 185, 206 real-options vs net-present-value, 135 sensitivity analysis, 154, 184 teledermatology, 43 n.6 variable costs, 182 ECRI (formerly Emergency Care Research Institute), 22 Education and training networks, 47 objectives and effects of telemedicine, 9, 153, 172-173 patient, 29 professional, 29, 36, 39-40, 42-43, 47, 48, 52, 66, 87, 88 radiology and pathology images, 42-43 technical, 58-59 Electrocardiograms, 38, 45, 51 Electronic housecall, 19, 21, 45-46 Electronic mail, 46, 77 Emergency services 911, 1, 36, 45 evaluation of, 167-168 image interpretation, 127-128 network, 52-53 telemetry, 38 Emory University, 44 Evaluation of telemedicine. See also Research strategies for access to care, 8, 12-13, 32, 173-179, 192, 205, 207 and acceptance, 8, 80-81, 205-207 assessment studies, 119, 128 business plan/project management plan, 3, 6, 148-149, 155, 202-203 categories, 118, 119, 134 challenges, 4-5, 10, 22, 116, 118, 183-184, 197-199 and continuous improvement, 154-155, 166 controlled vocabulary, 191-192 cooperation among institutions and individuals, 125, 198-199 criteria, 8, 32, 163, 191-192 definitions, 30-33 documentation of methods and results, 6, 154, 191, 202, 203 domains, 147, 162-163 economic analysis, 8, 13, 32, 47, 128, 134-135, 148, 156, 179-186, 192-193, 205-207 effectiveness and cost-effectiveness, 32, 132-136 elements, 144-154, 202-204 feasibility determinations, 140, 142-144, 191 federal role, 7, 117-118, 136, 141-142, 199-200, 204; see also individual agencies formative, 134, 193 frameworks, 2, 5-7, 17-18, 30-31, 86, 118-126, 137-161, 162, 173-174, 200-207 human factors assessment, 74-75, 155, 164, 195-196 importance, 137, 207-208 improvement of, 199-200, 207 institutional, 147 lack of evaluation, 17, 116-117 level of, 6, 146-148, 164, 179-180, 203 literature, 7, 126-127 needs assessment, 78-79 objectives, 12, 119, 136, 139-141, 145-146, 154 obstacles to, 118, 132, 137, 138, 184 patient and clinician perspectives, 14-15, 148, 186-190, 206 planning for, 138-144, 156, 201-202 policy-related variables, 84, 87 pooling of information, 124-125 population-directed, 32-33, 47, 164-165, 176, 178 principles, 5, 24-25, 137-138, 155, 200-201 priority-setting, 141-142 private-sector role, 7 processes of care, 6, 13, 151

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--> project description, 144-145, 203 purpose, 17, 116, 194 for quality of care, 8, 11, 32, 128, 163, 165-173, 205-207 and reimbursement for services, 117, 123-124, 166 resource issues, 142 strategies; see Research strategies summative, 134 system/societal, 147-148, 179 telecardiology, 190 teledermatology, 125, 128-129, 131-132, 143, 144-145, 147 telepsychiatry, 45, 147, 162, 181 teleradiology, 44, 116, 124, 127-128, 147, 168 F Fair Health Information Practices Act, 105 Fax machines, 77 Federal Communications Commission, 85 Federal Food, Drug, and Cosmetic Act, 114 Federation of State Medical Boards, 94-95 Florida, licensure laws, 90 Fluoroscopy, 38 Food and Drug Administration, medical device regulation, 57-58, 86, 113-115 Fort Detrick Army Medical Research and Materiel Command, 120 Freestanding specialty groups, 18 G Gastroenterology applications, 47 n.7 General Accounting Office, 87 George Washington University, 40 Georgia, telemedicine reimbursements, 109 Grants, federal, 41, 47-48, 52, 229-238 Greater Oregon Behavioral Health, Inc., 48 H Haiti, 131 Hardware. See also Computer systems; specific devices compatibility, 77, 241 definition, 244 problems, 75-76 standards, 3, 69-72, 82, 98 Harvard Community Health Plan, 101 Health care administration, telemedicine applications in, 29, 52, 62, 63 Health Care Financing Administration (HCFA) (DHHS) evaluation of telemedicine, 24, 117, 122, 123-124, 125, 126, 132-133, 134, 140-141, 199-200 grants, 236-237 payment policies, 107-109, 112, 123-124 Health Care Information Infrastructure (HCII), 244 Health care institutions, telemedicine capacity, 20 Health care restructuring, 4, 81-82, 105, 173, 199 Health care technologies, assessment of, 22-24 Health Information Applications Working Group, 74, 86 Health insurance programs, privacy issues, 103 Health Level Seven (HL7) standard, 69-72, 244 Health maintenance organizations (HMOs), 20, 51, 112, 159. See also Managed care Health Security Act of 1993, 105 Health Services Research, 154 Healthspan, 52 Hewlett-Packard, 49 High Performance Computing and Communications program, 86, 244 High Plains Rural Health Network, 232 Hippocratic Oath, 103

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--> Home health options, 1, 44-46, 168, 184 Human factors in telemedicine and acceptance of telemedicine, 73-82 assessment, 74-75, 155, 164, 195-196 cultural and socioeconomic, 79-82 needs and preference assessment, 78-79 equipment-related problems, 75-76 incorporation in existing practice, 76-78 recognition of, 74-75 I Image processing, 244 Implementation of telemedicine, 138, 152, 155 Indiana, licensure laws, 90 Information Infrastructure Task Force Committee on Applications, 74, 86 Information technologies, 28, 60-61. See also Clinical information systems Infrastructure. See Technical infrastructure Integrated services digital network (ISDN), 67, 244 Interactive video, 1, 16, 19, 28, 36, 38, 40-41, 48, 49, 50, 53 Interactive voice response systems, 45 Intergovernmental Health Policy Program, 87 International Standards Organizations, 69 Internet, 41, 46, 80, 125, 182, 244-245, 249. See also World Wide Web Interstate telemedicine, 3, 83, 89-95 Iowa Health System Telemedicine Demonstration, 236 programs and initiatives, 87 J Jackson Memorial Hospital, Miami, 38 Jean-Talon Hospital, 36 Johns Hopkins University, 127-128 Joint Commission on Accreditation of Health care Organizations, 95, 96, 103, 114 Joint Working Group on Telemedicine, 7, 24, 40, 86, 119, 120, 162, 200 Journal of the American Medical Association, 154 Journals. See also specific journals on-line, 20 peer-review process, 20 research documentation guidance, 154 K Kaiser Permanente of Southern California, 22 Kansas Board of Healing Arts, 91 telemedicine reimbursements, 109 Kentucky Telecare, 232-233 L Learning curve, 172 Legislation. See also Medicare; Payment for services; individual topics malpractice, 100 medical device, 114 national licensure, 93-94 privacy/confidentiality-related, 105-106 telecommunications, 66, 84-85, 132 n.5 Liability. See Malpractice liability Licensure, professional credentialing, 95-96 by endorsement, 91 issues, 3, 81, 83, 92 options, 93-95, 105 policies, current, 89-91, 196

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--> Literature buyers guide, 56 evaluation research, 116, 126, 149-150 outcome measures, 171 searches, 50 telemedicine applications, 40, 75 Lockheed Company, 39 Logan Airport, Boston, 38 Louisiana, licensure laws, 90 Lytton Gardens Health Care Center, 49-51 M Macedonia, 131 Magnetic resonance imaging, 42 Malpractice liability data security and, 106 issues, 3, 83, 97-99 options, 99-100 organizational, 99 policies, current, 96-97 Mammography, 113, 124, 128 Managed care cost effectiveness, 180 payment policies, 108, 111 quality-of-care assessments, 163, 164-165 and professional opportunities, 174-175 telemedicine in, 3, 9, 18, 20, 32-33, 52-53 Mary Imogene Bassett Hospital, 231 Maryland confidentiality of medical records, 92 trauma center, 89 Massachusetts General Hospital, 38 MDTV (Mountain Doctor Television), 229-230, 236-237 md/tv, inc., 49 Medica, 52 Medicaid, 180 Medical Advanced Technology Management Office, 120 Medical College of Georgia, 133-134, 236 Medical Device Amendments of 1976, 114 Medical devices definition, 114 regulation of, 57-58, 86, 113-115 safety evaluation, 118 Medical Outcomes Study, 189 Medical Outcomes Trust, 22 Medical Privacy in the Age of New Technologies Act, 105 Medical Records Confidentiality Act, 105 Medicare, 3, 42, 43, 81, 102-103, 107-108, 109, 111, 112, 117, 134, 141, 196 Memorial University of Newfoundland, 39-40 Miami Fire Department, 38 Microscopy, 38 Microwave transmission, 34, 38, 66, 245 Mid-Nebraska Telemedicine Network, 231 Military telemedicine evaluation of, 120-121, 130-131, 147, 168, 200 initiatives, 43, 56-57 interstate activities, 89 payment policies, 107 Minnesota confidentiality of medical records, 92 telemedicine initiatives, 52 Missouri Telemedicine Network, 233 Mt. Sinai School of Medicine, New York City, 38-39 Multiorganization medical consortia, 18 N National Academy of Engineering, 38 National Academy of Sciences Computer Science and Telecommunications Board, 102 National Aeronautics and Space Administration, 39

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--> National Association of Insurance Commissioners, 106 National Commission on Quality Assurance, 95 National Electrical Manufacturers Association, 72 National Information Infrastructure, 2, 20-21, 60-61, 86, 245 National Institute of Standards and Technology, 117 National Library of Medicine (DHHS), 2 evaluation of telemedicine, 117, 129, 142, 199 Grateful Med, 24 literature on telemedicine, 40 Loansome Doc, 24 Medline, 20, 24 privacy/security initiatives, 102 real-time treatment technology programs, 235-236 testbed networks, 234-235 Uniform Medical Language System Metathesaurus, 192 virtual reality, 235 workshops/conferences on telemedicine, 74 National Naval Medical Center, Bethesda, 59, 62-63 National Telecommunications and Information Administration, 84-86, 117, 237-238 Naval Medical Center, Annapolis, 59 Nebraska programs and initiatives, 87, 89 Networks and networking. See also specific networks circuit switched, 241 communications, 72 definition, 61, 245-246 packet switched, 246 peer, 48 privacy and confidentiality issues, 104 professional education, 47, 48 public switched telephone (PSTN), 246 rural area, 52, 135, 247 specialty consultation, 135 switched, 247 teleradiology, 44 wide area, 250 Neurological applications, 36, 47 n.7 Nevada, licensure laws, 90 New York, confidentiality of medical records, 92 Norfolk State Hospital, 36 Norman, Donald, 73-74 North Carolina Central Prison Telemedicine Project, 46-47 Emergency Consult Network, 168 programs and initiatives, 87, 167-168 Nurse practitioners, 39, 170, 172-173 Nurses, 18-19 emergency services, 53 telephone advisory services, 45 Nursing homes, telemedicine applications in, 38, 49-51 O Office of Rural Health Policy (DHHS) evaluation of telemedicine, 117, 135, 140, 142 grants, 41, 47-48, 52, 229-233 role in present study, 24 survey of telemedicine use, 20 workshops and conferences, 74-75 Oklahoma County, Oklahoma, City-County Health Department, 237 Oregon ED-NET, 48, 88 evaluation research, 129, 131-132 Health Sciences University, 48, 129, 131-132 malpractice legislation, 100 telepsychiatry program, 47-49, 66 Outcomes of care, measures, 6, 9, 11, 32, 128, 134, 146, 152-153, 163, 170-171, 176, 192, 205, 207 P Pacemaker surveillance, 45 Pacific Bell, 49

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--> Paramedics, 38 Patient and clinician perspectives methods and focus, 188 quality of care, 19, 186-187; see also Patient satisfaction questions, 14, 189-190, 206 Patient care, telemedicine applications, 29, 31, 38 Patient information systems applications of telemedicine, 31, 50 benefits and risks, 104 compatibility, 72-73, 77 computer-based patient record (CPR), 58, 86, 99, 103-104, 121, 171, 204, 207, 241 and evaluation of telemedicine, 7, 160-161, 171, 204 Health Level Seven (HL7) standard, 69-72 and malpractice liability, 99 privacy and confidentiality, 3-4, 78, 83, 92, 95, 99, 101, 103-106, 196 security measures, 101, 105-106 utilization, 20 Veterans Administration, 121 Patient satisfaction data, 8, 14, 147, 163, 176, 186-187, 188, 206 Patients, telemedicine use, 19 Payment for services. See also Medicare and acceptability of telemedicine, 81 capitation payment/fixed budget, 108, 111-112, 166, 171-172, 180, 183 commercial organizations, 113 copayments, 112 demonstration projects and, 113 evaluation research and, 117 fee-for-service, 43 n.6, 107-110, 111, 166, 180, 196 per case or other bundled methods, 110-111, 171-172, 183 policies, 83, 196 radiology, 3, 42, 43 Pennsylvania Keystone State Desktop Medical Conferencing Network, 238 licensure laws, 90 Physician hospital organizations (PHOs), 20 Physician Payment Review Commission, 109 Physicians. See also Human factors in telemedicine; Patient and clinician perspectives; Practitioners income concerns, 18 information technologies relevant to, 63 surplus, 18 use of telemedicine, 19-20 Picasso, 57 Picture archiving and communications system (PACS), 42, 43, 57, 62, 63, 114-115, 246 Policy issues. See Telemedicine policy Postsurgical monitoring, 49-51 Practitioner-patient relationships, 18 Practitioners databases, 92, 135 perceptions of telemedicine, 14-15 Preferred provider organizations (PPOs), 20 Prison telemedicine projects, 43 n.6, 46-47, 88, 89, 107 Privacy. See also Confidentiality; Data security informational, 101-102 issues, 3-4, 83, 101, 103-105, 196 options, 105-106 policies, current, 102-103 technical and administrative options, 106-107 Processes of care, 11, 31, 167, 168-170 Psychiatry. See Telepsychiatry Public health, telemedicine applications in, 29 Q Quality of care definitions and concepts, 8, 32, 165-168, 205 educational effects of telemedicine, 172-173

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--> outcome measures, 167-168, 170-171 patient risk and, 171-172 patient satisfaction measures, 163, 206-207 practitioner concerns, 19 process measures, 168-170 questions about, 11, 168-172 severity of illness and, 171-172, 206 teledermatology, 43 n.6 types of problems, 166 volume-outcome hypothesis, 173 R Radio News, 35-36, 37 Radiology. See Teleradiology Radiotelemetry, 38 Rapid City Regional Hospital, 230 REACH-TV, 231-232, 237 Regional Bell Operating Companies, 49, 52, 246 Regulation of medical devices, 57-58, 86, 113-115 Research, telemedicine applications in, 29, 36 Research strategies. See also Evaluation of telemedicine administrative processes, 6, 151-152, 203 automated telephone-based strategies, 129-130 clinical aspects, 6, 13, 119, 120, 141, 146, 147, 151, 155, 156, 167, 203 clinical practice study, 160 comparison (control) group, 6, 150-151, 198, 203 data collection, 161, 171, 178 with deployed troops, 130-131 design, 6, 7, 10, 119, 139, 142, 143, 149-150, 155, 156-161, 164, 204 digital vs conventional images, 127-129 effectiveness trial, 159, 160 efficacy, 157, 159 event/problem logs, 152, 155 experimental design, 157, 159, 161, 204 experimental group, 6, 150-151, 203 large simple trials, 159 literature on, 149-150, 156-157, 171 nonexperimental, 161, 204 objectives, 6, 145-146, 162 outcome measures, 6, 9, 11, 32, 128, 134, 146, 152-153, 163, 165-166, 167, 168-169, 170-171, 176, 192, 203, 205 patient information systems and, 7, 160-161, 171, 204 processes of care, 11, 31, 167, 168-170 quasi-experimental, 160-161, 204 questions (research), 6, 7-9, 11-15, 119, 124, 125-126, 140, 145, 147, 162, 163-165, 168-172, 176-179, 184, 185, 189-190, 193, 199, 203, 205, 206 randomized clinical trials, 157, 159 retrospective analysis, 161, 168-169 sensitivity analysis, 5-7, 153-154, 156, 164-165, 203 technical infrastructure, 6, 151, 203 teledermatology services for rural areas, 131-132 test-of-concept, 119, 121, 126, 134, 143-144, 148, 150, 193, 201, 202 validity, 157-158, 160, 171, 191, 249 RODEO NET (Rural Options for Development and Educational Opportunities), 47-48 Rural Health Alliance Telemedicine Network, 52 Rural telemedicine access issues, 173 dermatology, 131-132 cost effectiveness, 66, 85 effects, 9 payment for services, 112 psychiatry, 47-49 radiology, 43 utilization, 40

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--> S Saint Louis University School of Public Health, Missouri, 238 San Jose Medical Group, 51 Satellite systems, 66 Senate/House Ad Hoc Steering Committee on Telemedicine, 85 Sensitivity analysis economic, 154, 184 research strategies, 5-7, 153-154, 156, 164-165, 203 Social security numbers, private market for, 105 Software evaluation tools, 125-126 medical, regulation of, 57-58, 86, 115 Somalia, 43 n.6, 121, 131, 168 South Carolina, licensure laws, 90 South Dakota, licensure laws, 90 Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), 39 Speech therapy, 36 St. Paul Fire & Marine Insurance, 100 Standards/standardization of care, 97, 100 hardware and software, 3, 69-72, 82, 98 medical devices, 113-114 questionnaires, 133, 161, 171, 178, 187 Stanford University Medical Center, 49-51, 129 State confidentiality provisions, 102, 106 evaluation research, 118 licensure laws, 89-90, 102, 196 malpractice laws, 96-97 programs and initiatives, 40, 87-89 Stethoscope, electronic, 38, 50, 56 Store-and-forward technologies, 16-17, 50, 65, 77, 129, 247 Surgeon General of the Army, 117, 120 Surgery. See Telesurgery Survey of telemedicine users, 40 Switching, advanced digital, 42 T Tactile data, 31 Technical infrastructure compatibility of systems, 3, 27, 67-69, 195 costs, 182 digital technologies, 66-67 equipment and space configurations, 59 information carrying capacity, 61-65 information restructuring, 66-67 innovations, 21 location of units, 77 obsolescence, 4, 72-73, 182, 197-198 projects, 87 service providers, services, and resources, 57 standards for hardware and software, 3, 69-72 technologies, 4, 35, 55-56, 59-73 transmission media, 65-66 user needs and circumstances and, 3, 58-59, 198 Technology training, 48 Telecardiology, 109, 190. See also Electrocardiograms Telecommunications. See also Data transmission; Telephone communications costs, 2, 40, 63 definition, 248 evaluation of technology, 120 evolution of, 34-35 in health care sector, 56 infrastructure, 88 legislation, 66, 84-85, 132 n.5 media, 28 policy, 84-86 programs, 87 transoceanic, 38 Telecommunications Bill of 1996, 84-85 Teleconferencing administrative, 62, 63 audio, 240 clinical, 49, 62, 63 definition, 248

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--> educational, 20 interactive video, 16, 28, 48, 49, 62, 63, 249 real-time, 65 store-and-forward systems, 65 workstation, 49, 62, 63 Teleconsultation cost-effectiveness, 52 definition, 248 diagnostic, 36, 38 equipment and space configurations, 51, 59, 62-63 interstate licensure policies, 90, 91 and malpractice, 98 in nursing homes, 49 payment policies, 107, 109 scheduling problems, 76-77 specialist, 52 utilization, 47 n.7, 131 Teledermatology applications, 49, 51, 131 evaluation of, 125, 128-129, 131-132, 143, 144-145, 147 imaging, 56, 128-129, 143 rural applications, 131-132 utilization, 43 n.6, 47 n.7 Telediagnosis, 36, 38, 99, 167, 248 Telegraph, 34-35 Telemedicine. See also Payment for services applications, 1, 2-3, 7, 16-17, 19-20, 28-31, 40-53 context for, 18-22 definition, 1, 26-29, 248 development, 2-4, 35-40 demand for evidence of effectiveness, 1-2, 22-24, 109, 116 federal projects, 39; see also Demonstration projects; individual agencies and projects growth and diversity, 40-41, 198, 201-202 inventory of projects, 86, 121 obstacles to use, 3-4, 53, 58-59, 67-68, 83, 107, 108, 195-196 status, 19-21 structure of report, 33 study origins and approach, 24-26 Telemedicine Information Exchange, 41, 125 n.3 Telemedicine Journal, 154 Telemedicine policy. See also Licensure, professional; Malpractice liability; Payment for services; Privacy; Regulation of medical devices national communications policy and, 84-86 state programs and initiatives, 87-89 Telemedicine Research Center, 124-126, 129 Telemedicine Testbed, 120 Telementoring, 27, 28, 248 Telemonitoring, 27, 45, 49-51, 130, 133 n.6, 168, 184, 248 Telepathology, 109, 116, 128 Telephone communications advisory programs, 44-45 automated, 129-130 consultation and triage, 121 emergency 911, 1, 36, 45 evaluation of, 129-130 health risk assessment program, 129-130 history, 35, 77 human factors in, 77 importance, 53 lines, 65 monitoring system, 130 still-image system, 57 Telepresence, 27, 248-249 Telepsychiatry, 27, 36, 38, 45, 47-49, 65, 66, 104, 124, 147, 162, 175, 181 Telequest, 44 Teleradiology applications of telemedicine, 20, 36, 38, 41-44, 121 digital image management, 39, 42, 57 economic benefits, 181 evaluation of, 44, 116, 124, 127-128, 147 filmless, 43, 243 growth of, 36, 38, 40-41 image quality, 127-128

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--> networks, 39, 44 payment for services, 3, 42, 43, 109, 196 standards, 72, 100 workstation, 62, 63 Telesurgery, 1, 16, 86, 124 Television, 36, 37, 38. See also Cable television; Interactive video Texas licensure laws, 90 prison telemedicine program, 46, 88 Texas Tech, 47 Timeliness of care, 12-13, 128, 192 Total quality management, 166 Training effect, 153 Tripler Army Medical Center, 120 U Uniform State Code for Telemedicine Licensure and Credentialing, 93 University of California at San Francisco, 44 Colorado Health Sciences Center, 122 Iowa, 43 Miami School of Medicine, 38 Michigan, 133-134, 236 Minnesota Telemedicine Project, 233 Nebraska, 36, 87, 89 North Carolina at Chapel Hill, 230 Pennsylvania, 44 Texas Medical Branch at Galveston, 47 Washington, 135 Urban telemedicine ambulatory care clinics, 38-39 emergency telemetric, 38 nursing homes, 38, 49-51 U.S. Constitution Commerce Clause, 93 privacy protection, 102 U.S. Indian Health Service, 39 U.S. Office of Technology Assessment, 58, 105, 159-160, 161 U.S. Public Health Service, 39, 89 U.S. West, 52 Utah, initiatives and programs, 88 Utilization of telemedicine, 20, 40, 43 n.6, 47 n.7, 131, 153, 166, 169-170, 176, 178, 207 V VA facilities and services Baltimore medical center, 43, 121, 128 Bedford, Massachusetts, hospital, 38 Decentralized Hospital Computer Program, 43 evaluation of telemedicine, 200 pacemaker surveillance centers, 45 Palo Alto medical center, 121 San Francisco, 45 Washington, D.C., 45 Video technologies. See also Interactive video full-motion, 63 teleconferencing workstation, 62, 63 transmission considerations, 63-64 Virginia initiatives and programs, 88 Virtual glove, 31 Virtual reality, 86, 250 Voice mail, 77 W WAMI Rural Telemedicine Network, 135, 233 West Virginia, evaluation research, 133, 134 West Virginia University, 229-230 Western Governors Association, 87, 93-94 World Wide Web, 20, 41, 42, 46, 47, 113 n.11, 250 X X-rays, ship-to-shore transmission, 38. See also Teleradiology