Journal of Telemedicine and Telecare

Publisher: SAGE Publications

Journal description

Telemedicine' has been defined in general terms to be 'medicine practised at a distance' and as such it encompasses both diagnosis and treatment, as well as medical education. During the last decade certain telemedicine applications, such as videoconsulting and teleradiology, have matured to become essential health care services. Others, such as telepathology, remain the subject of intensive research effort. The Journal of Telemedicine and Telecare publishes peer-reviewed papers on all aspects of both telemedicine and telecare - the latter covering distance nursing and community support. It is relevant to both the primary and secondary medical sectors, as well as having application to the veterinary field, and includes papers on all aspects of these emerging fields. In addition to original articles, the journal publishes preliminary communications, commissioned review articles, case reports, letters to the Editor and book reviews.

Current impact factor: 1.74

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.736
2012 Impact Factor 1.467
2011 Impact Factor 1.207
2010 Impact Factor 1.274
2009 Impact Factor 0.921
2008 Impact Factor 0.89
2007 Impact Factor 0.963
2006 Impact Factor 0.802
2005 Impact Factor 0.749
2004 Impact Factor 0.749
2003 Impact Factor 1.094
2002 Impact Factor 1.366
2001 Impact Factor 1.351
2000 Impact Factor 1.733

Impact factor over time

Impact factor

Additional details

5-year impact 1.23
Cited half-life 6.10
Immediacy index 0.18
Eigenfactor 0.00
Article influence 0.27
Website Journal of Telemedicine and Telecare website
ISSN 1758-1109

Publisher details

SAGE Publications

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors retain copyright
    • Pre-print on any website
    • Author's post-print on author's personal website, departmental website, institutional website or institutional repository
    • On other repositories including PubMed Central after 12 months embargo
    • Publisher copyright and source must be acknowledged
    • Publisher's version/PDF cannot be used
    • Post-print version with changes from referees comments can be used
    • "as published" final version with layout and copy-editing changes cannot be archived but can be used on secure institutional intranet
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Using graphical annotations in surgical telementoring promises vast improvements in both clinical and educational outcomes. However, these assumptions do not consider the potential patient safety risks resulting from this feature. Major differences in regulations regarding the implementation of telestration encourage an assessment of the utility of this feature on the outcomes of telementoring sessions. Eight students participated in a randomized controlled trial, comparing verbal with annotation-supplemented telementoring via video conferencing. A remote mentor guided the participants through four localization exercises, identifying the features in a still laparoscopic surgery scene using a laparoscopic simulator. Clinical and educational outcomes were assessed; the time consumption and quality of mentoring were determined. The study revealed no significant difference in localizing the intervention between the studied methods, while educational outcomes favoured verbal mentoring. Telestration-supplemented guidance was considerably faster and resulted in fewer miscommunications between the mentor and mentee. The initial hypothesis of the major clinical and education benefits of telestration in telementoring was not supported. A potential 33% decrease in the duration of the mentored episodes is expected due to the ability to annotate live video content. However, the impact of time saving on the outcome of the procedure remains unclear. Regardless of the quantitative measures, most of the participants and the mentor agreed that graphical annotations provide advantages over verbal guidance. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15585071
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    ABSTRACT: Missed clinic appointments cause delays in treatment of other patients, under utilization of clinical manpower or facilities and impact upon hospital finances. The primary aim of this study is to evaluate whether a text messaging reminder service reduces the Did Not Attend rate. The secondary aim is to evaluate the cost-effectiveness of a mobile text message reminder service. The study focused on the outpatient department of a district general hospital. In January 2011 a patient text messaging reminder service was implemented across the outpatient departments in the trust. Data were collected prospectively 24 months prior and 24 months following the implementation of this service. A reminder was sent to patients one week prior to the scheduled appointment as a text message. All patients attending the orthopaedic department were included in the study. Patients who had an appointment and cancelled/rescheduled it prior to their original consultation date were excluded. Children were also excluded from the study. The overall Did Not Attend rate was reduced by 12% following the intervention (p < 0.0001). The new appointment follow-up rate was reduced by 2% (p = 0.74) and the follow-up rate decreased by 13.7% (p < 0.0001). The economic analysis revealed a saving of £19,853 over a two-year period following the intervention. Thus mobile technology is a feasible tool in improving attendance rates at outpatient clinics and is economically viable. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15583778
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    ABSTRACT: Currently, transmission of electrocardiograms (EKGs) from a small emergency department (ED) to specialists at referral hospitals can be a time-consuming and laborious process. We investigate whether text messaging by use of short message service (SMS) of EKGs from a small hospital to consultants at a large hospital is rapid and accurate. This study involved a one-month prospective evaluation of consecutive EKGs recorded in a small community ED. Investigators obtained de-identified photographs of each EKG via a mobile phone camera. Each EKG picture, along with a brief patient clinical history, was sent via SMS to on-call emergency physicians located at a large referral care site. All images were evaluated solely on a mobile phone. The primary outcome was the proportion of SMS that were received within two minutes of being sent. As a secondary outcome, the intra-rater evaluation of the initial EKG and the SMS EKG image were compared on 13 standardized features. The tertiary outcome was cost of text messaging. A total of 298 patients (14.6%) had 409 EKGs performed and a total of 926 SMS were sent. 921 SMS (99.5%, 95% confidence interval (CI) 98.7-99.8%) arrived within two minutes with a median transmission time of nine seconds (interquartile range (IQR) 3-32 s). Between the gold standard original EKG, and the interpretation of the texted image, six out of 409 (1.5%, 95% CI 0.6-3.3%) had any differences recorded, across all 13 categories. Overall, the study cost 4.1 cents per texted image. Systematic text messaging of ED EKGs from a small community hospital to a referral center is a rapid, accurate, portable, and inexpensive method of data transfer. This may be a safe and effective strategy to communicate vital patient information. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15587626
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    ABSTRACT: Technology-assisted substance use interventions such as 'high-tech' internet-based treatments are thought to be effective; however, the relatively 'low-tech' use of telephone counselling does not yet have an established evidence base. This paper reviews the literature including articles with information on the use of telephone counselling for the treatment of illicit drug or alcohol use. A systematic literature search using a set of telephone counselling and substance-related terms was conducted across four electronic databases. English studies prior to June 2014 that involved the use of telephone counselling with the treatment of illicit drug or alcohol use as a primary or secondary outcome were included. Review papers, opinion pieces, letters or editorials, case studies, published abstracts, and posters were excluded. In all, 94 publications were included in the review. The literature was supportive of telephone counselling for the treatment of alcohol use in the short term; however, literature regarding illicit drug use was particularly scarce. The generalisability of findings was limited by evident methodological issues in the included studies. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15587406
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    ABSTRACT: Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used. Tele-emergency log data and merged electronic medical record data from Avera Health (Sioux Falls, SD) were analysed for 60,193 emergency department (ED) encounters presenting over a two-and-a-half year period at 21 critical access hospitals using the tele-emergency service. Of these, tele-emergency was activated for 1512 ED encounters. Analyses indicated that patients presenting at rural EDs with circulatory, injury, mental and symptoms diagnoses were significantly more likely to have tele-emergency department services activated as were patients who were transferred to another hospital. Interviews conducted with 85 clinicians and administrators at 26 rural hospitals that used this service indicated that this pattern of utilization facilitated rapid transfers and followed recommended clinical protocols for patients needing serious and/or urgent attention (e.g. stroke symptoms, chest pain). Although only used in 3.5% of ED encounters on average, our findings provide evidence that tele-emergency activation is well reasoned and related to those situations when extra expert assistance is particularly beneficial. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586319
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    ABSTRACT: We performed a comparative study of a health education programme that was delivered either through one-way communication with printed media, or through interactive videophone interviews. We aimed to ascertain which mode of counselling, when used in combination with telemonitoring, is more effective at lifestyle modification intended to improve health status. Participants, who were residents of Kurihara city in Miyagi prefecture, Japan, were randomized into two groups: one group received individualized monthly documented reports (n = 33; 22 females; average age: 67.2 years), and the other received interactive videophone communication (n = 35; 22 females; average age: 65.1 years) for three months. Telemonitoring was conducted on both groups, using a pedometer, weighing scale and a sphygmomanometer. Pre- and post-intervention, anthropometric measurements and blood tests were performed; the participants also completed self-administered questionnaires. The two groups showed similar degrees of health status improvement and satisfaction levels. However, the participants in the videophone group were more aware of improvements in their lifestyles than were the participants in the document group. The individualized printed communication programme was less time-consuming compared to videophone communication. Further studies are needed to formulate a balanced protocol for a counselling-cum-telemonitoring programme that provides optimal health improvement and cost performance with the available human resources. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15587436
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    ABSTRACT: Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15587435
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    ABSTRACT: We aimed to assess use of and interest in mobile health (mHealth) technology and in-person services for diabetes self-care in vulnerable populations. We delivered a self-administered cross-sectional survey. Participants were recruited at two primary care practices (P1 and P2) with P1 located in a medically underserved area and P2 in an affluent suburb. Two-sample t-tests and chi-square tests were used with p < 0.05 significant. In addition, a secondary analysis was performed to analyse differences in use and interest in mHealth by age. Of 75 eligible patients, 60 completed the survey (80% response rate). P1 patients had significantly higher interest in three of five categories of in-person diabetes support services, one of four categories of health-related text messages (TM), and three of eight categories of mHealth applications (p < 0.05). Smartphone users reported higher interest in TM (p = 0.004) and mHealth applications for diabetes self-care (p = 0.004). Younger patients were more likely to have a smartphone (p < 0.006), use the Internet (p < 0.0012), use smartphone applications (p < 0.0004), and to be interested in using applications to manage their diabetes (p < 0.004). This study shows substantial patient interest in TM and mHealth applications for diabetes self-care and suggests that patients in underserved areas may have particularly high interest in using mHealth solutions in primary care. Younger patients and smartphone users were more likely to be interested in using applications to manage their diabetes. As more patients use smartphones, interest in using mHealth to support patient self-care and strengthen primary care infrastructure will continue to grow. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586641
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    ABSTRACT: Recent studies showed that the safety and benefit of early intravenous (IV) thrombolysis on favourable outcomes in acute ischemic stroke are also seen in the elderly. Furthermore, it has shown that age increases times for pre- and in-hospital procedures. We aimed to assess the applicability of these findings to telestroke. We retrospectively analysed 542 of 1659 screened consecutive stroke patients treated with IV thrombolysis in our telestroke network in East-Saxony, Germany from 2007 to 2012. Outcome data were symptomatic intracranial hemorrhage (sICH) by ECASS-2-criteria, survival at discharge and favourable outcome, defined as a modified Rankin scale (mRS) of 0-2 at discharge. Thirty-three percent of patients were older than 80 years (elderly). Being elderly was associated with higher risk of sICH (p = 0.003), less favourable outcomes (p = 0.02) and higher mortality (p = 0.01). Using logistic regression analysis, earlier onset-to-treatment time was associated with favourable outcomes in not elderly patients (adjusted odds ratio (OR) 1.18; 95% CI 1.03-1.34; p = 0.01), and tended to be associated with favourable outcomes (adjusted OR 1.13; 95% CI 0.92-1.38; p = 0.25) and less sICH (adjusted OR 0.88; 95% CI 0.76-1.03; p = 0.11) in elderly patients. Age caused no significant differences in onset-to-door-time (p = 0.25), door-to-treatment-time (p = 0.06) or onset-to-treatment-time (p = 0.29). Treatment time seems to be critical for favourable outcome after acute ischemic stroke in the elderly. Age is not associated with longer delivery times for thrombolysis in telestroke. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15585241
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    ABSTRACT: The objective of the current study was to examine the feasibility of telemedicine vs. telephone for the delivery of a multidisciplinary weekly family-based behavioural group intervention to treat paediatric obesity delivered to families living in rural areas using a randomized controlled trial methodology. 103 rural children and their families were recruited. Feasibility measures included participant satisfaction, session attendance and retention. Treatment outcome measures included child Body Mass Index z-score (BMIz), parent BMI, 24-hour dietary recalls, accelerometer data, the child behavior checklist and the behavioral pediatrics feeding assessment scale. Participants were highly satisfied with the intervention both via telemedicine and via telephone. Completion rates were much higher than for other paediatric obesity intervention programmes, and both methodologies were highly feasible. There were no differences in telemedicine and telephone groups on primary outcomes. Both telemedicine and telephone intervention appear to be feasible and acceptable methods of delivering paediatric obesity treatment to rural children. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586642
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    ABSTRACT: 'Store and forward' teledermoscopy is a technology with potential advantages for melanoma screening. Any large-scale implementation of this technology is dependent on consumer acceptance. To investigate preferences for melanoma screening options compared with skin self-examination in adults considered to be at increased risk of developing skin cancer. A discrete choice experiment was completed by 35 consumers, all of whom had prior experience with the use of teledermoscopy, in Queensland, Australia. Participants made 12 choices between screening alternatives described by seven attributes including monetary cost. A mixed logit model was used to estimate the relative weights that consumers place on different aspects of screening, along with the marginal willingness to pay for teledermoscopy as opposed to screening at a clinic. Overall, participants preferred screening/diagnosis by a health professional rather than skin self-examination. Key drivers of screening choice were for results to be reviewed by a dermatologist; a higher detection rate; fewer non-cancerous moles being removed in relation to every skin cancer detected; and less time spent away from usual activities. On average, participants were willing to pay AUD110 to have teledermoscopy with dermatologist review available to them as a screening option. Consumers preferentially value aspects of care that are more feasible with a teledermoscopy screening model, as compared with other skin cancer screening and diagnosis options. This study adds to previous literature in the area which has relied on the use of consumer satisfaction scales to assess the acceptability of teledermoscopy. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586701
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    ABSTRACT: Telehealth has been widely promoted as a technology to make healthcare more effective and affordable. However, current telehealth systems suffer from vendor lock-in and high cost, and are designed for managing chronic diseases rather than preventing them. We address shortcomings of existing consumer-level health informatics applications in supporting senior health consumers, and provide designers of such systems with a design framework. We assess the feasibility of patient-centred health management systems (HMSs) that are designed based on the proposed framework. In contrast to traditional telehealth, HMSs are patient centred and aim at enabling health consumers to take control of their own health by providing functionality for health self-management. Quantitative and qualitative methods were adopted in evaluating a prototype HMS. Senior healthcare consumers viewed our HMS prototype positively, and experienced a positive change in their attitude towards their health. We identified requirements and challenges for HMSs. In particular, participants indicated that social networking features must have a clear purpose beyond simple broadcasting of emotions and opinions. Our study indicates that seniors are able and motivated to leverage a web-based patient-centred HMS, provided that there are suitable health support applications tailored to their needs. This could be achieved by making it attractive for third party application developers to contribute HMS content. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586082
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    ABSTRACT: The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15587171
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    ABSTRACT: Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15583431
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    ABSTRACT: Internet computer-based psychological treatments have enjoyed rapid growth. Today, there are a number of them available for many mental disorders and psychological problems. Internet-based psychological treatments for anxiety disorders and phobias are amongst the most frequently observed. Treatment results with these resources are promising, but inconclusive. This paper reviews 11 systematic reviews and meta-analyses about the efficacy of Internet-based psychological treatments for anxiety disorders, including studies and clinical trials covering the majority of anxiety disorders and phobias, usually with adult patient samples. In general, these reviews agree on the efficacy of Internet-based psychological treatment as compared with non-treatment groups (with large effect sizes), finding similar efficacy compared with face-to-face therapies. Internet-based psychological treatments are further improved when combined with some type of therapist contact. On the negative side, some systematic reviews highlight high attrition rates of Internet-based psychological treatments. These findings remain inconclusive and more refined reviews (involving patient samples, therapy comparisons, type of therapist contact, etc.) are needed, in order to establish the scope and limits of Internet-based psychological treatments for anxiety disorders. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15586491
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    ABSTRACT: Telemedicine offers rural hospitals the ability to treat acute ischemic stroke on site with intravenous tissue plasminogen activator (t-PA). Most patients are subsequently transferred to a hub hospital with a primary stroke center for post t-PA care. There is little evidence that such transfer is beneficial. The purpose of our study is to determine whether the transfer of patients to hub hospitals is beneficial. We retrospectively analyzed data from our prospectively collected cohort in the AR SAVES (Stroke Assistance through Virtual Emergency Support) telestroke network from November 2008 till January 2012. We compared the outcome of patients who were transferred to a "hub" with those who remained at the "spoke" hospital where thrombolysis took place. We stratified patients according to stroke severity using admission NIHSS scores into two groups: patients with mild stroke (NIHSS <8) and those with moderate to severe stroke (NIHSS ≥8). We defined good outcome as a modified Rankin Scale (mRS) score ≤2. Statistical analysis was performed using Fisher's exact test, two-tailed, and significance was considered at p < 0.05. Out of 894 telestroke consultations, 206 patients received thrombolytic therapy; 134 patients had moderate to severe strokes and 160 patients (78%) were transferred to the hub after thrombolytic therapy. The percentage of patients with good outcome at 3 months was similar between patients transferred to hub and those who stayed at the spoke (61% vs. 55%, p = NS). However, when only patients with moderate to severe strokes were analyzed, patients transferred to the hub were more likely to have good outcomes at three months post t-PA (50% versus 24%, p = 0.026). Patients with moderate to severe ischemic strokes who were treated with t-PA in a telestroke network may potentially benefit from expert care at a primary stroke center. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15577531
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    ABSTRACT: Telehealth has become a very important tool that allows the monitoring of heart failure patients in a home environment. However, little is known about the effect that such monitoring systems have on patients' compliance, evolution and self-care behaviour. In particular, the effect that the selected user interface has on these factors is unknown. This study aims to investigate this, and to determine some practicalities that must be considered when designing and implementing a telehealth programme for heart failure. To achieve this, daily measurements of blood pressure, pulse, SpO2 and weight were collected from 534 patients suffering from heart failure. In addition, they were asked to fill in the European heart failure self-care behaviour scale questionnaire and the EQ-5D quality of life questionnaire, before and after the monitoring period. Two telehealth systems were used, the Motiva platform provided by Philips and the standalone unit provided by Docobo, the Doc@Home system. Significant differences were found between both systems concerning the compliance and adherence of patients. Moreover, a general, positive effect of telehealth was identified due to the fact that patients showed an increased self-awareness when managing their condition. These findings are supported by behavioural changes and a better understanding of heart failure from the patients' perspective. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15577310
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    ABSTRACT: The growing complexity of radiologic examinations and interventional procedures requires frequent exchange of knowledge. Consequently a simple way to share and discuss patient images between radiology experts and with colleagues from other medical disciplines is needed. Aims of this work were the development and initial performance evaluation of a fast and user friendly, platform independent teleconsultation system for medical imaging. A local back end system receives DICOM images and generates anonymized JPEG files that are uploaded to an internet webserver. The front end running on that webserver comprises an image viewer with a specially developed pointer element for indicating findings to collaborative partners. The front end that uses only standard web technologies works on a variety of different platforms, mobile devices and desktop computers. Images can be accessed by simply calling up a special internet address in a web browser that may be exchanged between users (e.g. via email). A speed evaluation of the system showed good results: For example the preparation and upload of a standard head CT took less than 21 seconds. The data volume of the same series and the viewer application could be transferred to a mobile phone in less than 42 seconds via a UMTS network or in less than 3 seconds via a HSPA network. The presented system with its minimal hard- and software requirements, its simplicity and platform independence might be a promising tool in the increasingly important area of teleconsultation. © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 05/2015; DOI:10.1177/1357633X15575237
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    ABSTRACT: The Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q'eqchí and/or Poqomchi' languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas). © The Author(s) 2015 Reprints and permissions:
    Journal of Telemedicine and Telecare 03/2015; DOI:10.1177/1357633X15575830