Radiology services for remote communities: cost minimisation study of telemedicine

Halvorsen, Peder Andreas; Kristiansen, Ivar Sønbø

doi:10.1136/bmj.312.7042.1333

Cited by 60 publications

(27 citation statements)

References 36 publications

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“…44 However, some results suggest that teleconsultation between physicians providing direct care and specialists helps to avoid patient transfer to a different medical center, and may thereby be cost-saving. 59 -61 A pragmatic approach has been attempted in northern Norway, where the costs associated with teleconsultation, patient travel to a medical center, and a visiting specialist service were compared.…”

Section: Cost-benefit Analysismentioning

confidence: 99%

Assessment of Telemedicine in Surgical Education and Patient Care

Demartines

Mutter²,

Vix³

et al. 2000

Annals of Surgery

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ObjectiveTo analyze the value of teleconferencing for patient care and surgical education by assessing the activity of an international academic network. Summary Background DataThe uses of telemedicine include teleeducation, training, and consulting, and surgical teams are now involved, sharing diagnostic information and opinions without the need for travel. However, the value of telematics in surgery remains to be assessed. MethodsDuring a 2-year period, weekly surgical teleconferences were held among six university hospitals in four European countries. To assess the accuracy of telediagnosis for surgical cases, 60 randomly selected cases were analyzed by a panel of surgeons. Participants' opinions were analyzed by questionnaire. ResultsSeventy teleconferences (50 lectures and 271 case presentations) were held. Ninety-five of the 114 participants (83.3%) completed the final questionnaire. Eighty-six percent rated the surgical activity as good or excellent, 75.7% rated the scientific level as good or excellent, 55.8% rated the daily clinical activity as good or excellent, and 28.4% rated the manual surgical technique as good or excellent. The target organ was identified in all the cases; the organ structure and pathology were considered well defined in 93.3%, and the fine structure was considered well defined in 58.3%. Diagnosis was accurate in 17 cases (28.3%), probable in 25 (41.7%), possible but uncertain in 16 (26.7%), and not possible in 2 cases (3.3%). Discussion among the remote sites increased the rate of valuable therapeutic advice from 55% of cases before the discussion to 95% after the discussion. Eighty-six percent of the surgeons expressed satisfaction with telematics for medical education and patient care. ConclusionsParticipant satisfaction was high, transmission of clinical documents was accurate, and the opportunity to discuss case documentation and management significantly improved diagnostic potential, resulting in an accuracy rate of up to 95%. Teleeducation and teleconsultation in surgery appear to be beneficial.In this information age, the new computer-based communication technologies called telematics offer enormous potential for applications in medical and surgical practice and education.1 The introduction of these tools in surgery has attracted much interest; however, the possibilities of combining increasing computing power 2 with surgeons' objectives and needs have not yet been properly analyzed. First, we must assess the results of telematic applications in medicine and surgery. 3,4 The field of telemedicine involves far more than just the transmission of patient files.5 It involves education, 6,7 training, 8 consulting, 9 and mentoring, 10 -12 and in the near future will include accreditation. 13 Currently, surgical teams are involved in teleconferencing, sharing medical advice and offering second opinions without the need to transfer the patient.14 -16 The time and costs of travel on the part of experts are limiting factors to joint consultations or meet- 282ings.17 Telemedicine s...

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Section: Cost-benefit Analysismentioning

confidence: 99%

Assessment of Telemedicine in Surgical Education and Patient Care

Demartines

Mutter²,

Vix³

et al. 2000

Annals of Surgery

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“…However, according to recent studies there is no significant decrease in the accuracy when a monitor is used to interpret teleradiology images [10][11][12][13] . There are few studies on the costs of teleradiology compared with its benefits 14,15 and only one concerning the effects of transmitted images on the diagnosis and primary treatment 10 .…”

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confidence: 98%

Effect of teleradiology on the diagnosis, treatment and prognosis of patients in a primary care centre

et al. 2002

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A prospective study was carried out to evaluate the effect of teleradiology on the diagnosis, treatment and prognosis of patients in primary care. A university hospital was sent 685 plain film examinations via an ISDN connection from a primary care centre, for a radiological report. The study was conducted in two phases: during phase 1 (446 cases) general practitioners (GPs) selected the examinations, and during phase 2 (239 cases) all consecutive examinations were transmitted. In phase 1, 40% of the examinations were of the chest and 24% were of the spine; the remaining 36% were mainly bone and sinus examinations. In phase 2, 28% of the examinations were of the chest and 19% were of the spine. The sensitivity and specificity of the GPs' interpretations (compared with the radiologists') were 0.85 and 0.62 respectively in the first phase, and 0.90 and 0.86 in the second. In at least one-third of all cases, teleradiology helped with the diagnosis, although completely new diagnoses were less common. An effect on treatment was noted in 15% of cases and on prognosis in 5%. However, an appropriate consultation level is required for these positive effects. Adequate accuracy and patient safety cannot be achieved if the examinations sent for radiological reporting are preselected by a GP.

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“…34 The study showed that the existing community-based system was the most costefficient, and the telemedical option the most expensive. The inconvenience caused when patients had to travel for specialist investigations was not factored into the study, nor was the possibility that some communities might not have access to local expertise.…”

Section: Inter-hospital Communicationmentioning

confidence: 99%

Protocols and evidence-based healthcare

Coiera¹

2003

Guide to Health Informatics, 2Ed

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IntroductionThe care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Indeed, if information is the lifeblood of healthcare then communication systems are the heart that pumps it.1 Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention. Whilst there is some significant advanced research in highly specific areas like telemedicine, the clinical adoption of even simpler services like voice-mail or electronic mail is still not commonplace in many health services. Much of this would change if it were more widely realised that the biggest information repository in healthcare sits in the heads of the people working within it, and the biggest information network is the complex web of conversations that link the actions of these individuals.There remain enormous gaps in our broad understanding of the role of communication services in health care delivery. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the interface between primary care and hospital services. Yet clinical laboratories in many ways are message-processing enterprises, receiving messages containing information requests, and generating results that are sent as messages back to clinical services. While there is much current focus on improving laboratory turn around times and internal efficiencies, little is really known about the broader communication processes within the healthcare system, of which clinical laboratories are but one link in the chain. Yet without this broader view, there is an ever-present risk that local systems within laboratories are optimised and over-engineered, but that the global performance of health services remain relatively unchanged.Given this lack of specific information about laboratory communication services, this paper will step back and generally review the components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarise some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery. Review Article Communication Systems in Healthcare Enrico CoieraCentre for Health Informatics, University of New South Wales, NSW 2052, Australia For correspondence: Dr E Coiera e-mail: e.coiera@unsw.edu.au AbstractThe care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, ...

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Radiology services for remote communities: cost minimisation study of telemedicine

Cited by 60 publications

References 36 publications

Assessment of Telemedicine in Surgical Education and Patient Care

Assessment of Telemedicine in Surgical Education and Patient Care

Effect of teleradiology on the diagnosis, treatment and prognosis of patients in a primary care centre

Protocols and evidence-based healthcare

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