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
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
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
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
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
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
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
regulation as medical devices, 114-115
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
transportation issues, 180
Costs of technologies, 2, 39-40
Credentialing, 95-96
Croatia, 131
D
Data
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
Data transmission
asynchronous, 239
costs, 66
digital/digitizing, 66-67
store-and-forward technologies, 16-17, 50, 65, 77, 247
synchronous, 247
by telephone, 65
Demonstration projects.
See also specific projects
diversity, 41
evaluation, 86, 118, 124, 135, 148
HCFA, 109
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
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
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
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
level and perspective, 179-180
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
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
business plan/project management plan, 3, 6, 148-149, 155, 202-203
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
definitions, 30-33
documentation of methods and results, 6, 154, 191, 202, 203
economic analysis, 8, 13, 32, 47, 128, 134-135, 148, 156, 179-186, 192-193, 205-207
effectiveness and cost-effectiveness, 32, 132-136
feasibility determinations, 140, 142-144, 191
federal role, 7, 117-118, 136, 141-142, 199-200, 204;
see also individual agencies
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
institutional, 147
lack of evaluation, 17, 116-117
level of, 6, 146-148, 164, 179-180, 203
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
project description, 144-145, 203
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
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
definition, 244
problems, 75-76
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
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
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
options, 99-100
organizational, 99
policies, current, 96-97
Managed care
cost effectiveness, 180
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
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
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
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
packet switched, 246
peer, 48
privacy and confidentiality issues, 104
professional education, 47, 48
public switched telephone (PSTN), 246
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
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
Paramedics, 38
Patient and clinician perspectives
methods and focus, 188
see also Patient satisfaction
Patient care, telemedicine applications, 29, 31, 38
Patient information systems
applications of telemedicine, 31, 50
benefits and risks, 104
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
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
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
outcome measures, 167-168, 170-171
patient risk and, 171-172
patient satisfaction measures, 163, 206-207
practitioner concerns, 19
process measures, 168-170
severity of illness and, 171-172, 206
teledermatology, 43 n.6
types of problems, 166
volume-outcome hypothesis, 173
R
Radiology. See Teleradiology
Radiotelemetry, 38
Rapid City Regional Hospital, 230
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
experimental design, 157, 159, 161, 204
experimental group, 6, 150-151, 203
large simple trials, 159
literature on, 149-150, 156-157, 171
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
effects, 9
payment for services, 112
psychiatry, 47-49
radiology, 43
utilization, 40
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
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
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
See also Electrocardiograms
Telecommunications.
See also Data transmission;
Telephone communications
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
audio, 240
definition, 248
educational, 20
interactive video, 16, 28, 48, 49, 62, 63, 249
real-time, 65
store-and-forward systems, 65
Teleconsultation
cost-effectiveness, 52
definition, 248
equipment and space configurations, 51, 59, 62-63
interstate licensure policies, 90, 91
and malpractice, 98
in nursing homes, 49
scheduling problems, 76-77
specialist, 52
Teledermatology
evaluation of, 125, 128-129, 131-132, 143, 144-145, 147
rural applications, 131-132
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
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
Telemonitoring, 27, 45, 49-51, 130, 133 n.6, 168, 184, 248
Telephone communications
advisory programs, 44-45
automated, 129-130
consultation and triage, 121
evaluation of, 129-130
health risk assessment program, 129-130
human factors in, 77
importance, 53
lines, 65
monitoring system, 130
still-image system, 57
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
image quality, 127-128
payment for services, 3, 42, 43, 109, 196
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
Minnesota Telemedicine Project, 233
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
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
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