Telehealth and eHealth

This article describes a benefits evaluation framework for the health information systems currently being implemented across Canada through Canada Health Infoway with its jurisdictional partners and investment programs. This framework is based on the information systems success model by DeLone and McLean, the empirical analysis by van der Meijden on the use of this model in the health setting and our own review of evaluation studies and systematic review articles in health information systems. The current framework includes three dimensions of quality (system, information and service), two dimensions of system usage (use and user satisfaction) and three dimensions of net benefits (quality, access and productivity). Measures have been developed and work is under way to establish detailed evaluation plans and instruments for the individual investment programs to launch a series of benefits evaluation field studies across jurisdictions later this year.

SummaryObjectives: Assess unforeseen consequences of Telehealth and suggest solutionsMethods: An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature.Results and Conclusion: A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken.

North Norway has been a world-leading area in the use of telemedicine services. Since the first telemedicine services were established in the late 1980ies, telemedicine and e-health services have been established in many areas of specialist health care. The goal has been to provide specialist health care to people living in rural and very remote areas. Success factors for this development are summarized in ten lessons learned: (1) Strong governmental involvement through National plans; (2) Access to a secure communication infrastructure; (3) Mandatory use of standards; (4) Implementation of Electronic Health Record (EHR); (5) Laws adapted to the modern way of working; (6) Reimbursement must be in place for telemedicine services; (7) Videoconference is often the best solution; (8) Management and support is essential; (9) KISS -Keep it simple, stupid; and, (10) Electronic messages for high volumes.

Background: Implementing telemedicine and digital health technologies in healthcare has increased, but patients still need help adopting and utilizing these technologies. To address this, a Digital Health Navigator (DHN) program was implemented to evaluate the benefits of improving patients' adoption. Objectives: To alleviate digital equity within hospitals, we introduced a holistic DHN program to promote using digital tools among hospitalized patients. The DHN program was designed to improve and expand patient adoption of digital portals and to engage in healthcare. In addition, our program was designed to develop a patient-facing portal education for hospitalized patients, which can be expanded to other hospitals. Methods: Over 30 days, the DHN program conducted patient visits in two hospitals on portal usage, collecting data, and adapting protocols based on patient feedback. Results: Feedback from patients indicated that 98% of patients found the education and the DHN helpful, and 92% recommended the University of Pittsburgh Medical Center Central Pennsylvania portal for accessing their healthcare information. The DHN program proved beneficial in promoting portal usage and addressing technological barriers experienced by patients. Discussion: We successfully implemented a DHN program for hospitalized patients across two hospitals. Patients reported a positive perception and satisfaction with DHN visits. Notably, our model overcomes challenges related to limited internet access and mitigates technology-related anxiety during hospital stays. The DHN program proved beneficial in promoting hospital portal usage and addressing technological barriers experienced by patients. Implementation and sustained adoption of digital technologies across a large healthcare organization can be achieved through a well-coordinated, team-based, and systematic approach with a DHN. Here, we present strategies and recommendations to implement such a program.

We aim to characterize the telehealthcare experiences of autonomic dysfunction in patients with Parkinson disease (PD). Background: Telemedicine is a popular modality for receiving healthcare. Due to its rising use, ensuring efficacy, satisfaction, and safety is important. Current literature finds high satisfaction with physical and emotional health benefits and desired feasibility among patients with PD. The results are promising. However, there is a need for more literature relevant to the autonomic dysfunction patient population, including qualitative data in the analysis of care experiences. Methods: We conducted a descriptive cross-sectional study using anonymous survey responses from patients with autonomic dysfunction findings within a large health system. The study questionnaire included Likertscale prompts and open responses. Results: Twenty-five patients with autonomic dysfunction or a PD diagnosis who completed the questionnaire successfully participated. More than 80% of participants reported they were confidently able to access medical appointments and providers via telehealth services. In 88% of cases, access to telehealth services was achieved without assistance. However, 68% did not agree that telehealth appointments were accessible during an impacted internet connection. More than nine out of 10 respondents (92%) were satisfied with the quality of care from telehealth appointments, with 76% finding the care comparable to in-person visits. Notably, 76% experienced improved care access to care and had telehealth met their needs. Among open responses, 43% highlighted how physical barriers and distance hindered in-person attendance. Four respondents discussed affected fine motor movements limiting telehealth access. Three preferred in-person appointments, denoting the importance of thorough physical exams. Conclusions: Compared to in-person visits, telehealth meets the needs of patients with autonomic dysfunction, improves access to care, and delivers high satisfaction. This modality is still inadequate during limited internet connection and for those with impacted fine motor skills. Telehealth holds promising utility for autonomic dysfunction and the care of patients with PD. Continued study into furthering accessibility for patients of all abilities and technological constraints is warranted.

The well-being of any country depends on the health of its citizens. As India is the most populated country and an emerging economy, a solution for India might also be a model for the rest of the world. Over the last eight years, India has taken significant steps to incorporate Digital Health (DH) at the core of its healthcare delivery system. Challenges, importance, fallout, specific applications, and growth of DH in the Indian setting are discussed in this report. Digital Health (DH) is a significant component of healthcare in the new Digital India. Technology is being used to achieve the bold objective of providing universal health coverage, initially to 500 million economically challenged citizens. This report traces the initiatives of the Government of India to meet this challenge, including the formation of the National Digital Health Authority, Ayushman Bharat Digital Health Mission, and Ayushman Bharat Health Account. In addition, showcased, as a specific illustration of the use of DH, is the The TB Free India campaign-a plan to eliminate tuberculosis by 2025. This report contains many agency names and programs. The Appendix at the end of this article defines each.

Montana's behavioral health and developmental disabilities systems are undergoing a transformative shift through the Behavioral Health Systems for Future Generations (BHSFG) initiative, a comprehensive effort aimed at addressing systemic challenges and improving service delivery. The Governor's proposed budget allocates historic investments across eleven Near-Term Initiatives, targeting critical areas such as crisis intervention, workforce development, telehealth expansion, and community-based services. This paper provides an in-depth analysis of the current challenges facing Montana's behavioral health infrastructure, including geographic disparities, workforce shortages, and funding limitations. It highlights the proposed initiatives, emphasizing their potential to close service gaps, enhance accessibility, and create a sustainable and future-ready behavioral health system.

Background Patients with opioid use disorder (OUD) often have complex health care needs. Methadone is one of the medications for opioid use disorder (MOUD) used in the management of OUDs. Highly restrictive methadone treatment—which requires patient compliance with many rules of care—often results in low retention, especially if there is inadequate support from healthcare providers (HCPs). Nevertheless, HCPs should strive to offer patient-centred care (PCC) as it is deemed the gold standard to care. Such an approach can encourage patients to be actively involved in their care, ultimately increasing retention and yielding positive treatment outcomes. Methods In this secondary analysis, we aimed to explore how HCPs were applying the principles of PCC when caring for patients with OUD in a highly restrictive, biomedical and paternalistic setting. We applied Mead and Bower’s PCC framework in the secondary analysis of 40 in-depth, semi-structured interviews with both HCPs and patients. R...

During  the  COVID-19  pandemic,  there  was  a  surge  in demand for telehealth services as patients sought to  avoid  in-person  visits  to  healthcare  facilities.  Patients  began  to  experience  and  expect  medical  services  without  geographic  constraint.  As  telehealth  modalities  expanded,  additional  benefits  were  realized.  For  example,  telehealth can be less expensive than in-person care, eliminat-ing the need for office space, equipment, and other overhead costs associated with the traditional delivery of  healthcare.1In  addition,  telehealth  can  contribute  to  improv-ing  patient  outcomes  by  providing  timely  access  to  care  and  increasing  patient  adherence  to  treatment  plans.1Enhancing communication between care teams can lead to better care coordination.2 Telehealth creates efficiencies for providers  by  reducing  time  spent  on  administrative  tasks  and providing flexibility in terms of  the location or setting where  providers  can  see  patients.3  These  benefits,  along  with  the  advent  of  an  array  of  telehealth  platforms  and  technical  capabilities,  enable  team-based  care  models  that  involve virtual nursing care. Combining virtual care mod-els with artificial intelligence (AI) offers the potential to be transformative to nursing practice

The U.S. Department of Veterans Affairs (VA)
is undergoing an Electronic Health Record
Modernization (EHRM) across the entire enterprise, with the goal of creating a shared Federal Electronic
Health Record (FEHR). In 2017, the Veterans Health
Administration (VHA) joined with the Department of
Defense (DOD) to plan for the transition to a modernized, combined EHR platform to capture the healthcare
delivery of both active-duty members and veterans.1
The
VHA anticipated transitioning to the new EHR across all
medical centers nationally over a period of 10 years—“the
largest EHR transition in history.”1
The first rollout was
in October 2020 in Spokane, Washington, USA.1
Implementing a new EHR within an organization is
challenging and requires flexibility and adaptability from
the implementation team.2
The VHA recognized that
“EHR transitions tend to be highly disruptive, affecting
health systems’ productivity, efficiency, care quality, and
employee satisfaction.”3
A multi-site qualitative analysis was conducted of end-users following a new EHRM
implementation at four U.S. healthcare systems. Several
lessons learned included the need to provide scheduled
time for EHR trainings, to reduce workload, and to incorporate robust internal support.4 To lessen some of these
challenges while optimizing the opportunity to deliver
safe and effective care to veterans, a multidisciplinary
team was established within the VHA—the National
EHRM Supplemental Staffing Unit (NESSU).

The implementation of virtual nursing enables remote support, which reduces the workload of bedside nurses and enhances
patient care. Its use expanded in response to workforce shortages during the COVID-19 pandemic, and it has since gained
approval from bedside staff and patients while helping mitigate staff burnout. Virtual nursing interventions have shown to
improve patient safety and quality of care. At Houston Methodist Hospital, virtual nursing is facilitated through an artificial
intelligence-assisted care platform, delivered via mobile carts equipped with tablets or two-way wall-mounted cameras with audio
and visual capabilities. This discussion highlights virtual nursing initiatives across our academic flagship hospital and seven
satellite hospitals, which commenced in June 2022. This article concludes with the authors’ vision of future goals for expansion

There is low utilization of  Posyandu Elderly services in Deli Serdang Regency, even as the number of  elderly is increasing. Today, only 5% – 10% of  the elderly population uses this service, as a result of  the perception of  inadequate service quality and a mindset that Posyandu is only for the sick, with minimal understanding of  its benefits. The purpose of  this study is to determine the role and influence of  students, village heads, cadres and peers on the utilization by the elderly Love House at the Integrated Health Post. This research design follows a quantitative cross-section involving 192 elderly respondents from a population of  7,883 regis-tered at the elderly health post in Lubuk Pakam District, using stratified random sampling and analyzed with the chi-square test at an alpha level of  0.05. This study reveals that the utilization of  the Rumah Kasih (elderly Love House) charity home (charged with caring for the poor, elderly, homeless, and abandoned individuals in government hospitals free of  charge) is significantly influenced by the roles of  stakeholders, including cadres, village heads, and peers, while student involvement remains suboptimal. Notably, emotional and informational support from families also plays a crucial role. These findings highlight the need for innovative collaboration among these key groups, emphasizing a holistic approach to elderly care that integrates community support and enhances access to and utilization of  Rumah Kasih.

Objective: To evaluate the usability and effectiveness of  telehealth services among healthcare providers in Karachi, Pakistan post-COVID-19 pandemic, focusing on the Sehat Kahani platform.Methods:  A  cross-sectional  study,  with  388  healthcare  professionals  utilizing  the  Telehealth  Usability  Questionnaire  (TUQ).  Sociodemographic information was gathered, encompassing age, gender, specialty, and experience.Results: The predominant demographic of  participants was female (89.9%), with ages ranging from 25 years to 46 years (90%). A majority of  participants (86%) were of  Pakistani origin. The average TUQ score was 5.73 (± 0.4), reflecting a favorable view of  telehealth. Identified key challenges included inadequate internet access (92%), limited financial resources (54%), legal issues (49%), and limitations in the treatment of  specific diseases (78%).Conclusion: Telehealth possesses considerable potential to enhance healthcare accessibility and quality in Pakistan. Addressing challenges, including infrastructure, budgetary limitations, and legal obstacles, are essential for extensive implementation. Future investigations should examine the enduring effects of  telemedicine on patient outcomes and the efficiency of  healthcare system

This paper aims to refocus attention on the mental health agenda, emphasizing the continued inadequacy in addressing the issue despite the issuance of the National Mental Health Policy in 2001 and the enactment of the Mental Health Act in 2018. It examines the current mental health situation, considers the initiatives undertaken by the Department of Health, identifies the issues and challenges confronting the mental health sector, and provides an overview of existing legislative proposals. The paper reveals that the country’s mental health situation, exacerbated by the pandemic, has not gained sufficient priority and attention even with its evident decline. The scenario was already worrisome pre-Covid 19, and then more so after. Social stigma, high treatment cost, limited primary care, low public spending on the sector, and lack of a national registry of cases present further complications. To underscore the mental health agenda, key recommendations include the passage of a telemedicine law, increased visibility for the Philippine Mental Health Council, reassessment of mental health integration in the education system, democratization of mental health service access through PhilHealth, and greater representation in the budgetary allocations, among other measures.

A scalable artificial intelligence (AI) framework is the next critical development in harnessing the benefits of connected healthcare systems. Event-driven wireless sensor systems for pervasive health monitoring can collect data on a vast number of parameters under real-world conditions. The sensor data, when accumulated in large volumes longitudinally, can be used to develop more personalized management strategies for patients, as well as better inform and monitor public health treatments, care delivery strategies, and research investigations than traditional cross-sectional measures. Relatedly, the sensor systems can aid caregivers or practitioners in understanding the effects of medical procedures, new drugs, and behavioral modification. Interpretation of sensor data presents a considerable analytical problem. Pure numerical approaches by identifying linear mathematical relations with outcomes are not an efficient or effective strategy. This is because there is a considerable lag between the acquisition of data and the development of medical signals. A more efficient approach is to combine data science methods that take inspiration from how humans perceive data.

This article provides an overview of sensors commonly used in low-cost, low-power systems, exploring key concepts in IoT, Big Data, and the operation of smart sensory devices. These terms are closely related to Telemedicine & E-health and specifically they are the tools that shape the methods and machines used in there areas. As such, the article defines sensors, their characteristics, and the technological advancements leading to the rise of 'smart sensors.' This is the first step in understanding the brick and mortar of the machines used. Additionally, the paper discusses mini-computing devices that interface with sensors, highlighting their capabilities beyond simple actuation. This is the second step to understand these devices and their components as these devices are affordable and energy-efficient, making them ideal for instrumentation of telemedicine and e-health applications, such as system monitoring and prototype validation. The article aims to educate graduates on integrating various types of sensors, understanding how they operate, and applying them in wireless sensor networks, IoT systems, and Big Data edge node computing in real-world scenarios so they can understand how these are fused into eHealth, telehealth, telemedicine and the revolutionization of the healthcare industry.

Las caracteristicas y las tendencias de la investigacion en telesalud en Latinoamerica, en especial los ensayos clinicos controlados aleatorizados, han sido poco explorados. El objetivo de este trabajo fue caracterizar los estudios registrados en clinicaltrials.gov sobre telesalud en Latinoamerica. Se hizo un estudio descriptivo donde se evaluaron las investigaciones sobre telesalud en Latinoamerica registradas hasta el ano 2018 en clinicaltrials.gov. Se evaluo el tipo de estudio relacionado con enfermedad o tema, pais, iniciativa y tipo de institucion. Se localizaron 37 trabajos registrados. Los referidos a telesalud fueron principalmente ensayos controlados de tipo asignacion paralela (81,1 %). Las enfermedades mas abordadas fueron: hipertension arterial (23,9 %), diabetes (11,3 %) y enfermedades cardiovasculares (9,9 %). El 64,9 % de los trabajos fueron de iniciativa local, en los que resultaron Brasil (29,3 %) y Argentina (14,6 %) los paises con mayor numero de investigaciones. ...

This material delineates the outcomes of a social initiative
undertaken by the charitable non-governmental organization "Association
of Palliative and Hospice Care", operational in eight regions of Ukraine since September 2022. The principal aim of the initiative was to devise
an innovative framework for delivering comprehensive services
encompassing medical, psychological, and social support to terminally ill
palliative patients residing in Ukraine.

This study delves into the impact of the National Tele
Mental Health Programme of India, known as Tele MANAS, on
public access to and perceptions of mental health services in Delhi
NCR. Despite India's rich history in mental health awareness,
contemporary hurdles such as accessibility and stigma persist.
Tele MANAS endeavours to tackle these challenges by offering
integrated tele-mental health services across the nation. Through
a cross-sectional study involving 207 participants, this research
delves into public attitudes, knowledge and awareness regarding
Tele MANAS. Findings reveal a notable demand for mental health
services but a limited awareness of the program. Notably, social
media and television emerged as primary channels for awareness
dissemination. While attitudes toward Tele MANAS were
generally positive, there remains a need for targeted outreach to
engage neutral segments of the population. Analysis uncovered
variations in demand, awareness, and perception, highlighting the
necessity for tailored strategies. This research holds significant
implications for improving Tele MANAS's efficacy and advancing
mental health care in India. By understanding the current
landscape and addressing gaps in awareness and access, Tele
MANAS can better serve the populace, particularly in regions like
Delhi NCR. Moreover, the study underscores the importance of
ongoing efforts to destigmatize mental health issues and ensure
equitable access to quality care for all individuals, regardless of
background or demographics.

Background: Acute unscheduled episodic care is an area of potential cost savings, given the high frequency and cost of unnecessary emergency department (ED) utilization. Methods: We developed a provider-assisted patient navigation program using a telehealth platform designed to decrease ED utilization and reduce costs while providing exceptional patient satisfaction. Results: Urgent care (UC) visits were analyzed from July 1, 2022, to June 30, 2023. The "ED comparison" group (n = 68,320) consisted of patients discharged to home after receiving care in the ED. The "avoided ED visits" group included patients (n = 7,430) who received care in a lower-acuity setting and did not require emergency services within 48 hours. The calculated overall medical expense savings comparing the costs between the ED vs. lower-acuity settings revealed that 50% (n = 450) of consultations were managed as outpatients, avoiding ED visits. Evaluation of distribution by source revealed that 67% of ConnectCare consults resulted in admission, 48% for UC, while 36% of patients were service center consults. Conversely, 31% of consultations resulted in recommendations to go to the ED, and 16% of these were assisted transfers where the Telehealth Emergency Medicine (TeleEM) clinician communicated with the receiving ED. Among the 280 patients directed to the ED, 243 were sent because of immediate clinical acuity, 28 were because of logistical or scheduling issues, three for non-qualifying insurance for outpatient workup, and six were redirected to the ED following diagnostic results. Our analysis suggests an estimated average avoided medical expense of $1,701 per case to insurers and patients if an ED visit was avoided. Conclusion: Implementing a TeleEM program to assist with triage and resource alignment, as well as identification and outpatient management of patients while avoiding an ED visit, is feasible within an integrated health system. Our TeleEM program may be a model for other integrated health systems.

More  than  50%  of  pediatric  patients  experience  significant  stress  and  anxiety  prior  to  surgery.1High  anxiety  can  result  in  increased  postoperative pain, analgesic consumption, and delayed recovery.2To  reduce  this  preoperative  anxiety,  multiple  therapeutic  modalities have been developed, including the use of  dis-traction,  such  as  playing  video  games,  watching  movies,  and  listening  to  music.  In  severe  cases  of  anxiety,  anxio-lytic  and  sedative  medications  like  midazolam  are  used.  However,  given  the  acknowledged  drawbacks  of  medications,  including  the  risk  of  paradoxical  reactions  to  the  drug, alternatives to medication for reducing preoperative anxiety in patients may be useful. We aim to compare the use of  virtual reality (VR) to midazolam in reducing pre-operative anxiety in surgical patients and assess differences in induction compliance, emergence delirium, pain scores, and opioid use in VR vs. midazolam-treated patients.

Telemedicine has emerged as a transformative solution to address the significant healthcare disparities faced by rural India, where over 70% of the population resides. In this article, the evolution of telemedicine in India, its current landscape, and its potential to revolutionize primary healthcare delivery in rural areas are reviewed. Despite progress in establishing Primary Health Centers, rural healthcare infrastructure remains underutilized due to staffing shortages and other challenges. Telemedicine offers a lifeline by bridging critical gaps in primary care, with government initiatives such as E-Sanjeevni and private entities such as M-Swasth and Apollo TeleHealth expanding access to healthcare services. The COVID-19 pandemic accelerated the adoption of more advanced, patient-centric telemedicine models incorporating artificial intelligence, machine learning, and Internet of Things technologies. These innovations aim to provide rural communities with healthcare standards comparable to urban areas. However, challenges persist, including technological barriers, digital literacy gaps, and concerns about data security and privacy. To fully realize telemedicine's potential, a multifaceted approach is necessary. This includes culturally adapting platforms for rural populations, strengthening data protection legislation, enhancing digital infrastructure, and increasing digital literacy. The collaborative efforts of government bodies, private enterprises, healthcare professionals, and non-profit private organizations are crucial in overcoming these challenges. By embracing telemedicine and addressing its implementation barriers, India can bridge the healthcare gap, improve the quality of life for millions of rural residents, and potentially catalyze economic development in rural areas.

Background: Individuals with intellectual disability (ID) experience substantial inequalities and barriers to accessing healthcare despite requiring ongoing access to their healthcare providers, as they are more likely to die from avoidable causes of death than those without ID. Telehealth technologies have the capacity to improve access to healthcare providers and information and could reduce morbidity and mortality rates in this population. This review explores the application of mobile health technology in the medical management of adults with ID. Methodology: PubMed, Institute of Electrical and Electronic Engineers Xplore (IEEE Xplore), Association of Computing Machinery, and Scopus databases were examined to extract peer-reviewed articles published between January 2000 and January 2022. Original research published in English on the use of telehealth technologies in the medical management of ID was deemed eligible. A narrative synthesis of study results structured around telehealth technologies used and outcomes was completed. Results: Thirteen of 1,008 reviewed articles-mostly small-scale cross-sectional studies-were eligible for inclusion. Most of the studies (n = 8) used videoconferencing platforms for real-time telehealth, while three focused on symptom or medication monitoring applications. The evidence supports the feasibility and potential effectiveness of telehealth to manage ID among adults. Users were generally satisfied with the telehealth technologies. Accessibility issues, including poor internet connectivity and poor knowledge of technology, might limit the use of telehealth in the management of ID. Conclusion: The use of telehealth was feasible, acceptable, and potentially effective for the management of ID among adults, although the varied methodology of included studies may be inadequate. A more structured methodology will be useful in future studies.

During COVID-19, telemedicine was adopted by many practices to serve patients with a variety of health con-
ditions, including those afflicted with cancer. Here, we report an 11-year-old patient who went to her dentist,
where a routine panoramic X-ray revealed multiple jaw keratocytes. She was referred to genetics because jaw
keratocysts have a hereditary predisposition to basal cell cancer and other tumors.
She received genetic counseling in 2021, where telehealth was the primary modality for visits. The hospital’s
secure video platform was used to gather medical history and counsel the mother on genetic testing for nevoid
basal cell carcinoma syndrome (NBCCS). Prior to 2013, the cost for genetic testing was often thousands of
dollars. In this case, the genetic testing company offered a patient pay option of $250.
Two days later, the patient presented to the cancer center, where a phlebotomist collected a blood sample. A
15-minute physical examination revealed macrocephaly and palmar pitting. Of note, the mother asked about
numerous pinpoint lesions around the patient’s ocular region.
Genetic testing was positive for a pathogenic variant in PTCH1 c.454_455del. The patient was referred to pedi-
atric dermatology, where more than 50 basal cells were diagnosed. Treatment was initiated with imiquimod and
fluorouracil. In addition, she was referred to cardiology and gynecology, given reports of individuals with cardiac
fibromas and gynecologic ovarian tumors. The patient is now 14 years old, doing well, and starting her freshman
year in high school. This case highlights how telehealth contributes to a holistic approach to patient care.

Plain Language Summary
We describe a patient with a rare pediatric genetic condition of jaw keratocysts and skin cancer at a young
age. Telehealth was used to help explain her condition to her and her family. It is important for providers to
engage patients through video visits and telephone visits, so that they have a successful telehealth experience
and get the best care. Genetic counseling lends itself to telehealth because much of the visit is counseling and
there are DNA saliva kits that can be mailed to the patient

Research Objective: The use of technology-enabled interventions such as telemedicine to monitor patients from home is on the increase with chronic diseases. Telemedicine technologies are often designed ad-hoc by IT developers but how patients interact and feel about using these technologies in the rollout phase is crucial because the effectiveness of a telemedicine treatment also depends on the interaction pattern between the technology and its users (patients). While clinical trials focus on assessing the effectiveness of telemedicine other study designs are needed to investigate patients' experiences with the technologies. We developed a novel qualitative methodology - the Clinical User-Experience Evaluation (CUE) - to complement a clinical trial, using evaluation methods from Human-Computer Interaction (HCI) discipline. The CUE was implemented within a telemedicine clinical trial of Type 2 Diabetes (T2D) in Townsville region in Queensland in Australia, conducted by the TMML (...

This research project aims to explore the benefits of online medical records in enhancing patient care. Electronic medical records (EMR) are important to implement because they reduce doctors' workload, costs, and errors. With Electronic Medical Records, Doctors and health workers also benefit from easy access to patient information which helps improve patient safety and clinical decision-making such as diagnoses, allergic reactions, and drug duplication. EMR benefits patients because of efficiency in the health care process.
The study will delve into the advantages of digitizing medical records, including improved accessibility, accuracy, efficiency, and patient engagement. By examining existing literature and case studies, this research seeks to provide insights into the transformative potential of online medical records in revolutionizing healthcare delivery and patient outcomes.

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19.

Objective: The coronavirus disease 2019 pandemic had greatly impacted health worldwide. The nationwide lockdown was imposed to contain the virus transmission, which indirectly affected health care utilization. Pediatric patients' , as they are considered as a vulnerable group, parents faced a significant challenge to manage their children's surgical and medical care needs during the coronavirus disease 2019 pandemic. The study aims to explore the parental approach to health care facilities to meet children's surgical care needs during the coronavirus disease 2019 pandemic. Materials and Methods: A qualitative approach was adopted to fulfill the objective by conducting an in-depth interview using a semi-structured interview schedule among 26 parents of children with perioperative surgical care needs at a tertiary care hospital, eastern India. The digitally recorded interviews were transcribed verbatim. Thematic analysis was employed to understand the parent's experience toward meeting children's surgical care needs during the coronavirus disease 2019 pandemic lockdown. QSR NVIVO software version 12 was used for data management. Results: The study found 3 themes related to parent's experience which include state of desperation (sub-themes: lockdown effect, ignorant to the health facility, phobic to coronavirus disease infection, and testing), state of assurance (sub-themes: telemedicine: accessibility, approachability, and applicability), and state of serenity (sub-themes: refrained from somatic symptoms and shouldering the responsibility). Conclusion: Despite various hurdles parents faced during the pandemic, telemedicine helped parents meet their children's surgical care needs. Framing guidance, protocols to deal with emergency and primary care delivery, and disseminating information on telemedicine facilities to grassroot level to the community can protect this vulnerable population in the upcoming surge of coronavirus disease 2019 waves.

Copyright held by the owner/author(s). CHI’20,, April 25–30, 2020, Honolulu, HI, USA ACM 978-1-4503-6819-3/20/04. https://doi.org/10.1145/3334480.XXXXXXX Abstract Pain interferes with many people’s mental well-being, quality of life, and general functioning. Non-pharmacological approaches which through distraction, hypnosis, and mindfulness, have been proven to be effective for pain relief. The development of Virtual Reality (VR) technology provides alternate solution to support pain relief in medical applications. Evidence from the analgesic effects of both VR and social support provides an argument for the effectiveness of social VR experiences to alleviate pain. Thus, in order to understand and provide optimizations on how we should adopt social VR to solve pain alleviation problems, this position paper presents the rationality of social VR for pain alleviation and discusses the opportunities and challenges of this topic for broader discussion.

Globally, the Coronavirus disease (COVID-19) pandemic in 2019 has accelerated the adoption of telehealth technologies. The implementation of the Saudi Telemedicine Network (STN) and other digital health initiatives, such as the telehealth clinic (THC) at King Abdullah bin Abdulaziz University Hospital (KAAUH), exemplifies this trend in Saudi Arabia. The aim of this study was to explore the patients' experience of THC in KAAUH during the COVID-19 pandemic and their' beliefs about their readiness to replace the traditional onsite clinical visits with THC from March to September 2020. A cross-sectional study targeted all 1398 patients who utilized THC at KAAUH. A self-administrated, validated survey collected the data. The survey used a Likert scale and included questions on satisfaction with THC services and the perceived effectiveness of telehealth as a substitute for in-person visits. The collected data was analyzed using frequency and percentage. A total of 252 patients responded to the THC postvisit survey. Overall, 217 patients (86%) were satisfied, 32 patients (13%) were dissatisfied, and only 3 patients (1%) were neutral about THC. Most patients (65.5%) agree that THC provided enough information about their health conditions, which can substitute for clinical visits. About 18.3% of patients were neutral, while 16.3% disagreed with the effectiveness of THC services and believed that they could not replace onsite visits. During the COVID-19 pandemic, most patients were satisfied at KAAUH-THC in Saudi Arabia and believed that it could replace the onsite visit to a physician's clinic. The 2 main causes of the patient's belief that THC could not replace an onsite clinical visit were: First, nonadherence to appointments led to missed calls and a complete medical service. Second, the patient's perception is that a physical examination and lab investigation cannot be completed through THC.

Introduction: Telemedicine in the pandemic of coronavirus disease 2019 (COVID-19) has responded to societal distancing in medical treatments by protecting health workers while also managing available resources. To attain best practices in telemedicine, a platform must be functional, and both patients and clinicians must be satisfied with the technology. To ensure the benefits of telehealth systems, usability refers to how easy the user interfaces of telehealth systems are to use.  In this study, the usability of telemedicine systems has been investigated.Material and Methods: The authors of this study review the study from 2015 to 2021 using a combination of the keywords "health", "telemedicine", "telemedicine", "mobile health", "usability" "Software", "System" and "Program", which led to the extraction of 119 articles in this field.Results: Articles in the field of remote health software and evaluation ...

This study is designed to investigate the impact of telehealth utilization in the United States of America's healthcare system on the environment to inform both healthcare and environmental policies. This study followed the PRISMA guidelines for systematic review analysis. As part of the literature search, and the selection of the articles, publications, and papers for the study's analysis; the data collection procedure considered the first and second authors of the completed simultaneous electronic and ancestral searches for peer-reviewed articles by using these online databases, which includes: Medline, EMBASE, Web of Science, Greenfile, and Google scholar as well as advanced Google scholar for all articles in the English language that evaluated the impact of telemedicine on the environment. With the help of Boolean search technique and experts' reviews, 20 articles were included in this study. This study finds that some of the types of telecommunication methods use in healthcare system include the following services: Body Area Networks (BANs), video-conferencing, website, telephone consultations, and other mobile application technology. In the literature, it was observed that telehealth utilization rapidly expanded during the onset of the COVID-19 pandemic and further continues to provide critical access to health care services to patients within and outside United States of America. Again, it was underscored in this study that some of the positive effects of telehealth use include but not limited to the following: (1) reduction in greenhouse gas emissions resulting from both patients and staff reduced travels, (2) reduction in waste production associated with each consultation through reduced patient and staff travel, (3) reduction in greenhouse gas and waste product associated with reduced equipment use, particularly through the reduction in raw materials needed, (4) air pollutant emission savings, and (5) reduction in sanitation required per consultation. Above all, some of the negative effects of telehealth use include but not limited to the following: (1) increased energy use associated with greater digitization, (2) The expansion of digital health increase demand for devices contributing to the environmental burden of electronics, (3) Inadequate resources to effectively handle e-waste leads to pollution of local environments, creating significant health risks, (4) the production and disposal of wearable technologies, robotics and devices used to facilitate telehealth (i.e. smartphones, tablets, laptops, etc.) cause environmental degradation, and (5) Raw materials (such as-iron, aluminum, gold, mercury, cyanide, etc.) required to produce telehealth technologies or devices require large mining operations leading to land and environmental degradation.

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19.

Background Telehealth services are essential to expand healthcare coverage for all in the era of modern technology. Knowledge, willingness, and involvement with the service are also significantly important in the utilization of the service. This study investigated factors associated with knowledge, perceived benefits, perceived concerns, and predisposition to use telehealth services in Bangladesh. This web-based survey was conducted among 1266 adults in Bangladesh. Respondents were enrolled by following a convenience sampling technique. Results Demographic, telehealth service, and perceived health related information were significantly associated with respondents' knowledge, perceived benefits, perceived concerns, and predispositions. The knowledge was significantly positively correlated with the perceived benefit (p <0.05) and predisposition of telehealth (p <0.05). Albeit, knowledge was significantly negatively correlated with perceived concerns of telehealth (p <0.05). Conclusion The findings of the study may assist policymakers in implementing telehealth services by addressing the associated factors of knowledge, perceived benefits, perceived concerns, and predispositions.

Introduction: Rural Americans face significant health disparities due to limited access to healthcare services. Telehealth has emerged as a promising solution to mitigate these disparities by facilitating remote access to medical care. This paper comprehensively reviews the advantages, challenges, and implementation strategies of telehealth in rural areas. Method: A narrative review methodology was employed to synthesize existing literature and case studies on telehealth in rural settings. Databases such as PubMed, Google Scholar, and JSTOR were searched for relevant studies published in the last three decades. Keywords such as "telehealth," "rural health," and "healthcare disparities" guided the search process. The review focused on studies assessing the impact of telehealth on healthcare access, cost-effectiveness, and quality of care in rural areas. Results: The review findings indicate that telehealth significantly enhances healthcare access by reducing travel distances, increasing availability of specialist consultations, and promoting patient engagement. It improves chronic disease management and patient satisfaction by enabling convenient access to healthcare services at home. Despite initial setup costs and challenges such as broadband access and regulatory issues, telehealth demonstrates long-term cost savings through reduced travel expenses and improved healthcare efficiency. Quality of care is enhanced through improved communication between healthcare providers and patients, leading to better treatment adherence and health outcomes. Conclusion: Telehealth represents a transformative approach to address healthcare disparities in rural areas. It offers a costeffective solution to improve access to healthcare services, enhance patient outcomes, and reduce healthcare costs in the long run. However, successful implementation requires addressing infrastructure challenges, refining reimbursement policies, and ensuring regulatory support. Future efforts should focus on expanding broadband infrastructure, refining policy frameworks, and conducting further research to optimize telehealth's impact on rural healthcare delivery.

Bilim ve teknolojinin gelişmesi her alanda olduğu gibi sağlık alanını da etkilemektedir. Telekomünikasyon hizmetlerinin yaygınlaşması sağlık hizmetlerinde de kullanımını zorunlu hale getirmiştir. Sağlık hizmetlerinde telekomünikasyon araçlarının kullanımı telesağlık olarak adlandırılmaktadır. Günümüzde telesağlık uygulamaları ile sağlık hizmetlerinin birçok alanında hizmet verilmektedir. Telenütrisyon, ilgili sağlık otoritelerinin vermiş olduğu sertifikalar ile anamnezin alınması, hastaların beslenme durumunun saptanması, antropometrik, laboratuvar ve fiziki bulguların değerlendirilmesi, beslenme tedavisinin planlanması ve takibi gibi tıbbi beslenme tedavisinin tüm basamakları içeren süreçte elektronik bilgi ve telekomünikasyon teknolojilerinin diyetisyenler tarafından etkili şekilde kullanılması olarak tanımlanmaktadır. Telenütrisyon hizmetleri hastalar için pek çok avantaj ve dezavantajı birlikte taşımaktadır. Özellikle hareket kısıtlılığı olan, zaman bulamayan veya yakın çevresinde uzmana ulaşamayan kişiler uzaktan tedavi seçeneklerinde büyük faydalar sağlamaktadır. Bunun yanında mevzuat veya yönetmelik yetersizlikleri, her hastanın sistemi kullanamaması, uzman eğitiminin olmaması, sigorta sorunları, kişisel verilerin korunması gibi alanlarda sorunlar görülebilmektedir. Telenütrisyon sistemlerinin günümüz gelişen teknolojisi göz önene aldığında büyük gelişim göstererek yaygınlaşacağı görülmektedir. Bu alanda çalışmaların arttırılması ve mezuatların geliştirilmesi gerekmektedir. Bu çalışma güncel literatür ve uygulamalara dayanarak telenütrisyon hizmetlerine genel bir bakış açısı sunmayı amaçlamaktadır.

SummaryObjectives: Assess unforeseen consequences of Telehealth and suggest solutionsMethods: An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature.Results and Conclusion: A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken.

Aim: This report presents the hospital stay of an elderly patient with septic encephalopathy who was admitted to the patient care unit. Through the use of enhanced remote care monitoring, admission to the intensive care unit (ICU) was avoided. Case History: An 81-year-old gentleman with diabetes and hypertension presented to the Emergency Department complaining of generalized bilateral weakness of the upper and lower limbs and a recent history of acute gastroenteritis.

Readers  of  Telehealth  and  Medicine  Today  might  ask,  “What  is  the  relevance  of  artificial  intelligence  (AI)  to  telehealth  and  telemedicine?”  Not  surprisingly, the answer lies, at least in part, in the appli-cation  of  AI  through  telehealth  to  mediate  the  issues  of  misdistribution  of  the  demand  versus  supply  of  health-care  services.  That  and  more  are  probably  possible.  Understanding  the  current  status  of  AI  in  healthcare  is  the first step and the goal of  this editoria

Two  driving  factors  in  the  advancement  of  medical  care today focus on the rapid adoption of  technologies into patient care and the social determinants of  health  (SDOH)  to  improve  patient  outcomes.  The  increasing  use  of  artificial  intelligence  (AI),  network  technologies,  mobile devices, and embedded sensors (among many others) to develop and deliver patient care is driving the revolution forward  in  one  area.  Another  area  focuses  on  nonmedical  factors  that  influence  health  outcomes,  known  as  SDOH.  These  SDOHs  contribute  to  wide  health  disparities  and  inequities. One of  the primary aims of  introducing technology to clinical practice has been to narrow health disparities by expanding healthcare access through telemedicine.One  lasting  impact  of  COVID-19  compelling  healthcare  providers  to  adopt  telemedicine  is  that  remote  patient  care  has become normalized as a channel for patient evaluation and treatment.1 Even as the virus moves from pandemic to endemic status, telemedicine is viewed as a way to see patients more  cost-effectively  and  reach  patients  who  might  have  had  difficulty  accessing  healthcare  in  the  past.2  Specifically,  among  patients  in  need  of  chronic  care,  telemedicine  can  significantly reduce the number of  outpatient visits. In addition, the increase in preventative procedures for patients with chronic  diseases  after  telemedicine  suggests  that  this  population  benefits  from  telemedicine  through  improved  disease  management,  preventative  and  follow-up  care,  and  avoid-ance of  costly emergency department or inpatient services

Komunikasi kesehatan digital adalah bentuk komunikasi yang melibatkan teknologi digital seperti komputer dan jaringan internet, misalnya media sosial atau perangkat lunak untuk menyampaikan informasi kesehatan dan memfasilitasi interaksi antara profesional kesehatan dan pasien ataupun pengguna (user) lainnya dalam rangka berinformasi tentang kesehatan. Komunikasi kesehatan digital bisa terjadi dalam berbagai bentuk seperti website, aplikasi mobile, pesan singkat, e-mail, media sosial, dan lain sebagainya (Hu, 2015). Komunikasi kesehatan digital memungkinkan para profesional kesehatan untuk menyampaikan informasi kesehatan secara lebih mudah, cepat, dan efektif kepada pasien. Selain itu, pasien juga dapat mengakses informasi kesehatan secara lebih mudah dan cepat melalui teknologi digital

Objective: The objective of this study was to identify and categorize influence strategy objectives pursued by JBS and Odebrecht in order to gain a competitive advantage in their relationship with the State. Theoretical framework: Beyond the theoretical perspective of the nonmarket strategy, and based on economic sociology, the concept of influence strategy was used to analyze social, political, and economic relations between the State and corporations. Method: We employed a 'structure analysis' for the identified events, based on over 35 hours of video recordings with 27 executives from the aforementioned companies. Results: We identified 23 cases of influence strategies, in which private actors used complex actions in Company-State relations in search of gains from sources of competitive advantages. Conclusion: Three common strategic goals were identified: i) contract winning; ii) regulation/exemption; iii) influence on the public bureaucracy at the municipal, state, and federal levels.

Recuperarea respiratorie este un proces terapeutic și de îngrijire medicală care vizează restabilirea și îmbunătățirea funcției sistemului respirator după o boală, intervenție chirurgicală afecțiuni pulmonare cronice, sau care au trecut prin situații sau eveniment care afectează sistemul respirator. Această formă de recuperare este deosebit de importantă în cazul pacienților care au suferit afecțiuni pulmonare, intervenții chirurgicale la nivelul plămânilor sau alte probleme de sănătate care au afectat funcționarea sistemului respirator. Recuperarea respiratorie este coordonată și supravegheată de către profesioniști în domeniul sănătății, cum ar fi medici, terapeuții respiratori, fizioterapeuții, asistenți medicali și alți membri ai echipei medicale. Planul de recuperare este adaptat nevoilor individuale ale pacientului și poate implica o varietate de metode și tehnici, inclusiv exerciții, terapie respiratorie, consiliere și educație pentru pacient și familia sa. Serviciile medicale acordate pacienților aflați în recuperare respiratorie pot varia în funcție de cauza și severitatea afecțiunii. Recuperarea cuprinde tratamente medicamentoase specifice, adaptate pentru afecțiuni cum ar fi BPOC și astmul, printre altele.

Purpose: There is limited research comparing virtual and in-person tobacco treatment specialist training. As a result of COVID-19, the Duke-UNC Tobacco Treatment Specialist Training Program (Duke-UNC TTS) transitioned from an in-person to a virtual format, allowing for a comparison of these two training formats. Materials and Methods: We conducted an observational study comparing Duke-UNC TTS attendance and evaluations at three courses provided in-person in 2019 with the same three courses provided virtually in 2020.  Results: The transition from in-person to virtual format was associated with more than a doubling of course attendance (in-person format enrolled 112 participants; virtual format enrolled 232 participants; p &lt; 0.05).  The virtual format was also associated with more than two times the proportion of out-of-state participant attendance (in-person format enrolled 22.3% out-of-state attendees; virtual format enrolled 52.8% out-of-state attendees; p &lt; 0.05). Course ev...

This survey paper explores the design patterns essential for constructing generative autonomous agents, a significant advancement over traditional LLM-based applications. These agents can independently plan, execute, and refine tasks, enabling them to overcome limitations such as the need for continuous human input and rules-based reasoning. I review four design patterns: reflection, planning, tool use, and multi-agent collaboration for building more efficient agents. Each is illustrated through a detailed, holistic analysis of a specific implementation technique.

This study is important because it explores how eHealth tools and telehealth services impact pelvic health practitioner satisfaction rates while treating clients with urgency and urge urinary incontinence. This study used a quantitative survey design. There were two different instruments. The first was satisfaction survey designed for pelvic health practitioner (PHP). The pretest survey was administered during the first week of the study and then the posttest was administered 13 weeks later. The second quantitative survey was administered once to clients who experiences urgency and urge urinary incontinence (UUI). The study setting was virtual, although the company using the program is considered a home health setting. There were two groups of participants. The first was PHPs employed by Balanced Pelvic Health, LLC. These participants were recruited with purposive sampling. The second set of participants were UUI clients who were older than 18 years old and experienced urgency or UUI symptoms. These participants were recruited using snowball sampling. One PHP participant completed the satisfaction survey. The results indicated that the PHP experienced 100 percent improvement in satisfaction. A total of six UUI participants. The screening tool had a reliability score of ω = .82, with an average inter-item correlation of r = .34. Item-drop analysis indicated minimal redundancies.