Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

Analysis of QoS Requirements for e-Health Services and Mapping to Evolved Packet System QoS Classes

E-Health services comprise a broad range of healthcare services delivered by using information and communication technology. In order to support existing as well as emerging e-Health services over converged next generation network (NGN) architectures, there is a need for network QoS control mechanisms that meet the often stringent requirements of such services. In this paper, we evaluate the QoS support for e-Health services in the context of the Evolved Packet System (EPS), specified by the Third Generation Partnership Project (3GPP) as a multi-access all-IP NGN. We classify heterogeneous e-Health services based on context and network QoS requirements and propose a mapping to existing 3GPP QoS Class Identifiers (QCIs) that serve as a basis for the class-based QoS concept of the EPS. The proposed mapping aims to provide network operators with guidelines for meeting heterogeneous e-Health service requirements. As an example, we present the QoS requirements for a prototype e-Health service supporting tele-consultation between a patient and a doctor and illustrate the use of the proposed mapping to QCIs in standardized QoS control procedures

User-centred design and evaluation of a tele-operated echocardiography robot

We present the collected findings of a user-centred approach for developing a tele-operated robot for remote echocardiography examinations. During the three-year development of the robot, we involved users in all development stages of the robot, to increase the usability of the system for the doctors. For requirement compilation, we conducted a literature review, observed two traditional examinations, arranged focus groups with doctors and patients, and conducted two online surveys. During the development of the robot, we regularly involved doctors in usability tests to receive feedback from them on the user interface for the robot and on the robot’s hardware. For evaluation of the robot, we conducted two eye tracking studies. In the first study, doctors executed a traditional echocardiography examination. In the second study, the doctors conducted a remote examination with our robot. The results of the studies show that all doctors were able to successfully complete a correct ultrasonography examination with the tele-operated robot. In comparison to a traditional examination, the doctors on average only need a short amount of additional time to successfully examine a patient when using our remote echocardiography robot. The results also show that the doctors fixate considerably more often, but with shorter fixation times, on the USG screen in the traditional examination compared to the remote examination. We found further that some of the user-centred design methods we applied had to be adjusted to the clinical context and the hectic schedule of the doctors. Overall, our experience and results suggest that the usage of user-centred design methodology is well suited for developing medical robots and leads to a usable product that meets the end users’ needs

TER: A Robot for Remote Ultrasonic Examination: Experimental Evaluations

This chapter: o Motivates the clinical use of robotic tele-echography o Introduces the TER system o Describes technical and clinical evaluations performed with TE

Improving access to ultrasound imaging in northern, remote communities

Access to healthcare services—including access to medical imaging—is an important determinant of health outcomes. This thesis aims to improve understanding of and address gaps in access to ultrasound imaging for patients in northern, remote communities, and advance a novel ultrasound technology with the ultimate goal of improving patient care and health outcomes. This thesis first brings greater understanding of patients’ perceptions of access and factors which shape access to ultrasound imaging in northern, remote communities in Saskatchewan, Canada. A qualitative study was performed using interpretive description as a methodological approach and a multi-dimensional conceptualization of access to care as a theoretical framework. The study identified barriers which patients in northern, remote communities face in accessing ultrasound imaging, and demonstrated that geographic remoteness from imaging facilities was a central barrier. To determine whether disparities in access to ultrasound imaging resulted in disparities in utilization of ultrasound services, two population-based studies assessed the association between sociodemographic and geographic factors and obstetrical and non-obstetrical ultrasound utilization in Saskatchewan. In the first study investigating obstetrical ultrasound utilization, multivariate logistic regression analysis demonstrated that women living in rural areas, remote areas, and low income neighbourhoods, as well as status First Nations women, were less likely to have a second trimester ultrasound, an important aspect of prenatal care. In a second study investigating non-obstetrical ultrasound utilization across the entire provincial population, multivariate Poisson regression analysis similarly demonstrated lower rates of non-obstetrical ultrasound utilization among individuals living in rural and remote areas, individuals residing in low income neighbourhoods, and status First Nations persons. To address the barriers which patients in northern, remote communities face in accessing ultrasound imaging and to minimize disparities in ultrasound imaging utilization as identified in previous studies in this thesis, telerobotic ultrasound technology was investigated as a solution to improve access to ultrasound imaging. Using this technology, radiologists and sonographers could remotely manipulate an ultrasound probe via a robotic arm, thereby remotely performing an ultrasound exam while patients remained in their home community. A clinical trial comparing conventional and telerobotic ultrasound approaches was undertaken, validating this technology for obstetrical ultrasound imaging. To determine the feasibility of using telerobotic technology to establish an ultrasound service delivery model to remotely provide diagnostic ultrasound exams in underserved communities, pilot telerobotic ultrasound clinics were developed in three northern, remote communities. Telerobotic ultrasound exams were sufficient for diagnosis in the majority of cases, minimizing travel or reducing wait times for these patients. This technology was subsequently evaluated during a COVID-19 outbreak in northern Saskatchewan, demonstrating the potential of this technology to provide critical ultrasound services to an underserved northern population and minimize health inequities during the COVID-19 pandemic. An economic evaluation was performed to compare a service delivery model using telerobotic ultrasound technology to alternative service delivery models. Telerobotic ultrasound combined with an itinerant sonographer service was found to be the lowest cost option from both a publicly funded healthcare payer perspective and a societal perspective for many northern, remote communities. This thesis provides key insights for health system leaders seeking improved understanding and novel solutions to improve access to ultrasound imaging in northern, remote communities. Findings suggest that telerobotic ultrasound is a viable solution to improve access to ultrasound imaging and reduce costs associated with ultrasound service delivery. Evidence in this thesis may be used to help improve ultrasound services and health equity for patients in underserved northern, remote communities. Continued respectful collaboration with northern, remote, Indigenous peoples and communities will be a critical aspect to ensure that ultrasound services meet community needs

Insight into the Digital Health System of Ukraine (eHealth): Trends, Definitions, Standards, and Legislative Revisions

Purpose. This article aims to provide an in-depth examination of the digital health system of Ukraine, focusing on the emerging trends, precise definitions, established standards, and recent legislative revisions that shape the practice and implementation of eHealth solutions within the country. Background. The digital health landscape in Ukraine has witnessed significant transformations, especially in the wake of the COVID-19 pandemic and subsequent military conflicts. These events have catalyzed the expansion of telemedicine services, leading to innovative approaches in healthcare delivery. The national strategy underscores the necessity for human-centric and accessible telemedicine, reinforced by technological neutrality, and harmonization with global standards. Methods. A review of the current literature, national strategies, and legal documents was conducted, alongside an analysis of data usage and service provision patterns in various Ukrainian regions. Participation in the "Science for Safety and Sustainable Development of Ukraine" competition facilitated project initiatives like the development of a cloud-based platform for patient-centered telerehabilitation for oncology patients. Findings. The utilization of telemedicine has significantly increased in conflict-affected regions, demonstrating the need for, and the effective deployment of, digital health strategies under crisis conditions. Private health facilities and entrepreneurs have been pivotal in the provision of telemedicine services. Legislative efforts have been geared toward framing telemedicine as an integral component of the national eHealth system, ensuring interoperability, and aligning with international standards and the Internet of Medical Things (IoMT). Interpretation. The findings underscore the resilience and adaptability of the Ukrainian healthcare system in the face of adversity. There is a clear trend towards a more integrated, patient-focused, and technologically advanced healthcare model, aligning with international trends and prioritizing public health goals over private profits. This progress, however, is contingent upon continuous development, investment in technological infrastructure, and legislative support to sustain and advance digital health initiatives