Search

Background: The U.S. infant mortality rate is the highest in the developed world, and disparity impacts underserved populations. Traditional maternal health focuses on women, excluding men from information affecting family health. Scholars advocate including men in prenatal health to reduce infant mortality, a proven strategy in developing nations. This study explored the role of U.S. men in prenatal health, barriers to involvement, and the use of e-health. Special attention was given to health literacy; research indicates e-health is effective in educating low health-literate audiences., Materials and Methods: This study interviewed men with an average age of 33 years (n=32). The sample was 38% Hispanic, 28% African American, 28% white, and 6% multiracial. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of the tablet, and willingness to use similar applications., Results: Men believe it is important to be involved in pregnancy to help ensure healthy births. Most use mobile devices and computers for health information and found the application to be useful and interesting. Most concluded they would use a similar application to learn about pregnancy. Health literacy had minimal impact on participants' use of the tablet and information., Conclusions: This study explored the role men play in prenatal health, a promising avenue toward better birth outcomes. Using e-health is an opportune approach-it can reach men unavailable to attend prenatal programs because of work or feeling unwelcome at programs deemed "only for women."

We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.

Objective: the goal of this study was to provide an independent and objective evaluation of the implementation of the Federal Communications Commission's Rural Health Care Pilot Program., Materials and Methods: thirty-nine of the programs that were provided funding through this program were interviewed and asked about their project deployment, network planning, and the involvement of their state in implementation., Results: RESULTS showed that programs recruited project team members from a variety of fields to fulfill different roles. Network partners were often chosen because they were stakeholders in the outcome of the project and because they had a past working relationship with the grant-receiving programs. In terms of deployment, many programs had made progress in filling out necessary paperwork and were tracking milestones, but had experienced changes since first receiving funding, such as losing participants. Additionally, many encountered challenges that inhibited deployment, such as coping with rule fluctuations. Many of the programs received support from their respective state governments in project development, often through matching funds, but few states were involved in the actual management of projects., Conclusions: as rural healthcare facilities often lack the information technology infrastructure compared with many urban facilities, it is important to understand the implementation process for programs such as the Rural Health Care Pilot Program and to examine what contributes to progress, stagnation, or disintegration. Although the programs reported some success, almost all had encountered challenges that inhibited implementation. A follow-up study is planned to further investigate deployment and determine the implications of Federal Communications Commission funding.

Objectives: The aim of this study was to determine organizational characteristics evident in successful telemedicine programs. The study proposed four research questions to identify the key organizational characteristics for successful telemedicine programs., Methods: Data were collected through an online survey using modified unified theory of acceptance and use of technology (UTAUT) and organizational change readiness (ORC) validated assessments., Results: Using the UTAUT instrument and the ORC assessment, themes of successful telemedicine programs emerged. Overarching themes of successful programs included being formally structured, forward thinking, seeking to improve the quality of patient care, and being financially stable., Conclusions: This research provides a data-driven understanding of organizational issues that serve to maximize a telemedicine program's ability to achieve the overall goals and mission of a healthcare organization.

Asthma is a chronic disease and a growing health problem worldwide. The objective of this pilot study was to test the feasibility and utilization of tracking asthma symptoms through an innovative mobile phone application. The subjects for this research project consisted of 4 individuals who are currently receiving treatment for asthma from a primary care physician in Ingham County, Michigan. Participants took their peak flow reading each day and used the short message service (SMS) function on their phone and sent it to a Web server. If they did not send it by 11 AM, they received a reminder via an automated SMS to their phone. The resulting data suggest that this method of management is feasible. The data also demonstrate participants' satisfaction in monitoring their asthma in this manner. Using mobile phones for asthma management could improve compliance with asthma action plans and reduce adverse asthma events. Future research could further demonstrate that mobile phones are a new and effective method for providing healthcare.

St. Vincent's Homecare implemented a remote monitoring project in which researchers studied whether the telehome health patients exhibit enhanced clinical outcomes and patient perceptions of telehome healthcare. Fifty congestive heart failure patients (n = 50) participated in this program. Data collection included pre and post Outcome and Assessment Information Set items, 12-Item Short-Form Health Survey and Minnesota Living with Heart Failure Questionnaire, and data from patient charts were used to capture demographic information. In addition, interviews were conducted in order to assess overall perceptions and attitudes. Results indicate significant changes occurring among respondents in three important aspects that impact their quality of life, namely, physical, behavioral, and emotional improvements. Specifically, statistical significance was documented at the 0.05 level regarding improvement for home telehealth patients in shortness of breath, management of oral medications, ability to engage in moderate activities, amount of energy, swelling in legs/ankles, need to sit/lie down during day, fatigue, need for hospitalization, side effects from treatment, and worry. Additionally, patients found the service easy to use and perceived the care they received via telehealth to be as good as regular in-person care.

This paper addresses the challenge of provider underutilization of telehealth which continues to surface as an ongoing problem. In addition, this essay offers a list of ideas to serve as a starting point from which to address this key issue.

Telehealth services show great promise to expand access to care while improving patient safety and reducing costs of care for all Americans. The expansion of telehealth has been slowed by a host of factors, including limited reimbursement, legal and regulatory barriers, limited provider capacity, and a lack of general public knowledge and/or acceptance of telehealth technologies and services. To hasten the expansion of telehealth requires a multifaceted and coordinated approach that will include healthcare professionals, regulators, payers, lawmakers, and patients. This paper will outline the steps necessary to scale telehealth services to a level that will help to address issues such as access to care, patient safety, quality, provider shortages, licensure and preparedness, all important elements of healthcare reform.

Objectives: This study asks: What theories are employed in telemedicine studies? How might they be categorized in ways that help distinguish the knowledge base of telemedicine?, Methods: Theories in use were identified from a database of telemedicine-related publications between 1990 and 2005. Eighty-three (5% of 1615) articles referred to a theoretical concept. Grounded Theory procedures were used to analyze and categorize theories, while descriptive statistics were used for supplementary information., Results: The proportion of studies with theory was 3% in 1999 and 7% in 2005. The 83 articles were dispersed among 48 of the in total 795 different journals in the original sample. Identified theories were grouped into two main categories; 'shared' (used in two or more studies) and 'lone ranger'. All of the shared theories are social science theories employed without notable adjustments to any uniquely defining features of telemedicine; diffusion, technology acceptance, health behavior, science and technology studies (STS), and economics. Theoretical concepts within the lone ranger category may well address unique features of telemedicine, but have yet to attract the attention of colleagues., Conclusion: The theories identified as 'shared' play an important role, but are inadequate in illuminating any unique features of telemedicine. The future of telemedicine as a field will need to identify its underlying theoretical components. Frameworks employed in the field of evaluation may aid in identifying the types of theories worth articulating in telemedicine.

In Michigan, the use of telemedicine for dialysis patients began in three centres in 2005. A total of 747 clinical consultations was conducted in the following 22 months. Telephone surveys were conducted with 34 patients and four providers. The patients and providers all had positive perceptions of the telemedicine system and the care that was delivered. Most of the clinical measures of the patients met or exceeded the recommendations made by Renal Network 11. In addition to the clinical work, the telemedicine equipment was used for educational events. Twenty-six professional educational events were provided with a total audience of 105 individuals, and 35 administrative meetings were provided with 286 staff members in attendance. The study showed that patients and providers could participate in educational events that might not be available locally. Despite the success of dialysis telemedicine, the Marquette General Health System discontinued its use in 2007 when the Center for Medicare and Medicaid Services re-affirmed that dialysis centres were not approved sites for telemedicine.

Telemedicine has garnered significant attention over the past decade as a solution to cost and access challenges facing healthcare. Yet, utilization rates have not reached their full potential. One major barrier to the adoption of telemedicine cited in the literature is the lack of universal reimbursement from private payers. The purpose of this investigation was to capture a current picture of private reimbursement for telemedicine services in the United States. This investigation was a follow-up to a 2003 survey conducted by the American Telemedicine Association (ATA) and AMD Telemedicine. Representatives from 116 telemedicine programs were contacted between September and November 2005 via telephone and/or e-mail to participate in this survey. Of those contacted, we received responses from 64 organizations, a 55% response rate. To provide answers to our research questions, descriptive statistics were used for data analysis. Data indicate that the United States is progressing toward expanded private reimbursement for telemedicine services with 58% of responding organizations who provide potentially billable telemedicine services receiving private reimbursement (up 5% from 2003). In addition, it was found that 81% of those who receive private pay reported no differences between reimbursement for telemedicine services as compared to traditional faceto-face consults. Finally, of those who receive private pay, data indicated that telemedicine programs are submitting on average approximately 40% of consults for private reimbursement. While this investigation does suggest that we are making small improvements in private payer reimbursement, the change appears to lag behind a pace needed to optimize telemedicine deployment.

We evaluated the use of home telehealth for patients with chronic obstructive pulmonary disease (COPD) and/or congestive heart failure (CHF). Patients diagnosed with COPD and/or CHF who were prescribed home health-care services were randomly assigned to an experimental group where they received home health care through a combination of traditional face-to-face and telemedicine visits (n = 83), and a control group where only conventional home care was employed (n = 78). Data were collected via the Short Form 36 (SF-36), Outcome and Assessment Information Set (OASIS) and patient charts. In the experimental group, patient perceptions of the home telecare services were collected via telephone interviews. Overall, the addition of telehealth to COPD/CHF patient care was not a significant predictor of health and wellbeing, either positively or negatively. Although those receiving telehealth had worse ratings on the SF-36 general health subscale after the intervention, this measure was only significant when controlling for a number of key variables in the model. In regard to patient perceptions of home telecare, patients were satisfied with the technology and the way that care was delivered via this modality.

We conducted a systematic review of 15 relevant databases for articles about telemedicine. After eliminating articles that did not meet the inclusion criteria, 1615 remained for analysis. Three raters coded the articles to assess various theoretical and methodological variables. Only 5% (n = 85) of the telemedicine articles made mention of any theory or paradigmatic approach. Studies commonly reported the objectives (96%) but rarely stated a research question or hypothesis (11%). Randomized selection of the subjects was reported in 11% of patient studies and 4% of studies where providers were the subject. There was a wide range in the number of subjects employed, although the majority of studies were based on sample sizes of less than 100. Only 26% of the studies reported a time frame. Until the telemedicine field adheres to agreed standards of reporting methodological details it will be difficult to draw firm conclusions from review studies.

The American Telemedicine Association (ATA) convened a panel of experts to generate a research agenda for the telemedicine community to further support and promote the long-term acceptance and use of telehealth. Three principles to guide research and four key areas within which research is greatly needed were identified. These four areas are technical, clinical, human factors and ergonomics, and economic analyses. It is the hope of the panel that the research recommendations put forth in this document will give investigators the inspiration, tools and goals to make this happen.

Telemedicine, the use of telecommunication technologies to provide health services over some distance, has a history that spans more than five decades. Technological development and deployment have been interrelated with shifting paradigmatic views. This paper proposes that telemedicine has evolved through three generations that began with telemedicine as a communication medium to complement traditional services to a technology of automation and decision tools that expands the scope and range of health services and creates a unique health communication context. This paper provides a literature review and overviews three proposed evolutionary stages for telemedicine to date, namely synchronous versus asynchronous modalities, data transfer and storage, and automating decision making and robotics. Finally, we conclude with a discussion of the barriers for telemedicine and a call for engineers to join with social scientists and medical professionals to set an agenda for future telemedicine development.

We used qualitative interviews to examine the perceptions of direct providers of telemedicine services, primary care providers (PCPs) and hospital administrators about opportunities and barriers to the implementation of telemedicine services in a network of Veterans Health Administration hospitals. A total of 37 interviews were conducted (response rate of 28%) with 17 direct telemedicine providers, nine PCPs and 11 administrators. The overall inter-coder reliability across all themes was high (Scott's pi = 0.94). Direct telemedicine providers generally agreed that telemedicine improved rapport with patients, and respondents in all three groups generally agreed that telemedicine improves access, productivity, and the quality and coordination of care. Respondents mentioned several benefits to home telemedicine, including the ability to better manage chronic diseases, provide frequent clinician contact, facilitate quick responses to patient needs and provide care in patient's homes. Most respondents anticipated future growth in telemedicine services. Barriers to telemedicine implementation included technical challenges, the need for more education and training for patients and staff, preferences for in-person care, the need for programme improvement and the need for additional staff time to provide telemedicine services.

Policy-makers and researchers lament the absence of telehealth registries to enhance knowledge regarding outcomes and efficacy of telehealth interventions. A number of different organizations operate registries, but there do not appear to be any true telehealth registries. One reason is that federal requirements through such policies as the Health Insurance Portability and Accountability Act (HIPAA) have led to heightened fear of inadvertently releasing confidential or unauthorized information. Also, it would be more efficient if patient data were captured electronically at the local level, ideally through electronic medical records (EMRs), and then transferred electronically to registries. However, the diffusion of EMRs at the local level is in its infancy. As a result, it is unlikely that we will see a comprehensive telehealth data repository within the next decade.

Telemedicine research addressing user satisfaction abounds in academic literature. Results from patient satisfaction studies indicate exceptionally high levels of perceived satisfaction, often above the rates of expected satisfaction for traditional forms of health delivery. Results from provider satisfaction studies are also generally quite positive; however, data from providers point to higher concerns with delivery barriers and challenges. Even though data from patient and provider satisfaction research suggests overwhelming optimism for this delivery modality, this paper urges cautious embracement of these results for several reasons. First, many of the studies exhibit serious methodological weaknesses related to design and data collection instruments. In addition, the construct of satisfaction is largely undefined and is not clear. Even recognizing these caveats, the results of the study do offer some evidence that patient satisfaction will not impede the deployment of telemedicine, but provider satisfaction merits additional study.

Background: This research was conducted as part of a telehospice study conducted by researchers at Michigan State University, in a partnership with Hospice of Michigan. The study took place from March 2000 through December 2002., Objective: One of the primary objectives of the study was to learn more about how providers feel about the provision of telemedicine services, in this case telehospice. Of particular importance was learning more about how providers' perceptions of services could change over the course of the project as they became more familiar and comfortable with providing telehospice services. Finally, researchers were interested in how the providers' perceptions of telehospice system might influence utilization., Setting/subjects: Four Hospice of Michigan offices took part in this telehospice study, two in rural areas and two in urban settings with a total of 187 patients receiving telehospice care. Health providers who offered telehospice services were recruited to share information about their perceptions of the technology., Measurements: Providers were surveyed at the beginning and end of the project to track their perceptions of telehospice services. Five focus groups with providers were also conducted over the course of the project to allow providers to elaborate their thoughts and perceptions in greater detail., Results: Actual utilization of the telehospice system did not have a significant impact on perceptions of services; for the most part, providers began the project with pre-conceived notions about the technology and these perceptions held over the course of the project. Even providers who praised the level of training and technical support and who were able to cite success stories did not display a significant change in attitudes toward telehospice. Providers did express concern regarding how telehospice would impact current aspects of their job such as autonomy or mileage reimbursement., Conclusions: Study results indicate that providers serve as gatekeepers to a new technology and manner of providing care. Telehospice services in this project were primarily provided by a handful of enthusiastic adopters. The results of this study provide important implications if telehospice care is to disseminate for general use among hospice recipients.

Telehospice (TH) utilizes telemedicine technology to provide care at the end of life. A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care. Videophones were deployed for telenursing visits and evaluations by social workers. In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology, we reviewed clinical records retrospectively for hospice nurse home visits. Clinical notes documenting home nursing visits were obtained from two large hospices, one based in Kansas, and the other in Michigan. Records were randomly selected for patients who received hospice nurse visits during the month of January 2000. The charts were reviewed for patient demographic information, patient assessments, teaching activities, and interventions. Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument. After careful review of the records, the coders also made a subjective observation regarding the suitability of each visit for telemedicine. As part of this analysis, we found that 64.5% of home hospice nursing visits could be performed by telemedicine. Using TH, it is possible to reduce the number of in-person visits, thereby significantly decreasing the cost of providing hospice care.

Telehospice, the use of telemedicine technologies to provide services to hospice patients, offers an innovative solution to the challenges of providing high-quality, cost-effective end-of-life care. Specifically, the technology allows caregivers to transmit video images of patients, which provide off-site nurses with the information they need to assist the caregiver. Our telehospice project was conducted in urban and rural Michigan between 2000-2002 and collected data from 187 patients receiving telehospice services in their homes during this study. Overall, nurses were the primary providers of telehospice services and initiated the majority of routine televisits. Often, patients who described themselves as "overwhelmed" at the time of enrollment declined telehospice. However, patients were extremely satisfied with telehospice and often expressed frustration that nurses did not use the telehospice equipment more frequently.

Telemedicine, the use of telecommunications technologies to deliver health services over a distance, is emerging as an innovative tool for the field of surgery. Recent feasibility and demonstration projects have documented the potential of telesurgery, the performance of a surgical intervention by a surgeon not physically located with the patient. However, the use of telemedicine for surgical services expands beyond telepresence surgery to include telementoring, teleproctoring, teleconferencing, and teleconsulting. This chapter overviews the current status of telemedicine applications across the full range of surgical care, which include training, preoperative, operative, and postoperative follow up. Although telesurgery garners the most attention, the paper concludes with the argument that the actual mainstay for telesurgery is the telemedicine components offered in the continuum of surgical services.

Outline the positive and negative predictors of telehospice use, namely its impact on organizational and management issues.

The Marquette General Health System (MGHS) initiated its telehealth program in 1995 with eight network sites in Michigan's Upper Peninsula. There are currently almost 30 active sites in this network that provide clinical, educational, and administrative services. In this article, MGHS is assessed against four criteria, namely, integration, evaluation, expansion, and acceptance. Several assessment data collection strategies were employed among patients, providers, administrators, and rural community members. This paper delineates the extent to which the MGHS program meets the definition of success as defined by this four-level model. Data and anecdotal evidence are presented that illustrate that the MGHS program has been successful in its attempt to increase access to medical services for the rural population of the Michigan Upper Peninsula, as well as facilitate medical and health education, and home care services.

We studied two rural telemedicine projects in the state of Michigan: one that enjoyed success and steady growth in activity, and one that experienced frustration and a lack of clinical utilization. Multiple data collection strategies were employed during study periods, which lasted approximately one year. Both projects enjoyed a grassroots approach and had dedicated project coordinators. However, the more successful project benefited from resources and expertise not available to the less successful project. In addition, the more successful project possessed a more formalized organizational structure for the telemedicine application. A comparison of the two projects leads to a simple conclusion. Telemedicine programmes are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine.

A longitudinal study of organizational issues affecting telemedicine adoption and diffusion in Kansas is presented. Key strategies highlighted include a centralized scheduling and coordinating process and leadership to oversee state activities.

Telemedicine programmes are often complex undertakings that result in combinations of success and failure. Michigan State University and LifeWays received a grant for a four-phase telepsychiatry research project in 2000. We employed multiple data-collection techniques, including patient and provider surveys, in-depth interviews, observation, patient chart analyses, and organizational archival data analyses. Of the four phases in the project, two proved to be successful, one failed in its initial goal but succeeded with a redefined goal, and one failed completely. Issues that affected success or failure included human resource conflicts, organizational structure, inter-organizational relationships and allocated resources.

In 1997, the University of Kansas Medical Center (KUMC) and the United School District 500 (USD 500) in Kansas City, Kansas, launched an innovative telehealth project that brought health care directly into elementary schools by interactive video technology and peripheral devices. This paper focuses on the attitudes and opinions of key players--teachers, nurses, and administrators--involved in providing the service. Research methodology involved analyzing archival data and conducting interviews with key players on the project from USD 500 and KUMC. The study highlights the difficulty in delivering health care, especially telehealth care, to underserved, urban children. The data also reveal that initial challenges and negative attitudes can be overcome to effectively deliver telehealth care in the school setting.

Two large hospice organizations in Kansas and Michigan began a telehospice project with the goal of improving care at the end of life using telemedicine. Hospice nurses provided services using video directly to the homes of hospice patients. The telemedicine equipment operated over ordinary telephone lines. Nursing services included symptom assessment and psychospiritual evaluations. Patients lived in both urban and rural settings. Studies were designed to evaluate utilization patterns, access to care, patient/carer acceptance, medical outcomes and cost. During the first year of the project, telehospice care was initiated at five rural sites (two in Michigan and three in Kansas) and three urban sites (two in Michigan and one in Kansas). There was greater telehospice activity in Michigan than in Kansas, with 118 and 44 patients served, respectively. The urban site in Kansas withdrew from the study after participating for only nine months. In an effort to understand the difference in utilization patterns and reasons for withdrawing from the project, in-depth interviews of key study participants, including hospice administrators, nurses and research personnel, were conducted. Human factors appear to be important in the adoption of novel telemedicine applications.

A telemedicine network has operated in the Upper Peninsula (UP) region of Michigan since 1995. The Marquette General Health System (MGHS) is the tertiary hospital that provides telemedicine services to 14 surrounding rural health facilities and another seven clinics. In order to assess the state of telemedicine in the UP region and its potential for development, three main factors were assessed: organizational development, telemedicine activity and perceptions of the key players. Data were collected through interviews with five MGHS telemedicine staff, 10 physicians (five from the MGHS and five from surrounding rural areas), 13 of the 14 chief executive officers (CEOs) of the remote telemedicine sites and a survey of 21 telemedicine site coordinators. This information was analysed in order to outline job roles and responsibilities; to document the process of doing telemedicine; and to understand current policies and procedures. Telemedicine activity from 1995 to 1999 was analysed in terms of the purpose of the session. In 1999, a total of 515 telemedicine sessions were conducted, 323 being non-educational and 192 being educational. Most CEOs of the rural hospitals were interested in furthering their use of clinical telemedicine applications. The data also indicated a great need for education, particularly of the rural physicians. The overall view of those surveyed about MGHS's telemedicine programme was positive. Respondents were quick to compliment the staff whenever possible. New telemedicine staff have been employed, which will allow responsibilities to be reassigned in such a way as to create a more efficient system.

One of the most researched areas in telemedicine concerns the issue of satisfaction. However, most of this research lacks any consistent methodological approach. As a result, it is difficult to conclude whether patients and providers are satisfied with telemedicine. However, this paper postulates that there is a bigger problem within the satisfaction literature than the quality of the research to date. Instead, the bigger question is whether the results from a specific telemedicine project can actually be generalized across all telemedicine contexts. This paper argues that research should focus on specific questions of interest rather than continue the tradition of generic satisfaction research if we hope to gain specific knowledge that will inform the field of telemedicine as a whole.

Objective: To review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video., Design: Systematic review of telemedicine satisfaction studies. Electronic databases searched include Medline, Embase, Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index, and the TIE (Telemedicine Information Exchange) database., Subjects: Studies conducted worldwide and published between 1966 and 1998., Main Outcome Measures: Quality of evidence about patient satisfaction., Results: 32 studies were identified. Study methods used were simple survey instruments (26 studies), exact methods not specified (5), and qualitative methods (1). Study designs were randomised controlled trial (1 trial); random patient selection (2); case-control (1); and selection criteria not specified or participants represented consecutive referrals, convenience samples, or volunteers (28). Sample sizes were 100 (7), and not specified (1). All studies reported good levels of patient satisfaction. Qualitative analysis revealed methodological problems with all the published work. Even so, important issues were highlighted that merit further investigation. There is a paucity of data examining patients' perceptions or the effects of this mode of healthcare delivery on the interaction between providers and clients., Conclusions: Methodological deficiencies (low sample sizes, context, and study designs) of the published research limit the generalisability of the findings. The studies suggest that teleconsultation is acceptable to patients in a variety of circumstances, but issues relating to patient satisfaction require further exploration from the perspective of both clients and providers.

We attempted a meta-analysis of telemedicine research studies of the costs associated with telemedicine. First, we performed a search of six well known databases with a variety of relevant keywords. After discarding non-English publications, books and duplicate publications resulting from the same study, we were left with 551 articles for analysis. Our second step was to separate the articles into two groups: those with and those without quantitative cost data. Only 38 articles contained any type of real data. Because many of these 38 studies proved to be inadequately designed or conducted, we were unable to perform a traditional meta-analysis. Furthermore, there were a number of disturbing features common to these studies, including the omission of the number of consultations or patients, almost non-existent longitudinal data collection and lack of uniformity in cost analyses. We conclude that it is premature for any statements to be made, either positive or negative, regarding the cost-effectiveness of telemedicine in general.

Local and county jails rarely offer telepsychiatry services to their inmates. We have established a telepsychiatry pilot project between the Kansas University Medical Center and the Lyon County Jail in Emporia, Kansas. A total of 264 telepsychiatry consultations were conducted with jail inmates. Of these, 70 were initial evaluations and 194 were follow-up visits; only one inmate refused to be seen. Approximately one-third of all inmates were seen for psychiatric consultation within one week of their incarceration and 68% were seen within one month of incarceration. Among lessons learned during the first year of service were: the monthly demand for consultations was five times greater than projected; moderately to severely ill inmates with a broad range of psychiatric illness can be seen and treated effectively using videoconferencing; and the technology was accepted by the jail personnel and the inmates alike and integrated into the jail's routine in terms of the delivery of psychiatric care.

This study investigated the telemedicine program at East Carolina University School of Medicine. In-depth interviews, organizational texts, and archival records provided data for a case study that sought to understand what telemedicine is to organizational members and how they came to create this contextual reality. The goal of this study was to apply interpretive paradigmatic assumptions in the privileging of telemedicine as the very context of the organization. The findings explain how organizational members make sense of this new way of providing health care. Organizational members' talk revealed that telemedicine is multifaceted: It is access, an economic tool, education, technology, and a grant activity. With the single exception of technology, these themes emerged equally, regardless of whether the telemedicine provider was located at the urban hub site or the rural spoke site. Interestingly, members at both locations talked about critical events in relation to receipt of grant or financial support for new projects. Implications for future research are advanced.

In 1997, a telemedicine project began in Kansas which brought health-care directly into elementary schools using interactive video-links. The project initially involved four schools, but was expanded to cover 10 schools, including two middle and one high school. We examined the organizational issues related to telemedicine links to schools. Specific attention was paid to the perceptions of the nurses, teachers and key administrators. The research involved analysing archive data and interviewing participants in the project from the schools and the medical centre. The results showed the difficulties in delivering health-care, especially by telemedicine, to under-served urban children. However, the data also revealed that these can be overcome. Once they had experienced it at first hand, almost all concerned began to see telemedicine as an effective and important asset to the delivery of health-care.

In the USA, children in low-income, medically understaffed areas have difficulty accessing health care. A pilot telemedicine service was established in Kansas, linking four elementary schools with a local hospital at 128 kbit/s. PC-based videoconferencing systems, a stethoscope, an otoscope and fax machine were installed for each school's nurse. During the first three months of operation, 187 consultations were conducted by a hospital physician over the video-link. Ear, nose and throat problems were the most common reason for referral (29%), followed by dermatological problems (20%) and mandatory school physicals (20%). Prescriptions were issued in 67% of cases. Eighteen per cent of children required referrals for specialist care. The pilot service successfully enabled medically disadvantaged children to receive health care and prompted four additional schools to join the project.

The ATSP (Association of Telemedicine Service Providers) supplies current and future telemedicine providers with practical information and other services. One way to obtain useful data is to conduct focused studies on important issues. This ATSP survey of vendor and equipment satisfaction is a collaborative effort between the Telemedicine Research Center and the ATSP research staff, and addresses some basic questions that telemedicine providers might have: What kinds of equipment are programs using? Who is providing this equipment? How do users rate the equipment and the vendors? The results will be periodically updated and made available to members in the members-only section of the ATSP website (www.atsp.org).

Elderly individuals involved in a home telenursing project were studied. The project nurses provided home health services from 'telenursing cockpits' located in three separate sites in Kansas. A cable television-based interactive video system was used to transmit video pictures at 30 frames/s, with 288 horizontal lines of resolution. During phase 1 of the study, interview data were collected from 22 subjects (4 men, 18 women). During phase 2, the original participants were contacted but only 9 (1 man, 8 women) were still receiving home health services. Contrary to expectations, the technology was not an important issue for the participants. They did not express any particular worry or excitement about it. Nor did they describe difficulties in adapting to its use. Use of telemedicine technology did not appear to have any negative effects on communication. The results suggests that further thought needs to be given to defining clearly the purpose and goals of telemedicine projects.

Objectives: To conduct an in-depth case analysis of the University of Kansas Telemedicine Program in order to identify organizational and communications elements that may be hindering the program's effectiveness., Methods: A case analysis was done, employing a combination of methodologies (direct observation, interview, and survey) involving extensive data collection from telemedicine program personnel throughout the state of Kansas. Analysis of this program's organizational communication focused on structure and boundaries, definitions and goals, leadership and decision making, and membership and roles., Results: Significant organizational communication deficits were identified. These included a dearth of perceived central leadership, lack of information about the technology itself, poorly designed and cumbersome means for scheduling and utilizing telemedicine technology, absence of explicit strategic goals; and poor communication in introducing this technology to medical personnel and to the public. Other important findings were: organizational members expanded the scope of this organization beyond the providing of a simple consultation; the perception that decision making falls into the hands of almost everyone but the referring physician; and the role that language (or lack of common terminology) plays in confusion about this innovation., Conclusion: Organizational factors may be critical determinants of success or failure of a telemedicine program. Innovations in telemedicine technology need to be matched by innovations in organizational communication and structure. Findings from this study can be applied to existing or planned programs. Examples include redefinition of the roles and responsibilities of certain personnel, increasing the efficiency and decreasing the complexity of the consultation scheduling process, clarification and formalization of leadership and decision making, and development of a universal terminology of telemedicine.