Evaluating usability, effectiveness, and usage of telehealth technologies /

Includes vita.Affordable Care Act (ACA) has allowed more patients that did not previously have health care insurance to have coverage and access to care. This increase in the number of patients seeking medical care will only add additional stress to the existing disproportion of supply and demand for health care providers. In addition, rising health care costs have major effect on how, where, and even if consumers will get needed care. This study examined three different telehealth platforms in three different medical specialties in order to evaluate the perception that they would be appropriate vehicles for increasing access to care. I also wanted to find out what the users' perceptions of these technologies are, as that can be a driving factor in adoption of new technologies. The first study examined the usability and acceptance of new mobile application in teledermatology clinic. The second study focused on usability and acceptance of ICU Robots in a medical ICU. Finally, the third study evaluated if children and youth currently using telepsychiatry as a care delivery method would have other in-person options if telehealth was not available. The results of these three studies point at the complexity and richness of telehealth. The adoption and acceptance of mHealth was very fast and streamlined. In the same fashion, children might not have other appropriate options for care if telepsychiatry was not available in rural Missouri. Interestingly, though, the provider acceptance of ICU Robots was slow, with some provider disengagements observed. This research contributes to the field of health informatics and medical informatics by evaluating adoption and usability of technologies from the provider perspective, vs. the more traditional approach of examining patient satisfaction, or even provider satisfaction without fully understanding the implications of attitudes on the adoption itself. This study has focused purposefully on different groups of providers using different types of telehealth technologies so we could try to see the bigger picture of how telehealth actually contributes to the health care organizational structure.Dr. Lanis L. Hicks, Dissertation Supervisor.|Includes vita.Includes bibliographical references

Dermatology ECHO : a case report demonstrating benefits of specialty telementoring in primary care

Poster presented at the 2017 Health Sciences Research Day which was organized and sponsored by the University of Missouri School of Medicine Research Council and held on November 9, 2017.Conclusion: Timely access to quality care may not be possible for patients living in rural and underserved areas. However, a telementoring platform such as Dermatology ECHO increases self-efficacy, knowledge, and capacity of PCPs to provide diagnosis and immediate treatment that may reduce patient suffering and improve health outcomes

Dermatology ECHO : an evaluation of physical learning using the guided practice model

Poster presented at the 2017 Health Sciences Research Day which was organized and sponsored by the University of Missouri School of Medicine Research Council and held on November 9, 2017."Traditional telemedicine has been successful in addressing direct patient care over the past four decades, but its main limitation of providing one--to--one care still remains today. The current use and availability of emerging services, however, allows for a disruptive innovative approach to include a one--to--many service optimizer. The primary objective of this retrospective study was to quantify the degree of diagnostic disagreement between participating PCPs compared to dermatologists. Our aim was also to evaluate the associated patient characteristics."--Introduction and background

Chronic pain management echo project learning collaborative network

"Virtual education and continuing medical education (CME) are on the rise. As the available technologies become more affordable and user friendly, it is expected that the acceptance rate will rise accordingly. While CPM ECHO offers a virtual platform for CME, its primary value is in its ability to create knowledge-sharing networks and increase collaboration between organizations and providers. It creates a community of learning, where all teach and all learn. Challenges with chronic pain management are well documented in current literature. In addition, rural providers may encounter barriers such as professional isolation. CPM ECHO uses disruptive innovation technologies (telemedicine) to provide guided practice and increase professional collaboration."--Conclusions

Dermatology echo : an evaluation of physician learning using the guided practice model

"The most prevalent provisional and final diagnoses were in the categories of dermatitis, hypersensitivity, and psoriasis/scaling. These categories were also the most prevalent of the cases that had matching provisional and final diagnosis categories. These findings indicate the need to focus didactic presentations on dermatologic disorders within these categories to further improve the percentage of provisional diagnoses that identically match final diagnoses. The significant improvement in PCPs' ability to correctly diagnose dermatologic conditions after participating in Dermatology ECHO may indicate the impact the virtual community has on physician learning outcomes."--Conclusions

Dermatology echo saves money!

"The preliminary retrospective data from this convenience sample suggests that length of patient suffering and healthcare cost associated with dermatologic conditions may be reduced if dermatology expertise is available early. The difference between the total average cost of visits, treatments, and diagnostic workups prior to case presentation at ECHO and the cost of ECHO recommendations was statistically significant (p <0.5). Additionally, the cost determined using physician fee schedule underestimates the cost charged by Hospitals and Clinics to patients and insurance companies. Future plans include obtaining and analyzing a randomized sample of ten or more cases from the first year of ECHO. Additionally, it would be valuable to determine the associated healthcare costs after the Dermatology case presentation and tele-mentoring."--Conclusion and future plans

Improving behavioral health consultant effectiveness with telehealth implementation

"Limited Behavioral Health Consultant (BHC) services are available to University Physicians (UP) primary care clinics supporting integrated care practices. Numerous studies have shown the positive impact of integrating behavioral health providers into primary care clinics; however, barriers such as funding mechanisms still exist. Disruptive innovation technologies, such as telehealth, support utilization of existing resources at minimal, or no additional cost. Telehealth has been shown effective in many other settings for providing increased access to services without compromising quality of care. This study applied telehealth practices to increase BHC integration within UP primary care clinics. Prior to the pilot project, Smiley Lane clinic received 2.5 days per week of BHC coverage, and Keene clinic received 2.0 days per week of BHC coverage. This created a significant gap in coverage for both clinics and decreased the feasibility of warm handoffs and paired PCP/BHC visits."--Background

Access to dermatologic expertise saves patients from suffering

"To describe a dermatologic condition that that may present in different variations, making it difficult to identify and diagnose. We present a patient case discussed in Dermatology ECHO (Extension for Community Healthcare Outcomes) clinic. Patients from rural Missouri, such as the case described here, may not have adequate timely access to specialty care. Dermatology ECHO serves as a vehicle for education and mentoring of primary care providers in evidence-based medicine.

Show-me echo project : state wide capacity building program

"Extension for Community Healthcare Outcomes (ECHO) Project utilizes telemedicine technologies to deliver care and education to rural and underserved areas. The Missouri Telehealth Network at the University of Missouri spearheads the Show-Me ECHO Project, consisting of 6 separate specialties: endocrinology, autism, chronic pain, hepatitis C, pediatric asthma, and dermatology. Show-Me ECHO's goal is to educate providers in underserved areas in order to enhance patient care and minimize health care costs. Program evaluation is conducted on an ongoing basis (Figures 1, 2). All ECHO clinics collect participating providers' demographics data. Pre and post self-efficacy surveys are administered in addition to knowledge tests in most ECHO clinics as well. MoHealth Net data is analyzed annually-patient demographics, provider prescription patterns, geographic data, ED visits, hospitalization and re-admission dates, outpatient visits, etc.

Utility of pediatric expertise in dermatology echo conference

"Extension for Community Healthcare Outcomes (ECHO) is a program that uses videoconferencing technology to connect specialists with primary care providers (PCPs) to reduce healthcare disparities and promote cross- disciplinary education. Each weekly conference consists of two parts: a short didactic session from the specialists (Fig. 1) and real, de-identified case presentations from the PCPs. PCPs present unsolved or difficult cases with a preliminary diagnosis and treatment plan, and specialists provide their recommendations for diagnosis and treatment. This innovative approach utilizes a 'one-to-many' service model, as educating PCPs has the potential to impact hundreds of patients over the years. The University of Missouri spearheads Dermatology ECHO, which supports a frequently sited workforce shortage - pediatric dermatology. These sub-specialists are often only located at large academic centers, resulting in limited access to the majority of the population. The aim of this study was the evaluate the use and impact of pediatric dermatology expertise in Dermatology ECHO conferences."--Introduction and background