Kathryn Pyle Krages

Diagnosis, access and outcomes: Update of a systematic review of telemedicine services

Telemedicine services are being increasingly used. Although insurers and other payers are covering some services in the USA, the rationale for these coverage decisions is not always evidence-based. We reviewed the literature for telemedicine services that substitute for face-to-face medical diagnosis and treatment. We focused on three types of telemedicine services: store-and-forward, home-based and office/hospital-based services. Studies were included if they were relevant to at least one of the three study areas, addressed at least one key question and contained reported results. We excluded articles that did not study a service requiring face-to-face encounters (i.e. teleradiology was excluded). Our search initially identified 4083 citations. After review, 597 were judged to be potentially relevant at the title/abstract level. Following a full-text review, 106 studies were included. Store-and-forward services have been studied in many specialties, the most common being dermatology, wound care and ophthalmology. The evidence for their efficacy is mixed. Several limited studies showed the benefits of home-based telemedicine interventions in chronic diseases. Studies of office/hospital-based telemedicine suggest that telemedicine is most effective for verbal interactions, e.g. videoconferencing for diagnosis and treatment in specialties like neurology and psychiatry. There are still significant gaps in the evidence base between where telemedicine is used and where its use is supported by high-quality evidence. Further well-designed research is necessary to understand how best to deploy telemedicine services in health care.

Outreach to Oregon Physicians and Hospitals: 5000 by 2000

Hcalth care is a much-debated subject in the 1990s. Concerns about cost, quality, and outcomes permeate both the popular media and the medical community. The quality of clinical decision making is now recognized as the primary manageable determinant of hospital expense and health care quality in this decade, and effective decision making in the health care setting is dependent on access to information. Timely and accurate information is needed for clinical care, outcomes evaluation and reporting, meeting regulatory requirements, and financial purposes. With advances in information technology physicians should be able to rely on information tools and networks to assist them in their clinical care. Yet, in the past hospital information systems have not been oriented toward aiding professional decision making and education.’ This is changing throughout the country as medical centers in numerous states accept the challenge of using computer networks t o extend clinical consulting.