Telemedicine journal and e-health : the official journal of the American Telemedicine Association
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Case Reports
Telemedicine physician providers: augmented acute stroke care delivery in rural Texas: an initial experience.
We describe the first report of intravenous thrombolytic therapy for acute ischemic stroke given by a rurally based advanced practice nurse (APN) with a telemedicine team of an emergency physician and stroke specialists. A three-way T1 connection between the APN in Dickerson Memorial Hospital in Jasper, TX, the Houston, TX-based Emtel emergency physician, and the University of Texas-Houston Stroke Team physicians facilitated tissue plasminogen activator treatment 80 min into the patient's ischemic stroke, which was manifested by dysarthria, facial palsy, and near-total left-body hemiplegia (NIH Stroke Scale = 9). She was transferred to Memorial Hermann Hospital in Houston for further care. ⋯ This represents successful acute stroke care given by an APN under supervision of a telemedicine physician team and may be an option for underserved areas. Educational training of health care providers remains the key for acute stroke care delivery. This case report illustrates a model for telemedicine that has been cost-effective for rural medical care.
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The objective of this research was to examine the fiscal impact of telemedicine consultations for acutely ill and injured children in a rural setting using pediatric intensive care unit (ICU) telemedicine. One hundred seventy-nine acutely ill and injured infants and children were cared for in the Mercy Redding ICU from April 2000 to April 2002. Data were gathered from these patients, including 47 patients who received 70 pediatric ICU telemedicine consultations during the same time period. ⋯ Additionally, this program resulted in generating $186,000 and $279,000 of inpatient revenue annually for the two groups at the rural hospital. The cost of this program was approximately $120,000 per year. Given the substantial financial savings, support for underserved rural programs, and significant funds kept in the rural community, this may serve as a viable model for providing care to acutely ill and injured infants and children.
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Although national justice and technology associations have endorsed the utilization of telemedicine and telehealth, little is known about the current utilization of this technology across our nation's correctional facilities. Several voluntary registries and state Web sites exist, but only limited information on telemedicine utilization may be gleaned from these. The purpose of the present study was to fill this void by reporting the utilization patterns in telemedicine programs in state and federal correctional facilities throughout the United States. ⋯ Slightly over half of state correctional institutions and 39% of federal institutions are using some sort of telehealth or telemedicine applications. The most common benefits cited were improved security, personnel safety, costs savings, and access to specialists. The most common barriers cited were costs of technology, resistance from medical personnel, lack of staff technical expertise, and difficulties coordinating services.
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Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. ⋯ The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.
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The purpose of this study was to determine telehealth professionals' current experience with technology, expectations of future technical improvements, and how the technology might impact the delivery of care, including communication with patients and patient safety. We developed a semi-structured interview protocol with eight open-ended questions. A sample of telehealth professionals of the Missouri Telehealth Network (MTN) was selected to represent all major clinical specialties. ⋯ Thirty-two percent of the respondents did not know whether practicing telemedicine over the telehealth network would increase the risk of security and privacy violations. The study findings suggest that telehealth professionals need to be educated about the security features of a telehealth network. In addition, continuous quality improvement, including internal and external benchmarking, is applicable to telemedicine settings and can both improve the quality of teleconsultations and minimize errors.