Cost factors in urban telemedicine

National emergency medical teleconsultation: A novel system applied during the COVID-19 pandemic in Taiwan

OBJECTIVE

Telemedicine can facilitate social distancing during an infectious disease pandemic and reduce the burden on health-care resources. Moreover, telemedicine can be utilized for medical care in remote island regions, in home health care, and during isolated major disasters such as regional earthquakes. However, the effectiveness of telemedicine for emergency consultation remains unclear. This study introduced and analyzed the national emergency medical teleconsultation (NEMTC) established in Taiwan in 2022 during the COVID-19 pandemic.

METHODS

In response to the COVID-19 pandemic, Taiwan's Centers for Disease Control established a temporary 24-h NEMTC contingency system. Patient information was collected from consultations through the NEMTC from April 28 to June 28, 2022. After successful consultation, physicians made recommendations for home observation, emergency department (ED) visit, or outpatient follow-up. ED visits were divided into two categories, namely self-transport and transport, by the emergency medical service system (EMSS).

RESULTS

During the aforementioned period, 20,902 consultation requests were made through the NEMTC, and 11,804 consultations (56.5% of 20,902) were successful. Consultation success rates were significantly higher for those who had a consultation between 08:00 and 16:00, had a waiting time of less than 10 min, and were not aged between 18 and 45 years. Moreover, 8.2% of the analyzed patients were advised to visit the ED, and only 0.4% required ambulance transportation. Children and older individuals and patients with cardiovascular symptoms, shortness of breath, or neurological or abdominal symptoms had a significantly higher chance of being referred to the ED than did other individuals.

CONCLUSIONS

The NEMTC response system can enhance the efficiency of the EMSS and can reduce the burden of patients with mild conditions overloading the EMSS and EDs. The NEMTC could serve as an effective rapid response system during future pandemics.

Will videoteleconsultation have been just a stopgap in French orthopedics-traumatology? A national survey of 280 surgeons

INTRODUCTION

There have been no studies assessing French orthopedic surgeons' satisfaction with video and telephone consultations. These were encouraged during the coronavirus pandemic. We therefore performed a prospective study to assess (1) the profile of physicians using videoteleconsultation (VTC) during the pandemic and factors influencing use, (2) satisfaction with VTC, and (3) the pros, cons and prospects of VTC.

HYPOTHESIS

The study hypothesis was that VTC in orthopedics-traumatology is sufficiently satisfying to be used in everyday practice outside of pandemic contexts.

MATERIAL AND METHOD

A French nationwide survey was conducted in the form of an assessment of professional practices. Orthopedic and traumatology surgeons were sent a digital questionnaire, using the mailing lists of some of the French professional and scientific societies, with an estimate of 2000 practitioners who could be reached. The survey concerned use of VTC, modalities and satisfaction and the practitioner's profile. On the basis of the questionnaire responses, a Net Promoter Score (NPS) was calculated, evaluating the number (from -100 to +100) of respondents likely to recommend VTC.

RESULTS

In total 280 of the estimated 2000 practitioners who were contacted (14.0%) responded. Their mean age was 47.7±10.0years (range: 30-84years). The rate of use of VTC rose from 8.9% (n=25/280) before the pandemic to 55.3% (n=155/280) during it. In the 155 practitioners who had used VTC, NPS was -46.4. Only 51% (n=79/155) were in favor of continuing VTCs outside of pandemic settings. Likewise, 50.3% (n=78/155) reported that clinical examination was more time-consuming via VTC than in face-to-face consultation, and 57.4% (n=89/155) said the same about visualizing complementary examinations. Finally, 98.1% (n=152/155) found VTC less satisfying than face-to-face consultation for clinical examination, and only 18.1% (n=28/155) scheduled surgery after VTC alone.

CONCLUSION

To date in French orthopedics-traumatology, VTC does not satisfy surgeons, with its virtual rather than physical clinical examination; even so, it offers a solution in pandemic settings.

LEVEL OF EVIDENCE

IV; prospective study without control group.

How NPs can help expand telehealth services

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.

Describing advanced practice provider roles within critical care teams with Tele-ICUs: Exemplars from seven US health systems

Telehealth is an acknowledged strategy to meet patient healthcare needs. In critical care settings, Tele-ICU's are expanding to deliver clinical services across a diverse spectrum of critically ill patients. The expansion of telehealth provides increased opportunities for advanced practice providers including advanced practice nurses and physician assistants; however, limited information on roles and models of care for advanced practice providers in telehealth exist. This article reviews current and evolving roles for advanced practice providers in telehealth in acute and critical care settings across 7 healthcare systems in the United States. The health system exemplars described in this article identify the important role of advanced practice providers in providing patient care oversight and in improving outcomes for acute and critically ill patients. As telehealth continues to expand, additional opportunities will lead to novel roles for advanced practice providers in the field of telehealth to assist with patient care management for subacute, acute, and critically ill patients.

Tele-aesthetics in South Asia

BACKGROUND

Telemedicine is becoming increasingly popular. The best use for it is in the field of aesthetic dermatology - where conditions are not life-threatening, and treatments can be topical and very safe.

AIMS

In this study, we demonstrate that a simple store-and-forward telemedicine system can be applied safely to the field of aesthetic dermatology.

METHODS AND MATERIALS

This was a prospective study was carried out in Singapore. A total of 102 patients filled up a medical questionnaire and submitted photographs via our online system. Upon submission, there was an independent doctor on the back-end who would review their medical details and their photographs and make diagnoses and recommendations based on this information. There was another doctor who examined the patients face-to-face. Diagnoses made by the online doctor and by the face-to-face doctor were compared for congruency.

RESULTS

A total of 358 diagnoses were made by the face-to-face doctor from 102 patients; 346 diagnoses were made by the teleconsultation doctor. For the purpose of this study, the diagnoses made by the FTFD were presumed to be correct. There was total agreement between both doctors in 342 diagnoses, giving a concordance rate of 95.5%. There were 12 missed diagnoses by the teleconsultation doctor and four discordant diagnoses.

DISCUSSION

Our system demonstrates that a store-and-forward system enables our doctor to make accurate skin diagnoses. Our system was also able to detect dangerous conditions such as melanomas, skin cancers, actinic keratosis, and other dangerous diagnoses. There were discordant or missed diagnoses. This was mostly attributed to poor photograph quality.

CONCLUSION

Emerging telemedicine technologies should be rigorously evaluated before they become widely implemented. Any system of value must uphold certain principles. It has to be fundamentally sound, safe, and clearly beneficial to the patient. With current technological limitations, the best use of such a system would be in aesthetics.

The impact of fatigue on patient safety

Modern medicine is founded on a culture of diligent, fatigued physicians. Fatigue is not desirable; however, the task of managing fatigue in health care professionals is complex and an ideal solution has not been described. Solutions need to integrate the immediate need for continued high-quality patient care, education of trainees, and the limited supply of health and human resources. Exploration of alternate scheduling models, broadened scope of practice, and new models of care delivery in demonstration projects or formal studies should be performed before widespread implementation. Appropriate evaluations are essential if well-meaning but larger scale errors in the name of patient safety are to be avoided.

Evaluating telemedicine in an accident and emergency setting

This paper outlines the methodology of an evaluation of telemedicine in an Accident and Emergency (A&E) setting. Telemedicine technology consisting of ISDN 2 based videoconferencing and 'store & forward' software has been installed and is currently being evaluated in two minor injury units (MIUs) and a District General Hospital (DGH) A&E department in Lincolnshire. A cost-benefit analysis will be conducted using a pragmatic prospective case-control study with both a concurrent and retrospective control group. Any differences in resource use (including direct and indirect costs) between the intervention (Telemedicine) and the control (No Telemedicine) groups will be identified from both a patient and NHS perspective. A variety of health and non-health outcome measures will be recorded including staff and patient acceptability of the new technology.

Evaluating the cost of one telehealth application connecting an acute and long-term care setting

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.

A proposed model for telemedicine to supplement the physician workforce in the USA

Maldistribution of physicians is the norm in much of the USA. This paper explores the effect that the integration of telemedicine into the health system could have on physician workforce requirements in the USA. The analysis is based on preliminary evidence suggesting that telemedicine is an effective and efficient means of delivering a broad spectrum of health services to medically under-served rural and inner-city communities. While the emphasis here is on interactive, video-based telemedicine services, other telemedicine modalities, such as store-and-forward techniques and remote monitoring, are likely to have a parallel effect. As these new technologies become a normal part of health care, they will reshape the medical workforce and exert a profound influence on physician workforce requirements in the USA. This paper presents a potential model for this reshaped workforce that emphasizes an expanded role for mid-level health-care providers.

Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study

The objective of this multicentre study was to undertake a systematic comparison of face-to-face consultations and teleconsultations performed using low-cost videoconferencing equipment. One hundred and twenty-six patients were enrolled by their general practitioners across three sites. Each patient underwent a teleconsultation with a distant dermatologist followed by a traditional face-to-face consultation with a dermatologist. The main outcome measures were diagnostic concordance rates, management plans and patient and doctor satisfaction. One hundred and fifty-five diagnoses were identified by the face-to-face consultations from the sample of 126 patients. Identical diagnoses were recorded from both types of consultation in 59% of cases. Teledermatology consultations missed a secondary diagnosis in 6% of cases and were unable to make a useful diagnosis in 11% of cases. Wrong diagnoses were made by the teledermatologist in 4% of cases. Dermatologists were able to make a definitive diagnosis by face-to-face consultations in significantly more cases than by teleconsultations (P = 0.001). Where both types of consultation resulted in a single diagnosis there was a high level of agreement (kappa = 0.96, lower 95% confidence limit 0.91-1.00). Overall follow-up rates from both types of consultation were almost identical. Fifty per cent of patients seen could have been managed using a single videoconferenced teleconsultation without any requirement for further specialist intervention. Patients reported high levels of satisfaction with the teleconsultations. General practitioners reported that 75% of the teleconsultations were of educational benefit. This study illustrates the potential of telemedicine to diagnose and manage dermatology cases referred from primary care. Once the problem of image quality has been addressed, further studies will be required to investigate the cost-effectiveness of a teledermatology service and the potential consequences for the provision of dermatological services in the U.K.

Prevalence of sickle cell trait and HbC-trait in Blacks from low socioeconomic conditions

In the present investigation we did not observe age or sex differentials in the prevalence of sickle cell or HbC-traits in Black males or females of low socioeconomic status. When our data were compared to those of others, we found no evidence for a socioeconomic differential in the prevalence of these traits.