Telemedicine A Guide to Assessing Telecommunications for Health Care (1996) / Chapter Skim
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Pages 259-271
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From page 259... ...
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 End ~,v~,lonm~,nt 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, 239 259 Agamemnon, 34 Agency for Health Care Policy and Research, 22, 117 Allina Healthcare 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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From page 260... ...
see Patient and clinician perspectives Cochrane Collaboration, 22 CODEC, 50,241 Colorado confidentiality of medical records, 92 prison telemedicine program, 46 teleradiology standards, 100 INDEX Columbia University Health Sciences Division (New York) , 237 Community effects of telemedicine, 9, 163 Comparison (control)
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From page 261... ...
see Teledermatology Dialysis center, 49, 51 Digital images/imaging conventional images compared to, 127-129 direct, 242 software, 86 store-and-forward technologies, 1617 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.
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From page 262... ...
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 INDEX 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, 179186, 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, 141142, 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 .
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, 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)
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From page 264... ...
, 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, 244245, 249. See also World Wide Web Interstate telemedicine, 3, 83, 89-95 Iowa Health System Telemedicine Demonstration, 236 programs and initiatives, 87 INDEX J Jackson Memorial Hospital, Miami, 38 Jean-Talon Hospital, 36 Johns Hopkins University, 127-128 Joint Commission on Accreditation of Healthcare 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.
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From page 265... ...
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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From page 266... ...
, 246 rural area, 52, 135, 247 specialty consultation, 135 INDEX 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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From page 267... ...
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, 90 267 Physician hospital organizations (PHOs)
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From page 268... ...
, 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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From page 269... ...
Paul Fire & Marine Insurance, 100 St an d ard s/stan d ar din ati on of care, 97, 100 hardware and software, 3, 69-72, 82, 98 medical devices, 113-114 questionnaires, 133, 161, 187 171, 178, 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, 42 269 T Tactile data, 31 Technical infrastructure compatibility of systems, 3, 27, 6769, 195 costs, 182 digital technologies, 66-67 equipment and space configurations, 59 information carrying capacity, 6165 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.
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From page 270... ...
See also Licensure, professional; Malpractice liability; Payment for services; Privacy; Regulation of medical devices national communications policy and, 84-86 state programs and initiatives, 8789 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 Teloquest, 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, 127128, 147 filmless, 43, 243 growth of, 36, 38, 40-41 image quality, 127-128
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From page 271... ...
West, 52 271 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.
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