No abstract

The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery.despite being relatively new,the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modernc are of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The university medical center and the arizona Te lemedicine program (aTp) in Tu cson, arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobilet elemedicine program. The southern arizona Te lemedicine and Te lepresence (saTT) program is an inter-hospital telemedicine program, while the Tu cson eR-link is al ink between prehospital and emergency room system,and both are built upon asuccessful existing award winning aTpand the technical infrastructureofthe city of Tu cson. These two programs represent examples of integrated and collaborative community approaches to solvingthe lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18 month-old girl who was the only survival of acar crash with three fatalities. The success of this case and the pilot project of saTT that ensued led to the development of ar egional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, Latifi, R. S. Weinstein,J.M.Porter,M.Ziemba, D. Judkins,D.Ridings, R. Nassi, T. Valenzuela, M. Holcomb, F. Leyva through teletrauma, has infused confidencea mong local doctors and communities and is beingu sed to identifyk nowledgeg aps of rural health care providers and the needs for instituting new outreach educational programs.

The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings.

Teleradiology, telepathology, and teleoncology are important applications of telemedicine. Recent advances in these fields include a preponderance of radiology PACS (Picture Archiving and Communications System) users, the implementation of aroundthe-clock teleradiology services at many hospitals, and the invention of the first ultrarapid whole-slide digital scanner based on the array microscope. These advances have led to the development of a new health-care-delivery clinical pathway called the ultrarapid breast care process (URBC), which has been commercialized as the UltraClinicst process. This process bundles telemammography, telepathology, and teleoncology services and has reduced the time it takes for a woman to obtain diagnostic and therapeutic breast-care planning services from several weeks to a single day. This paper describes the UltraClinics process in detail and presents the vision of a network of same-day telemedicine-enabled UltraClinics facilities, staffed by a virtual group practice of teleradiologists, telepathologists, and teleoncologists. INTRODUCTIONTelemedicine is the delivery of physician services using telecommunications and, often, video-imaging technology. In the United States, its most common applications are teleradiology, telepsychiatry, teledermatology, and telepathology. Over 60 other applications have been identified, but most of them are used on a more limited basis. Telehealth is a broader term and includes non-physician healthcare services, such as telenursing and telepharmacy.

The Arizona Telemedicine Program (ATP) was established in 1996 when state funding was provided to implement eight telemedicine sites. Since then the ATP has expanded to connect 55 health-care organizations through a membership programme formalized through legal contracts. The ATP's membership model is based on an application service provider (ASP) concept, whereby organizations can share services at lower cost; that is, the ATP acts as a broker for services. The membership fee schedule is flexible, allowing clients to purchase only those services desired. An annual membership fee is paid by every user, based on the services requested. The membership programme income has provided a steady revenue stream for the ATP. The membership-derived revenue represented 30% of the ATP's 2.6 million dollars total income during fiscal year 2003/04.

The Arizona Telemedicine Program was established in July 1996 by the Arizona state legislature. The organizational center for the program is the Arizona Health Sciences Center in Tucson. Key goals for the program include increased access to specialty services for rural, underserved populations; development of cost-effective telemedicine services; and expansion of opportunities for education of health professionals in rural areas. The program provides several levels of services based on both store-and-forward and real-time interactive applications. The telecommunication infrastructures is provided by two methods: The first is a private asynchronous transfer mode network established and operated by program personnel. The second is dial-up access via the public switched telephone network. After an extensive period of organization and vendor evaluations, most of the private network was implemented between June and December 1997. This paper describes experiences establishing the asynchronous transfer mode network.

Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model for establishing telemedicine programs in developing countries.

Faculty members from the Department of Pathology at The University of Arizona College of Medicine-Tucson have offered a 4-credit course on enhanced general pathology for graduate students since 1996. The course is titled, “Mechanisms of Human Disease.” Between 1997 and 2016, 270 graduate students completed Mechanisms of Human Disease. The students came from 21 programs of study. Analysis of Variance, using course grade as the dependent and degree, program, gender, and year (1997-2016) as independent variables, indicated that there was no significant difference in final grade (F = 0.112; P = .8856) as a function of degree (doctorate: mean = 89.60, standard deviation = 5.75; master’s: mean = 89.34, standard deviation = 6.00; certificate program: mean = 88.64, standard deviation = 8.25), specific type of degree program (F = 2.066, P = .1316; life sciences: mean = 89.95, standard deviation = 6.40; pharmaceutical sciences: mean = 90.71, standard deviation = 4.57; physical sciences: mean = 87.79, standard deviation = 5.17), or as a function of gender (F = 2.96, P = .0865; males: mean = 88.09, standard deviation = 8.36; females: mean = 89.58, standard deviation = 5.82). Students in the physical and life sciences performed equally well. Mechanisms of Human Disease is a popular course that provides students enrolled in a variety of graduate programs with a medical school-based course on mechanisms of diseases. The addition of 2 new medically oriented Master of Science degree programs has nearly tripled enrollment. This graduate level course also potentially expands the interdisciplinary diversity of participants in our interprofessional education and collaborative practice exercises.