Database Project To Track Health Of 100,000 U.S. Children

“An ambitious new government study to follow the health of 100,000 U.S. children from before birth to age 21 is launching in January, and information technology for data collection and analysis is playing a central role.
The National Institutes of Health National Children’s Study, which was authorized by Congress in the Children’s Health Act of 2000, will examine the effects of genes and environmental factors on the health of American children based on volunteer participants in 105 locations, representing a composite of the U.S. population.”
Article
Marianne Kolbasuk McGee, InformationWeek, 7 October 2008

Electronic Health Records Improve Care for Texas Foster Children

“To anticipate the future, take a look at the past. It makes particular sense in health care when critical decisions are based on patients’ medical history. However, for foster children who arrive at new homes with few or no treatment records, knowing the past poses a major challenge. Documented allergies, immunizations and illnesses are often shrouded in mystery when foster parents welcome a child.”
Article
Patrick Michels, Government Technology, 29 September 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

Holland aims for electronic child records

“All child healthcare providers will have to introduce electronic patient records by the end of 2009.
André Rouvoet, the Dutch minister for youth and family, has said all institutions and bodies dealing with the healthcare of children must be using electronic patient files by the end of 2009.
Article
e-Health Europe, 5 September 2008

What Makes a Great Pediatric EHR?

“A great pediatrician is caring, attentive, available and knowledgeable; a great pediatric office is full of people with these qualities; and a great pediatric EHR allows the doctor and staff to demonstrate what makes them great. Being able to express a caring persona by adding an alert to a child’s record (reminding to ask about Tigger, the family cat) may seem like fluff to the doctor, but the family sees this as a good quality. Let’s consider the remaining qualities of a great pediatrician: attentive, available, and knowledgeable.
Article
Michael A. Blum, Charles Webster, EMR Blog, 31 July 2008

Impact of a Patient-Centered Technology on Medication Errors During Pediatric Emergency Care

“Objective
The aim of this study was to determine the impact of a patient-centered health information technology (HIT) on the error rate for ordering and prescribing of medications during emergency pediatric care.
Methods
We conducted a quasi-experimental intervention study by using control and intervention periods to evaluate the effect on medication ordering and prescribing from a patient-centered HIT designed to enhance communication between parents and emergency clinicians during emergency care. Parent-child dyads presenting to 2 emergency department (ED) sites with complaints of fever, asthma, head trauma, otalgia, and dysuria were eligible. During intervention periods, parents used the HIT to enter data on symptoms and medication-related history; a printout provided recommendations to clinicians. Data on errors/adverse drug events were collected via record reviews and phone interviews with parents. The primary outcome was the number of medication errors in orders or prescriptions for drugs targeted by the HIT.
Results
Of 2002 parent-child dyads screened, 1810 (90%) were eligible, 1411 of 1810 (78%) were enrolled, and 1410 analyzed; 1097 subjects had a total of 2234 orders or prescriptions written. Of these events, 1289 of 2234 (58%) were associated with at least 1 error. Of the 1755 errors discovered, 232 errors were serious and preventable. Among 654 patients exposed to medications targeted by the HIT, the number of errors per 100 patients during control versus intervention periods was not significantly different (173 vs 134 with both sites combined; P = .35.)
Conclusion
The patient-centered HIT demonstrated minimal impact on medication errors during ED care.”
Abstract
Stephen C. Porter, Rainu Kaushal, Peter W. Forbes, Donald Goldmann and Leslie A. Kalish, Ambulatory Pediatrics, In Press, Corrected Proof, Available online 21 July 2008, doi:10.1016/j.ambp.2008.06.003

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

Babies Bar Coded To Prevent Medicine Mixups

“After several cases of children being harmed or even killed after being given the wrong dose of medication, a local hospital’s policy became more prevalent.
Centennial Medical Center switched recently to a bar coding system, which is similar to what is seen in stores and will match the correct medicine to patients.”
Article
Tom Randles, WSMV, 18 July 2008

Der elektronische Gesundheits-Check

“Wenn der Nachwuchs noch klein ist, wollen Eltern ihn am liebsten lückenlos überwachen. Sie wollen wissen, wo er ist, was er macht und wie es ihm geht. Irgendwann aber dreht sich das um: Haben die Eltern das Rentenalter erreicht und steht es mit ihrer Gesundheit nicht mehr zum Besten, sind es die Kinder, die stets über das Wohlbefinden von Mutter und Vater informiert sein wollen.”
Article (German)
Alexander Stirn, F.A.Z., 21 July 2008

Yuma patients benefitting from telemedicine program

“The telemedicine program came to Yuma Regional as part of the Arizona Department of Health Services Children’s Rehabilitation Services program. The center’s Neonatal Intensive Care Unit is linked to University Medical Center in Tucson for emergency consultations on infants with serious, often life-threatening conditions.”
Article
Tucson Citizen, 7 July 2008

Use of telemedicine expanding in Ohio’s rural areas, Appalachia

“Children’s Hospital Medical Center of Akron is using telemedicine to connect special-needs children at two schools in rural areas of Ashland and Wayne counties to their family doctors if the children get sick at school. The system features video conferencing, electronic stethoscopes and the capability to transmit photos of symptoms.”
Article
James Hannah, Chillicothe Gazette, 30 June 2008

New Telemedicine Service To Help In The Care Of Sick Babies

“Tiny Tom”, an innovative new telemedicine service which will help with the care of sick babies in North Queensland was launched in Townsville today Friday, June 27.
Tiny Tom is the latest development of the telepaediatric service, a major research project run by The University of Queensland’s Centre for Online Health (COH), a research centre based in the Royal Children’s Hospital in Brisbane.”
Article
Medical News Today, 27 June 2008

Telemedicine and eHealth, TOC, June 2008

Mobile Health Clinics and Telemedicine
“Think of mobile health clinic and what comes to mind? Depending on where you live, it might mean Tommy the Tooth van dispensing free brushes and toothpaste to the community. Maybe a loved one received a mammogram in their small town or received diabetes education. The Lions Club may have sponsored a mobile vision clinic where senior citizens were screened for glaucoma. Perhaps migrant farm workers lined up for
hours to get free medical care while working in the fields. Whether you live in the city or the country, chances are some type of mobile health clinic has visited your community sporting colorful graphics on the outside and various medical/dental services on the inside.”
Article
Kevin D. Blanchet,Telemedicine and e-Health. June 2008, 14(5): 407-412.

Acceptance of Telemonitoring to Enhance Medication Compliance in Patients with Chronic Heart Failure
Sixty-two congestive heart failure patients participated in a controlled, longitudinal study at two ambulatory medical centers in Hamburg, Germany. Two groups, a control (no telemedicine intervention) and the study group (telemedicine) were evaluated for medication intake. A medication box, networked to the patient’s electronic health record, was used for the telemedicine group. The main objective was to evaluate noncompliance of medication intake. The research showed that the system was effective. However, nearly 50% felt it was not necessary to continue the reporting after the study.
Article
Silke Schmidt, Sarah Sheikzadeh, Britta Beil, Monica Patten, Jürgen Stettin, Telemedicine and e-Health. June 2008, 14(5): 426-433.

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity
A retrospective review of patient medical records was conducted of children and adolescents who received pediatric weight management consultations using telemedicine. Ninety-nine patient files were reviewed. Analysis indicated that weight management using telemedicine can result in modification in patient care plans and outcomes.
Article
Ulfat Shaikh, Stacey L. Cole, James P. Marcin, Thomas S. Nesbitt, Telemedicine and e-Health. June 2008, 14(5): 434-440.

Optometric Referrals to Retina Specialists: Evaluation and Triage via Teleophthalmology
A teleophthalmology program linked Canadian optometrists to retina specialists for 171 patients and 190 consultations. In this carefully described study, 21/25 patients who required treatment condensed their visit to the specialist to a single day by having diagnostics done by telemedicine. Office visits to the specialist were reduced by 48%.
Article
Chris Hanson, Matthew T.S. Tennant, Chris J. Rudnisky, Telemedicine and e-Health. June 2008, 14(5): 441-445.

The Value of Provider-to-Provider Telehealth
The Center for Information Technology examined the value of providers with the patient and a distance site using three models of telehealth: store-and-forward, real-time video, and hybrid systems. A detailed literature review was conducted to elucidate where value had been reported. The data was evaluated by a computer simulation, which calculated the national value of provider-to-provider telehealth. Overall, the potential benefits of telehealth far outweigh the implementation costs, especially in emergency departments.
Article
Eric Pan, Caitlin Cusack, Julie Hook, Adam Vincent, David C. Kaelber, David W. Bates, Blackford Middleton, Telemedicine and e-Health. June 2008, 14(5): 446-453.

A Wireless Medical Information Query System Based on Unstructured Supplementary Service Data (USSD)
Wireless data management and data access for telemedicine extend far beyond the realities of short text messaging limits. This report offers a query system based on Unstructured Supplementary Service Data (USSD) that can work at 100 bit/sec with the advantage to limited system consumption, terminal support, and expense.
Article
Zhelong Wang, Hong Gu, Dewei Zhao, Weiming Wang, Telemedicine and e-Health. June 2008, 14(5): 454-460.

Acceptability of Telepsychiatry in American Indians
The acceptability of conducting psychiatric assessments with rural American Indian veterans by real-time videoconferencing versus in person visits was evaluated. Fifty-three North Plains American Indian veterans from the Vietnam Era participated in this study. A videoconferencing link between the University of Colorado at Denver Health Science Center and the rural community was established. Participants were administered the Structured Clinical Interview for DSM-III-R (SCID) for psychiatric assessments using this videoconferencing link. This assessment tool was administered face-to-face by telehealth in different ways and by different interviewers. Telepsychiatry was well received and was comparable to in-person interactions.
Article
Jay H. Shore, Elizabeth Brooks, Daniel Savin, Heather Orton, Jim Grigsby, Spero M. Manson, Telemedicine and e-Health. June 2008, 14(5): 461-466.

An Experience of Health Technology Assessment in New Models of Care for Subjects with Parkinson’s Disease by Means of a New Wearable Device
This report characterizes a system combining gastrocnemius expansion measurement unit (GEMU), a step-counting device, with a telemedicine application for patients with Parkinsonism. GEMU by telemedicine correlated strongly with motion decrement in a robust and reliable system, which enjoyed high user acceptance.
Article
Daniele Giansanti, Giovanni Maccioni, Sandra Morelli, Telemedicine and e-Health. June 2008, 14(5): 467-472.

Development of a Multidisciplinary Osteoporosis Telehealth Program
This report from Toronto details a comprehensive women’s bone health program with referrals from 20 family doctors. The patients engaged in an average 2-hour consultation with very positive perceptions. Increased access to care was the principle outcome.
Article
Leigh Dickson, Cathy Cameron, Gillian Hawker, Azeena Ratansi, Ina Radziunas, Vinita Bansod, Susan Jaglal, Telemedicine and e-Health. June 2008, 14(5): 473-478.

Uncompressed Video Image Transmission of Laparoscopic or Endoscopic Surgery for Telemedicine
A robust, high-speed telecommunications link was established between Shanghai, China and Fukuoka, Japan for videoconferencing. This system was utilized to support real-time interactions during laparoscopic and endoscopic surgical procedures. Images, transmitted via a digital video transfer system (DVTS), were evaluated by participating physicians who completed a mini-questionnaire. A number of hospitals across the region participated, including Japan, Korea, Hong Kong, and Taiwan. Thirty-eight physicians completed the questionnaire. The majority (73.8%) indicated the images were very good. This tool has been viewed as an efficient and useful tool for the medical community in this region.
Article
Ke-Jian Huang, Zheng-Jun Qiu, Chun-Yu Fu, Shuji Shimizu, Koji Okamura, Telemedicine and e-Health. June 2008, 14(5): 479-485.

Using e-Health to Enable Culturally Appropriate Mental Healthcare in Rural Areas,br /> Relevant research issues in providing culturally appropriate e-mental health care were reviewed with intent to determine where research efforts could be expanded or prioritized. A workshop was held in California to address the provision of mental health care in rural areas due to a variety of barriers, including language, culture, and poverty. A set of recommendations for expanding and prioritizing research efforts was developed in both science and policy.
Article
Peter Yellowlees, Shayna Marks, Don Hilty, Jay H. Shore, Telemedicine and e-Health. June 2008, 14(5): 486-492.

Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication

“Abstract
This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication.The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also reviewed. The primary care pediatrician, as part of the medical home, plays an important role in the interdisciplinary effort to provide appropriate assistive technology and may be asked to make a referral for assessment or prescribe a particular device. This report provides resources to assist pediatricians in this role and reviews the interdisciplinary team functional evaluation using standardized assessments; the multiple funding opportunities available for obtaining devices and ways in which pediatricians can assist families with obtaining them; the training necessary to use these systems once the devices are procured; the follow-up evaluation to ensure that the systems are meeting their goals; and the leadership skills needed to advocate for this technology. The American Academy of Pediatrics acknowledges the need for key resources to be identified in the community and recognizes that these resources are a shared medical, educational, therapeutic, and family responsibility. Although this report primarily deals with assistive technology specific for communication impairments, many of the details in this report also can aid in the acquisition and use of other types of assistive technology.”
Article
Larry W. Desch, Deborah Gaebler-Spira and the Council on Children With Disabilities, Pediatrics Vol. 121 No. 6 June 2008, pp. 1271-1280 (doi:10.1542/peds.2008-0695)

Telemedicine a Cost-Effective Alternative to ER Visits

“Telemedicine is a cost-effective way to replace more than a quarter of all visits to the pediatric emergency department, according to a community-wide study conducted in New York.”
Article
The Washington Post, 9 May 2008

Children’s database delayed to review security

“The government has announced that the £224m children’s database, ContactPoint, will be delayed for five months, so that a full security review can take place, following last week’s HM Revenue and Customs child benefit data loss scandal.”
Article
e-Health Insider Primary Care, 28 November 2007

Searching for sound medical advice online

“Today’s parents solve their children’s health problems in very different ways than they did even five years ago.
In the past, they may have called a friend or a mother-in-law for advice. Now, parents call Telehealth, check with Dr. Google, discuss treatment strategies on chat lines and e-mail experts for timely advice.”
Article
Michael Evans, Globe and Mail, 13 November 2007

AHIMA to launch PHR campaign, Web site

“Health information professionals are hoping their Web site and an awareness campaign will lead individuals to begin maintaining their own personal health record.”
Article
Jean DerGurahian, Modern Healthcare Online, 27 September 2007

Successful Adoption of a School-Based Telemedicine System

“Telemedicine, the provision of healthcare at a distance via telecommunication technology, has been used to address a wide range of health concerns in a variety of settings. Given the challenges schools face in keeping students healthy, telemedicine could be viewed as a mechanism to provide healthcare services directly to students in schools. This research focuses on a school-based telemedicine project in Kansas, a project of the Kansas University Medical Center (KUMC) called TeleKidcare. TeleKidcare makes use of interactive television systems located in the school health office to let school nurses interact with KUMC physicians to provide consultations for sick children.”
Results point to factors to success both in the planning and operational phases of TeleKidcare. Examples of such factors include: (a) recognizing, and accounting for, the fact that different sites in a multisite telemedicine system might adopt the system in different ways; (b) the importance of involving actual users in the planning of the system, to ensure it could be built into the everyday work of school nurses; and (c) the importance of unintended appropriation of the technology by school nurses, using the system in ways that were completely unplanned.”
Abstract
Michael Mackert, Journal of School Health 77 (6), 327–330

School-Based Telemedicine Program Holds Promise for Student Health

“TeleKidcare, operated by the Kansas University Medical Center, is believed to be the first and most successful school-based telemedicine program. As such, it has had to successfully adapt to the changing needs of its users.”
Article
Colleen Egan, iHealthBeat, 14 September 2007