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Secourgeon A, Bigot P, Martin L, Lebdai S. [Prospective controlled study evaluating teleconsultation and tele-semiology for the management of renal colic]. Prog Urol 2023; 33:1033-1040. [PMID: 37806910 DOI: 10.1016/j.purol.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Physical examination appears to be a limiting factor of teleconsultation (TC). We evaluated the feasibility of self-percussion of the lumbar fossae (sPLF) and TC for simple renal colic (SRC) in comparison with a face-to-face consultation (FC). MATERIAL AND METHODS We performed a comparative prospective study in two steps. First: evaluation of the quality of an sPLF on a standardized patient in TC, without and with tutorial. Secondarily: evaluation of a TC and a FC for a SRC with a standardized patient in real conditions. Evaluation using objective clinical scores and qualitative scales by an observer, the standardized patient and the practitioner himself. RESULTS Forty-two practitioners were included in the study. In the absence of a tutorial, the sPLF was most often "poorly done". The tutorial led to a significant improvement in the quality of sPLF. There was no difference in diagnostic and therapeutic performance among senior physicians between TC and FC. The therapeutic performances of the interns were significantly lower in TC without his being aware of it. The qualitative scores were significantly lower in TC vs FC according to the practitioners, the standardized patient and the observer. CONCLUSION An sPLF is feasible but its practice should be taught. Unlike interns, senior physicians were able to perform a TC comparable to FC for the management of SRC. TC and telesemiology therefore require dedicated training and an experienced practitioner. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Secourgeon
- Service d'urologie, CHU d'Angers, Angers, France.
| | - P Bigot
- Service d'urologie, CHU d'Angers, Angers, France
| | - L Martin
- Service de dermatologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
| | - S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
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Symeonidis EN, Veneziano D, Borgmann H, Zapała Ł, Zachariou A, Brenneis H, Haensel SM, Haas H, Dimitriadis F. Telemedicine in Urology: Where Have We Been and Where Are We Heading? EUR UROL SUPPL 2023; 50:106-112. [PMID: 36910337 PMCID: PMC9999165 DOI: 10.1016/j.euros.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Context Humanity is facing significant challenges, and in 2019, a new coronavirus caused an unprecedented global disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic vastly impacted health care delivery, generating devastating economic, social, and public health disruption. Although previously underutilized, it was not until recently that telemedicine emerged and amassed tremendous popularity. Objective To examine and assess telemedicine's past, present, and future roles in urology. Evidence acquisition We queried relevant literature investigating the role of telemedicine in urology using the electronic PubMed database and mainly focused on English-language studies of any design. Evidence synthesis Growing attention has been paid to the widespread adoption of novel telehealth technologies for managing various diseases. Meanwhile, solid evidence supports the meaningful use of telemedicine for most urological diagnoses. Existing literature delineates telemedicine as a viable, safe, and convenient alternative to in-person clinical visits. Conclusions The present article overviews the evolution of telemedicine in urology, and discusses its application in outpatient and physician's office settings. In addition, it highlights the technical, legal, ethical, and financial aspects of telemedicine while providing valuable insights and practical considerations for the future of telehealth in urology. Patient summary Urologists must adopt telemedicine carefully in daily practice, always adhering to predefined regulatory frameworks.
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Affiliation(s)
- Evangelos N Symeonidis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | | | - Hendrik Borgmann
- Department of Urology, University Hospital Medical School Brandenburg, Brandenburg an der Havel, Germany
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Horst Brenneis
- Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Stefan M Haensel
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | | | - Fotios Dimitriadis
- Department of Urology I, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Ong CSH, Lu J, Tan YQ, Tan LGL, Tiong HY. Implementation of a Ureteric Colic Telemedicine Service: A Mixed Methods Quality Improvement Study. Urology 2021; 147:14-20. [PMID: 33091386 PMCID: PMC7573635 DOI: 10.1016/j.urology.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.
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Affiliation(s)
- Chloe Shu Hui Ong
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Jirong Lu
- Department of Urology, National University Hospital, National University Health System, Singapore.
| | - Yi Quan Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore
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Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020; 78:786-811. [PMID: 32616405 PMCID: PMC7301090 DOI: 10.1016/j.eururo.2020.06.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Context Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse. Objective To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth. Evidence acquisition After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed. Evidence synthesis We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good. Conclusions Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary. Patient summary The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.
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Affiliation(s)
- Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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Michael P, Tran VT, Hopkins M, Berger I, Ziemba J, Bansal UK, Balasubramanian A, Chen J, Mayer W, Fang A, Rais-Bahrami S, James A, Harris A. Comparison of Urologic Transfers to Academic Medical Centers: A Multi-institutional Perspective. Urology 2019; 136:100-104. [PMID: 31751623 DOI: 10.1016/j.urology.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/25/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers. METHODS Four academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories. RESULTS Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302). CONCLUSION Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
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Affiliation(s)
- Patrick Michael
- Department of Urology, University of Kentucky, Lexington, KY
| | - Vi T Tran
- Department of Urology, University of Kentucky, Lexington, KY.
| | - Marilyn Hopkins
- Department of Urology, University of Kentucky, Lexington, KY
| | - Ian Berger
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Justin Ziemba
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Utsav K Bansal
- Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Jessie Chen
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Wesley Mayer
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Andrew Fang
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Andrew James
- Department of Urology, University of Kentucky, Lexington, KY
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, KY
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Berger I, Hopkins M, Ziemba J, Skokan A, James A, Michael P, Harris A. Comparison of Interhospital Urological Transfers between a Metropolitan and Rural Tertiary Care Institution. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ian Berger
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marilyn Hopkins
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Justin Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alexander Skokan
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Andrew James
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Patrick Michael
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
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Witherspoon L, Liddy C, Afkham A, Keely E, Mahoney J. Improving access to urologists through an electronic consultation service. Can Urol Assoc J 2017; 11:270-274. [PMID: 28798830 DOI: 10.5489/cuaj.4314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. METHODS Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. RESULTS Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. CONCLUSIONS Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists.
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Affiliation(s)
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa and C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute; Ottawa, ON, Canada
| | | | - Erin Keely
- Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute; Ottawa, ON, Canada
| | - John Mahoney
- Department of Urology, University of Ottawa; Ottawa, ON, Canada
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Ellimoottil C, Skolarus T, Gettman M, Boxer R, Kutikov A, Lee BR, Shelton J, Morgan T. Telemedicine in Urology: State of the Art. Urology 2016; 94:10-6. [PMID: 27109596 DOI: 10.1016/j.urology.2016.02.061] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
Whereas telemedicine is recognized as one of the fastest-growing components of the healthcare system, the status of telemedicine use in urology is largely unknown. In this narrative review, we detail studies that investigate the use of televisits and teleconsultations for urologic conditions. Moreover, we discuss current regulatory and reimbursement policies. Finally, we discuss the significant barriers to widespread dissemination and implementation of telemedicine and reasons why the field of urology may be positioned to become a leader in the provision of telemedicine services.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
| | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Matthew Gettman
- Department of Urology, Mayo Clinic College of Medicine, Rochester, MN
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, CA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Benjamin R Lee
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jeremy Shelton
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Todd Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
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Chu S, Boxer R, Madison P, Kleinman L, Skolarus T, Altman L, Bennett C, Shelton J. Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics. Urology 2015; 86:255-60. [PMID: 26168998 DOI: 10.1016/j.urology.2015.04.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/24/2015] [Accepted: 04/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the use of telemedicine to deliver general urologic care to remote locations within the Veterans Affairs Greater Los Angeles Healthcare System. We describe the diagnoses managed, patient satisfaction, safety, and benefit to patients in terms of saved travel time and expense. METHODS We conducted a retrospective chart review examining care delivered through urology telemedicine clinics over a 6-month period. We examined the urologic conditions, patient satisfaction, and emergency department visits within 30 days of the visit. We estimated patient benefit by calculating travel distance and time and the saved travel-associated costs using Google Maps and US Census income data. RESULTS Ninety-seven unique telemedicine visits were conducted and a total of 171 urologic diseases were assessed. The most common conditions were lower urinary tract symptoms (35%), elevated prostate-specific antigen level (15%), and prostate cancer (14%). One patient was seen in the emergency department within 30 days with an unpreventable urologic complaint. Patient satisfaction was "very good" to "excellent" in 95% of cases, and 97% would refer another veteran to the urology telemedicine clinic. Patients saved an average of 277 travel miles, 290 minutes of travel time, $67 in travel expenses, and $126 in lost opportunity cost. CONCLUSION Telemedicine was successfully and safely used to evaluate and treat a wide range of urologic conditions within the Veterans Affairs Greater Los Angeles Healthcare System, and saves patients nearly 5 hours and up to $193 per visit. Further investigation of the potential of telemedicine for the delivery of urologic care in a cost-effective manner is warranted.
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Affiliation(s)
- Stephanie Chu
- Department of Urology, University of California, Los Angeles, CA.
| | - Richard Boxer
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | | | | | - Ted Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI; HSR&D Center for Health Communications Research, Veterans Affairs Ann Arbor, Ann Arbor, MI
| | - Lisa Altman
- Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Carol Bennett
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
| | - Jeremy Shelton
- Department of Urology, University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles, Los Angeles, CA
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Ahmed M. Integration of Competences. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Saqui O, Chang A, McGonigle S, Purdy B, Fairholm L, Baun M, Yeung M, Rossos P, Allard J. Telehealth videoconferencing: improving home parenteral nutrition patient care to rural areas of Ontario, Canada. JPEN J Parenter Enteral Nutr 2007; 31:234-9. [PMID: 17463150 DOI: 10.1177/0148607107031003234] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Telehealth videoconferencing is a medium for health care professionals to communicate and care for patients living in remote areas. The aim of this study was to provide a survey to examine management outcome of home parenteral nutrition (HPN) patients when followed by telehealth as an alternative modality of care. METHODS Twenty-six individuals who were identified to benefit from tele-health were invited to participate in a satisfaction survey. The survey was sent to patients by postal mail. The survey also documented the incidence of line sepsis and other medical HPN complications. A cost analysis was also performed according to technology, human resources, and infrastructure. RESULTS Eighty-one telehealth videoconference sessions have been held since the inception of telehealth in 2002. Of the current telehealth patients, 13 were eligible for the survey. The satisfaction survey response rate was 11/13 (84.6%). The average line sepsis rate for the 13 patients was 0.89/1000 catheter-days. All patients were generally satisfied with videoconferencing as an alternative method of communication and care for new consultation, patient and family education, and follow-up. Travel time and costs to the patients, their families, and the health care system were significantly less. For example, a patient who resides 611 km from Toronto would cost CDN (Canadian) 724.00 dollars for flight and accommodation to meet with the team at the HPN clinic in Toronto. CONCLUSION Telehealth incorporated the cost-saving ability for HPN patients to maintain proper medical care, support, and collaboration of specialists inaccessible to their local community. Thus, its strongly positive role in HPN care deserves further consideration for a national application.
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Affiliation(s)
- Olivia Saqui
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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12
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Coughlan J, Eatock J, Eldabi T. Evaluating telemedicine: a focus on patient pathways. Int J Technol Assess Health Care 2006; 22:136-42. [PMID: 16673690 DOI: 10.1017/s0266462306050938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway.
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Affiliation(s)
- Jane Coughlan
- Information Systems and Computing, School of Information Systems, Computing and Mathematics, Brunel University, Uxbridge, Middlesex, UK.
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Razdan S, Johannes J, Kuo RL, Bagley DH. The camera phone: A novel aid in urologic practice. Urology 2006; 67:665-9. [PMID: 16618555 DOI: 10.1016/j.urology.2005.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 09/12/2005] [Accepted: 10/04/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe a novel use of the camera phone for efficient, reliable, and cost-effective collection and transmission of medical data in the urologic setting. METHODS We used camera phones (Verizon VGA and Sanyo-Sprint PCS) with a resolution of 640 x 480 pixels to capture images in the operating room, as well as in the outpatient clinic. Images were obtained directly from the monitor or the x-ray viewing box. These were then immediately transmitted to the office computer through a secure Internet connection. The images were then incorporated into operative and office notes, as needed. RESULTS The images obtained with this method were of adequate quality for demonstration purposes, with the added advantage of allowing secure transmission and storage. The best-quality images were those obtained directly from the x-ray viewing box or from a liquid crystal display monitor. In addition, the images could be edited and labels added with the aid of the software that came with the camera phone. CONCLUSIONS This method allows the acquisition of fair-quality digital images of surgical procedures and radiographic studies with simultaneous data transmission and storage for clinical documentation. The technology reduced costs and increased the efficiency of our practice considerably.
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Affiliation(s)
- Sanjay Razdan
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Heinzelmann PJ, Williams CM, Lugn NE, Kvedar JC. Clinical outcomes associated with telemedicine/telehealth. Telemed J E Health 2005; 11:329-47. [PMID: 16035930 DOI: 10.1089/tmj.2005.11.329] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This paper is a comprehensive review and synthesis of the literature concerning clinical outcomes associated with various telemedicine applications. It starts out with a brief description of the findings reported by similar literature reviews already published. Subsequently, it proposes a conceptual model for assessing clinical outcomes based on Donabedian's formulation of the Medical Care Process. Accordingly, research findings are reported in terms of the relevant components of the medical care process, namely, diagnosis, clinical management, and clinical outcomes. Specific findings are organized according to the designated clinical and diagnostic application. This is followed by a general report of studies dealing with patient satisfaction.
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Abstract
Advances in image processing and display technologies, such as digital imaging, HDTV, and virtual reality, will ultimately allow integration of endoscopic imaging with diagnosis and therapy during ureteroscopic procedures. Further improvements in simulation technology and telemedicine should improve surgical training and greatly benefit patient care.
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Affiliation(s)
- Yeh Hong Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Box 3167, Room 1572D, White Zone, Durham, NC 27710, USA
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16
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References. J Telemed Telecare 2002. [DOI: 10.1258/1357633021937622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sezeur A, Degramont A, Touboul E, Mosnier H. Teleconsultation before chemotherapy for recently operated on patients. Am J Surg 2001; 182:49-51. [PMID: 11532415 DOI: 10.1016/s0002-9610(01)00662-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some operated on cancer patients require specialized complementary chemotherapy. Often, this takes place in another institution, where the patient consults the medical oncologist before hospitalization. The aim of this study was to analyze the potential benefit of a videoconference consultation within this framework. METHODS Sixteen operated on cancer patients hospitalized in the Surgical Unit received a teleconsultation in the presence of their surgeon and with the chemotherapist at some distance. During this period, the modalities of chemotherapy proposed, the duration of the teleconsultation, the economy of transport, and so on were noted. Twenty-four hours later each patient filled in a questionnaire aimed at, one, evaluating the quality of the image on an visual analogue scale (VAS) and the potential inconvenience involved; and two, evaluating the index of patient satisfaction on VAS. Furthermore, the last 12 patients filled in a questionnaire adapted to each of them, according to the information they had received. Each correct answer was noted 1, and each incorrect answer was noted 0. A memorization percentage was deduced. RESULTS The average age of the 16 patients was 63.4 years (range 46 to 78). The average duration of the teleconsultation was 27 minutes (12 to 40). The index of image satisfaction was 61.3%. As for the last 12 patients, 9.8 questions (7 to 12) enabled the calculation at 24 hours of the percentage of data retained by the patient (memorization index) based on the modalities and consequences of the chemotherapy. The percentage of correct answers was 80.5%. Fourteen of the 16 patients considered that teleconsultation had its advantages. Two patients would have preferred a classic consultation. The global satisfaction index was 79.9%. The average cost of functioning per patient was 187.76 FF A saving in transport of 509.92 FF was recorded per patient. CONCLUSIONS In the context of this original study, teleconsultation neither altered the doctor-patient relationship nor the quality of the message transmitted. Furthermore, it encourages closer links between complementary teams working at a distance and multidisciplinarity in cancerology.
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Affiliation(s)
- A Sezeur
- Service de Chirurgie Générale et Digestive, Hôpital Rothschild, 33 bd de Picpus, 75012, Paris, France.
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Lamminen H, Ruohonen K, Uusitalo H. Visual tests for measuring the picture quality of teleconsultations for medical purposes. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2001; 65:95-110. [PMID: 11275330 DOI: 10.1016/s0169-2607(00)00120-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Telemedicine provides a new way of delivering medical services. The good quality of the picture is, however, essential for a proper and reliable teleconsultation, especially in the cases when visual information about the patient's physical condition is of great importance as in ophthalmology and dermatology. Therefore real-time telemedical applications need standards for these procedures, e.g. minimum requirements for resolution, as well as contrast and color discrimination. The present study was carried out to test these parameters in a real environment. A panel of different resolution, contrast sensitivity and color discrimination tests was carried out for five test persons via PictureTel videoconference system by ISDN 128 kbit/s line speed and in a normal way. The good color discrimination of the teleconsultation system makes it possible to use the system in the evaluation of different skin lesions and exemas. However, the poor resolution and especially poor contrast sensitivity makes the use of the equipment valueless in the evaluation of diseases where the diagnoses are based on the discrimination of small details, like the biomicroscopical analysis of inflammatory cells in the aqua's humor in cases of intraocular inflammation. The authors are suggesting a simple panel of tests to optimize and standardize these parameters.
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Affiliation(s)
- H Lamminen
- Department of Ophthalmology, Tampere University Hospital, P.O. Box 2000, FIN-33501, Tampere, Finland.
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19
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Abstract
Internet-based imaging is changing the way urology services are delivered by allowing rapid communication between remote locations. This review focuses on Internet-based imaging modalities, the hardware needed to transmit and view these images, and current applications. With the continuing expansion of Internet-based resources, all physicians must become accustomed to integrating the Internet and Internet-based imaging into their practices.
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Affiliation(s)
- N McFarlane
- Department of Urology, Univeristy of Western Ontario, London, Canada
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Kuo RL, Delvecchio FC, Babayan RK, Preminger GM. Telemedicine: recent developments and future applications. J Endourol 2001; 15:63-6. [PMID: 11248922 DOI: 10.1089/08927790150500971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telemedicine, or the delivery of health care from a distance, is an exciting field that has undergone rapid advancements over the past three decades. Previous studies have demonstrated that telemedicine can effectively assist in patient care. However, cost issues and the lack of resources to sustain telemedicine systems have previously limited the use of this technology. Herein, we explore the development, current applications, and future of telemedicine.
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Affiliation(s)
- R L Kuo
- The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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21
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Abstract
In the not too distant future, the minimally invasive renal surgeon will be able to practice an operation on a difficult case on a three-dimensional virtual reality simulator, providing all attributes of the real procedure. The patient's imaging studies will be imported into the simulator to better mimic particular anatomy. When confident enough of his or her skills, the surgeon will start operating on the patient using the same virtual reality simulator/telepresence surgery console system, which will permit the live surgery to be conducted by robots hundreds of miles away. The robots will manipulate miniature endoscopes or control minimally or noninvasive ablative technologies. Endoscopic/laparoscopic footage of the surgical procedure will be stored digitally in optical disks to be used later in telementoring of a surgery resident. All this and more will be possible in the not so distant third millennium.
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Affiliation(s)
- F C Delvecchio
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Bruno D, Delvecchio FC, Preminger GM. Digital still image recording during video endoscopy. J Endourol 1999; 13:353-6; discussion 356-7. [PMID: 10446795 DOI: 10.1089/end.1999.13.353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the advances in telemedicine and virtual consultation services comes the need for state-of-the-art endoscopic imaging techniques and equipment. Concomitant with current day concerns of cost containment, the ability to utilize the aforementioned tools in a cost-effective fashion that lowers operating expenses, accurately depicts procedures, and expedites chart documentation is paramount. We report on a fast and efficient way to obtain and store images during endoscopic procedures, which can be stored on standard 3.5-inch floppy disks using an innovative digital image recorder. These images are stored as high-resolution (640x480x24) JPEG files, which can be placed in electronic medical records, imported into Internet Web pages, incorporated into slide presentations, and, most importantly, stored in easily accessed archives.
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Affiliation(s)
- D Bruno
- The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Kuo RL, Aslan P, Dinlenc CZ, Lee BR, Screnci D, Babayan RK, Kavoussi LR, Preminger GM. Secure transmission of urologic images and records over the Internet. J Endourol 1999; 13:141-6. [PMID: 10360490 DOI: 10.1089/end.1999.13.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Telemedicine has become a common method for the transmission of images and patient data across long distances. Our goal was to assess the efficiency and accuracy of Photomailer MD software, a store-and-forward telemedicine system, in the urologic setting. METHODS Photomailer MD software was loaded on two computers in the host institution, one with a T1 connection to the Internet and the other with a dial-up modem connection (24,000 bits/second), and computers at three remote sites. A total of 14 clinical cases, comprised of digitized histories and radiographic images, were sent to the remote institutions four separate times using the four transmission modes available: nonencrypted, 56-bit encryption, 128-bit encryption, and 128-bit encryption with password. The following data points were recorded: file size before and after encryption, file transmission times, and diagnostic accuracy of the remote urologists. One-way ANOVA was used to compare mean values statistically, while the z-test was used to compare diagnostic accuracies. RESULTS Encryption increased the file size by a mean of 37.8%, with the three encryption modes increasing file sizes by the same number of kilobytes. When a dial-up modem was used, encrypted files required a significantly longer transmission time (P < 0.05) than the unencrypted files. The same trend was seen with the T1 connection, although the differences often were not significant. When T1 transmission times were compared with modem times with other variables held constant, modem times were significantly longer (P < 0.05). Diagnostic accuracies for each of the three remote centers ranged from 85.7% to 100%. Differences in accuracy rates between attending physicians and residents were not significant. CONCLUSIONS Photomailer MD provides a secure, convenient, and affordable method of transmitting patient images and records via the Internet. Transmission speed was significantly greater when using a T1 line and also tended to be faster when files were not encrypted. There was no significant difference in transmission time among the three encryption modes; therefore, 128-bit encryption with a password should be used to maximize security. Diagnostic accuracies were comparable to those in the literature. In general, 640 x 480-pixel resolution was adequate for urologic diagnoses, although higher-resolution images may improve accuracy.
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Affiliation(s)
- R L Kuo
- Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
This past year produced some remarkable reports on renal (and other urinary) calculi. Randall's plaques have returned, phosphate relates to insulin and lipid metabolism, and sialic acid is out. Risk factors for astronauts, cystinuric individuals, older and indinavir patients achieve importance. Discovery by spiral computed tomography advances, teleconsultation emerges and shot-gun therapy with potassium-magnesium citrate succeeds. Endoscopic or shock wave lithotripsy vie for which is best, and both attempt to eliminate open surgery. Yet open surgery still has its place.
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Affiliation(s)
- G W Drach
- Division of Urology, University of Pennsylvania, Philadelphia 19104, USA. drachgw-mail.med.upenn.edu
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25
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Abstract
Urologists are faced with increasing demands for clear documentation of their work. We report the use of a digital camera in our practice to capture images throughout the urologic setting. The digital camera was a quick and convenient means of obtaining good quality reproductions of radiographic and pathologic findings. Use of the camera greatly enhanced the efficiency of our practice by allowing incorporation of images into patient records and an image library.
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Affiliation(s)
- R L Kuo
- Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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