A Systematic Review of the Economic Evaluation of Telemedicine in Japan.

ObjectivesThere is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan's telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine's financial sustainability.MethodsWe searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan's telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars.ResultsAmong the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users' willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period.ConclusionsOverall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies

Health and mobility: Current status and future paradigms

The movement of telemedicine to the wireless and mobile Internetable applications is imminent in the next few years. This migration from the desktop platforms to the wireless and mobile configurations will have significant impact on the future health care delivery system and their globalisation. The recent telecommunications and biomedical computing advances will significantly enhance the current methodologies of telemedicine and telecare systems. This editorial will present some of the evolutionary issues and important aspects that have to be considered in the developing technologies for the next generation of Internet and Third Generation of Mobile Systems (3G), geared for future telemedical applications. These will provide new dimensions to existing medical services and areas of outreach, that are not possible in the current generation and will have tremendous impact on how the health care delivery will be shaped for the 21 Century

Applications of medical wireless LAN systems (MedLAN)

This is a post-peer-review, pre-copyedit version of an article published in Journal of Medical Marketing. The definitive publisher-authenticated version "Konstantinos A. Banitsas, R.S.H. Istepanian, Sapal Tachakra. Applications of medical Wireless LAN systems (MedLAN). Journal of Medical Marketing, Volume 2, Number 2, 1 January 2002 , pp. 136-142(7)" is available online at: http://www.ingentaconnect.com/content/pal/jomm/2002/00000002/00000002/art00008.In this paper the Wireless LAN (WLAN) networking principals are presented along with some of the implementation scenarios dedicated for Accidents and Emergencies wards. Preliminary simulation results of the MedLAN concept are also presented together with ongoing and future work in this area

Intelligent protocol adaptation for enhanced medical e-collaboration

Copyright @ 2003 AAAIDistributed multimedia e-health applications have a set specific requirements which must be taken into account effective use is to be made of the limited resources provided by public telecommunication networks. Moreover, there an architectural gap between the provision of network-level Quality of Service (QoS) and user requirements of e-health applications. In this paper, we address the problem bridging this gap from a multi-attribute decision-making perspective in the context of a remote collaborative environment for back pain treatment. We propose intelligent mechanism that integrates user- related requirements with the more technical characterisation Quality of Service. We show how our framework is capable of suggesting appropriately tailored transmission protocols, by incorporating user requirements in the remote delivery e-health solutions

Economic viability of eCare solutions

Provisioning of good quality care to the elderly population and at the same time reducing the pressure on the health care expenditures is a challenging issue for governments today. Many ICT supported, distant care systems (eCare) have been proposed but few have found their way to the market. The problem is to provide a viable business case for each actor involved (including eCare platform, health care and finance providers) when offering eCare services. We have constructed a model for evaluating the (socio-)economic viability of different business models when introducing eCare solutions. A multi-actor approach has been implemented, calculating and evaluating the business case for each actor involved. For a Belgian case we will show (socio)-economic advantages to participate in an eCare ecosystem

The impact of location of the uptake of telephone based healthcare

Telephone healthcare systems have been put forward as a key strategy to overcome geographical disadvantage, however, evidence has suggested that usage decreases with increasing rurality. This research aimed to identify geographical high and low areas of usage of NHS Direct, a leading telephone healthcare provider worldwide to determine if usage is influenced by rurality. National call data was collected (January, 2011) from the NHS Direct Clinical Assessment System for all 0845 4647 calls in England, UK (N=360,137). Data extracted for analysis included; unit postcode of patient, type of call, date of call, time of call and final disposition. Calls were mapped using GIS mapping software using full postcode, aggregated by population estimate by local authority to determine confidence intervals across two thresholds by call rate. Uptake rate Output Area Classification (OAC) group profiles was performed using the chi-square goodness of fit. The majority of calls were ‘symptomatic’ (N=280,055; 74.8%) i.e. calls that were triaged by an expert nurse, with the remaining 25.2% of calls health/ medicine information only (N=94,430). NHS Direct were able to manage through self-care advice and health information 43.5 of all calls made (N=99,367) with no onward referral needed. Geographical pattern of calls were highest for more urbanised areas with significant higher call usage found in larger cities. Lower observed usage was found in areas that are more rural of which were characterised by above average older populations. This was supported by geo-segmentation, which highlighted that rural and older communities had the lowest expected uptake rate. There is a variation of usage of NHS Direct relating to rurality, which suggests that this type of service has not been successful in reducing accessible barriers. However, geographical variations are likely to be influenced by age. There is a need for exploratory to determine the underlying factors that contribute to variation in uptake of these services particularly older people who reside in rural communities. This will have worldwide implications as to how telephone based healthcare is introduced