Remote Health Monitoring: Using Communications Technology to Deliver Health Care Services

“Last week, the Better Health Care Together coalition held a briefing at the National Press Club to unveil a new study written by economist Dr. Robert Litan.
The study, entitled Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives, found that the United States could cut $197 billion from its health care bill over the next 25 years by the widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes.”
Article
Robin Strongin, Disruptive Women in Healthcare, 31 October 2008

Tele-guidance of chronic heart failure patients enhances knowledge about the disease. A multi-centre, randomised controlled study

“Background
New strategies are required to optimize care in increasing numbers of chronic heart failure patients. The aim of this randomised trial was to evaluate a remote guidance system.
Methods
Intervention group patients received a home TV-channel providing educational materials. Tele-guidance was performed by a Medical Service Centre. Control group patients were followed by cardiologists and HF-nurses. Primary endpoints were total days in hospital for all causes and days alive and out of hospital. Secondary endpoints were: quality of life and knowledge of disease and self care.
Results
214 patients were enrolled, median age was 66 years, 89% had systolic LV dysfunction, and 90% were in NYHA class II or III. The mean LVEF was 31%. Over a mean follow-up duration of 288 days, there were 199 hospital admissions in 105 patients. Comparison of the groups revealed no differences for the primary outcomes or for QoL or self care behaviour. Knowledge about heart failure however, increased significantly more in the Intervention group (p<0.001).
Conclusion
Tele-guidance may play a role in the management of heart failure patients since it takes over some of the tasks of HF-nurses. This may facilitate delivery of optimal care to more patients with the same level of experienced staff.”
Abstract
Aggie H. Balka, Wim Davidse, Paula van Dommelen, Ellen Klaassen, Kadir Caliskan, Pieter van der Burgh, Christina M. Leenders, European Journal of Heart Failure, Volume 10, Issue 11, Pages 1136-1142, doi: 10.1016/j.ejheart.2008.08.003

Cardiologist ‘gets’ telehealth

“It’s great to see Dr Lance Forbat, a consultant cardiologist in the UK so excited by, and committed to, the implementation of telehealth with appropriate patients that he has embedded it into his private practice. He uses Docobo equipment and told Telecare Aware “it has transformed the way I think about the management of my patients and is proving to be a masterful tool in their empowerment.”
Article
Telecare Aware, 20 October 2008

Journal of Telemedicine and Telecare, TOC, September 2008

Telemedicine can improve the health of youths in detention
“Young people in correctional care facilities often have physical or psychological disorders that contribute to their behavioural problems. In the US, the need for medical services in youth facilities far exceeds current resources, especially for paediatric mental health and specialty services. There is obvious potential for telemedicine to improve access to care and thus the level of health care for juvenile detainees. A few studies have indicated that in specific instances telemedicine has improved access to care, referrals, contact between providers, and has also reduced unnecessary referrals. The question remains, however, whether this improved access and timeliness to care has any effect on the major goals of the incarceration: treatment, education and rehabilitation. Further investigation of this linkage is needed.”
Abstract
Karen C Fox and Anna Lyn Whitt, J Telemed Telecare 2008;14 275-276, doi:10.1258/jtt.2008.008002

Emergency telepsychiatry
“Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or manmade disaster.”
Abstract
Peter Yellowlees, Michelle M Burke, Shayna L Marks, Donald M Hilty, and Jay H Shore, J Telemed Telecare 2008;14 277-281, doi:10.1258/jtt.2008.080419

Hageseth’s principle of extraterritorial jurisdiction and international telemedicine
“At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law.”
Abstract
Thomas R McLean and Alexander B McLean, J Telemed Telecare 2008;14 282-284, doi:10.1258/jtt.2008.080416

The use of information and communications technology for health service delivery in Namibia: perspectives of the health service providers
“We surveyed health service providers in Namibia to find out how they used information and communication technologies (ICTs) to deliver health services to their patients. A structured questionnaire was administered to 21 health service providers in two regions of the country (one urban, one rural). There was overwhelming consensus among the health service providers that ICTs were very important, especially for medical services (100%). Ninety-one percent of health service providers viewed ICT as helping them to interact with other providers in other health institutions. The most commonly used ICT was the telephone, which was used in the admission areas of most health institutions (36%); the next most commonly used ICT was the PC (23%). The most commonly used channels for communication with patients were the telephone followed by TV. Some of the problems common to all health institutions in Namibia were poor budgetary resources and lack of basic infrastructure such as electricity or telephone lines. There is a need to promote ICT use for health service delivery and also to stimulate patients to use ICT to access health services and relevant information.”
Abstract
Meke I Shivute, Blessing M Maumbe, and Vesper T Owei, J Telemed Telecare 2008;14 285-289, doi:10.1258/jtt.2008.071204

Assessment of a remote monitoring system for implantable cardioverter defibrillators
“We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient’s condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users.”
Abstract
Cristina Masella, Paolo Zanaboni, Francesca Di Stasi, Serena Gilardi, Patrizia Ponzi, and Sergio Valsecchi, J Telemed Telecare 2008;14 290-294, doi:10.1258/jtt.2008.080202

Quality of diabetes care among patients managed by teleconsultation
“We studied a new teamwork-based teleconsultation model for treating patients with diabetes, where a specialist in diabetes care, a diabetes nurse and a patient attended by videoconference. The study series consisted of all the patients (n = 101) at three health centres in northern Finland whose care was provided by a single physician at a remote diabetes clinic. A total of 101 patients with diabetes (19 of type 1 and 82 of type 2) were studied at baseline and at 10–14 months after the first consultation. Mean HbA1c was 8.0% at baseline and 7.6% at follow-up (P = 0.007). The proportion of patients with poor glycaemic control decreased from 32% to 13%. Mean LDL cholesterol was 3.3 mmol/L at baseline and 2.7 mmol/L at follow-up (P < 0.001). The percentage of patients with optimum lipid levels increased from 20% to 50%. Mean systolic blood pressure was 146 mmHg at baseline and had decreased by 6 mmHg at follow-up (P = 0.004). The percentage of patients with poor blood pressure control decreased from 19% to 8%. The most common changes in medication were the introduction or modification of insulin treatment and the introduction of statin and antihypertensive drugs and acetylsalicylic acid. Although the study was uncontrolled, there were improvements in glucose and LDL cholesterol levels and blood pressure in patients who were managed by teleconsultation.”
Abstract
Tuula Nikkanen, Markku Timonen, Kirsti Ylitalo, Olavi Timonen, Sirkka Keinänen-Kiukaanniemi, and Ulla Rajala J Telemed Telecare 2008;14 295-299, doi:10.1258/jtt.2008.080313

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
“We studied the effects of home telemonitoring in elderly patients with congestive heart failure (CHF) on mortality and rate of hospitalization, compliance with treatment, quality of life and costs of CHF management, by comparison with a group receiving usual care. Fifty-seven elderly CHF patients were randomized to standard care or to home telemonitoring-based care and followed for 12 months. In the subjects who were monitored, weekly reports on their clinical status were obtained and their management was modified accordingly. Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations (P = 0.006), a better compliance with therapy, more frequent use of beta-blockers and statins, lower total cholesterol level and a better reported health perception score. The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients.”
Abstract
Roberto Antonicelli, Paolo Testarmata, Liana Spazzafumo, Cristina Gagliardi, Grzegorz Bilo, Mariaconsuelo Valentini, Fabiola Olivieri, and Gianfranco Parati, J Telemed Telecare 2008;14 300-305, doi:10.1258/jtt.2008.071213

Acceptability to primary care providers of telemedicine in diabetes case management
“We studied the perceptions of primary care providers (PCPs) about the telemedicine intervention in a trial of telemedicine for management of diabetes in medically under-served areas of New York State. A survey was mailed to 206 rural and 159 urban PCPs. The response rates were 25% and 22%, respectively. Eighty percent of respondents believed that a diabetes telemedicine case management system would help their practice. An overall satisfaction score (possible range 0–80) suggested good acceptability (mean 66, SD 12). In multiple linear regression, the rural location and younger age of the PCPs were independent predictors of higher satisfaction (both P < 0.01). Within-PCP comparisons showed a higher perceived impact on patients, as compared to impact on PCP practices (P < 0.001). However, the findings should be interpreted with caution due to the low response rates."
Abstract
Walter Palmas, Jeanne Teresi, Ruth S Weinstock, and Steven Shea, J Telemed Telecare 2008;14 306-308, doi:10.1258/jtt.2008.080410

The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre
“We evaluated the effect of telemedicine compared with traditional telephone conversations when evaluating patients for aeromedical retrieval. A convenience sample of consecutive patients referred for retrieval from Palm Island over a six-month period was compared retrospectively with patients referred during the previous six months. There was a significant difference (P = 0.014) in the number of patients referred in the telemedicine period (113) compared to the previous six months (78), which may have been a seasonal fluctuation. There was a smaller proportion of aeromedical retrievals in the telemedicine period (78%) compared to the control period (92%), P = 0.009. Other significant differences between the telemedicine and control period included a larger proportion of patients not transferred at all (16% compared to 5%, P = 0.022) and a smaller percentage of rotary flights (52% compared with 73%, P = 0.004). Retrieval coordinators perceived that telemedicine use prevented 10 aeromedical flights and six night flights. The coordinators and referrers felt that telemedicine improved patient care in 75% and 65% of consultations, respectively. The coordinators felt that it improved communication with the referring doctor for 84% of the consultations.”
Abstract
Kate A Mathews, Mark S Elcock, and Jeremy S Furyk, J Telemed Telecare 2008;14 309-314, doi:10.1258/jtt.2008.080417

A pilot study of videotelephone-based support for newly diagnosed paediatric oncology patients and their families
“As part of the preparation for a randomized controlled trial, we conducted a pilot study to investigate the feasibility of providing videotelephone-based support to a sample of families (,em>n = with a child diagnosed with cancer, returning home for the first time after diagnosis and initial treatment. Seven of these families received support via videotelephone over a three-month period. Twenty videotelephone calls were made totalling 400 minutes (median 21 min, IQR 16–24). All videotelephone calls involved the specialist nurse providing support to mothers (85%) or fathers (15%) and involved communicating directly with the patient in most of the calls (55%). Social workers were involved in three calls (15%). All families expressed satisfaction with services delivered in this way. There were few technical problems. The use of a hybrid approach to providing videotelephony, using the family home computer and Internet connection for video and the home telephone line for full-duplex audio, was less costly than the custom-made device used in past studies.”
Abstract
Mark Bensink, Nigel Armfield, Helen Irving, Andrew Hallahan, Deborah Theodoros, Trevor Russell, Adrian Barnett, Paul Scuffham, and Richard Wootton, J Telemed Telecare 2008;14 315-321, doi:10.1258/jtt.2008.080505

Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction
“We examined the use of telemedicine for improving access to care in a work-site clinic. A prospective study of 100 patients was conducted over a four-month period in a work site that housed 700 employees. Sinusitis (10 visits), upper respiratory tract infections (9 visits), otitis media (9 visits), hypertension (9 visits) and back pain (8 visits) were the most common reasons for the visits. In 99 visits, clinicians were of the opinion that the telemedicine visit felt similar to a face-to-face visit. For most of the visits (67), patients strongly agreed or agreed that telemedicine had a positive effect on their relationship with the health-care provider. The otoscope, microscope and stethoscope telemedicine peripherals were important in aiding diagnosis (and ruling out other causes) in about 55% of the visits (upper respiratory tract infection, sinusitis, otitis media, cough, sore throat, nevi, rhinitis and ear wax related concerns). The ability for the patient to watch their ENT examination and see any associated abnormalities was appreciated by many patients. Physicians, nurses and patients were capable of using the technology with little training.”
Abstract
Prathibha Varkey, Kay Schumacher, Claudia Swanton, Barbara Timm, and Philip T Hagen, J Telemed Telecare 2008;14 322-325, doi:10.1258/jtt.2008.080512

Journal of Telemedicine and Telecare, TOC, July 2008

Telerehabilitation for service delivery in speech-language pathology
“Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person’s everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.”
Abstract
Deborah G Theodoros, J Telemed Telecare 2008;14 221-224, doi:10.1258/jtt.2007.007044

Telehealth: a child and family-friendly approach to mental health-care reform
“Limited access to paediatric mental health services and high drop-out rates from treatment result in poor health outcomes for families with children with mental health problems. New ways of delivering care are required. Telehealth is a promising approach. The Family Help programme employs manualized, distance treatment by telephone. Participants in the Family Help programme (both adults and children) have reported a strong therapeutic alliance with their telephone coach. Participants also described how during treatment sessions they felt comfortable and safe in their own home; they did not feel stigmatized or judged; they had little apprehension about self-disclosure and they felt that treatment was delivered at their convenience. Treatment calls were often scheduled after typical working hours. Attrition rates were found to be very low and children actively engaged in the structured, distance treatment. Evidence-based, distance delivery using non-professionals is a promising approach to the delivery of paediatric mental health care.”
Abstract
Patricia Lingley-Pottie and Patrick J McGrath, J Telemed Telecare 2008;14 225-226, doi:10.1258/jtt.2008.008001

Effect of a behavioural health and specialty care telemedicine programme on goal attainment for youths in juvenile detention
“We conducted a pre-post study of the effect of a telepsychiatry counselling service on youths housed in three juvenile detention facilities. In the first year of the telemedicine programme, 321 psychiatry consultations were conducted via telemedicine; in the second year of the programme, 573 psychiatry consultations were conducted. Records for 190 students were then examined by two raters. The total number of behavioural goals for each adolescent increased from 8.2 in the pre-telemedicine year to 8.7 in the first year of telemedicine and then to 10.0 in the second year (P < 0.05). In Year 2 of the study, subjects also had a significantly higher number of goals in four of the five categories: education, family, health and social skills (P < 0.05). Although other changes at the youth detention facilities or in the juvenile justice system may have been partly responsible for the effects observed, the study suggests that telemedicine may be useful for improving the rate of attainment of goals associated with family relations and personality/behaviour."
Abstract
Karen C Fox, Pamela Connor, Elizabeth McCullers, and Teresa Waters, J Telemed Telecare 2008;14 227-230, doi:10.1258/jtt.2008.071102

Non-invasive monitoring of the activities of daily living of elderly people at home – a pilot study of the usage of domestic appliances
“We conducted a feasibility study of a system for non-invasive monitoring of subjects at home. Electrical activity was recorded from room lights and from electrical domestic appliances; this was translated into the probability of physical activity or a particular Activity of Daily Living (ADL). Thirteen volunteer subjects were monitored for a period of 6.4 months (range 3–8). The mean age of the subjects was 80 years and they all lived alone at home; one had moderate Alzheimer’s disease. A one-week validation was carried out to ascertain whether the recorded activity actually occurred. The results showed that daily and nocturnal activity could be well differentiated. The probability of having eaten, taken a bath and going to the toilet could be calculated each day. Eating was the most accurately measured ADL; toileting and bathing results were less accurate. The system appears to be a promising component of home telecare.”
Abstract
Georgina Corte Franco, Floriane Gallay, Marc Berenguer, Christine Mourrain, and Pascal Couturier, J Telemed Telecare 2008;14 231-235, doi:10.1258/jtt.2008.071207

A paediatric therapeutic alliance occurs with distance intervention
“We investigated whether a distance therapeutic alliance occurs when children receive manualized, cognitive-behavioural treatment via telephone, in the absence of face-to-face contact. The therapeutic alliance scores were measured in 55 child–parent pairs. The mean total Working Alliance Inventory child scores were 236 (95% confidence interval [CI]: 232, 240) and the mean parent scores were 245 (95% CI: 242, 247). Parent scores were significantly higher than child scores, although the difference may not be clinically meaningful. This study provides evidence that a strong therapeutic alliance does occur between child–coach and parent–coach pairs when treatment is delivered from a distance by non-professionals. The term ‘child’ encompasses both children and adolescents.”
Abstract
Patricia Lingley-Pottie and Patrick J McGrath, J Telemed Telecare 2008;14 236-240, doi:10.1258/jtt.2008.080101

International telepsychiatry: a study of patient acceptability
“An international telepsychiatry service was established between Denmark and Sweden for cross-cultural patient groups, such as asylum seekers, refugees and migrants. Over an 18-month period starting in mid 2006, 30 patients were treated by telepsychiatry (21 men and 9 women). The patients received mental health care by videoconferencing from providers who spoke the patients’ own language, i.e. without the assistance of interpreters. The total number of telepsychiatry sessions was 203 (range 1–22; average 6.8 sessions per patient). Patients completed a satisfaction questionnaire at the end of treatment. Seven patients (23%) were not able to complete a questionnaire, due to illiteracy and/or a psychotic condition. The rest of the patients (n=23) reported a high level of acceptance and satisfaction with telepsychiatry, as well as a willingness to use it again or recommend it to others. Any disadvantages of telemedicine were compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. Mentally ill asylum seekers, refugees and migrants are under-served in their mother tongue and telepsychiatry can improve access to scarce health-care resources.”
Abstract
Davor Mucic , J Telemed Telecare 2008;14 241-243, doi:10.1258/jtt.2008.080301

The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit
“We examined records of all admissions to an isolated community neonatal intensive care unit (NICU) in California between 2001 and 2006. We also reviewed the echocardiograms for diagnosis, disposition of patient and necessity for transport. In 2004, a telemedicine link (mainly store-and-forward) was established to a university children’s hospital (UCH) 290 km away. The number of NICU patients having an echocardiogram increased from 280 (27% of 1029 admissions) to 385 (40% of 963, P = <0.001) after telemedicine became available. There was an increase in the proportion of normal studies, from 31% to 37% (P = 0.03), and an increase in the number of patients diagnosed with cardiac pathology from 192 (19% of all admissions) to 241 (25%, P < 0.001). Twenty-four patients were transferred for cardiac reasons during each three-year period; however seven pre-telemedicine transfers were avoidable, compared with two post-telemedicine transfers (P = 0.06). There was a change in referral pattern (65% to the UCH pre-telemedicine, compared with 78% post-telemedicine) although it was not significant (P = 0.10). Thus the availability of the telecardiology link was associated with increases in the utilization of echocardiography, in the proportion of normal studies, and in the percentage of neonates diagnosed with cardiac pathology without an increase in the number transferred for cardiac reasons. There was a reduction in unnecessary transfers and a strengthened relationship with the centre providing the telecardiology service."
Abstract
Tannie Huang, Anita J Moon-Grady, Craig Traugott, and James Marcin, J Telemed Telecare 2008;14 244-248, doi:10.1258/jtt.2008.080102

Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis
“We conducted a randomized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/hand function (the Home Care Activity Desk [HCAD] training) in a home setting. Usual care was compared to HCAD training. The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) with respect to their arm/hand function. Eighty-one patients with affected arm/hand function resulting from either stroke, MS or TBI were recruited in Italy, Spain and Belgium; 11 were lost during follow-up (14%). The outcome measures were the Action Research Arm Test (ARAT) and the Nine Hole Peg Test (NHPT). There were no significant differences between the two groups on the outcome measures (ARAT and NHPT); in both groups, patients maintained or even improved their arm/hand function. The HCAD training was found to be as feasible as usual care in terms of clinical outcomes, and both therapists and patients were satisfied with the HCAD intervention. A telerehabilitation intervention using HCAD may increase the efficiency of care.”
Abstract
Barbara CH Huijgen, Miriam MR Vollenbroek-Hutten, Mauro Zampolini, Eloy Opisso, Montse Bernabeu, Johan Van Nieuwenhoven, Stephan Ilsbroukx, Riccardo Magni, Claudia Giacomozzi, Velio Marcellari, Sandro Scattareggia Marchese, and Hermie J Hermens, J Telemed Telecare 2008;14 249-256, doi:10.1258/jtt.2008.080104

Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home
“We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment. We compared the degree of satisfaction of patients undergoing a virtual reality (VR) therapy programme at home (Tele-VR group) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting (VR-group). The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient’s movement was represented. In tele-therapy, the patient equipment was installed in their homes, connected to the hospital by four ISDN lines at a total bandwidth of 512 kbit/s. Rehabilitation data were transmitted via one line and videoconferencing via the other three. Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke, were randomized into VR or Tele-VR groups. A questionnaire was used at the end of treatment to measure each patient’s degree of satisfaction. Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated, except one. In motor performance, the Tele-VR group improved significantly (P ? 0.05), while the VR group showed no significant change. Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required.”
Abstract
Lamberto Piron, Andrea Turolla, Paolo Tonin, Francesco Piccione, Lisa Lain, and Mauro Dam, J Telemed Telecare 2008;14 257-260, doi:10.1258/jtt.2008.080304

Caregivers’ acceptance of electronic documentation in nursing homes
“A comparative study was conducted in two Australian nursing homes operated by the same organization. One home had implemented an electronic documentation system and the other remained paper-based. Survey questionnaires were answered by 14 of the 17 caregivers at the electronic documentation site (82%) and 10 of the 23 caregivers at the paper documentation site (43%). They provided opinions about satisfaction with their home’s documentation system, and the training and support provided. Information was also obtained on the caregivers’ attitudes towards using electronic documentation. The caregivers at the electronic documentation site quickly adapted to the use of the new technology after receiving effective training and support. Caregivers at both homes were satisfied with their homes’ documentation system, and had positive attitudes towards using electronic documentation systems. As an important communication tool, electronic nursing documentation may lead to improved efficacy of telemedicine in nursing home settings.”
Abstract
Ping Yu, David Hailey, and Haocheng Li, J Telemed Telecare 2008;14 261-265, doi:10.1258/jtt.2008.080310

The use of videoconferencing for mental health services in Finland
“The utilization of telemental health (TMH) services in Finland was surveyed in 2006. In total, 135 health-care units provided responses. Eighty-four responses were received from primary care units (health-care centres and clinics) and eight from other clinics, in all hospital districts. The overall rate of TMH consultations was 4 per 100,000 population. The highest TMH consultation per population ratio, 22 per 100,000, was in northern Finland. Most of the sites used telepsychiatry services for less than 10% of clinical outpatient services. The sites with over 20% utilization of clinical TMH services from all psychiatric consultations were all rural health centres. Compared with Finland, the utilization rates of TMH were higher in Canada; that might be due to differences between the countries in the organization of mental health services in primary and specialized care. In Finland TMH consultations made up only a very small proportion of all mental health services. The use of TMH was particularly common in remote areas; however, there were many rural centres that did not utilize clinical TMH. TMH was widely utilized for continuing and medical education.”
Abstract
Arto Ohinmaa, Risto Roine, David Hailey, Marja-Leena Kuusimäki, and Ilkka Winblad, J Telemed Telecare 2008;14 266-270, doi:10.1258/jtt.2008.071212

Use of mobile phone cameras for after-hours triage in primary care
“Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P = 0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios.”
Abstract
Chandra Jayaraman, Paul Kennedy, Gaelle Dutu, and Ross Lawrenson, J Telemed Telecare 2008;14 271-274, doi:10.1258/jtt.2008.080303

AOK Plus to use ICW telemedicine system

“German health insurers AOK Plus has commissioned InterComponentWare to implement a telemedicine system to care for patients with serious chronic heart failure.
The service will be offered to patients living in the German state of Saxony.”
Article
e-Health Europe, 3 July 2008

Indiana hospital to provide portable medical records to patients

“Patients at St. Vincent Heart Center of Indiana will now be able to carry their medical records with them in case of emergencies. The hospital is offering patients a small compact disc that contains their updated cardiovascular medical information and history.”
Article
Richard Pizzi, Healthcare IT News, 28 May 2008

Balearic Islands connect to joint network

“All public hospitals and around 80 connected Primary Health Centers in the Balearic Islands are now connected to a joint network, where the use of a master patient index is enabling Balearic doctors to access patient data and medical findings anytime.”
Article
eHealth Europe, 5 May 2008

Home Monitoring Program Improves Outcomes for Heart Patients

“Remote monitoring can improve the condition of mobile heart failure patients and may reduce hospital readmissions, according to a pilot study that included 150 patients admitted to Massachusetts General Hospital in Boston.”
Article
Washington Post, 1 May 2008

Misys to Embed Content in EHR

“Starting in July, Misys will offer the software for primary care and cardiology practices embedded with reference and drug information, evidence-based guidelines, clinical decision support, and documentation and coding tools specific to those practices. Over time, the vendor will add Wolters Kluwer content for other specialties.”
Article
Health Data Management, 28 April 2008

VitalJacket: Heart Monitoring Shirt

“In an attempt to make heart monitoring less visible and bulky for individuals requiring continuous monitoring of their heart, BioDevices, SA, has a unique solution. The company has developed a T-shirt which continuously monitors heart rate and ECG waves. This is an ideal solution for elderly patients and has a lot of potential for fitness applications as well.”
Article
MedGadget, 25 April 2008

Berlin University opens telemedicine centre

“The Charité University Hospital, part of Berlin University, has opened a centre for cardiovascular telemedicine that will carry out research and provide services to patients.
It is the first academic telemedicine centre in Germany to support a full 24/7 call-centre service.”
Article
e-Health Europe, 9 April 2008

MDs launch online tool for patients

“Doctors may soon be tracking patients with high blood pressure or asthma over the Internet using online tools launched yesterday by the Canadian Medical Association.
The web portal, called mydoctor.ca, is geared to help doctors and patients work more closely together, especially to manage chronic diseases, including diabetes and heart disease. The secure portal also allows patients to input health information and lets them track their blood pressure, asthma and weight loss.”
Article
Megan Ogilvie, The Star, 2 April 2008

Combining Internet With Office Visits Cut Heart Attack Risks

“Whether it’s done in person or electronically, good doctor-patient communication helps reduce the risk of heart disease, says a Temple University School of Medicine study.”
Article
Washington Post, 30 March 2008

Design and Development of a Knowledge driven Web based ECG Data monitoring and Diagnostic Tool in Lab-view

Abstract:
Knowledge driven technological developments, the growth and speed of application oriented products in the field of web based services, medical technology and information science, the use of sensor networks for remote patient monitoring is currently playing a major role in quality healthcare delivery to the masses. However, further research need to be done for more effective diagnosis and treatment of diseases remotely. An improved web based, knowledge driven, patient data monitoring and diagnosis system remotely, is developed to acquire, store and process the data using specially developed GUI (Graphical User Interface) on lab-view platform. The GUI displays, communicates and processes vital biomedical parameters such as Heart rate (HR), beat to beat ratio (R-R), QRS and QT intervals etc after acquiring ECG, pulse rate, body temperature etc. from the patient’s body sensors. The system detects any emergency condition automatically, if the patient develops any abnormality in his heart rate or irregularity in rhythm heart line and establishes direct connectivity between specialists and patient. The provision to store the online data on remote PC in auto mode is given. The storage of data files on demand on local and remote PC and online data communication between the two is done through shared variables. A case study to evaluate the performance and to verify the experimental implementation is conducted on two patients with varying heart rate (HR) and varying rhythm and the results were found exactly to be in accordance with the expected outcome.

H.R. SINGH and Manju SINGH
Biomedical Measurements and Standards Group, National Physical Laboratory New Delhi, India

To be published in “Medical and Care Compunetics 5″, IOSPress, 2008.
To be presented at the ICMCC Event 2008.

Philips buys Tomcat Systems

“Dutch IT giant Royal Philips Electronics has announced it will acquire Tomcat Systems Ltd, a Northern Ireland-based supplier of cardiac information systems, terms of the deal were not disclosed.
Tomcat provides integrated cardiac care software said to provide a comprehensive, patient-centric presentation of patient data and the ability to address both clinical and operational needs.”
Article
e-Health Insider, 28 March 2008

Get wired, send SMS from your ailing heart!

“This comes straight from the heart. Doctors in the Indian capital have successfully implanted a device on a heart patient that can keep a tab on cardiac problems, send an SMS and even e-mail to the doctor concerned.”
Article
Prashant K. Nanda, New Kerala, 7 March 2008

The TeleGuard trial of additional telemedicine care in CAD patients.

1 Utilization of the system

“Abstract:
Patients with established coronary artery disease (CAD) were recruited in 11 hospitals and randomized to an intervention (telemedicine system; n = 752) or a control group (usual medical care; n = 748). On the day before discharge, patients in the intervention group were equipped with a 12-lead event recorder and trained to use the device. Whenever they had symptoms, they could contact the call centre, transmit an ECG (without redialling) and consult a physician. During a 12-month study, 171 patients (23%) in the intervention group contacted the call centre, a total of 269 times. The main reasons for calling were chest pain and radiating pain. Pathological changes were seen in 24% of the transmitted ECGs. Only 23% of the calls were made in the first hour after onset of symptoms and a further 12% in the subsequent hour, suggesting that patients should be encouraged to use ECG transmission at an earlier stage. At follow-up, 157 patients (21%) had had at least one recurrent cardiac event (myocardial infarction, cardiac hospital stay, re-vascularization). The proportion was significantly higher in telemedicine users (35%) than in non-users (17%), P < 0.001. Regardless of utilization, the majority of the intervention patients considered that the telemedicine system was helpful (users = 93%, non-users = 89%; P = 0.095).”
Abstract
Katalinic, Alexander; Waldmann, Annika; Schwaab, Bernhard; Richardt, Gert; Sheikhzadeh, Abdolhamid; Raspe, Heiner, Journal of Telemedicine and Telecare, Volume 14, Number 1, January 2008, pp. 17-21(5)

2 Morbidity and mortality after 12 months

“Abstract:
In the TeleGuard trial, 1500 patients with established coronary artery disease (CAD) were recruited and randomized to control or intervention groups. Patients in the intervention group were equipped with a 12-lead event recorder and could contact a call centre and transmit an ECG whenever they wished. In a 12-month study, the composite endpoint (all-cause mortality, myocardial infarction, re-hospitalization or re-vascularization) was seen in 40% of the intervention patients and in 38% of the control patients. In both groups, approximately 40% were re-hospitalized. In total, 73 patients experienced re-vascularization, 75 showed an infarction and 33 died. Equipping CAD patients with a 12-lead ECG device and providing a telemedicine centre with 24-hour availability did not decrease risk for the composite endpoint (re-hospitalization, re-vascularization, (subsequent) myocardial infarction and/or death). It is likely that the clinical pathway used in the telemedicine centre led to an increased hospital admission rate in the intervention group.”
Abstract
Waldmann, Annika; Katalinic, Alexander; Schwaab, Bernhard; Richardt, Gert; Sheikhzadeh, Abdolhamid; Raspe, Heiner, Journal of Telemedicine and Telecare, Volume 14, Number 1, January 2008, pp. 22-26(5)

Over 3.5 mn rural people get tele-ECG benefit through Byrraju Foundation

“Satyam Computer Services Ltd has announced that its global healthcare practice, working with the Byrraju Foundation, has implemented a programme to provide tele-electrocardiograms (ECGs) to patients in remote areas of the country who would otherwise have no access to such care.
The programme already covers some 3.5 million people in rural villages across India, and is delivered through the Byrraju Foundation’s Ashwini centres, local facilities that provide high-quality healthcare, education, agriculture, and job training for villagers. In the past, patients would have had to travel to a city, at great cost, to receive an ECG or imperil their health by not having one at all.”
Article
Pharmabiz.com, 4 February 2008

Brown pledges telehealth for 100,000

“Prime minister Gordon Brown has pledged to offer telehealth services to 100,000 people with long term conditions in a speech outlining his plans for a more preventative and personal NHS.
Brown’s speech, designed to regain the political initiative on health, also revealed government plans to offer patients screening for heart disease, stroke, diabetes and kidney disease.”
Article
e_Health Insider Primary Care, 8 January 2008

Kaiser Gets Grant for EHR Study

“Kaiser Permanente’s Center for Health Research has received a $600,000 grant from the Agency for Healthcare Research and Quality to analyze its electronic health records to help improve cardiovascular care.”
Article
Health Data Management, 17 December 2007

Finnish company trials cardiac telemedicine

“VTT Technical Research Centre of Finland has developed remote healthcare services that allow patients to be treated globally, irrespective of the solutions provided by hardware and data system suppliers.”
Article
e-Health Europe, 5 December 2007

Southampton City to use cardiac telemedicine

“Southampton City PCT is to begin use of a telemedicine electrocardiogram interpretation service to give expert cardiology reporting for patients in clinics.”
Article
e-Health Insider Primary  Care, 3 December 2007

Video gamers’ tactile vest to fund telemed development

“A vascular surgeon who developed a touch-sensitive ‘vest’ to facilitate the hands-on part of the examination for remote diagnosis has turned to the video game industry to fund the development. Read an interview with him.”
Article
Telecare Aware, 7 November 2007

Remote monitoring first for Amsterdam hospital

“St. Lucas Andreas Hospital, Amsterdam has become the first in the Netherlands to introduce a remote monitoring system for cardiac patients into its daily operations.”
Article
e-Health Europe, 2 November 2007

Miniature ultrasound machines developed

“What if your doctor could swipe a wand over your neck and reveal whether you have hidden heart disease?
That is now possible in places other than the sickbay of the starship Enterprise.”
Article
Marilynn Marchione,  Globe and Mail, 7 October 2007

Philips acquires cardiac home care company

“Royal Philips Electronics announced Oct. 4 that it is extending its cardiac care services into the home. The Dutch firm announced that it would acquire Raytel Cardiac Services, a U.S.-based supplier of home cardiac monitoring services, and other ancillary operations from Israeli-based SHL Telemedicine, Ltd. for approximately $110 million in cash.”
Article
Eric Wicklund, Healtcare IT News EU, 4 October 2007

Tanzania keen on tie-ups with Bangalore hospitals for telemedicine

“With the IT city fast emerging as a global health destination, Tanzania is looking at tie-ups with two Bangalore-based hospitals for telemedicine.”
Article
The Hindu Business Line, 20 September 2007

Online help for Mumbai’s heart patients

“The Asian Heart Institute (AHI) today launched its telemedicine facility for heart patients of the city.”
Article
New Kerala, 18 September 2007

Research aims to boost RFID security, integration

“Researchers at Rochester Institute of Technology have announced that they will begin to work on enhancing the integration of radio frequency identification into cardiac sensor networks - a wireless technology for telemedicine delivery - as well as enhancing security within these systems.”
Article
Molly Merrill, Healthcare IT News, 19 September 2007