David Balch

Patient Satisfaction with Telemedicine

The objective of this study was to evaluate patient satisfaction when telemedicine is used for clinical consultations. Patient satisfaction data from 495 real-time interactive telemedicine clinical consultations at the Telemedicine Center at East Carolina University School of Medicine in Greenville, NC were collected and evaluated. Patient satisfaction was examined in relation to patient age, gender, race, income, education, and insurance. Overall patient satisfaction was found to be 98.3%. Because so few patients were dissatisfied with their telemedicine consultation, correlation with the sociodemographic variables was limited. Patients are highly satisfied with consultations through telemedicine, and report that care was easier to obtain. The sample size in this study is larger than other reported telemedicine studies, but its findings are consistent with those of previous studies. In non-telemedicine settings where patient satisfaction has been studied, several significant factors have been correlated ...

Teledermatology: Issues in remote diagnosis and management of cutaneous disease

Abstract Since the 1970s, long distance communication technology has become highly developed. Along with the communications revolution has been a parallel in the use of the technology to deliver health care. Early work in rural Western states, Canada, and Europe laid the groundwork for the rapid expansion of telemedicine programs throughout the world in the 1990s. Dermatology has played an important role in many programs because of the visual nature of the field. Pilot programs in both interactive video and store-and-forward have demonstrated effectiveness in diagnosing cutaneous disease and skin tumors. Equally important to the delivery of teledermatologic care is the ability of dermatologists to make management recommendations beyond the training of most primary care physicians. Telemedicine technology is continuing to advance with improvements in cameras, lenses, and monitors and increased access to higher-end communications options such as integrated services digital network and digital subscriber lines. Further advances over the next decade in both hardware and software will likely further enhance the ability to diagnose cutaneous disease at a distance. As with any clinical practice, understanding the legal ramifications is very important before entering into a field. Licensure issues continue to be a barrier for teleconsultations across state lines. Consent for teleconsultations, credentialing where applicable, and liability and liability insurance issues are very important to address before starting a teleconsultation service. The technology of telemedicine, although decreasing in cost, still has a high price tag. To date there are few good data to justify teleconsultations on a cost savings basis. Intangible factors such as distance traveled for a live consultation and time away from work become important in the overall cost-effectiveness analysis but have little direct financial benefit for a practicing physician. Improvements in technology and increased accessibility often mean lower costs, which may eventually favor teleconsultations. Despite the cost and difficulties associated with teledermatology, it still presents itself as a very viable form of health care for rural or underserved populations and may serve to reach communities where dermatologists are not readily available. (Curr Probl Dermatol 2002;14:1-40.)

Developing a National Inventory of Telehealth Resources for Rapid and Effective Emergency Medical Care: A White Paper Developed by the American Telemedicine Association Emergency Preparedness and Response Special Interest Group

This document is a report from the American Telemedicine Association (ATA) Emergency Preparedness and Response (EPR) Special Interest Group (SIG). It addressed the issues in developing a national response to disaster using telehealth.

Telemedicine and endovascular aortic grafting

Endovascular aortic grafting represents a minimally invasive approach to aortic aneurysm repair. The technique requires a variety of new skills and extensive training. Telemedicine enhances mentoring and technical support for surgeons performing the technique.

Original ArticlesTelemedicine and endovascular aortic grafting1

Endovascular aortic grafting represents a minimally invasive approach to aortic aneurysm repair. The technique requires a variety of new skills and extensive training. Telemedicine enhances mentoring and technical support for surgeons performing the technique.