What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation

Introduction: Determining appropriate remuneration for teledermoscopy service is important because inadequate remuneration can be a barrier to practitioner uptake and participation. This study explores dermatologist remuneration expectations for a single lesion store-and-forward teledermoscopy consultation. Methods: Fourteen dermatologists participated in telephone interviews during May–June 2017. Questions regarding remuneration focused on a clinical scenario involving teledermoscopy of a single lesion suspected to be skin cancer. The initial scenario was an existing patient, with a provisional diagnosis of benign neoplasm from the images, to be followed-up with routine skin checks, taking three minutes to review. Participants indicated their remuneration expectation by selecting from an ascending array of pre-determined remuneration ranges. The question was repeated a further four times with one aspect of the scenario changed each time; consultation length, source (patient or general practitioner), required follow-up, and a new rather than existing patient. Participants were also asked how appropriate they thought teledermoscopy was for the scenario, and whether they would choose to undertake the consultation presented. Results: Nine dermatologists selected the AU$61–90 or AU$91–120 remuneration ranges for the initial scenario. When given the opportunity to comment on teledermoscopy service provision in Australia, respondents reflected that it was a valuable, advanced dermatology service, but they would prefer face-to-face consultation with patients where possible to allow for a full body examination. Discussion: Dermatologists expect to be remunerated in the range of AU$61–120 for a single lesion store-and-forward teledermoscopy consultation when face-to-face examination is not possible

Speech-language Pathology Services Delivered by Telehealth in a Rural Educational Setting: the School’s Perspective

Introduction: Access to speech-language pathology services for children in rural and remote communities is often limited. Telehealth is increasingly used to provide these services to schools, demonstrating high satisfaction with both service providers and recipients, but the requirements for successful program implementation are as yet unclear. We aimed to explore the implementation requirements for a telehealth speech-language pathology service for children from the perspective of a rural school. Methods: A qualitative approach, supplemented by program activity data, was used to understand the experiences and perceptions of the benefits, limitations, enablers and barriers of a telehealth speech-language pathology program delivered to a school servicing approximately 400 children in a small rural town in the state of Queensland, Australia. Thematic analysis was conducted of transcripts of individual semi-structured interviews with nine school teaching staff and field notes of informal discussions regarding 85 speech-language pathology telehealth sessions (n = 9 children) during program establishment and implementation. Results: The speech-language pathology telehealth service was acceptable to teaching staff at the rural school, who cited improved access, the suitability of the technology for child engagement, and perceived effectiveness. Implementation issues were highlighted as critical to program success and scalability, particularly staff workload, technological issues, communication processes, and sustainability. Conclusion: School-based speech-language pathology services delivered via telehealth were perceived as a suitable way of increasing access for children by rural school staff. Future implementations of telehealth speech-language pathology programs should prospectively consider workload implications and develop strategies to communicate with and involve school staff.     &nbsp

The Model for Assessment of Telemedicine (MAST): a scoping review of empirical studies

The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use of participatory design), followed by multidisciplinary assessment, including description of the patients and the application and assessment of safety, clinical effectiveness, patient perspectives, economic aspects organisational aspects and socio-cultural, legal and ethical aspects. Twenty-two studies met the inclusion criteria and were included in the review. In this article, research design and methods used in the multidisciplinary assessment are described, strengths and weaknesses are analysed, and recommendations for future research are presented

Artificial intelligence-ready skin cancer alchemy:transforming routine teledermatology data into metadata-embedded DICOM files

Most skin artificial intelligence (AI) classifiers are trained only on images with diagnostic labels. However, the addition of clinical information can improve predictive accuracy. Recent interest has been stimulated in incorporating clinical data into image files, using the well-established international Digital Imaging and Communication in Medicine (DICOM) standards (Caffery L, Weber J, Kurtansky N et al. DICOM in dermoscopic research: experience report and a way forward. J Digit Imaging 2021; 34: 967–73). We have developed an automated process of creating metadata-embedded DICOM files, directly from a live teledermatology system, described below. Through our Community and Locality Imaging Centre (CLIC) model, patients referred from primary care are triaged to CLIC for high-quality image capture. There, trained health professionals use a mobile application to capture standardized DICOM information for each lesion. Each lesion dataset contains images (macroscopic, dermoscopic) and clinical metadata (patient and lesion information). Datasets are transferred to an image management system, for teledermatology and verification of ground-truth diagnoses by a consultant dermatologist. On completion of diagnoses, datasets are flagged for conversion into DICOM format, where metadata are embedded in the image files. Flagged datasets are cleaned and clinical metadata are mapped to DICOM attributes. Datasets are converted into metadata-embedded DICOM files, and reviewed for conformance to the DICOM standard using the open-source fo-dicom library (v5). These files are further tested for conformance to DICOM standard using the dciodvfy validator tool. Compliant DICOM files are then transferred to a trusted research environment for research. To test whether these DICOM files are usable for AI research, they are examined using the DICOM viewing software 3D Slicer (https://www.slicer.org/), ensuring images are usable and metadata are correctly translated. Image pixel data and clinical metadata are extracted using pydicom, into a format suitable for AI algorithm development. In our pilot work, 658 lesion datasets have been converted into metadata-embedded DICOM files. Conversion on existing hardware [virtual Intel central processing units with 2.60 GHz (two processors) and 8 GB of memory] took < 1 s per image. Metadata-embedded DICOM files were approximately 0.2 kB bigger than the original JPEG files. For 3-MB images, this represented a negligible 0.003% increase in storage requirement. Testing has shown that these files can be successfully handled by algorithms within an AI research environment. In summary, we have demonstrated the feasibility of automating the conversion of routine teledermatology data into AI-ready image files encoded with clinical metadata. Future work is planned to evaluate the utility of this output on the performance of AI classifiers

Tele-orthopaedics: a snapshot of services in Australia

Health services in the United States and Europe have reported that tele-orthopaedics saves significant patient travel time, reduces time off work, increases satisfaction with care and in some scenarios reduces the cost of care. Less is known about the role of tele-orthopaedics in Australia. The aim of this study was to explore Australian-based tele-orthopaedic services, and to identify the barriers and enablers associated with these services. We used a qualitative case study methodology where specific services were identified from multiple sources and invited to participate in a structured interview. Nine tele-orthopaedic services contributed to the study. Telehealth activity in each service ranged from one to 75 patients per week, and service maturity ranged from three months to 10 years. Services were used predominantly for fracture clinics and peri-operative consultations. The majority (78%) of services used videoconferencing. Two services used asynchronous methods to review radiographs without direct patient involvement. Tele-orthopaedics was found to be disruptive as it required the redesign of many care processes. However, all services found the redesign feasible. Staff resistance was a commonly cited barrier. Further, imaging repositories from multiple imaging providers complicated access to information. Key enablers included clinical champions, picture archiving and communication systems, and the perceived benefit to patients who would avoid the need for travel. Whilst it appears that tele-orthopaedics is not widely utilised in Australia, recognition of the barriers and enablers is important for the development of similar services

Telemedicine – a bibliometric and content analysis of 17,932 publication records

Objectives: We aimed to provide an up-to-date contemporary bibliometric view of the Received in revised form telemedicine and telehealth literature and a longitudinal analysis of changes in content 30 June 2014 themes. Accepted 2 July 201

An economic analysis of email-based telemedicine: A cost minimisation study of two service models

<p>Abstract</p> <p>Background</p> <p>Email-based telemedicine has been reported to be an efficient method of delivering online health services to patients at a distance and is often described as a low-cost form of telemedicine. The service may be low-cost if the healthcare organisation utilise their existing email infrastructure to provide their telemedicine service. Many healthcare organisations use commercial-off-the-shelf (COTS) email applications. COTS email applications are designed for peer-to-peer communication; hence, in situations where multiple clinicians need to be involved, COTS applications may be deficient in delivering telemedicine. Larger services often rely on different staff disciplines to run their service and telemedicine tools for supervisors, clinicians and administrative staff are not available in COTS applications. Hence, some organisations may choose to develop a purpose-written email application to support telemedicine. We have conducted a cost-minimisation analysis of two different service models for establishing and operating an email service. The first service model used a COTS email application and the second used a purpose-written telemedicine application.</p> <p>Methods</p> <p>The actual costs used in the analysis were from two organisations that originally ran their counselling service with a COTS email application and later implemented a purpose-written application. The purpose-written application automated a number of the tasks associated with running an email-based service. We calculated a threshold at which the higher initial costs for software development were offset by efficiency gains from automation. We also performed a sensitivity analysis to determine the effect of individual costs on the threshold.</p> <p>Results</p> <p>The cost of providing an email service at 1000 consultations per annum was $19,930 using a COTS email application and$31,925 using a purpose-written application. At 10,000 consultations per annum the cost of providing the service using COTS email software was $293,341 compared to$272,749 for the purpose-written application. The threshold was calculated at a workload of 5216 consultations per annum. When more than 5216 email consultations per annum are undertaken, the purpose-written application was cheaper than the COTS service model. The sensitivity analysis showed the threshold was most sensitive to changes in administrative staff salaries.</p> <p>Conclusion</p> <p>In the context of telemedicine, we have compared two different service models for email-based communication – purpose-written and COTS applications. Under the circumstances described in the paper, when workload exceeded 5216 email consultations per annum, there were savings made when a purpose-written email application was used. This analysis provides a useful economic model for organisations contemplating the use of an email-based telemedicine system.</p

Consumer preference and willingness-to-pay for direct-to-consumer mobile-teledermoscopy services in Australia

Objective: To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. Methods: Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. Results: The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18–73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1–20 or AUD 21–40. Conclusion: Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions

Proposed technical guidelines for the acquisition of clinical images of skin-related conditions

IMPORTANCE Standardizing dermatological imaging is important to improve monitoring of skin lesions and skin conditions, ensure the availability of high-quality images for teledermatology, and contribute to the development of a robust archive of skin images to be used for research