Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home

Objectives

This document offers guidance to clinicians and facilities on the use of telemedicine to deliver medically necessary evaluation and management of change of condition for nursing home residents.

移动医疗新纪元：互联医疗（cHealth）模式及应用

基于人口老龄化加剧及慢性疾病增长等社会背景,介绍互联医疗模式,分析互联医疗与移动医疗的区别及互联医疗的优势,给出互联医疗在当代的应用,探讨互联医疗面临的挑战：包括优化传感策略,创建数据整合、分析新模式,优化反馈策略,开发新的医疗保险模式。     

Diagnostic utility of flexible fiberoptic nasopharyngolaryngoscopy recorded onto a smartphone: A pilot study

ObjectivesTo evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded onto smartphones.MethodsProspective, blinded study of inpatients requiring laryngoscopy. A live exam was performed, then a smartphone was attached to the endoscope using a novel coupling device and the same examination was recorded. The live and recorded exams were evaluated by two laryngologists, each blinded to the findings of the other.ResultsEighteen subjects were evaluated. Evaluation of airway patency was identical (Kappa = 1.0 [1, 1]). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa = 0.69 [0.38, 1]).ConclusionThere is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings using a coupling device to transfer the recordings on to smartphones. Critical findings such as airway patency and vocal fold motion showed the highest correlation.     

Off-site real-time review of remote ambulatory care obstetric and gynecologic ultrasound examinations: Implications to radiologists for managed care contract negotiations

We present a cost comparison of contracts to provide obstetric and gynecologic ultrasound (US) services to a managed care provider group (MCPG) and discuss the long-term implications of off-site monitoring of US procedures by video/voice technology to radiologists in competing for managed care contracts.During a 19-month period, 1,741 ultrasound examinations were performed for a MCPG in a clinic located 7 miles from our institution. The costs of different arrangements to provide this service and a 5-year cost analysis are provided.Based on the reported obstetric and gynecologic US caseload, annualized first year cost to the MCPG under the current contract was $183,945, compared with $252,000 under a prior contract. Without a contract, the cost would be $325,907.Our analysis shows that the use of the citywide fiberoptic network for remote monitoring of US examinations enables US radiologists to compete for managed care contracts and provides cost savings to payors.     

Telemedicine: benefits to advanced practice nursing and the communities they serve

PURPOSE: To review the use of telemedicine in a variety of advanced nursing practice settings, its contribution in expanding the service and role of the nurse practitioner, and the regulatory issues of reimbursement and licensure. DATA SOURCES: Literature review of relevant journals, research articles, case examples, and web searches. CONCLUSIONS: Although telemedicine has been utilized for many years, it has historically been used primarily by physicians. In recent years, telemedicine has been demonstrating its growing potential in advanced nursing practice in terms of economy, efficacy, and quality of care. When used appropriately, telemedicine complements advanced nursing practice in cost-effective ways and improves healthcare access to the populations served. IMPLICATIONS FOR PRACTICE: Incorporating telemedicine into the advanced nursing practice can be rewarding for both clinicians and their patients. Because of the high variability that exists among state regulations and payer reimbursements, clinicians are advised to verify their respective Board of Nursing Examiners, State, and payers' policies prior to investing in the establishment of telemedicine in practice.     

The effectiveness of Internet-based blood glucose monitoring system on improving diabetes control in adolescents with type 1 diabetes

Landau Z, Mazor‐Aronovitch K, Boaz M, Blaychfeld‐Magnazi M, Graph‐Barel C, Levek‐Motola N, Pinhas‐Hamiel O. The effectiveness of Internet‐based blood glucose monitoring system on improving diabetes control in adolescents with type 1 diabetes. Objective: To determine whether the use of an Internet‐based blood glucose monitoring system could improve glycemic control in adolescents with type 1 diabetes mellitus (T1DM). Methods: In a randomized, controlled clinical trial, a total of 70 adolescent subjects with T1DM were recruited. Subjects randomized to the intervention group (n = 36) were instructed to submit their blood glucose levels weekly by Internet to the Diabetes Care Team during a period of 6 months. Subjects randomized to the control group (n = 34) did not submit results but were under routine follow‐up. Results: At baseline, patients were 15.1 ± 2.6 years of age with mean HbA1c of 8.3 ± 1.3%. At the 6‐month follow‐up period, no by‐group differences in change from baseline to end of treatment HbA1c levels were detected. In the intervention group, 12/36 did not submit blood glucose levels and were classified as non‐compliant. In a secondary exploratory analysis in which non‐compliant patients were omitted, HbA1c values in the compliant intervention group declined from 8.5 ± 1.7% at baseline to 8.2 ± 1.2% at 6 months, while in the control group HbA1c values increased from 8.2 ± 1.1 to 8.4 ± 1.1%, this difference did not reach statistical significance. Conclusions: An Internet‐based blood glucose monitoring system was not associated with improved glycemic control in adolescents with T1DM. Identification of a sub‐group of compliant subjects who may improve metabolic control by using this tool is needed.     

Methodologies for assessing telemedicine: a systematic review of reviews

Background and objectives

Previous reviews have expressed concerns about the quality of telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine research, discuss knowledge gaps and recommendations and suggest methodological approaches for further research.

Methods

We conducted a review of systematic reviews of telemedicine according to a protocol listing explicit methods, selection criteria, data collection and quality assessment procedures. We included reviews where authors explicitly addressed and made recommendations for assessment methodologies. We did a qualitative analysis of the reviews included, sensitized by two broad methodological positions; positivist and naturalistic approaches. The analysis focused on methodologies used in the primary studies included in the reviews as reported by the review authors, and methodological recommendations made by the review authors.

Results

We identified 1593 titles/abstracts. We included 50 reviews that explicitly addressed assessment methodologies. One group of reviews recommended larger and more rigorously designed controlled studies to assess the impacts of telemedicine; a second group proposed standardisation of populations, and/or interventions and outcome measures to reduce heterogeneity and facilitate meta-analysis; a third group recommended combining quantitative and qualitative research methods; and others applying different naturalistic approaches including methodologies addressing mutual adaptations of services and users; politically driven action research and formative research aimed at collaboration to ensure capacity for improvement of services in natural settings.

Conclusions

Larger and more rigorous studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine services for pre defined outcome measures. Summative methodologies acknowledging telemedicine as complex innovations and outcomes as partly contingent on values, meanings and contexts are also important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing collaborative achievements and engage with stakeholders, including patients to produce and conceptualise new and effective telemedicine innovations.