Acceleration of Telemedicine Use for Chronic Neurological Disease Patients during COVID-19 Pandemic in Yogyakarta, Indonesia: A Case Series Study

COVID-19 preventions have cut access to routine medical care, especially for many chronic neurological disease patients. This condition has especially promoted telemedicine use in providing healthcare. This study aims to review telemedicine use catalyzed by several regulations of the Indonesian Government and review 20 cases from Bethesda Hospital in Yogyakarta providing online consultation services. Perceptions of experience on telemedicine were collected from neurological patients at the hospital who were asked about their impressions of consultations and pharmacy medication services, and their suggestions about the new system in outpatient consultations. The regulations for telemedicine use are relevant because of these patients’ risks related to comorbidities and treatments. Of 20 respondents involved in this study, 15 (75%) were satisfied with the service, 3 (15%) very satisfied, and 2 (10%) others neutral. Most respondents suggest improvement of reimbursement (80%) and others suggest improvement on medications (10%) and services (10%). System and hospital requirements for telemedicine services for neurological cases have been accelerated due to the pandemic. Telemedicine is a way to provide healthcare needed by patients at high risks for COVID-19 fatality related to comorbidities and treatments. Payment regulations, regulatory structures, state licensing, and credentialing across hospitals for better telemedicine experience need to be enhanced

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Increasing Specialty Care Availability

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 2: "Increasing Specialty Care Availability"Solutions such as telemedicine, innovative partnerships between specialists and primary care physicians, and centralized local referral networks improve access to specialty care

A paediatric telecardiology service for district hospitals in south-east England: an observational study.

The attached article is a Publisher version of the final published version which may be accessed at the link below. Copyright © 2010 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reservedOBJECTIVES: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements. DESIGN: Prospective cohort study over 15 months. SETTING: Four district hospitals in south-east England and a London paediatric cardiology centre. PATIENTS: Babies and children. INTERVENTION: A telecardiology service introduced alongside outreach clinics. MEASUREMENTS: Clinical outcomes and mean NHS costs per patient. RESULTS: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days). CONCLUSION: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project

The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation

Explores how North Dakota has met the healthcare challenges of rural communities with support for primary care and the idea of a medical home, organization of care through coordination and cooperation networks, and the innovative use of technology

Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility

OBJECTIVES: Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus. DESIGN: Cross-sectional. SETTING: A tertiary pediatric center and its satellite facility. PATIENTS: Patients admitted to the satellite facility. INTERVENTIONS: Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support. MEASUREMENTS AND MAIN RESULTS: We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model. MAIN RESULTS: Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation. CONCLUSIONS: Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities

Asynchronous Remote Medical Consultation for Ghana

Computer-mediated communication systems can be used to bridge the gap between doctors in underserved regions with local shortages of medical expertise and medical specialists worldwide. To this end, we describe the design of a prototype remote consultation system intended to provide the social, institutional and infrastructural context for sustained, self-organizing growth of a globally-distributed Ghanaian medical community. The design is grounded in an iterative design process that included two rounds of extended design fieldwork throughout Ghana and draws on three key design principles (social networks as a framework on which to build incentives within a self-organizing network; optional and incremental integration with existing referral mechanisms; and a weakly-connected, distributed architecture that allows for a highly interactive, responsive system despite failures in connectivity). We discuss initial experiences from an ongoing trial deployment in southern Ghana.Comment: 10 page

Economic Environment and Applications of Telemedicine

Telemedicine is broadly defined as the transmission of electronic medical data across a distance among hospitals, clinicians, and/or patients. This definition is deliberately unlimited to what kind of information is transmitted, how the information is transmitted, or how the information is used once received (HCAB, 2003). Telemedicine has the potential of making a greater positive effect on the future of healthcare and medicine than any other modality. Fueled by advances in multiple technologies such as digital communications, full-motion/compressed video, and telecommunications, providers see an unprecedented opportunity to provide access to high-quality care, independent of distance or location