Measuring the 'success' of telehealth interventions

Despite substantial investment over recent years in telehealth there appears to be little consensus regarding what a successful implementation should achieve. However, defining success is often controversial and complex due to differing views from the large number of stakeholders involved, the local environment where telehealth is deployed and the scope, or size, of any planned initiative. Nevertheless, a number of generic measures are proposed in this paper which then provides a framework for the measurement of success. The local context can then be applied to determine the exact emphasis on specific measures, but it is proposed that all of the measures should be included in the holistic measurement of success. Having considered what constitutes success attention is then given to how success should be quantified. Robust evaluation is fundamental and there is much debate as to whether the �gold standard� Randomised Control Trial (RCT) is the most appropriate methodology for telehealth. If the intervention, technology and system, can be maintained in a stable state then the RCT may well provide the most authoritative evidence for decision makers. However, ensuring such stability, in what is still a novel combination of technology and service, is difficult and consequently other approaches may be more appropriate when stability is unlikely to be maintained

Older People, Telematics and Care

About the book: What are the implications of current economic, social and political trends in Britain for older people? Social and demographic changes have led to traditional areas of welfare being transformed. The contributors to this book take a critical look at the current situation and assess the implications for future practice. They debate the assumptions and values underlying established welfare programmes and consider the case for change as growing demands put health and social services under increasing pressure. The second part of the book discusses specific areas in detail, ranging from the organisation of effective domiciliary social care to the impact of new technologies on older people's lives. This book provides a comprehensive and practical overview of the provision of services for older people and will be a valuable and thought-provoking resource for anyone involved in caring for and supporting them

A Jini-Based Solution for Electronic Prescriptions

In most countries today, handwritten, paper-based medical prescriptions are the norm.While efforts have been made in the past and are being made at present to migrate toward electronic dispensation of prescriptions, these have generally omitted to incorporate ubiquitous computing technology in their proposed solutions. In this paper, we focus on this issue and describe a Jini-based prototypical solution for electronic prescriptions, which allows for their wireless transmission to in-range pharmacies and the augmentation of the service levels rendered to the user, with, for instance, information about queue lengths and estimated waiting times being provided to the patients. Clinical and user evaluation revealed that there were high levels of agreement as regards the prototype’s effectiveness, ease of use, and usefulness

ICTs and Family Physicians Human Capital Upgrading.Delightful Chimera or Harsh Reality?

In the present paper we provide a quantitative assessment of ICTs role in Family Physicians/General Practitioners (GPs) medical daily practice and scientific performance. It focus on the Portuguese underexplored context, where the Health Sector has been under pressure for wide and profound reforms. These reforms have been extensively relying on ICTs, namely on the Internet. Based on the responses of 342 GPs, we concluded that 94% uses the Internet and 57% agrees that the Internet is essential to their medical daily practice. This is a slightly lower percentage than that observed for other European physicians (62%). GPs tend to use the Internet mainly for professional purposes. On average, they spend 10 hours/week on the Internet for professional purposes. Further data shows that to have or to be enrolled in advanced training fosters the use of the Internet for professional purposes, which in its turn, tends to grant GPs access to more and up-to-date information and knowledge on these matters. A worrisome evidence is that at the workplace, a substantial proportion of GPs (over 70%) do not use the Internet or other related ICTs, namely Telemedicine. Although Electronic Prescription is used by roughly 60% of the respondent GPs, for all other activities – teleconsultation, telediagnosis, and telemonitoring – only a meagre percentage of physicians (10%) claim to use such technologies. Thus, Telemedicine at the workplace is still a chimera. Notwithstanding such dishearten scenario, our data shows that the Internet for the respondent GPs has a critical role on updating and improving their professional knowledge basis. They recognise, however, that the vast majority of GPs lack specific and general training in ICT-related technologies. In fact, half of them agree that they need to attend specific training actions on ICTs. A large percentage of GPs admitted that in the previous year they did not take any professional training targeting ICTs and those who did undertook rather short-term (less than one week) courses: Because of that, such training handicap uncovers that a large part of Portuguese GPs may be unable to reap the benefits of ICTs in their daily medical practice.GPs; Human Capital; Information and Communication Technologies (ICTs)

Evaluating a telehealth intervention for urinalysis monitoring in children with neurogenic bladder

Telehealth as a community-monitoring project within children’s urology care is an innovative development. There is limited evidence of the inclusion of staff and parents in the early-stage development and later adoption of telehealth initiatives within routine urological nursing care or families’ management of their child’s bladder. The aim was to explore the experiences of key stakeholders (parents, clinicians, and technical experts) of the proof of concept telehealth intervention in terms of remote community-based urinalysis monitoring by parents of their child’s urine. A concurrent mixed-methods research design used soft systems methodology tools to inform data collection and analysis following interviews, observation, and e-surveys with stakeholders. Findings showed that the parents adopted aspects of the telehealth intervention (urinalysis) but were less engaged with the voiding diary and weighing. The parents gained confidence in decision-making and identified that the intervention reduced delays in their child receiving appropriate treatment, decreased the time burden, and improved engagement with general practitioners. Managing the additional workload was a challenge for the clinical team. Parental empowerment and self-efficacy were clear outcomes from the intervention. Parents exercised their confidence and control and were selective about which aspects of the intervention they perceived as having credibility and which they valued

Business Plan to reconfigure Mediseen INC early strategy

El modelo comercial actual de MediSeen se centra en tener doctores en su plataforma virtual para que realicen visitas a domicilio. Sin embargo, esta estrategia no tiene una propuesta de valor direccionable para los doctores o para la compa??a que pueda conducir a un ?xito financiero sostenible. Adem?s, existe un grave riesgo de desintermediaci?n, es decir, los clientes recurren directamente a los proveedores de servicios despu?s de la primera transacci?n a trav?s de la plataforma de Mediseen. Para agravar a?n m?s el problema, MediSeen tiene efectivo limitado y solo puede sobrevivir hasta fines de 2019 sin recaudar capital adicional. MediSeen tiene dos posibles alternativas para abordar estos problemas estrat?gicos clave. Primero, MediSeen podr?a desviar su atenci?n de los doctores y limitarla solo al segmento de atenci?n m?dica aliada, que incluye servicios como masajes, fisioterapia, terapia de yoga, nutricionistas y entrenamiento personal. Al hacer este cambio, la estructura de la comisi?n tambi?n necesitar?a ser revisada para reducir el riesgo de desintermediaci?n y mantener a los proveedores de servicios motivados. Al final del a?o 2019, se deber?an lograr un total de 42,000 descargas de aplicaciones, 1,800 consultas y obtener 1,260 usuarios activos, que se traducir?n en $59,400 de ingresos para hacer viable esta alternativa, y lograr un EBITDA rentable en el a?o 2020. En segundo lugar, MediSeen podr?a salir del negocio cerrando sus operaciones. Como la compa??a no tiene acreedores, no es elegible para declararse en bancarrota (de acuerdo a la Ley Canadiense). Seg?n los valores de liquidaci?n t?picos de los activos, estimamos que el valor de liquidaci?n de MediSeen actualmente es de$ 550,000, lo que representa un retorno de 5.5 ? / $ para los inversionistas originales

A Participatory Action Research approach to telemedicine supported health care delivery in rural Nepal

Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services. Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology. The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged. The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment. In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment

Formative stages of the common medication card and potential challenges with implementation of this service

Western healthcare is provided in various levels in different organizations. Fragmented information flow and the need to improve the continuity of care has been a serious concern in healthcare system. Fragmented healthcare can result in medication errors that could have been avoided if information flow was organized better. Use of IT services in healthcare organization is seen as possible solution to reduce these mistakes. Common medication card project in Norway was initiated as a part of national strategy for electronic cooperation in health and social sector. Two similar projects in Tromsø and Trondheim were studied. The intentions of these projects are to reduce medication errors and improve the information flow between primary and secondary healthcare levels. This thesis is an interpretive study and has addressed the potential challenges with implementing the common medication card service. Interviews were the main data source. The main challenges that could be met when implementing the common medication card are dealing with the distributed character of healthcare work and interdependency of medication information, as well as obtaining the sustainable use of this service. Changes in work routines and responsibility are likely to appear but the consequences of these changes are hard to foresee

The Evolution of Telecom Technologies: Current Trends and Near-Future Implications

A project commissioned by The Centre for Cross Border Studies with funding from eirco

Service user and staff acceptance of fetal ultrasound telemedicine

Objective We present qualitative findings from interviews with frontline clinicians and service users of a fetal telemedicine service. Methods Semi-structured interviews with clinical stakeholders and service users were conducted, undertaken as part of a service evaluation. Data collection was undertaken by different teams, using interview schedules aligned to independent evaluation aims. Data were subjected to thematic analysis. Results Sonographers reported four main challenges: delivering a shared consultation; the requirement to resist scanning intuitively; communications during the scan; and restricted room space. Notwithstanding, all clinicians reported that participating women were accepting of the technology. Service users reported few concerns. The main benefits of fetal telemedicine were identified as upskilled staff, increased access to specialist support and improved management of complex pregnancies. Convenience was identified as the main benefit by service users, including savings in time and money from not having to travel, take time off work, and arrange childcare. Conclusions Service users and clinical stakeholders were accepting of the service. Service users reported satisfaction with communications during the consultation and awareness that telemedicine had facilitated local access to clinical expertise. Whilst clinical stakeholders reported challenges, the iterative nature of the evaluation meant that concerns were discussed, responded to, and overcome as the pilot developed. Clinical stakeholders’ perception of benefits for service users encouraged their acceptance. Moreover, the evaluation established that fetal ultrasound telemedicine is a viable method to access expertise safely and remotely. It provided demonstrable evidence of a potential solution to some of the healthcare challenges facing rural hospitals