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Internet accessibility, coupled with rapidly improving technology, makes telemedicine increasingly practical. But reimbursement and regulatory issues pose major obstacles to more widespread use. [ABSTRACT FROM AUTHOR]

Purpose: Reducing childhood blindness and vision impairment (BVI) remains a global health priority. Our purpose was to summarize the peer-reviewed literature to date on measuring and reporting childhood BVI using population-based surveys and vision examinations., Methods: We conducted a scoping review of published studies that aimed to report BVI prevalence in children or studies that aimed to report BVI prevalence in the general population but which also included children. There were 201 articles identified for abstract review, and 86 studies were included in the final review., Results: There were 52 studies (60%) that specifically aimed to investigate prevalence of blindness and/or vision impairment among child populations, while the remaining 34 studies aimed to study BVI in the general population but still reported data for age ranges that included children. The majority of researchers used the WHO criteria for blindness and vision impairment, sometimes with modifications. Age definitions for children varied considerably, with maximum cutoffs ranging from 3 to 20 years., Conclusion: The available literature on childhood blindness indicates that while there has been substantial progress towards establishing an evidence base, more remains to be accomplished in terms of addressing gaps in understanding of the true prevalence and impacts of childhood blindness and vision loss. All studies in this review cited the need for improved vision care services, either for all ages or for the childhood years in particular.

Purpose: This study seeks to review published research on the global epidemiology of corneal blindness, with a specific focus on the available published estimates of incidence, prevalence, and trends in incidence or prevalence, as well as the contribution of corneal causes to overall burden of blindness., Methods: A scoping review was conducted of the published literature on the global epidemiology of corneal blindness, with emphasis on prevalence and incidence studies. Four databases were searched using both epidemiological and corneal blindness keywords. This review was limited to studies with a primary aim of determining the incidence, prevalence, or trends in corneal blindness or the percentage of blindness due to corneal causes. Only conditions considered to signify current blindness were included, not diseases that eventually could lead to blindness if left untreated., Results: A total of 185 articles met the selection criteria. Of these, 145 articles investigated all-cause blindness prevalence. Only 10 articles specifically aimed to determine estimates of corneal blindness prevalence, 7 articles provided results for all-cause blindness incidence, and no studies focused on obtaining corneal blindness incidence. Data on corneal blindness were most often present in studies investigating all-cause blindness and in trachoma studies., Conclusions: The results demonstrate the somewhat inconsistent and fragmented information regarding corneal causes of vision loss. A significant outcome of this research is the demonstration of a need for further research into global corneal blindness and the necessary steps to address the problem.

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.

This article highlights the deployment of telemedicine by the U.S. Army through the various echelons of care and in overseas locations, including range and scope of health services provided by telemedicine in a challenging environment. This is followed by a discussion of technological developments advances in mobile communications likely to change the practice of telemedicine in the military from limited fixed-point access to a highly mobile individual with handheld communication devices.

The purpose of this article is to present a taxonomy for telemedicine. The field has markedly grown, with an increasing number of applications, a variety of technologies, and newly introduced terminology. A taxonomy would serve to bring conceptual clarity to this burgeoning set of alternatives to in-person healthcare delivery. The article starts with a brief discussion of the importance of taxonomy as an information management strategy to improve knowledge sharing, facilitate research and policy initiatives, and provide some guidance for the orderly development of telemedicine. We provide a conceptual context for the proliferation of related concepts, such as telehealth, e-health, and m-health, as well as a classification of the content of these concepts. Our main concern is to develop an explicit taxonomy of telemedicine and to demonstrate how it can be used to provide definitive information about the true effects of telemedicine in terms of cost, quality, and access. Taxonomy development and refinement is an iterative process. If this initial attempt at classification proves useful, subject matter experts could enhance the development and proliferation of telemedicine by testing, revising, and verifying this taxonomy.

Following efforts at addressing health care reform that spanned decades, the US Congress passed massive health reform legislation in 2010, with key provisions to be implemented over the next few years. This legislation has been heralded as the ultimate legislative response to the spiraling cost of care and inequity of access to care. Yet, these reforms have left many unanswered questions about the perennial issue of tort reform, in particular, caps on non-economic damages. This article begins with a broad perspective on tort reform and the debate surrounding the issue, and ends with a search for common ground where the threat of litigation may be reduced while the constitutional rights of citizens remain safeguarded.

The changing health care environment is generating a number of challenges for Academic Health Centers' (AHC) ability to pursue their traditional tripartite mission of medical care, education, and research. A number of strategies have been suggested to aid the AHC to respond, among them telemedicine. In this paper, telemedicine is examined for its potential to assist in meeting financial, cost, and quality challenges. In particular, the model developed at the University of Michigan Health System for implementing telemedicine within the AHC is presented together with lessons learned. This model, based largely on intramural rather than extramural funding, is offered as a basic strategy to be considered by AHCs facing these challenges.

This paper examines the context and status of evaluation research in telemedicine, and it proposes a two-pronged strategy for addressing the critical policy and programmatic concerns in this field. It explains the evolution of evaluation research in the United States, and it describes a comprehensive typology and requirements for valid evaluation. Major impediments for definitive evaluation are discussed, together with a summary of major trends in empirical studies. Two concurrent strategies are proposed for producing definitive findings and for assessing the available empirical evidence. These consist of large-scale experimental studies and theoretical and empirical triangulation for assessing the available empirical evidence.

The resurgence of telemedicine can be attributed to its potential for addressing intransigent problems in health care, including limited accessibility, cost inflation, and uneven quality. After discussing definitions and the genesis of telemedicine, this review focuses on conceptual issues and an assessment of past research. The scope and methodological rigor necessary for sustained development and policy making have been limited in this area of research, owing to the nature of extant telemedicine projects and the lack of a comprehensive research strategy that specifies the objectives of telemedicine research regarding accessibility, cost, and quality. Research strategies and a framework for analysis are discussed. Without a commitment to the types of research objectives, framework, and strategy presented here, the considerable promise of telemedicine, as an innovative system of care, may not be fully realized.

Understanding the full financial effects of telemedicine systems on payers, providers, and patients has been hampered by the lack of data from full-fidelity systems operating at a steady state. The vast majority of telemedicine systems in the United States have yet to achieve their full potential in serving their target populations and are operating well below capacity. The purposes of this research are two-fold: (1) to develop a methodology that compensates for the limited availability of empirical data on the financial effects of telemedicine; and (2) to test this methodology in a comprehensive telemedicine system in West Virginia. The proposed methodology utilizes simulation modeling techniques for evaluating the financial performance of a mature telemedicine system. It is particularly suitable for analyzing large, complex systems that have not yet achieved steady-state operation. Although complex, the methodology can be described simply as consisting of two major steps. The first is the identification of all of the relevant variables and parameters for modeling. The second consists of simulating "real world" decision situations involving all relevant variables and parameters. The relation among the variables and parameters are described in terms of mathematical equations. The ability of the researcher to estimate the financial effects of a given telemedicine system is a function of the extent to which the resulting model approximates conditions of the real world; i.e., the fit between model and reality.

Objective: It is doubtful that any new health care delivery system that requires as much adjustment as telemedicine does will be sustained if its users do not fully support it. We sought to determine the familiarity with, perceptions of, and attitudes toward telemedicine among rural adults in West Virginia., Methods: Data were collected in a statewide telephone survey of 461 non-institutionalized rural adults. The survey contained questions about familiarity with telemedicine, perceptions about its attributes and benefits, and willingness to use it for routine, specialty, and emergency care. Responses were examined in relation to the subjects' age, sex, socioeconomic status, access to care, and insurance coverage., Results: Despite mass media coverage of the subject, only one third of the respondents had heard of telemedicine. Nearly two thirds thought patients would find it less satisfactory than seeing a physician in person. Male subjects, younger subjects, and those with higher incomes were more likely to think telemedicine would be as satisfactory as a face-to-face meeting. There was a general consensus on the benefits of telemedicine, such as greater convenience and easier contact with specialists. For chronic conditions, 47% of the respondents would use telemedicine if no physician was available locally, whereas 27% would go out of town to see another physician in person, and 25% would wait for their own physician. For emergency care, these figures were 41%, 58%, and 0. Three fourths of the respondents were somewhat or very willing to use telemedicine for routine or specialist care., Conclusion: More work needs to be done to demonstrate the efficacy of telemedicine and disseminate this knowledge to the public.

Critical issues facing the development of telemedicine today are described and analyzed as dilemmas or paradoxes. The technological dilemma involves the difficult choice between using the latest technology regardless of how well it fits specific needs on the one hand, and the reluctance to capitalize on the available technological capability to create efficient and effective organizations for expanding the reach of health care on the other hand. The evaluation paradox points to the disjuncture between policy making requirements and the scientific enterprise. This engenders the difficulty of producing scientifically valid and policy relevant results from programs that have not achieved maturity or a steady state of operation. The contextual hazards of limiting the scope of telemedicine to rural areas are discussed, as well as the potential for creating a second tier of care for the remote and isolated populations. Finally, professional maturation is addressed as it underscores the importance of self regulation and control.

The new federalism is now taking hold in Washington, with far-reaching implications for the role of the federal government in health, education, and welfare programs; financial support for such programs; and the shift of control to the states. For telemedicine, the implications of these changes include having to make do with less external financial support and a need to establish partnerships between state and local governments, public sector developers and vendors, third-party payers, and community-based telemedicine programs. The long-term challenge for telemedicine programs, particularly in rural, medically underserved areas, is likely to be their sustainability in an adverse financial environment. The problem is further compounded by the lack of reimbursement for teleconsultations.

In the United States, we are witnessing a renewed emphasis on the potential role of telemedicine in redressing issues of accessibility, cost, and quality of medical care. This paper describes several major problems confronting the current generation of telemedicine projects as they move toward maturity. In fact, it is argued here, the future development of telemedicine as an integral component of the health care system depends on the successful resolution of these concerns. Included for discussion are issues related to physicians, institutions, patients, and the general public. On the basis of the tenets of telemedicine and its capacity to transcend traditional boundaries of medical care via telecommunications, informed speculations are presented that are intended to stimulate discussion and provide direction for addressing a number of potential problems. Included are suggestions pertaining to restructuring the medical licensure system to accommodate telemedicine and the virtual regionalization of health care; implications for provider liability and reimbursement; patient privacy; system design; and diffusion of information.

Recent Congressional budget recissions are likely to reduce the development of telemedicine in the United States, yet federal support is considered essential for such development. Both the executive and the legislative branches continue to show interest in the field. Pressure is mounting for research data documenting the effects of telemedicine on health care cost, quality, and access. Other policy issues arise from the recent revolution in the telecommunications industry and changes in health care delivery.

Following a brief review of lessons learned from first generation telemedicine projects, an analytical framework for assessing the potential effects of telemedicine on cost, quality, and accessibility of health care is provided. It is proposed that the effects of telemedicine on cost, quality, and accessibility are interconnected, and a comprehensive assessment should incorporate all three aspects, each considered from the perspectives of clients, providers, and society.

Issues related to the definition and evaluation of telemedicine are articulated as a basis for conducting theoretically based, empirically sound, and policy-relevant evaluation. This paper includes a proposed operational definition of telemedicine, a discussion of the role of telemedicine in the healthcare system and economic analysis of telemedicine, an analysis of the basic approaches and requirements for telemedicine evaluation, and an identification of basic issues for evaluation. Telemedicine is conceived of as an integrated system of health-care delivery that employs telecommunications and computer technology as a substitute for face-to-face contact between provider and client. It has the potential for ameliorating seemingly intractable problems in healthcare such as limited access to care among segments in the population--especially the geographically disadvantaged--uneven quality of care, and cost inflation. Its true merit has yet to be determined by systematic empirical study. Such study should include a clear and precise identification of inputs and output and the nature of the relations between them, an assessment of the changes that might occur in the process of care as a consequence to telemedicine, and, ultimately, an evaluation of the effects of telemedicine on the healthcare system in terms of cost, quality, and accessibility. Several basic questions regarding the effects of telemedicine are posed as potential hypotheses for future research.

Health attitudes and behaviours were determined for residents of Western Alaska in a survey administered during the winter of 1988-89. One third of the villages in this region were randomly selected for inclusion in he study and one in three households in these villages were randomly selected to be interviewed. Bilingual interviewers successfully completed questionnaires for 477 households (77%). The vast majority of the sample population believed that a balanced diet, weight control, regular physical exercise, stress avoidance, regular medical attention and cessation of smoking and excessive drinking were important to health. Nevertheless 41% of respondents did not deny smoking, and 50% of these did not believe smoking cessation was important for health. Similarly, 34% of the population did not deny heavy drinking, and 38% of them did not think it was important to stop. When those who did not deny smoking were asked if they had tried to stop, 36% said they did not try. Of those who did not deny drinking heavily, 26% did not try to stop. Western Alaska has high rates of alcohol-related health problems and growing rates of tobacco-related diseases. The attitudes and behaviours with respect to alcohol and tobacco use exhibited in this study suggest a great need for health education and promotion activities directed at these habits.

Federal health and medical care programs recently mandated for American Indians living in cities are predicated upon information pertaining to their unmet health needs and assessments of their accessibility to medical care. Based upon a household survey conducted among a representative Indian population living in a large metropolitan area, an evaluation is made of the accessibility experience of this population as it pertains to primary medical care. Using measures of accessibility including travel time, appointment delay time, and waiting room time, the experiences of Indian residents of major residential sections of the area are illustrated. Comparative assessments are made on the basis of the individual convenience factors as well as on the basis of an aggregate index of accessibility that has been proposed for health planning and evaluation. Significant differences in accessibility to primary care between residents in certain residential areas are demonstrated and suggestions for revision of the accessibility standards are offered.

Data and findings are presented pertaining to the expressed travel limits for general medical care of a rural population and the degree to which their observed travel behavior reflects these limits. Considerable variation in expressed reasonable and maximum travel distances and times was observed among respondents in a countywide cross-section sample of the resident population in western Maine. A substantial proportion of the respondents' visits for general medical care exceeds their reasonable travel limits and some visits exceed the travel limits they considered maximal. Additionally, a comparison of expectations from this study with those of a similar population in another section of the county reveals significant differences. The findings suggest that health planning could be considerably enhanced by a better understanding of patient preferences for medical care travel behavior, the origins of these preferences, and their relationship to the use of available medical care opportunities. This is particularly true if stated goals of incorporating patient preferences into the health planning process are to be realized.

The inverse relationship between distance from mental health services and their use has been noted over many decades and on several continents. Although many factors--diagnostic, socioeconomic, and nosocomial--may modify this correlation, its persistence is remarkable. As other barriers to use are diminished, distance remains a mutable variable for planning more effective use of many health care services.

Lebanon's experience in the development of its health care system over the last century is reviewed; inasmuch as experiences can be generalizable, the case of Lebanon reflects the attempts of middle-income countries to balance the public and private sectors' roles in health care. Lebanon's health care system followed a predictable trend that was accelerated and intensified by the civil disturbances during the past decade. Its main feature has been the absence of a coherent and sustained health policy that promotes a stable and long-lasting relationship between the public and the private sectors in health. The role of the State has been most effective during periods of political, social and economic stability, when serious planning efforts could be undertaken and resultant policies be implemented. An effective partnership between the State and the private sector is recommended for the reconstruction of Lebanon's health care system, as well as for other countries with a strong private sector involvement in health care.

Results are presented of a study of the medical care-seeking behavior of black adult residents of lower and middle socioeconomic status in two predominantly black, yet geographically and socioeconomically distinct communities within the District of Columbia. Against a varied distribution of primary medical care opportunities within the District, substantial differences are demonstrated in their use by lower- and middle-status residents of a lower-class community. These differences are not, however, manifested among lower- and middle-status residents of an essentially middle-class neighborhood. The patterns of medical care-seeking behavior are observed within a framework of an almost total avoidance of the available medical care personnel and facilities in the proximate suburbs.

This paper examines the relationship between choice of career and perception of the medical labor market, as well as the effects of social origin, type of medical school, and place of internship. The data are derived from a survey of interns which was conducted in Mexico during 1978, when a substantial proportion of physicians was unemployed or underemployed. Career preferences were operationalized in terms of type of activity (general practice or specialty), site (ambulatory or hospital) and institution (public assistance, social security or private). Perceptions of the medical labor market were measured as an 'objective' feasibility perception and a 'subjective' opportunity assessment. Additionally, composite indices of career preferences and perceptions were constructed in order to take account of two integrated career patterns: dominant (or majority preference) vs alternative (or minority preference). Analysis of the data consistently revealed that perception of the medical labor market had a much stronger impact on preference for alternative than for dominant career patterns. Whereas social origin had no effect on career preference, type of medical school and place of internship exhibited a statistical interaction with career preference, suggesting that certain structural conditions of the medical school and the teaching hospitals led to preference for alternative rather than dominant careers. The implications of the findings are discussed with regard to health manpower policy, to conceptions of rational career choice and to the professional status of medicine in Mexico.