TOC J Telemed Telecare: Volume 14, Number 8; December 2008 (selection)

Journal of Telemedicine and Telecare
Volume 14 Number 8, December 2008 (Selection)

Wireless mesh networks
“Wireless telemedicine using GSM and GPRS technologies can only provide low bandwidth connections, which makes it difficult to transmit images and video. Satellite or 3G wireless transmission provides greater bandwidth, but the running costs are high. Wireless networks (WLANs) appear promising, since they can supply high bandwidth at low cost. However, the WLAN technology has limitations, such as coverage. A new wireless networking technology named the wireless mesh network (WMN) overcomes some of the limitations of the WLAN. A WMN combines the characteristics of both a WLAN and ad hoc networks, thus forming an intelligent, large scale and broadband wireless network. These features are attractive for telemedicine and telecare because of the ability to provide data, voice and video communications over a large area. One successful wireless telemedicine project which uses wireless mesh technology is the Emergency Room Link (ER-LINK) in Tucson, Arizona, USA. There are three key characteristics of a WMN: self-organization, including self-management and self-healing; dynamic changes in network topology; and scalability. What we may now see is a shift from mobile communication and satellite systems for wireless telemedicine to the use of wireless networks based on mesh technology, since the latter are very attractive in terms of cost, reliability and speed.”
Abstract
Xinheng Wang, J Telemed Telecare 2008;14:401-403, doi:10.1258/jtt.2008.008003

Experience with the implementation of a web-based teledermatology system in a nursing home in Singapore
“We introduced a web-based teledermatology system, the distributed personal health information management system (DPHIMS), into a nursing home in Singapore. The introduction was conducted in two phases. Five staff nurses in Phase 1 and nine nurse aides in Phase 2 performed the data entry and uploaded digital images of the resident’s skin condition. By the end of Phase 2, there were 50 residents registered with DPHIMS. The average age of the participants was 82 years and 84% were women. There were 31 first-time referral requests registered in the system during Phase 2. The average time taken to complete a referral request was 86 minutes. The average time taken by the dermatologist to prepare and submit a diagnosis/treatment report was 11 minutes. An online survey form was given to the nurses and the dermatologists to gauge their level of satisfaction and their experience of using DPHIMS. All the nurses said they would readily recommend DPHIMS to other nurses. Overall, the dermatologists felt that DPHIMS was helpful in obtaining specialist care for the residents. However, some skin conditions required a face-to-face consultation. Thus a mixture of face-to-face consultations and consultations via teledermatology may be necessary to provide complete diagnosis and treatment to patients. Our experience suggests that understanding and addressing the organizational concerns is as important as solving the technical problems.”
Abstract
Lavanya Janardhanan, Yung H Leow, Martin TW Chio, Yongmin Kim and Cheong B Soh, J Telemed Telecare 2008;14:404-409, doi:10.1258/jtt.2008.080105

Mobile phone text messaging for pharmaceutical care in a hospital in China
“We have developed a mobile pharmacy service system (MPSS) to deliver individualized pharmaceutical care via text messages sent to the mobile phones of patients. The text messages were: (1) reminders about medication – from the day following discharge, reminder messages were automatically sent to patients approximately 10 minutes before their medication was due to be taken. The system stopped sending messages when the prescription ran out and suggested that patients should come to hospital to renew any prescribed medicines; (2) practical information about medicines, such as information about methods of administration; (3) information about adverse drug reactions. In a 3-month trial in a general hospital, 100 patients were provided with pharmaceutical care using the MPSS for an average of 3.5 medicines per patient (range 1–9). They received pharmaceutical care for an average of 12 days per patient (range 3–19). A survey was then conducted which indicated that most patients were satisfied with the pharmaceutical care provided by MPSS through text messages, and that they had positive attitudes despite some limitations. The use of the MPSS should improve pharmaceutical care, widen the knowledge of pharmacists, reduce the burden on pharmacy staff, improve pharmacist–patient interaction, and improve the effect and safety of medication.”
Abstract
Yudan Mao, Yantao Zhang and Suodi Zhai, J Telemed Telecare 2008;14:410-414, doi:10.1258/jtt.2008.080406

Service users’ acceptability of videoconferencing as a form of service delivery
“We conducted a study of videoconferencing for delivering an Augmentative and Alternative Communication (AAC) service. AAC is a clinical field that attempts to compensate for the impairment and disability of people with severe expressive communication disorders. A total of 12 participant groups trialled initial AAC assessments via videoconference at a bandwidth of 768 kbit/s. The participant groups consisted of the client, the assessing speech and language therapist, and those who accompanied them to the session (usually their local speech and language therapist and any relatives or carers). Six of these groups progressed to receive review appointments. Following each of the sessions, all of the participants completed a questionnaire. Participants indicated an 88% satisfaction with the videoconference assessment session and a 95% satisfaction with review videoconference sessions. Clients provided the most positive feedback in their questionnaires, while the speech and language therapists were the most critical of the process. The findings suggest that an AAC service can be delivered effectively by videoconference.”
Abstract
Victoria Styles, J Telemed Telecare 2008;14:415-420, doi:10.1258/jtt.2008.071202

Email for distance diagnosis of oral diseases: a preliminary study of teledentistry
“We examined the feasibility of distance diagnosis of oral diseases, using transmission of digital images by email. Twenty-five cases of oral lesions were documented during a 12-month study in a primary care public health clinic in Paraná in Southern Brazil. Clinical electronic charts and images were produced and sent by email to two oral medicine specialists with a median of 10 years experience in the field. The consultants provided a maximum of two clinical hypotheses for each case. In 15 of the 25 cases (60%) both consultants made a correct diagnosis; in seven cases (28%) only one consultant made a correct diagnosis; and in three cases (12%) neither consultant made a correct diagnosis. Thus in 88% of cases, at least one consultant was able to provide the correct diagnosis. The results suggest that distant diagnosis can be an effective alternative in the diagnosis of oral lesions and that the using two distant consultants improves diagnostic accuracy. Primary care public health clinics may benefit from the use of email and digital cameras for telehealth in remote areas where oral medicine specialists are not available.”
Abstract
Cassius Torres-Pereira, Renata Seleme Possebon, André Simões, Marcelo Carlos Bortoluzzi, Jair Carneiro Leão, Allan Fernando Giovanini and Cleto Mariosvaldo Piazetta, J Telemed Telecare 2008;14:435-438, doi:10.1258/jtt.2008.080510

The effectiveness of low-cost teleconsultation for emergency head computer tomography in patients with suspected stroke
“Teleradiology in an emergency situation can be used to support rapid neurological decision-making when specialists are remote from the hospital concerned. We have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. We used commercially available toolbar software for transmitting the information through the mobile phone network. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean size of the original picture was 20.9 kByte and the images were compressed by approximately 2:1 before transmission. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The overall transmission cost was 400 Thai baht per case. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.”
Abstract
Kanitpong Phabphal and Siriporn Hirunpatch, J Telemed Telecare 2008;14:439-442, doi:10.1258/jtt.2008.080603

Telemedicine for the benefit of patients, healthcare systems and society

“Telemedicine - the provision of healthcare services at a distance - can help improve the lives of European citizens, both patients and health professionals, while tackling the challenges to healthcare systems.
European citizens are getting older and are increasingly living with chronic diseases. Their health condition often requires enhanced medical attention. Medical support may not be available in remote areas and for certain specialities as easily or as frequently as their health condition would require.
Telemedicine can improve access to specialised care in areas suffering from a shortage of expertise, or in areas where access to healthcare is difficult. Telemonitoring can improve the quality of life of chronically ill patients and reduce hospital stays. Services such as teleradiology and teleconsultation can help to shorten waiting lists, optimise the use of resources and enable productivity gains.
The benefits go beyond improving patient care and healthcare system efficiency. Telemedicine can also make a significant contribution to the EU economy. This sector, where European industry - including thousands of small and medium-sized enterprises (SMEs) - is well placed, has been expanding rapidly in the past decade and is expected to continue to grow at a fast pace.
Despite the potential of telemedicine, its benefits and the technical maturity of the applications, the use of telemedicine services is still limited, and the market remains highly fragmented. Although Member States have expressed their commitment to wider deployment of telemedicine, most telemedicine initiatives are no more than one-off, small-scale projects that are not integrated into healthcare systems.”
Communication
The Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, 4 November 2008

Teleradiology paves way for remote medicine

“On a computer monitor in his office in the high-tech hub of Bangalore, Indian radiologist Arjun Kalyanpur examines a scan of the skull of a six-year-old boy who fell off his bicycle.
A few minutes later, thousands of miles away, doctors at a hospital in Philadelphia prepare the boy for surgery after receiving an urgent email from Kalyanpur diagnosing a subdural hemorrhage in the child’s brain.”
Article
Kavita Chandran, Reuters, 14 October 2008

Teleradiology Plus Electronic Health Record

“Klinikum Chemnitz gGmbH has become one of the first hospitals in Germany to link its teleradiology service with the electronic health record (EHR). This means that, effective immediately, data obtained from a remote diagnosis, e.g. computed tomography images and the corresponding findings, can be stored in a shared health record and then used for information exchange between different facilities participating in the patient’s treatment. Siemens supplied and implemented the overall technical solution: This included the software for the radiological image communication as well as the Soarian Integrated Care (Soarian IC) eHealth solution for the electronic health record. In cooperation with the regional county hospitals as well as numerous practicing physicians and medical centers in its service area, Klinikum Chemnitz has thus assumed a leading role in integrated healthcare in Germany.”
Article
eHealthNews.eu, 6 June 2008

Teleradiologie plus elektronische Patientenakte

As one of the first German hospitals, the Klinikum Chemnitz gGmbH has connected its teleradiology service with the German EHR.

Article (German)
Marion Bludszuweit, Innovations Report, 5 June 2008