Telehealth and eHealth

In recent years, telemedicine has been increasingly incorporated into medical practice, a process which has now been accelerated by the COVID-19 pandemic. As telemedicine continues to progress, it is necessary for medical institutions to incorporate telemedicine into their curricula, and to provide students with the necessary skills and experience to effectively carry out telemedicine consultations. The purposes of this study are to review the involvement of medical students with telemedicine and to determine both the benefits and the challenges experienced. A literature review on the MEDLINE; CINAHL Plus; APA PsychInfo; Library, Information Science and Technology Abstracts; and Health Business Elite databases was performed on September 7, 2020, yielding 561 results. 33 manuscripts were analysed, with the main benefits and challenges experienced by medical students summarized. In addition to increasing their understanding of the importance of telemedicine and the acquisition of telemedicine-specific skills, students may use telemedicine to act as a valuable workforce during the COVID-19 pandemic. Challenges that students face, such as discomfort with carrying out telemedicine consults and building rapport with patients, may be addressed through the incorporation of telemedicine teaching into the medical curricula through experiential learning. However, other more systemic challenges, such as technical difficulties and cost, need to be examined for the full benefits of telemedicine to be realized. Telemedicine is here to stay and has proven its worth during the COVID-19 pandemic, with medical students embracing its potential in assisting in medical clinics, simulation of clinical placements, and online classrooms.

E-commerce has been identified as an enabler of economic development/growth in developing countries. This is due to the preponderant role that e-commerce plays in developing world as a catalyst towards improved customer service ; expansion of market reach [11]; improved customer relationship and communications and supply chain integration . In the South African case, the currently installed undersea cable which promises faster and more reliable Internet connection and the current government efforts to increase SMMEs online visibility make e-commerce an attractive platform to conduct online business. It is in this context that this paper seeks to investigate factors that contribute to e-commerce adoption. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model, this paper investigates the adoption of e-commerce from 180 SMMEs in Pietermaritzburg area in South Africa. The findings reveal that although facilitating conditions have not influenced the decision to adopt e-commerce in the surveyed SMMEs, social influence, effort expectancy, performance expectancy are determinants of e-commerce within the selected SMMEs. Thus, this paper recommends a managerial approach towards the adoption of e-commerce focusing on making it easier for employees to execute their daily tasks.

This paper presents a novel human joint motion recording method, The recorded data are sent to the receiver, which is placed in the close proximity or in the same room with the patient, via a wireless short-range communications system that guarantees 3 days of battery life. This method exploits commercially available bend sensors to convert mechanical human joint movements into electric signals which are then acquired, pre-processed, wireless transmitted and post-processed. We propose a novel way of sensor's application, underlying advantages and drawbacks which could be drastically reduced by electronic circuitry anyway. The network configuration and the specific air interface are chosen to satisfy system requirements in terms of data rates, battery autonomy, and mobility.

Objectives: Cognitive-behavioral therapies (CBT) for fibromyalgia syndrome (FMS) are important interventions in the management of this condition. Empirical evidence reports that although the results are promising, further research is needed to respond more appropriately to these patients. This study focuses on exploring the use of Virtual Reality (VR) as an adjunct to the activity management component. The aim of this study is to present the results of a small-sized randomized controlled trial to test the preliminary efficacy and acceptability of this component. Materials and Methods: The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology. The sample was randomly allocated to 2 conditions: VR treatment and treatment as usual. Results: Participants in the VR condition achieved significant improvements in the primary outcome: disability measured with the FIQ. The improvement was also significant in secondary outcomes, such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory: task persistence and exercise. There were no differences in other secondary outcome measures like pain intensity and interference and depression. Participants reported high satisfaction with the VR component. Discussion: The effects were related to the psychological aspects targeted in the treatment. The component was well accepted by FMS patients referred from a public hospital. These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS.

The novel coronavirus disease-19 (COVID-19) infection has altered the society, economy, and entire healthcare system. Whilst this pandemic has presented the healthcare system with unprecedented challenges, it has rapidly promoted the adoption of telemedicine to deliver healthcare at a distance. Telemedicine is the use of Information and Communication Technology (ICT) for collecting, organizing, storing, retrieving, and exchanging medical information. But it is faced with the limitations of conventional IP-based protocols which makes it challenging to provide Quality of Service (QoS) for telemedicine due to issues arising from network congestion. Likewise, medical professionals adopting telemedicine are affected with low QoS during health consultations with outpatients due to increased internet usage. Therefore, this study proposes a Software-Defined Networking (SDN) based telemedicine architecture to provide QoS during telemedicine health consultations. This study utilizes secondary data from existing research works in the literature to provide a roadmap for the application of SDN to improve QoS in telemedicine during and after the COVID-19 pandemic. Findings from this study present a practical approach for applying SDN in telemedicine to provide appropriate bandwidth and facilitate real time transmission of medical data.

É objetivo deste trabalho aprofundar o conhecimento sobre a evolução e a prática da telemedicina em Portugal e o grau de aceitação e participação dos intervenientes, com especial enfoque na classe médica e nos utentes. Como sublinha Rita Espanha (2013: 37), “a principal alteração introduzida na mediação no contexto da saúde é o facto de se abandonar uma relação construída essencialmente na interação paciente-profissional de saúde, para uma relação contruída a partir de múltiplas interações, face a face e mediadas (...).”
A escolha da telemedicina enquanto objecto deste estudo surge, inicialmente, a partir da constatação de Castells, de que vivemos numa sociedade em rede onde as relações sociais se desenvolvem num cenário mediado pelas novas tecnologias de informação e comunicação e estas interferem nas estruturas sociais. Na saúde, inevitavelmente, surgem novas formas de relacionamento entre os profissionais e os utentes como consequência desta comunicação mediada. A telemedicina, em particular, detém as maiores potencialidades para modificar e revolucionar a prestação de cuidados de saúde (Craig e Patterson, 2005).

The present study explores emerging domestic healthcare technologies in Japan.
The research was guided by the following questions:
• Material Dimension: What kind of domestic healthcare technologies can be found in Japan? What stage of development or implementation can be observed?
• Social Dimension: What added value do domestic healthcare technologies generate from the perspective of users and developers?
• Financial and Regulatory Dimension: What financial and regulatory requirements do domestic healthcare technologies face?

We therefore not only looked at the technical viability of specific solutions (material dimension), but also considered developer motivation and user acceptance (social dimension) and economic viability as well as compliance with safety requirements (financial and regulatory dimension). By moving beyond the technical characteristics, we were able to take into account the embeddedness of technology in specific social, economic and regulatory environments and to assess the actual practicality of solutions.

Based on secondary sources, one chapter describes the demographic and related challenges in more detail, outlines respective government policies and gives an overview of the country’s long-term care insurance (LTCI) scheme and the domestic care technologies covered by the system at present. The following chapter presents the results of case studies that examined the development and use of high-tech solutions including ICT-based telehealth systems, monitoring sensor systems and care robots. Two case studies specifically looked at implementations in peripheral regions, where ageing and labour shortages are most severe.

This report presents findings from the research project “Ageing in Japan: Domestic Healthcare Technologies ” jointly conducted by the Leiden Asia Centre and the German Institute for Japanese Studies (DIJ).

The COVID-19 pandemic has put the delivery of vital health and nursing services uniquely challenged. Restrictions in social mobility, fear of contraction, and risks of transmission posed by this pandemic prompted healthcare institutions to deliver health care services remotely using information and telecommunications technologies, also known as telehealth. Telenursing is one of the components of telehealth. Although there are several strides in the use of nursing-related technologies in the country, telenursing is not a mainstream nursing service. Exploring telenursing and articulating the roles of nurses in this care delivery model is imperative given the current paradigm shift to telehealth and telemedicine in the healthcare system. This article provides a context for telenursing use in the local setting by providing factors affecting its implementation. A literature search was conducted to identify the benefits, challenges, requirements, competencies, activities, and outcomes of telenursing. Despite the limitations posed by this pandemic, telenursing offers a viable, cost-effective, and patient-centered approach in health services delivery. The implications in nursing practice, education, and research are explained.

Wireless implanted medical devices (WIMD) help millions of device users experience a better quality of life. Because of their life-saving benefits, the devices are experiencing a dramatic growth in usage, application, and complexity. Yet, the rapid growth has precipitated an increase in cybersecurity risks and threats to the devices.  The literature posited that WIMD cybersecurity is a shared responsibility among manufacturers, healthcare providers, and patients.  What is not clear is what role a patient should play in WIMD cybersecurity and how a patient can assume such a role. The multiple case study examined: How are the cybersecurity risks and threats related to WIMDs being communicated to patients who have or will have these devices implanted in their bodies?  The population was cardiac device specialists at surgical hospitals and medical centers across the United States. The sample included 16 cardiac device specialists in the United States, each possessing at least one year of experience working with WIMD patients using in-home cardiac device monitoring systems. By using semistructured interviews with expert cardiac device specialists, the ideas, experiences, and perceptions of healthcare professionals responsible for the cybersecurity awareness and education of WIMD patients were examined. Through thematic analysis (TA), results yielded five themes: (a) the influence of the media on patient cybersecurity awareness, (b) the need for risk/benefit analysis at all levels of patient interaction, (c) a culture of noncommunication in the healthcare field and the medical device industry, (d) the need for collaboration and education among manufacturers, providers, and patients, and (e) the obstacles and challenges present in all phases of patient care.  Information gathered from healthcare professionals who worked intimately with the highly vulnerable WIMD patient population (cardiac device patients) provided valuable insights for medical device manufacturers, healthcare providers, policymakers, and patients across the WIMD macrocosm.  The research contributes scientific data to the body of knowledge in the field of WIMD cybersecurity and assists scholars and practitioners in advancing education and research in the field of healthcare cybersecurity.

Telehealth is a double-edged sword. With the advent of widely available and inexpensive telecommunication technologies, telehealth practices have grown prosperously in healthcare. At the same time, a number of scholarly works have already pointed out the potential medico-legal risks inherent in such practices. The author has conducted legal research to check the prevalence of medical negligence lawsuits in telehealth practices in Australia, Hong Kong, the United Kingdom, and the United States at the federal court level. This article discusses possible lessons learned from a few court cases identified, with an attempt to minimize the medico-legal risks of telehealth.

There are now few hundred thousand healthcare apps, yet there is a gap in our understanding of the theoretical mechanisms for which, and how, technological features translate into improved healthcare outcomes. In particular, the technological convergence, within mobile health (mHealth) apps, of the processes of mass and interpersonal communication, and human-computer interaction requires greater parsing in the literature. This paper analyzed 85 empirical studies on mHealth apps using the Input-Mechanism-Output model. We found in the literature that, firstly, there is a greater emphasis on technological inputs (87%) of accessibility, usability, usage, and data quality, than health outputs (52%) such as system process efficiencies and individual level behavioral or health outcomes. Secondly, there is little evidence of explanatory mechanisms (19%) of how the effects of mHealth apps are achieved. While we believe that successful apps would require research that incorporates technological inputs, theoretical mechanisms and health outputs, such studies are a rarity (n = 3). There is a minor increase in rigor with randomized control trials (n = 5), and a preponderance of discussion around social influence (n = 8) and gamification (n = 7), albeit in a scattered manner. We discuss the implications of the trend towards socialization and gamification findings in terms of future research, particularly in terms of study design guided by theoretical mechanisms.

Software development project becomes difficult because of the complexity in the business requirements, rigid framework and unpredictable performance. These cause difficulties to deliver the software on time, to maintain it and to adapt to new requirements. These scenarios had been faced in developing the healthcare information system which typically complex and comprehensive. Due to its complexities, the development of healthcare information system and other related healthcare applications typically disparate and less integrated. This led to maintenance and system integration issues that recently struggling by most healthcare providers around the world to resolve it by putting effort to link all existing disparate system into integrated one. This was due to the fact that a proper software engineering process was given less attention at the beginning of the health ICT project. This paper proposed, a systematic software engineering process based on customized Rational Unified Process for managing the development of integrated telehealth system. This paper also proposed literate modeling approach for performing system analysis and design model for users " accessibility and comprehensibility.

Objectives: Assess unforeseen consequences of Telehealth and their solutions Methods: 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.

Background: The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost.

Telehealth refers to the provider-to-provider and provider-to-patient communication; the parties use information technology, telecommunication, and devices to provide training and share important information (Edmunds, Tuckson, Lewis, Atchinson, Rheuban, Fanberg, &Thomas, 2017). At the same time, telehealth devices are used by the providers to deliver administrative health and clinical assistance to the population. Telehealth is rated as one of the fastest growing departments in the healthcare industry (Edmunds et al., 2017). Approximately, 60% of all hospitals and 40%-50% of all health facilities already use one or more forms of telehealth or device market to monitor the condition of the patients who suffer chronic connections (Edmunds et al., 2017). Furthermore, it is expected that most large employers will offer some form of telehealth coverage to their employees by 2020. In line with the same, most states have already enacted parity laws that require employers to reimburse telehealth services in the same way they reimburse in-person services (Edmunds et al., 2017). A notable factor is that telehealth aids the rural communities as it provides care, which could otherwise be hard to access in these locations (Edmunds et al., 2017). This paper provides an action plan for the implementation of a statewide network of telehealth program that will improve the quality of care in the community. The plan shows how I will work with my physician colleagues and other staff. It also recognizes my leadership role because I will be the liaison to other clinics and the academic health centers statewide.

Background: The rising prevalence of chronic illnesses hinders the sustainability of the health care system because of the high cost of frequent hospitalizations of patients with complex chronic conditions. Clinical trials have demonstrated that telemonitoring can improve health outcomes, but they have generally been limited to single conditions such as diabetes, hypertension, or heart failure. Few studies have examined the impact of telemonitoring on complex patients with multiple chronic conditions, although these patients may benefit the most from this technology. OBJECTIVE: The aim of this study is to investigate the impact of a smartphone-based telemonitoring system on the clinical care and health outcomes of complex patients across several chronic conditions. METHODS: A mixed-methods, 6-month randomized controlled trial (RCT) of a smartphone-based telemonitoring system is being conducted in specialty clinics. The study will include patients who have been diagnosed with one or more of any of the following conditions: heart failure, chronic obstructive pulmonary disease, chronic kidney disease, uncontrolled hypertension, or insulin-requiring diabetes. The primary outcome will be the health status of patients as measured with SF-36. Patients will be randomly assigned to either the control group receiving usual care (n=73) or the group using the smartphone-based telemonitoring system in addition to usual care (n=73). RESULTS: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by the fall of 2018. CONCLUSIONS: This RCT will be among the first trials to provide evidence of the impact of telemonitoring on costs and health outcomes of complex patients who may have multiple chronic conditions. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 41238563; http://www.isrctn.com/ISRCTN41238563 (Archived by WebCite at http://www.webcitation.org/6ug2Sk0af) and Clinicaltrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 (Archived by WebCite at http://www.webcitation.org/6uvjNosBC).

The acknowledged potential of using mobile phones for improving healthcare in low-resource environments of developing countries has yet to translate into significant mHealth policy investment. The low uptake of mHealth in policy agendas may stem from a lack of evidence of the scalable, sustainable impact on health indicators. The mHealth literature in low- and middle-income countries reveals a burgeoning body of knowledge; yet, existing reviews suggest that the projects yield mixed results.
This article adopts a stage-based approach to understand the varied contributions to mHealth research. The heuristic of inputs-mechanism-outputs is proposed as a tool to categorize mHealth studies. This review (63 articles comprising 53 studies) reveals that mHealth studies in developing countries tend to concentrate on specific stages, principally on pilot projects that adopt a deterministic approach to technological inputs (n = 32), namely introduction and implementation. Somewhat less studied were
research designs that demonstrate evidence of outputs (n = 15), such as improvements in healthcare processes and public health indicators. The review finds a lack of emphasis on studies that provide theoretical understanding (n = 6) of adoption and  appropriation
of technological introduction that produces measurable health outcomes. As
a result, there is a lack of dominant theory, or measures of outputs relevant to making
policy decisions. Future work needs to aim for establishing theoretical and measurement
standards, particularly from social scientific perspectives, in collaboration with
researchers from the domains of information technology and public health. Priorities
should be set for investments and guidance in evaluation disseminated by the scientific
community to practitioners and policymakers.

Objective: To compare clinical and process outcomes of cognitive processing therapy-cognitive only version (CPT-C) delivered via videoteleconferencing (VTC) to in-person in a rural, ethnically diverse sample of veterans with posttraumatic stress disorder (PTSD). Method: A randomized clinical trial with a noninferiority design was used to determine if providing CPT-C via VTC is effective and "as good as" in-person delivery. The study took place between March 2009 and June 2013. PTSD was diagnosed per DSM-IV. Participants received 12 sessions of CPT-C via VTC (n = 61) or in-person (n = 64). Assessments were administered at baseline, midtreatment, immediately posttreatment, and 3 and 6 months posttreatment. The primary clinical outcome was posttreatment PTSD severity, as measured by the Clinician-Administered PTSD Scale. Results: Clinical and process outcomes found VTC to be noninferior to in-person treatment. Significant reductions in PTSD symptoms were identified at posttreatment (Cohen d = 0.78, P < .05) and maintained at 3-and 6-month follow-up (d = 0.73, P < .05 and d = 0.76, P < .05, respectively). High levels of therapeutic alliance, treatment compliance, and satisfaction and moderate levels of treatment expectancies were reported, with no differences between groups (for all comparisons, F < 1.9, P > .17). Conclusions: Providing CPT-C to rural residents with PTSD via VTC produced outcomes that were "as good as" in-person treatment. All participants demonstrated significant reductions in PTSD symptoms posttreatment and at follow-up. Results indicate that VTC can offer increased access to specialty mental health care for residents of rural or remote areas. Trial Registration: ClinicalTrials.gov identifier: NCT00879255 J Clin Psychiatry 2014;75(5):470-476 P osttraumatic stress disorder (PTSD) is a costly and debilitating disorder that is associated with an elevated risk for a host of problems, including suicide, 1 substance use, 2 and anger problems. 3 The prevalence is estimated to be 6% in the US population, 4 with increased rates in military populations, including 9%-15% of Vietnam veterans 5 and 10%-20% of veterans of the wars in Iraq and Afghanistan. 6 Despite the urgent need for care and the availability of effective treatments, mental health services for veterans are characterized by high rates of underutilization and attrition. Among veterans in need of PTSD services, 50%-90% attend an insufficient number of visits or do not initiate them at all. 7,8 Furthermore, veterans who do initiate PTSD treatment demonstrate high rates of treatment dropout, ranging from 20% to 40% in clinical trials. 9 Factors associated with treatment nonengagement or dropout include PTSD symptomatology (avoidance), fear of stigmatization, and logistical problems (transportation, scheduling, child care). 10 These barriers are compounded for rural residents, whose access to evidence-based mental health care for PTSD is typically limited, 11,12 in part due to lack of treatment providers. 13 This disparity is particularly concerning given that 40% of US veterans live in rural areas. 11 Technological innovations, such as videoteleconferencing (VTC), can help address many of the clinical and logistical impediments to accessing care for underserved rural populations. 12 The delivery of services via VTC involves use of telecommunications equipment so that a clinician in one location can provide treatment to patients in another. VTC offers a number of advantages over traditional treatment approaches, 14,15 as VTC patients benefit in terms of decreased transportation costs, travel time, and missed work 16 and enhanced access to treatment for veterans with serious injuries or scheduling difficulties due to work, school, or childcare responsibilities. Studies of psychotherapy delivered via VTC have shown high degrees of patient and clinician satisfaction 17 and outcomes comparable to in-person delivery with regard to rates of attendance 18 and information retention. 19 VTC is an effective delivery modality for non-trauma-focused interventions for veterans with PTSD. 19-21 Preliminary evidence supports the effectiveness of VTC delivery of PTSD care with veterans. 22,23 However, questions remain about the feasibility of using VTC to deliver trauma-focused interventions, which directly assess a particular traumatic event and the subsequent thoughts or behaviors associated with that event, because patients with PTSD are often reluctant to engage in such therapies due to avoidance. Thus, the next step in assessing the feasibility and safety of VTC as a delivery modality is a rigorous evaluation of whether trauma-focused treatments delivered by VTC produce comparable outcomes to in-person delivery. One efficacious treatment for PTSD is cognitive processing therapy (CPT). 24 CPT is a trauma-focused psychotherapy that can be delivered in

The main objective of this paper is to assess the feasibility of an ad-hoc wireless network system for use within a hospital. The proposed system would operate as follows: Every bed within a hospital would be transformed into an eBed. These eBeds would monitor and record a patient’s details and vitals. In addition every doctor on the ward would possess a Personal Digital Assistant (PDA)/laptop that would function as an eChart. These eCharts would be capable of wirelessly connecting to any eBed on the eWard, thereby allowing a doctor to view manipulate and save a patient’s vitals, medical details and history.

ABSTRACT

This survey explored the support available and the effect of lockdown on children with autism spectrum disorder and their families in India and the United Kingdom. Our findings showed significant problems for children and families due to lockdown. App-based information delivered to parents with support showed encouraging feedback.


Keywords: Anxiety behavior, App-based support, Lockdown, Telehealth.

—In this paper, a smart wireless wristband is proposed. The potential of innovative gesture based interactivity with connected lighting solutions is reviewed. The solution is intended to offer numerous benefits, in terms of ease of use, and enhanced dynamic interactive functionality. A comparative analysis will be carried out between this work and existing solutions. The evolution of lighting and gesture controls will be discussed and an overview of alternative applications will be provided, as part of the critical analysis.

Tematem wystąpienia jest problematyka bezpieczeństwa pacjenta podczas świadczenia usług zdrowotnych na odległość. Prezentacja problemu skupiać się będzie wokół dwóch kwestii: telemonitorowania stanu zdrowia pacjenta oraz recept elektronicznych.

W kontekście omawianego zagadnienia istotne jest zwrócenie uwagi na działania Unii Europejskiej w przedmiotowej materii. W wydanym 4.11.2008 r. Komunikacie w sprawie korzyści telemedycyny dla pacjentów, systemów opieki zdrowotnej i społeczeństwa Komisja Europejska podkreśliła profity płynące z wykorzystania technologii informacyjno – komunikacyjnych (TIK) w sektorze zdrowia (eZdrowie, eHealth) oraz podkreśliła swoje zaangażowanie w rozwój telemedycyny. Konsekwencją powyższego jest Plan działania w dziedzinie e-zdrowia na lata 2012-2020 – Innowacyjna opieka zdrowotna w XXI wieku zakładający działania mające na celu usuwanie barier (zwł. prawnych) utrudniających pełne zastosowanie technologii informacyjno – komunikacyjnych w dziedzinie zdrowia. Działaniom promującym rozwój telemedycyny stale towarzyszy postulat wprowadzenia przejrzystości prawnej zapewniający pacjentom ochronę prywatności i bezpieczeństwa.
Polski ustawodawca stanął na stanowisku, iż lekarz może orzec o stanie zdrowia pacjenta wyłącznie po uprzednim osobistym zbadaniu (art. 42 ustawy o zawodach lekarza i lekarza dentysty), natomiast wysyłkowa sprzedaż dopuszczona jest wyłącznie dla produktów leczniczych wydawanych bez przepisu lekarza (art. 68 ust. 3 ustawy prawo farmaceutyczne). Jednakże, 24 czerwca 2014 r. Rada Ministrów przyjęła założenia do projektu ustawy o zmianie ustawy o systemie informacji w ochronie zdrowia oraz niektórych innych ustaw dotyczące wprowadzenia pełnego systemu informacji w ochronie zdrowia. Wspomniane działania zakładają przygotowanie rozwiązań prawnych umożliwiających monitorowanie przez lekarza stanu zdrowia pacjenta bez osobistego kontaktu oraz wprowadzenie od 1 sierpnia 2016 r. recept elektronicznych.
W wystąpieniu zostaną przedstawione problemy, z jakimi będzie musiał się zmierzyć legislator celem zapewnienia bezpieczeństwa pacjenta przy jednoczesnym pełnym wykorzystaniu telemedycyny. Postawione zostaną m.in. następujące pytania: czy wykorzystanie telemedycyny będzie wymagało akredytacji? czy telemedycyna zostanie ograniczona do telemonitoringu? jak zabezpieczyć transmisję danych by zagwarantować ochronę danych pacjenta?  w jaki sposób będzie wybierana apteka, która będzie realizowała eReceptę? czy eRecepta rozszerzy działalność aptek internetowych o leki na receptę?

Wystąpienie zostało zakończone konkluzją, iż tylko kompleksowa regulacja prawna może zapewnić pełne wykorzystanie telemedycyny przy udzielaniu świadczeń zdrowotnych przy jednoczesnym zapewnieniu bezpieczeństwa pacjenta.

A 2014 World Health Organization (WHO) study reported that almost 27 million people with disability live in Pakistan with fewer than one allied rehabilitation professional per 10,000 people. The current study sought to determine the attitudes toward telerehabilitation via a survey administered to 329 Pakistani rehabilitation professionals. Study results indicate that rehabilitation professionals in Pakistan are knowledgeable about telerehabilitation and Information and Communication Technology (ICT), and are receptive to employing telerehabilitation programs and applications. Therefore, we can infer that the future of telerehabilitation can be bright in Pakistan but requires the attention of policy makers and non-government organizations to launch an appropriate program nationwide. The authors suggest that a range of telerehabilitation services (e.g., consultation, assessment, and therapy) could alleviate the shortage of rehabilitation personnel in Pakistan.

Aim / Purpose /
The sustainability of health policies for the mental well-being of healthcare workers is essential for not only patients but also for the community. The purpose of this study was to analyze the contents and problems of managing mental health issues for healthcare workers during COVID19 at primary care using telehealth to suggest directions for future research.
Method:
The reviews that were published via PubMed were selected by using keywords as “mental health and COVID-19 and primary care and telehealth and review”. In the search made in June 2021, from 2018 till 11.06.2021; 25 reviews have been found. The most proportion of published reviews was about patients’ mental health via telehealth; only three of the reviews were about healthcare workers. Two of the research were excluded because they were not "review".
Result:
Telehealth is a growing option for the safety of healthcare workers and patients. Besides appropriate conditions and evidence-based data is needed for effectiveness. According to the reviews, structured methodology and tools could be to obtain comfort and privacy (for
patient/counselee and physician/healthcare worker), appropriate and sustainable technology, effective communication, privacy, and safety (for the protection of personal data).
Conclusion:
Research on managing mental health problems and telehealth in the family medicine discipline is increasing. Health policy also another question to be answered in different countries on the basis of legacy. However, more research to test the effectiveness of telehealth mental health at primary care and solutions to overcome burdens are needed

Although both online and in-person positive psychology interventions (PPIs) exist, no randomized controlled trials (RCT)—the gold standard in intervention research—have compared the effectiveness of these formats. We created a 12-week skills-based PPI (ENHANCE), organized into three target area: the core self (e.g., values, strengths), the experiential self (e.g., mindfulness, self-compassion), and the social self (e.g., gratitude, social life). In two 6-month randomized controlled trials (RCT) with a total community sample of 154 healthy adults, we administered the ENHANCE program online (N = 100) and in-person (N = 54). The in-person version of the program involved 2-hour weekly group sessions run by clinical practitioners. The online version followed a parallel structure with identical content; each participant created an account on a custom-designed integrated web platform, where they were able to view the session content, complete exercises, and save their responses to those exercises. We did not find differences between the online and the traditional program in the key predicted increases in positive affect and life satisfaction. This finding provides critical evidence for the potential of online PPIs to bring about similar changes in well-being as traditional, in-person interventions—but at a much larger scale. This research thus lays the foundations for administering empirically validated interventions to populations who may not be able to afford access to in-person interventions— from busy professionals to underprivileged populations.

Background: Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. Methods: PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. Results: Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. Conclusion: This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. Systematic review registration: International Prospective Register of Systematic Reviews CRD42015029846

Background: Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective: We aimed to assess European medical students' perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students' most pressing needs. Methods: The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results: The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions: This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties.

We conducted semistructured interviews with telemedicine program administrators as part of a national survey of physicians and managers regarding attitudes toward, and knowledge of, telemedicine. Telemedicine administrators were interviewed regarding factors affecting physician adoption of interactive video (IAV) telemedicine. The seven networks with which these managers were affiliated represented “traditional” telemedicine programs, primarily providing specialty teleconsultation via IAV. These programs were located in different geographic regions, and included both consulting and referring sites. We include data only for well-established networks for which multiple administrators responded. Data were analyzed using standard qualitative research methods. We conclude that reimbursement issues are important determinants of the rate of adoption, but that by themselves they do not fully account for the slow diffusion of IAV telemedicine. Likewise, appeals to physicians as rational decision-makers are necessary but insufficient means of increasing the volume of telemedicine within a network. Telemedicine networks and administrators that have been effective in persuading physicians to practice telemedicine or to refer patients demonstrate an emphasis on aggressive recruitment of physicians who will be involved actively in one or the other role. Most efforts to encourage physicians to adopt telemedicine, however, have focused on the supply of specialists, rather than stimulating demand among primary are providers who have patients to refer. Habit was identified as an important, albeit overlooked, factor explaining physician adoption of telemedicine.

This survey explored the support available and the effect of lockdown on children with autism spectrum disorder and their families in India and the United Kingdom. Our findings showed significant problems for children and families due to lockdown. App-based information delivered to parents with support showed encouraging feedback. Keywords: Anxiety behavior, App-based support, Lockdown, Telehealth.

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Purpose of the Project: To examine the change in telehealth use growth during the COVID-19pandemic with non-elderly patients in Bangladesh. Methods: Using patients of age between 18-64 from residents in and outside Dhaka, this study analyzed telehealth visits and all health care procedures from 2019-2021. The inflection point of interest was March 2020, the month when the COVID-19 pandemic was officially declared as a national emergency. Analyses were controlled for age, gender, and socioeconomic index. We used DiD approach to see the growth in telehealth use and then performed logistic regression to evaluate the association between any telehealth use and patient characteristics.

Results: There were more than 3000 observations in the analysis, where more than 60% were female. The percentage of females did not decrease after the inflection point. The onset of the pandemic was associated with an increase in telehealth usage in Dhaka relative to outside Dhaka (DiD estimate 0.07;95% CI, -0.77-0.62). The mean telehealth visits in Dhaka after March 2020 was 33% higher than outside Dhaka per person-year. The mean (SD) of Dhaka and outside Dhaka were 1.69 (7.03) and 1.48 (7.62)respectively. Interpretations Overall, telehealth use was associated with the youngest age group of 18-34, living in more urban areas and living in areas of higher socioeconomic status.

Conclusion: In this study, we found a significant decrease to in-person services and a rise in telehealth visits.

Materi yang saya bawakan di Seminar Online SONJO ke 18 dengan tema Telemedicine Masa Pandemi, tanggal 16 Agustus 2020.

Pembicara:
a) Kebijakan Telemedicine Kemenkes : dr. Iin Dewi Astuty, MKK, Kepala Seksi Pelayanan Penunjang Medik Kementerian Kesehatan
b) Pengelolaan Telemedicine di RS : Dody Naftali, Instalasi Teknologi Informasi, RSUP Dr. Sardjito
c) Tantangan infrastruktur teknologi di Telemedicine : Surahyo Sumarsono, Konsultan TI di Telemedicine
Moderator: Luluk Lusiantoro (FEB UGM)

Butler is a multi-application system based on Internet technology and virtual reality, designed to meet the needs of elderly users. Its objectives are to assist elderly populations in accessing technology and new forms of communication, replicating, as far as possible the way of lineal interaction that this population group had traditionally to interact with information in order to facilitate the first contacts with technology. Butler is equipped with e-mail, videoconferencing, blogging, access to the Internet through a well-known web search engine, image and sound gallery, new contacts searcher, and two virtual reality environments. In this paper we describe Butler's most relevant features taking into account the usability design process and the usability evaluation of the system, which, after pilot testing, have proven to be highly acceptable and satisfactory to users. We also present the results of evaluations pertaining to the iconography used in the program, the navigation and users' help design process, and the first functional prototype, all of which were designed and redesigned with the aid of web heuristics and guidelines for the web design for elderly users. Results suggest important features to be taken into account when designing and developing this sort of application for the elderly.

Background and aims Telehealth allows healthcare workers to see patients virtually in locations that were not accessible previously, which has reduced cost and time and saved lives. The research aims to examine gender disparity among telehealth usage during the pandemic in 2020. This study will leverage a timely national experiment to evaluate the users of telehealth across the Bangladeshi population. Methods We obtained de-identified data for 200 patients among outpatient telehealth visits from Global Health Data Exchange as it captured telehealth use throughout Bangladesh. Results The analysis showed that male patients had a higher dependency on telehealth than female patients. 14% of the female patients opted for telehealth visits only with 57% cases of missed doses of medication, compared to males with 20% of them choosing telehealth visits and 29% missing their doses of medication. We found that the youngest age group, 16–25, had the highest dependence on telehealth compared to any other age group, and the lowest dependence was among the oldest age group of 45 years and above. Conclusions There was a strong association between telehealth use and gender disparity with p value = 0.02 < 0.05. Longitudinal and geographical data are needed to understand more about the gender disparities and impact in telehealth utilizations.

E-Health ist in unterschiedlichen Anwendungsvarianten bereits Teil arbeitsmedizinischer Praxis. Es bedarf einer fortlaufenden, auch ethischen Evaluation der positiven wie negativen Effekte, die die Einführung solch umfassender technischer Eingriffsmöglichkeiten mit sich bringen.

Background: The development of new virtual care technologies (including telehealth and telemedicine) is growing rapidly, leading to a number of challenges related to health policy and planning for health systems around the world.

Methods: We brought together a diverse group of health system stakeholders, including patient representatives, to engage in policy dialogue to set health system priorities for application of virtual care in the primary care sector in the Province of Ontario, Canada.
We applied a Nominal Group Technique (NGT) process to determine key priorities, and synthesized these priorities with group discussion to develop recommendations for virtual care policy. Methods included a structured priority ranking process, open-ended note-taking, and thematic analysis to identify priorities.

Results: Recommendations were summarized under the following themes: (a) Identify clear health system leadership to embed virtual care strategies into all aspects of primary and community care, (b) Make patients the focal point of health system decision-making, (c) Leverage incentives to achieve meaningful health system improvements, and (d) Building virtual care into streamlined workflows. Two key implications of our policy dialogue are especially relevant for an international audience. First, shifting the dialogue away from technology toward more meaningful patient engagement will enable policy planning for applications of technology that better meet patients’ needs. Second, a strong conceptual framework on guiding the meaningful use of technology in health care settings is essential for intelligent planning of virtual care policy.

Conclusions: Policy planning for virtual care needs to shift toward a stronger focus on patient engagement to understand patients’ needs.

Background
E-health is increasingly being identified as a cost-effective method to deliver health services and remote monitoring in rural and remote areas. There is a paucity of research that identifies successful implementation of e-health and remote monitoring in rural communities.

Objective
To identify the evidence regarding the impact of e-health for rural residents.

Design
A systematic, rapid review of grey and published peer reviewed literature, using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included telemedicine, telehealth, e-health, regional, rural and remote communities; NSW, Australia, other OECD countries. Electronic health records and educational programs literature for health care professionals were excluded.

Results The search yielded 105 articles and reports. Following removal of duplicates, initial screening, and full text screening 19 articles remained of which 16 of which were peer reviewed publications and 3 were grey literature. This included 2 systematic reviews, 1 literature review, 6 descriptive reviews of services, and 9 reviews of specific interventions and identification of barriers and facilitators to implementation of an intervention. There is sufficient evidence that E-health can increase access to services without any detrimental effects across a range of medical specialities and improve professional development for staff.

Conclusion
E-health has the potential to increase access to services to people in rural and remote communities. The evidence shows that it is as safe, effective and reliable as most conventional methods for interacting with patients whilst enabling people to stay within their own communities.


Keywords:  e-health, tele-health, telemedicine, tele-care, rural and remote service.
 

Butler is a multi-application system based on Internet technology and virtual reality, designed to meet the needs of elderly users. Its objectives are to assist elderly populations in accessing technology and new forms of communication, replicating, as far as possible the way of lineal interaction that this population group had traditionally to interact with information in order to facilitate the first contacts with technology. Butler is equipped with e-mail, videoconferencing, blogging, access to the Internet through a well-known web search engine, image and sound gallery, new contacts searcher, and two virtual reality environments. In this paper we describe Butler's most relevant features taking into account the usability design process and the usability evaluation of the system, which, after pilot testing, have proven to be highly acceptable and satisfactory to users. We also present the results of evaluations pertaining to the iconography used in the program, the navigation and users' help design process, and the first functional prototype, all of which were designed and redesigned with the aid of web heuristics and guidelines for the web design for elderly users. Results suggest important features to be taken into account when designing and developing this sort of application for the elderly.

Background: Low sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment. Aim: To determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner. Methods: Sixteen cisgender women (M age = 31.9) with female Sexual Arousal/Interest Disorder worked through a pilot module of eSense in person at a sexual health laboratory. Outcomes: Qualitative semi-structured interviews and online questionnaires were used to assess participants' experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress. Results: Participants reported a high level of satisfaction with the website's functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable pre-post improvements in sexual desire, arousal, and satisfaction. Clinical Implications: Initial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants. Strengths & Limitations: This is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher's presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability. Conclusion: The format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online.

Background: Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process of scale-up and spread, for which a potentially fruitful theoretical approach is to consider the adoption and use of technologies as social practices.
Objective: This study aimed to use an in-depth case study of assisted living to explore the feasibility and usefulness of a social practice approach to explaining the scale-up of an assisted-living technology across a local system of health and social care.
Methods: This was an individual case study of the implementation of a Global Positioning System (GPS) “geo-fence” for a person living with dementia, nested in a much wider program of ethnographic research and organizational case study of technology implementation across health and social care (Studies in Co-creating Assisted Living Solutions (SCALS) in the United Kingdom). A layered sociological analysis included micro-level data on the index case, meso-level data on the organization, and macro-level data on the wider social, technological, economic, and political context. Data (interviews, ethnographic notes, and documents) were analyzed and synthesized using structuration theory.
Results: A social practice lens enabled the uptake of the GPS technology to be studied in the context of what human actors found salient, meaningful, ethical, legal, materially possible, and professionally or culturally appropriate in particular social situations. Data extracts were used to illustrate three exemplar findings. First, professional practice is (and probably always will be) oriented not to “implementing technologies” but to providing excellent, ethical care to sick and vulnerable individuals. Second, in order to “work,” health and care technologies rely heavily on human relationships and situated knowledge. Third, such technologies do not just need to be adopted by individuals; they need to be incorporated into personal habits and collaborative routines (both lay and professional).
Conclusions: Health and care technologies need to be embedded within sociotechnical networks and made to work through situated knowledge, personal habits, and collaborative routines. A technology that “works” for one individual in a particular set of circumstances is unlikely to work in the same way for another in a different set of circumstances. We recommend the further study of social practices and the application of co-design principles. However, our findings suggest that even if this occurs, the scale-up and spread of many health and care technologies will be neither rapid nor smooth.

The present study tested a prototype teledentistry system in which regional Community Health Centers are linked to the Melbourne Dental School or the Royal Children's Hospital in Melbourne (RCH). Three general dental practitioners (GDP) working in community dental clinics in the Australian state of Victoria were trained to manipulate an intraoral camera and to use existing ICT infrastructure to communicate with a dental specialist at RCH and transmit video images for remote assessment. Participants were recruited from the RCH's patient database for cleft lip and palate (CL&P) and orthodontics, living in the selected rural locations. Patients/parents of patients participating in the study completed a questionnaire to assess their experiences with the program. Forty-two assessments/consultations were conducted; 26 CL&P patients, and 16 in orthodontics. For most patients, the outcome of the consultation was the avoidance of trips to the centrally located RCH for initial assessment and/or follow-ups. This field trial provided initial evidence on how teledentistry might improve access to specialist care; identified broader community benefits for both the family and the services providers. From the RCH perspective, the potential reduction of inappropriate referrals with the concomitant reduction of waiting lists for specialist consultation, were important advantages of teledentistry.

This paper presents a novel human joint motion recording method, The recorded data are sent to the receiver, which is placed in the close proximity or in the same room with the patient, via a wireless short-range communications system that guarantees 3 days of battery life. This method exploits commercially available bend sensors to convert mechanical human joint movements into electric signals which are then acquired, pre-processed, wireless transmitted and post-processed. We propose a novel way of sensor's application, underlying advantages and drawbacks which could be drastically reduced by electronic circuitry anyway. The network configuration and the specific air interface are chosen to satisfy system requirements in terms of data rates, battery autonomy, and mobility.

This paper seeks to understand the use of telehealth technologies post COVID-19. For many years, academics have sought to provide evidence that the use of telehealth can have positive effects on patient outcomes, increase access to healthcare for populations, and to ensure a better use of resources
for all healthcare economies.

Although a number of trials and implementations on local, regional and national scales have found positive outcomes, healthcare providers have resisted the drive to greater telehealth adoption. This paper does not examine the history of telehealth in any great detail, but examines the use of telehealth during the COVID-19 pandemic.

The authors suggest that the increased use of telehealth is here to stay, and that health and care economies globally will need to adopt more telehealth solutions to continue to provide their services in a manner most appropriate for changing global populations.

As part of the study, the authors identify that technology programmes alone cannot lead to better telehealth implementation. They suggest that telehealth needs to ensure and support safe healthcare; that it must be effective; that patient centricity is important; that timeliness is a major factor; that telehealth can increase efficiency; that it reduces health inequalities; and that big, bold, visionary change is required.

The paper does not include any primary research but is based on examining the current academic and scientific evidence available.

Economic development of African countries has reached the level where the government can begin a strategic reform of health systems to create a modern health care delivery system, meeting the world standards of health care. Zambia being one of these countries decided to implement telehealth services. The Ministry of Health in conjunction with various stakeholders like Zambian mobile service provided developed strategies using Information and Communications Technologies to transform healthcare delivery so as to alleviate the delivery of health care. However, Zambia is still a developing nation, therefore they are some challenges.
The aim of this research is to assess the provision of telehealth services by Zambian mobile services providers. Special focus was directed to user awareness, usage of telehealth services, fields of healthcare where telehealth is being applied, the measures that providers are taking to improve the service, and the barriers faced.
A target group of 100 LIS students from University of Zambia was selected since the students are from almost all corners of the country and are ICT literate. A well-structured questionnaire was used to collect data.
With regards to awareness 57 percent of the target population were aware of telehealth services provided in Zambia. The results indicated that telehealth services were applied particularly in six fields namely counselling, chronic health, cholera, fitness, parenting and sexual health. Out of 70% were found to be users of the telehealth services provided by Zambian mobile service providers and out of those 70, 15 % were frequent users, frequent being once or twice a week. The majority expressed that the measures being taken to provide telehealth services in communities without infrastructure needed for offering telehealth were not sufficient due to poor advertising, services provided by the MSPs are not marketed well enough, poor network, intended benefactors are not reached due to lack of infrastructure and low levels of awareness. The biggest barrier in the provision of health was found to be lack of awareness followed by lack of policies and legal frameworks.
Ultimately, the paper assessed that telehealth provision by Zambian mobile service providers is fully functional or operational and the scope of improving the service in wide enough despite the challenges involved.