Michael J. Ackerman

Developing Next-Generation Telehealth Tools and Technologies: Patients, Systems, and Data Perspectives

The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?

Comparing In-Person, Video, and Telephonic Medical Interpretation

ABSTRACTBACKGROUNDUsing trained interpreters to provide medical interpretation services is superior to services provided on an ad hoc basis, but little is known about the effectiveness of providing their services remotely, especially using video.OBJECTIVETo compare remote medical interpretation services by trained interpreters via telephone and videoconference to those provided in-person.DESIGNQuasi-randomized control study.PARTICIPANTSTwo hundred and forty-one Spanish speaking patient volunteers, twenty-four health providers, and seven interpreters.APPROACHPatients, providers and interpreters each independently completed scales evaluating the quality of clinical encounters and, optionally, made free text comments. Interviews were conducted with 23 of the providers, the seven interpreters, and a subset of 30 patients. Time data were collected.RESULTSEncounters with in-person interpretation were rated significantly higher by providers and interpreters, while patients rated all methods the same. There were no significant differences in provider and interpreter ratings of remote methods. Provider and interpreter comments on scales and interview data support the higher in-person ratings, but they also showed a distinct preference for video over the phone. Phone interviews were significantly shorter than in-person.DISCUSSIONPatients rated interpretation services highly no matter how they were provided but experienced only the method employed at the time of the encounter. Providers and interpreters were exposed to all three methods, were more critical of remote methods, and preferred videoconferencing to the telephone as a remote method. The significantly shorter phone interviews raise questions about the prospects of miscommunication in telephonic interpretation, given the absence of a visual channel, but other factors might have affected time results. Since the patient population studied was Hispanic and predominantly female care must be taken in generalizing these results to other populations.

Evidence-based medicine among internal medicine residents in a community hospital program using smart phones.

BackgroundThis study implemented and evaluated a point-of-care, wireless Internet access using smart phones for information retrieval during daily clinical rounds and academic activities of internal medicine residents in a community hospital. We did the project to assess the feasibility of using smart phones as an alternative to reach online medical resources because we were unable to find previous studies of this type. In addition, we wanted to learn what Web-based information resources internal medicine residents were using and whether providing bedside, real-time access to medical information would be perceived useful for patient care and academic activities.MethodsWe equipped the medical teams in the hospital wards with smart phones (mobile phone/PDA hybrid devices) to provide immediate access to evidence-based resources developed at the National Library of Medicine as well as to other medical Websites. The emphasis of this project was to measure the convenience and feasibility of real-time access to current medical literature using smart phones.ResultsThe smart phones provided real-time mobile access to medical literature during daily rounds and clinical activities in the hospital. Physicians found these devices easy to use. A post-study survey showed that the information retrieved was perceived to be useful for patient care and academic activities.ConclusionIn community hospitals and ambulatory clinics without wireless networks where the majority of physicians work, real-time access to current medical literature may be achieved through smart phones. Immediate availability of reliable and updated information obtained from authoritative sources on the Web makes evidence-based practice in a community hospital a reality.

The PDA as a portal to knowledge sources in a wireless setting.

Two recent parallel developments, the widespread deployment of wireless networks and increased use of handheld devices like the personal digital assistant (PDA), have contributed to the development of mobile access to the Internet. Recent surveys show that approximately 25% or more of physicians use PDAs. Although used mainly for personal information management and static medical applications, PDAs have capabilities to connect to the Internet. We studied the use of handheld devices to access MEDLINE and other knowledge sources in a wireless setting.

Toward a Common Validation Methodology for Segmentation and Registration Algorithms

The National Library of Medicine and its partners are sponsoring Insight, a public software toolkit for segmentation and registration of high dimensional medical data. An essential element of this initiative is the development of a validation methodology, a common means of comparing the precision, accuracy, and efficiency of segmentation and registration methods. The goal is to make accessible the data, protocol standards, and support software necessary for a common platform for the whole medical image processing community. This paper outlines the issues and design principles for the test and training data and the supporting software that comprise the proposed Insight Validation Suite. We present the methods for establishing the functional design requirements. We also present a framework for the validation of segmentation and registration software and make some suggestions for validation trials. We conclude with some specific recommendations to improve the infrastructure for validating medical image processing research.

SLIM: an alternative Web interface for MEDLINE/PubMed searches - a preliminary study

BackgroundWith the rapid growth of medical information and the pervasiveness of the Internet, online search and retrieval systems have become indispensable tools in medicine. The progress of Web technologies can provide expert searching capabilities to non-expert information seekers. The objective of the project is to create an alternative search interface for MEDLINE/PubMed searches using JavaScript slider bars. SLIM, or Slider Interface for MEDLINE/PubMed searches, was developed with PHP and JavaScript. Interactive slider bars in the search form controlled search parameters such as limits, filters and MeSH terminologies. Connections to PubMed were done using the Entrez Programming Utilities (E-Utilities). Custom scripts were created to mimic the automatic term mapping process of Entrez. Page generation times for both local and remote connections were recorded.ResultsAlpha testing by developers showed SLIM to be functionally stable. Page generation times to simulate loading times were recorded the first week of alpha and beta testing. Average page generation times for the index page, previews and searches were 2.94 milliseconds, 0.63 seconds and 3.84 seconds, respectively. Eighteen physicians from the US, Australia and the Philippines participated in the beta testing and provided feedback through an online survey. Most users found the search interface user-friendly and easy to use. Information on MeSH terms and the ability to instantly hide and display abstracts were identified as distinctive features.ConclusionSLIM can be an interactive time-saving tool for online medical literature research that improves user control and capability to instantly refine and refocus search strategies. With continued development and by integrating search limits, methodology filters, MeSH terms and levels of evidence, SLIM may be useful in the practice of evidence-based medicine.

Virtual Microscopy: Potential Applications in Medical Education and Telemedicine in Countries with Developing Economies

We evaluated the diagnostic accuracy of a virtual microscopy setup using surgical pathology specimens commonly encountered in a university hospital setting. The high quality images, Internet sharing and collaborative capability, interactivity, and ease of use suggested to us that this might have applications in countries with developing economies. We discuss the development process and its potential applications in medical education and telemedicine in countries with developing economies.

Open source software for medical image processing and visualization

Societies often create smaller subsets or communities that connect with one another for commerce and intellectual exchange over mutual interests. In science and engineering, the need for communication among researchers is often hampered by artificial barriers of university politics, economic market forces, and the sheer momentum of an academic reward structure that values individual discovery over joint development. Recent initiatives have attempted to reduce some of these barriers, encouraging collaborative multidisciplinary research programs. Through this effort, we have studied the processes that lead to the successful foundation of new communities.

Cellular radio telecommunication for health care: benefits and risks.

Cellular radio telecommunication has increased exponentially with many applications to health care reported. The authors attempt to summarize published applications with demonstrated effect on health care, review briefly the rapid evolution of hardware and software standards, explain current limitations and future potential of data quality and security, and discuss issues of safety.

An exploratory study of co-location as a factor in synchronous, collaborative medical informatics distance education

BackgroundThis study determined differences in learning, judgments of teaching and technology, and interaction when videoconferencing was used to deliver instruction on telemedicine to medical students in conditions where they were co-located and dispersed. A lecture on telemedicine was given by videoconference to medical students at a distant site. After a question and answer period, students were then given search problems on the topic and encouraged to collaborate. Half the students were randomly assigned to a co-located condition where they received the presentation and collaborated in a computer lab, and half were assigned to a dispersed condition where they were located in different rooms to receive the presentation and collaborate online using the videoconferencing technology. Students were observed in both conditions and they individually completed a test on presentation content and a rating scale about the quality of the teaching and the technology.FindingsThere were no differences between the two groups in the learning outcomes or judgments about the teaching and technology, with the exception that more students in the dispersed condition felt more interaction was fostered. The level and patterns of interaction were very different in the two conditions and higher for dispersed students.ConclusionsSynchronous communication at a distance via videoconference may give sufficient sense of presence that the learning experience may be similar to that in actual classrooms, even when students are far apart. The technology may channel interaction in desirable ways.