Health-based payment and computerized patient record systems. (1/1282)

Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care.  (+info)

Telemedicine in the NHS for the millennium and beyond. (2/1282)

This article defines telemedicine, discusses evidence of its effectiveness, looks at its advantages and disadvantages (and barriers to implementation), and considers its role in the NHS for the millennium and beyond.  (+info)

Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. (3/1282)

BACKGROUND AND PURPOSE: Immediate access to physicians experienced in acute stroke treatment may improve clinical outcomes in patients with acute stroke. Interactive telemedicine can make stroke specialists available to assist in the evaluation of patients at multiple urban or remote rural facilities. We tested whether interrater agreement for the NIH Stroke Scale (NIHSS), a critical component of acute stroke assessment, would persist if performed over a telemedicine link. METHODS: One bedside and 1 remote NIHSS score were independently obtained on each of 20 patients with ischemic stroke. The bedside examination was performed by a stroke neurologist at the patient's bedside. The remote examination was performed by a second stroke neurologist through an interactive high-speed audio-video link, assisted by a nurse at the patient's bedside. Kappa coefficients were calculated for concordance between bedside and remote scores. RESULTS: Remote assessments took slightly longer than bedside assessments (mean 9.70 versus 6.55 minutes, P<0. 001). NIHSS scores ranged from 1 through 24. Based on weighted kappa coefficients, 4 items (orientation, motor arm, motor leg, and neglect) displayed excellent agreement, 6 items (language, dysarthria, sensation, visual fields, facial palsy, and gaze) displayed good agreement, and 2 items (commands and ataxia) displayed poor agreement. Total NIHSS scores obtained by bedside and remote methods were strongly correlated (r=0.97, P<0.001). CONCLUSIONS: The NIH Stroke Scale remains a swift and reliable clinical instrument when used over interactive video. Application of this technology can bring stroke expertise to the bedside, regardless of patient location.  (+info)

Making house calls: using telecommunications to bring health care into the home. (4/1282)

According to the U.S. Federal Trade Commission, an estimated 22 million Americans used their computers to seek medical information in 1995, making health concerns the sixth most common reason for using the Internet in the United States. Market research firms estimate that the number of people going online for this purpose is growing by 70% annually. Developments in computer technology, the Internet, and wireless and satellite telecommunications have led to major innovations in the nature and delivery of health care that have broad implications for the way people will receive health information and treatment in the future, even allowing health care providers to interact through cyberspace with their patients and other caregivers.  (+info)

Education of health professionals using a proposed telehealth system. (5/1282)

The movement of health care from hospitals to the community has demanded a major shift in the way in which health care professionals are being taught. This paper describes the collaboration of the Schools of Nursing and Medicine in the use of telehealth technology for the education of health care professionals. The specific aims of the project were to use the technology for the verification of the students' assessment and physical examinations, for the conduct of multi-professional patient rounds, and provision of consultations to professionals at remote sites. Capitalizing on the Schools' previous experience for observing students via computer technology at remote sites, we employed PC-based workstations, specialized peripherals, and Internet connecting protocols to implement a telehealth project for professional clinical education. Initial student, faculty and staff reactions were generally positive. The formal evaluation plan focuses on students, faculty, and staff. Structured questionnaires are used and a comparison of learning by telehealth technology will be made with alternative (more conventional) methods in evaluating knowledge and quality of verification of physical examination findings, and satisfaction with the learning process.  (+info)

Initial experiences with building a health care infrastructure based on Java and object-oriented database technology. (6/1282)

A multi-tiered telemedicine system based on Java and object-oriented database technology has yielded a number of practical insights and experiences on their effectiveness and suitability as implementation bases for a health care infrastructure. The advantages and drawbacks to their use, as seen within the context of the telemedicine system's development, are discussed. Overall, these technologies deliver on their early promise, with a few remaining issues that are due primarily to their relative newness.  (+info)

Process models for telehealth: an industrial approach to quality management of distant medical practice. (7/1282)

Process modeling is explored as an approach for prospectively managing the quality of a telemedicine/telehealth service. This kind of prospective quality management is more appropriate for dynamic health care environments compared to traditional quality assurance programs. A vector model approach has also been developed to match a process model to the needs of a particular site.  (+info)

Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave. (8/1282)

A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.  (+info)