Effect of telemedicine on patients' diagnosis and treatment.
ABSTRACT We conducted a post-consultation survey during 1998-2002 (n = 412 consultations) in the Rural Hospital Telehealth Project run by the University of Arkansas for Medical Sciences. Changes in the patient's diagnosis and treatment plan as a result of the telemedicine session were assessed. There were 47 consultants, who conducted 2-82 consultations each. The teleconsultants established a diagnosis in 74 consultations. This was 26% of the 286 respondents. Of the 63 respondents for cases where there was a prior diagnosis and a change was applicable, 17 consultants (27%) reported that there was a change in the patient's diagnosis. The consultants established a patient treatment plan in 139 consultations. This was 52% of the 268 respondents. Of the 123 respondents for cases where there was a prior treatment plan and a change was applicable, 82 (67%) consultants reported a change in the treatment plan. The changes in diagnosis and management imply benefits for the rural population in Arkansas as a result of the use of telemedicine.
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ABSTRACT: This study examined teleconsultants' specialty, practice setting, type of employment, years and training in telemedicine to evaluate the effect of these characteristics on diagnoses and treatment. A postuse survey was conducted during 1998-2003 (n = 454 consultations) in the University of Arkansas for Medical Sciences' Rural Hospital, Telehealth Project. There were 61 consultants who conducted the teleconsultations. The teleconsultants established a diagnosis in 121 consultations and reported a change in diagnoses in 29 consultations. The consultants established a treatment plan in 219 consultations and reported a change in the treatment plan in 100 consultations. Dermatologists were significantly more likely to establish (P < .01) and change (P = .005) the diagnosis and to establish a treatment plan (P = .03), when compared to all other specialties. Teleconsultants who were self-employed were significantly more likely to change the treatment plan (P = .012). The findings suggest that teleconsultants' characteristics can affect diagnoses and treatment in telemedicine.International Journal of Telemedicine and Applications 01/2011; 2011:701089.
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ABSTRACT: Telemedicine is increasingly being used to provide consultation for healthcare in rural areas. Little work has been done with dementia although preliminary research suggests that clinical diagnosis performed via telemedicine consultation is valid. We implemented a program to provide multidisciplinary, state-of-the-art diagnosis of cognitive impairment by video-telemedicine (VTM) integrated into a clinical setting. Patients at a rural veteran's community clinic were referred by their local provider for evaluation of memory complaints by the multidisciplinary team of the San Francisco Veterans Administration (SFVA) Memory Disorders Clinic (MDC). The evaluation was integrated into the usual clinic structure and included a neurological evaluation and neuropsychological testing by the MDC team via video assisted by a remote clinician at the community clinic. We evaluated 15 new patients referred to our multidisciplinary clinic. In each case, the VTM format permitted the MDC team to arrive at a working diagnosis; 12 patients with dementia, two with mild cognitive impairment, and one cognitively normal. Relevant treatment recommendations were made to the patients and caregivers. The evaluation results were discussed with providers who joined the MDC postclinic conference via VTM. In the majority of cases, recommendations were followed and there was satisfaction with VTM by providers and patients. VTM is emerging as an effective way to provide consultation and care to rural residents who may not have access to specialty services and can be integrated into current clinical settings.Telemedicine and e-Health 12/2011; 17(10):789-93. · 1.40 Impact Factor
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ABSTRACT: We study a specialty hospital providing traditional face-to-face consultations by experts and telemedicine services by tele-specialists. As accuracy of diagnosis and treatment by tele-specialists are paramount in such a setting (unlike call center management), our main focus is to determine the optimal investment level in telemedicine technology with the trade off being between accuracy/quality and cost. Using a heuristic proposed in queuing theory, we provide the optimal investment in telemedicine technology together with the staffing policy, considering the various cost components, including staffing, technology investment, incorrect treatment, and waiting. The model also incorporates buy-in by the patients in the form of the arrival (show-up) rate dependent on the technology level established. We find that under certain conditions the hospital should not invest in telemedicine. Finally, we provide the optimal tele-specialist policy of the ratio of patients to treat via telemedicine and to refer to the face-to-face consultation. Our model also suggests that a policy of treating all patients via telemedicine is never optimal.Decision Support Systems. 01/2009;