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Information and communications technologies in Health. TELEMEDICINE. Lecture


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University of Vic – Central University of Catalonia (UVic-UCC). Medical School

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Information and communications technologies in Health. TELEMEDICINE. Lecture

  1. 1. Dr Josep Vidal i Alaball ICT in Health Telemedicine Course 2018-2019 Medicine
  2. 2. 204/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  3. 3. 304/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  4. 4. 404/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  5. 5. 504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 86b2-4299-817d-dfa374e69059 Kahoot !
  6. 6. 604/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  7. 7. Index 704/06/2019 1.History of telemedicine 2.Types of telemedicine 3.Use of telemedicine 4.Evidence for telemedicine 5.Telemedicine in Central Catalonia 6.Other examples of telemedicine - eConsulta 7.Questions ICT in HealthMEDICINE Course 2018 - 2019
  8. 8. Definition of Telemedicine 804/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Telemedicine can be defined as “the use of telecommunications technology to provide medical information and services” (Perednia and Allen, 1995) or as “medicine practiced at a distance” (Wootton, 1996) In 1997, the World Health Organization defined telemedicine as: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (WHO, 1998).
  9. 9. History of Telemedicine 904/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  10. 10. History of Telemedicine 1004/06/2019ICT in HealthMEDICINE Course 2018 - 2019 It is very difficult to determine when telemedicine was used for the first time Zundel theorises that telemedicine in the form of bonfires may have been used as early as in the ancient Greece to transmit information relating to war or later on across Europe to transmit information about bubonic plagues (Zundel, 1996) Some authors have suggested telemedicine started in late 18th century with the invention of the telegraph. It is recorded that the telegraph was used in Australia to unite a dying man with his wife and in America during the American Civil War to pass information about wounded soldiers (Eikelboom, 2012).
  11. 11. History of Telemedicine 1104/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Other authors consider that the invention of the telephone by Graham Bell in 1875 constitutes the origin of telemedicine, as it is probable that the telephone was used to discuss medical matters between physicians (Garcia Vega, 2003) It is published that in 1879 the telephone was used by an anonymous doctor to listen to a cough and reassure a mother convinced that their child had croup. In that time, some experiments were done to transmit amplified heartbeats though the telephone (Aronson, 1977).
  12. 12. History of Telemedicine 1204/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Bashshur and Shannon explain that “from a technological perspective, modern telemedicine emerged from a continuous series of technological advancements in electronic communication and computer processing”. This advances started with the telegraph, continued with television and is now an ongoing process in the internet and digital age (Bashshur and Shannon, 2009).
  13. 13. Types of Telemedicine 1304/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  14. 14. Types of Telemedicine 1404/06/2019ICT in HealthMEDICINE Course 2018 - 2019 According to the timing of the information transmitted, there are 3 main types of telemedicine: 1. Store-and-forward or asynchronous (not real- time) telemedicine 2. Videoconference or synchronous (real-time time) telemedicine 3. Remote patient monitoring.
  15. 15. Types of Telemedicine 1504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Asynchronous. Clinical data is collected, stored, and then forwarded to be interpreted later It has the advantage that there is no need for the patient and the clinician to be available at the same time or place (American Telemedicine Association, 2013) Disadvantages: • There is no immediacy of direct patient contact • Some images can have poor quality • It may require repeat consultations if clinical details are not complete enough (Kanthraj and Srinivas, 2007).
  16. 16. Types of Telemedicine 1604/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Real-time time telemedicine It has the advantage of saving time by the opportunity to provide direct interaction between health care professionals that allow clarifying clinical details. Disadvantages: • Higher costs of the technology • Need for significant bandwidth • Video images may have lower resolution than photographs (Coates, Kvedar and Granstein, 2015).
  17. 17. Types of Telemedicine 1704/06/2019ICT in HealthMEDICINE Course 2018 - 2019 (Coates, Kvedar and Granstein, 2015)
  18. 18. Types of Telemedicine 1804/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Remote patient monitoring can be considered a type of telemedicine as patient’s health information is gathered with technological devices and send and stored in the patient’s electronic medical records for future evaluation and use (Daniel and Sulmasy, 2015) Useful in patients with chronic conditions. Can allow patients to maintain independence, prevent complications and minimize personal costs Uses sensors on a device enabled by wireless communication to measure physiological parameters
  19. 19. Types of Telemedicine 1904/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Wearables: Electronic devices with micro-controllers that can be worn on the body as implants or accessories
  20. 20. Examples of Telemedicine 2004/06/2019ICT in HealthMEDICINE Course 2018 - 2019 (Daniel and Sulmasy, 2015)
  21. 21. Use of Telemedicine 2104/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  22. 22. Global Survey on eHealth 2009 (WHO) 2204/06/2019ICT in HealthMEDICINE Course 2018 - 2019 The majority of telemedicine services, most of which focus on diagnosis and clinical management, are routinely offered in industrialized regions Some predict that telemedicine will profoundly transform the delivery of health services in the industrialized world by migrating health care delivery away from hospitals and clinics into homes In low-income countries and in regions with limited infrastructure, telemedicine applications are primarily used to link health-care providers with specialists, referral hospitals, and tertiary care centres.
  23. 23. Global Survey on eHealth 2009 (WHO) 2304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Potential barriers to telemedicine diffusion: • Costs +++ • Some patients and health care workers resist adopting service models that differ from traditional approaches • Shortage of studies documenting economic benefits and cost-effectiveness of telemedicine • Legal considerations: absence of an international legal framework • Technological challenges: the systems being used are complex.
  24. 24. Global Survey on eHealth 2009 (WHO) 2404/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  25. 25. Global Survey on eHealth 2009 (WHO) 2504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Approximately 30% of responding countries have a national agency for the promotion and development of telemedicine, and developing countries are as likely as developed countries to have such an agency (World Health Organization, 2010) Findings from the survey show that teleradiology currently has the highest rate of established service provision globally (33%)
  26. 26. Global Survey on eHealth 2009 (WHO) 2604/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Results of survey:
  27. 27. Global Survey on eHealth 2009 (WHO) 2704/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  28. 28. Global Survey on eHealth 2009 (WHO) 2804/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  29. 29. Global Survey on eHealth 2009 (WHO) 2904/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  30. 30. Global Survey on eHealth 2009 (WHO) 3004/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  31. 31. Evidence for Telemedicine 3104/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  32. 32. Efficacy and effectiveness of telemedicine 3204/06/2019ICT in HealthMEDICINE Course 2018 - 2019 In 2002, Hailey et al. published a large systematic review of 66 studies looking at the evidence for benefits of telemedicine and found little good quality studies However, they found convincing evidence of the efficacy and effectiveness of teleradiology, telepsychiatry, teleechocardiography, teledermatology and home telecare Savings and clinical benefits identified mainly derived from the avoidance of travel (Hailey, Roine and Ohinmaa, 2002).
  33. 33. Efficacy and effectiveness of telemedicine 3304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Ekeland et al. in 2010 published a comprehensive systematic review of reviews including 80 studies They found 31 reviews concluding that telemedicine was effective and 18 reviews with promising but incomplete evidence They concluded that the evidence base of the effectiveness of telemedicine was accumulating (Ekeland, Bowes and Flottorp, 2010).
  34. 34. Efficacy and effectiveness of telemedicine 3404/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Of all studies looking at the efficacy and effectiveness of the different telemedicine services, the largest number of studies came from teledermatology. The most assessed aspect of teledermatology is its accuracy, reliability and particularly interobserver concordance Nami et al. in a study including 391 patients obtained a concordance rate between face-to-face and store-and-forward teledermatology of 91.05% (Nami et al., 2015).
  35. 35. Access 3504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Access is one of the best studied aspects relating to telemedicine. Telemedicine provides better access to users in addition to reducing the waiting time between diagnosis in primary care and hospital In 2014 Vidal-Alaball et al. demonstrated that waiting times for the usual dermatology services could be reduced with teledermatology from a mean of 30 days before the implementation of teledermatology to a mean of 16 days after its implementation (Vidal-Alaball et al., 2014).
  36. 36. User and professional acceptance 3604/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Telemedicine services enjoy a high acceptance among users A cross-sectional satisfaction survey that included 1.734 patients reported 95% of patients were very satisfied with the quality of the health care they received (Polinski et al., 2016) Good professional acceptance has also been reported with teleulcer programmes. For example by Kolltveit et al. using focus groups to assess health professionals’ experience with a telemedicine programme (Kolltveit et al., 2016).
  37. 37. User and professional acceptance 3704/06/2019ICT in HealthMEDICINE Course 2018 - 2019 A comprehensive systematic review recently published by Mounessa et al. reported that patients and providers where highly satisfied with the 2 types of telemedicine: store-and-forward and real time telemedicine (Mounessa et al., 2017).
  38. 38. Costs of Telemedicine 3804/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Several studies have studied the costs of telemedicine using different methods of health economics Bashshur et al. published a literature review reporting the results of 7 studies comparing costs of teledermatology in primary care with face-to- face consultations. The methods used included cost-effectiveness analysis & cost-benefit analysis. They concluded that teledermatology in primary care is increasingly demonstrating to be cost- effective (Bashshur et al., 2016).
  39. 39. Limitations of Telemedicine 3904/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Armfield and colleagues have argued that despite the fact that we have a large literature base on telemedicine, the evidence base for it is limited as very few of the thousands of articles relating to medicine, telehealth or telecare on MEDLINE are incorporated into critically appraise summaries. Reasons: • It is difficult to use randomised controlled trials for determining the effectiveness of telemedicine • Clinicians are adopting telemedicine slowly and patchy They recommend that studies looking at telemedicine should look at efficacy, effectiveness, economic aspects and health worker’s preferences and these aspects should be introduced when designing telemedicine programs (Armfield et al., 2014).
  40. 40. Telemedicine in Central Catalonia 4004/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  41. 41. Telemedicine in Central Catalonia 4104/06/2019ICT in HealthMEDICINE Course 2018 - 2019 In the Catalonian central region, three counties, Anoia, Bages and Berguedà, have developed several telemedicine programs, which have had considerable success in reducing waiting lists while having wide acceptance among users Among the programs of telemedicine, the most successful is teledermatology and the most innovative are teleulcers and teleaudiometries Teledermatology was first introduced in the in the county of Anoia in 2007. Since them, this programme has evolved and has consolidated.
  42. 42. Telemedicine in Central Catalonia 4204/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  43. 43. Telemedicine in Central Catalonia 4304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 All telemedicine programs work in the same way; the primary care physician or nurse take a photograph of the lesion or the injury and attaches it to the electronic medical records of the patient along with an explanation of the injury The use of electronic medical records guaranties confidentiality of images, since it avoids potentially insecure electronic storage and e-mail The specialists of the hospital access the electronic medical records, review the images and propose a treatment or action plan.
  44. 44. Telemedicine in Central Catalonia 4404/06/2019ICT in HealthMEDICINE Course 2018 - 2019 The primary care physician or nurse review these instructions and makes a telephone call to the patient to explain the results of the consultation All of this can usually be done in less than 5-7 working days If the specialist of the hospital has any doubts, ask the primary care professional to refer the patient for a face-to-face visit.
  45. 45. Teledermatology 4504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 This program has had considerable success in reducing dermatology waiting lists, from a mean of 30 days (95% CI: 29-32) to a mean of 16 days (95% CI: 15-17) after its implementation (Vidal- Alaball et al., 2014).
  46. 46. TeleUlcers 4604/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Inspired by the good results of teledermatology, in November 2012 Teleulcers was introduced in the counties of Bages and Berguedà Teleulcers is a project aiming to improve the care of patient with chronic wounds or ulcers. Expert vascular advice is available for primary care nurses. Three main features define this service: 1. Transversality 2. Virtual teleconsultation system 3. Nursing leadership in the care of patients with chronic wounds (Navarro et al., 2014).
  47. 47. TeleAudiometries 4704/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Latest telemedicine service being introduced in Bages and Berguedà (2013). Has some similarities with teledermatology &Teleulcers but no photographs are taken Patients are referred to a Primary Care Centre when an audiometry is performed Audiometry, together with some clinical information is scanned and inserted in the electronic medical records Otorhinolaryngologist access electronic medical records, review the audiometry and propose an action plan Primary care physician reviews these instructions and makes a telephone call to the patient to explain results This service also used to follow up patients with hearing loss.
  48. 48. Teleaudiometries 4804/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  49. 49. TeleOphthalmology 4904/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Used to screen for diabetic retinopathy (DR) Photographs of the retina are taken by a nurse and included in the e-clinical history Primary Care doctors specialized in screening for DR access electronic medical records, review the photographs, write a diagnosis and suggest a follow up Primary care physician reviews these instructions
  50. 50. Other examples of Telemedicine 5004/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  51. 51. TeleStroke (“TeleIctus”) 5104/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Treatment of Cerebrovascular disease (CVD) Communicate a local hospital with a third level hospital with and on-call Neurologist (videoconferencing) The objective of offering better, more equitable and efficient care, to people who suffer from an episode of stroke or who is suspected of being suffering from it The system allows you to work from portable stations from which you can establish triple band multiconferencing systems through which the patient and the radiological image can be visualized simultaneusly.
  52. 52. TeleStroke (“TeleIctus”) 5204/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  53. 53. Teleburns 5304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Treatment of patients with severe burns Characteristics: • Perform a direct diagnosis by an expert doctor from the Burns Unit (videoconferencing) • Indicate the correct treatment and the type of subsequent control • Indicate, where appropriate, the transfer to the burning unit and the appropriate type of transport • Direct control of the evolution of the wounds • Register the patients or indicate their subsequent transfer if the evolution is not adequate • Medical / nursing training.
  54. 54. Teleburns 5404/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Advantages: • Avoid unnecessary journeys for patients • Receive treatment in a center closest to their home • Give added value to the quality of the treatment of burned patients.
  55. 55. Teleradiology 5504/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Communicate local hospitals with bigger hospitals with and on-call Radiologist (asynchronous – synchronous) Objectives: • Offer greater clinical coverage and better access to the diagnosis of radiological images • Improve diagnosis • Improve health care coverage. Possibility of providing 24- hour radiologists coverage in small hospitals • Saving costs through more efficient use of available resources.
  56. 56. Home monitorization: Arrhythmias - Pacemakers 5604/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Monitoring of chronic patients with arrhythmias to control them remotely Their wear a home monitor, connected to a defibrillator device, which periodically sends data to a web platform and from here on the hospital's website, where the Arrhythmias team carries out the follow-up Similar project to control remotely pacemakers. cardiaca
  57. 57. Private Services 5704/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Telepsicology platform that provides access to psychologists throughout Spain from anywhere at any time Insurance companies (“mutuas”) are increasingly offering Telemedicine services
  58. 58. Private Services 5804/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  59. 59. Telepediatrics 5904/06/2019ICT in HealthMEDICINE Course 2018 - 2019 On line consultations
  60. 60. eConsulta 6004/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  61. 61. eConsulta 6104/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  62. 62. eConsulta 6204/06/2019ICT in HealthMEDICINE Course 2018 - 2019
  63. 63. eConsulta 6304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 López Seguí F, Vidal Alaball J, Sagarra Castro M, García Altés A, García Cuyàs F Does teleconsultation reduce face to face visits? Evidence from the Catalan public primary care system JMIR Preprints. 25/04/2019:14478 DOI: 10.2196/preprints.14478 URL:
  64. 64. 6404/06/2019ICT in HealthMEDICINE Course 2018 - 2019 A cost minimisa on analysis of an asynchronous teledermatology service in the Catalan central region Josep Vidal-Alaball Primary Care Physician Catalonia
  65. 65. Cost minimisation analysis 6504/06/2019 The ain objective of this study was to assess the economic impact of asynchronous telemedicine services in the Catalan central region comparing the cost of teledermatology with the cost of traditional outpatient consultations A cost minimisation analysis comparing teledermatology with traditional dermatology consultations in the county of Bages was performed measuring direct and indirect costs of and the cost of the visits saved.
  66. 66. Results 6604/06/2019 During 2016, 5,606 patients were referred to the teledermatology service, of which 1,104 patients were further referred to traditional outpatient consultation (within the next 3 months). Consequently, the teledermatology service saved a total of 4,502 face-to-face visits Cost of primary care physicians and dermatologists: Service Primary Care Dermatology Initial consultations Telephone calls Face-to-face Teledermatology N. Visits min 45020 9004 67530 22510 4502 hours 750,3 150,1 1125,5 375,2 Cost 17333 3467 23073 7691
  67. 67. Cost minimisation analysis 6704/06/2019 Cost of time lost (patient) by primary care centre: Time adding Total time Time spent consultation with consultationin Primary TeleDM in hospital to hospital care visits Referrals Saved visits (25 mins) Minutes hours (20 mins) hours CAP MANRESA 2 1067 227 840 34 28560 476 16800 280,0 CAP SAGRADA FAMILIA 828 178 650 28 18200 303,3 13000 216,7 CAP SALLENT 376 53 323 40 12920 215,3 6460 107,7 CAP SANT FRUITÓS 294 64 230 32 7360 122,7 4600 76,7 CAP SANT JOAN DE VILATORRADA 494 105 389 36 14004 233,4 7780 129,7 CAP SANT VICENÇ DE CASTELLET 345 69 276 37 10212 170,2 5520 92,0 CAP SANTPEDOR 286 59 227 36 8172 136,2 4540 75,7 Other 1916 349 1567 1183 522,7 Total 5606 1104 4502 Total Time 2840 1500,7 Total € 60208 21815
  68. 68. Results 6804/06/2019 Patients would have travelled a total of 49,684 km if they had attended traditional outpatient consultations instead of using teledermatology. This amounts to 12,421 € in petrol Primary Care centre Saved visits Km to Hospital Saved Km Cost Km saved CAP MANRESA 2 840 2,8 2352 588 CAP SAGRADA FAMILIA 650 1,2 780 195 CAP SALLENT 323 15 4845 1211 CAP SANT FRUITÓS 230 6 1380 345 CAP SANT JOAN DE VILATORRADA 389 9 3501 875 CAP SANT VICENÇ DE CASTELLET 276 9,2 2539 635 CAP SANTPEDOR 227 9,2 2088 522 Other 1567 32199 8050 Total 4502 49684 12421
  69. 69. Results 6904/06/2019 The estimated added costs of the teledermatology service during 2016 were of 61,870 €. For the same period, the estimated costs of the traditional outpatient services if all patients had been referred to face-to-face visits would have been of 113,034€. This represents savings of 51,164 € during 2016 Since in 2016 a total of 4,502 patients used these services, the savings amount to 11.4 € per patient visited. Cost per year in € Teledermatology Dermatology Difference Equipment 1565 0 1565 Primary care staff 20799 17332 3467 Hospital staff 7691 23073 -15382 Subtotal 30055 40405 -10350 Society Time 31815 60208 -28393 Petrol 12421 -12421 TOTAL 61870 113034 -51164
  70. 70. Discussion 7004/06/2019 In the analysis, societal costs emerge as the variable with the biggest impact on our calculations; savings due to teledermatology amounted to 40,814 € per annum The main savings derived from time saved by not travelling to the hospital When removing societal costs, teledermatology savings amounted to 10,350 € in 2016 Staff costs were also significant, particularly in the hospital, since the use of teledermatology saved considerable time to dermatology consultants.
  71. 71. Discussion 7104/06/2019 In primary care, staff costs increased slightly with teledermatology because primary care physicians were required to phone patients to explain the results The setting of this study is the county of Bages. However, we believe that the data are extrapolable to the other regions of Catalonia. We calculated that the savings for the whole population of Catalonia (7,519,000 inhabitants) would amount to 2,085,061 € Conclusions: Using a teledermatology service instead of face-to-face dermatology consultations could save 11.4 € per patient visited.
  72. 72. 7204/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Questions?
  73. 73. Thank you ! 7304/06/2019ICT in HealthMEDICINE Course 2018 - 2019 Information/contact: Twitter/Instagram: @jvalaball
  74. 74. Bibliografia 7404/06/2019 • Perednia, D. and Allen, A. (1995) ‘Telemedicine technology and clinical applications.’, JAMA, 273(6), pp. 483–8. • Wootton, R. (1996) ‘Telemedicine: a cautious welcome’, BMJ. BMJ Publishing Group Ltd, 313(7069), pp. 1375–1377 • World Health Organization (1998) ‘A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics’, WHO Group Consultation on Health Telematics. Geneva: World Health Organization, pp. 1–39 • Zundel, K. M. (1996) ‘Telemedicine: history, applications, and impact on librarianship.’, Bulletin of the Medical Library Association, 84(1), pp. 71–9. • Eikelboom, R. H. (2012) ‘The telegraph and the beginnings of telemedicine in Australia’, Studies in Health Technology and Informatics, 182, pp. 67–72. • Garcia Vega, J. (2003) Teledermatología, Store-and-Forward. Santiago de Compostela: Servicio Galego de Saúde, Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, avalia-t. • Aronson, S. H. (1977) ‘The Lancet on the telephone 1876-1975.’, Medical history, 21(1), pp. 69–87. MEDICINE Course 2018 - 2019 ICT in Health
  75. 75. Bibliografia 7504/06/2019 • American Telemedicine Association (2013) State Medicaid Best Practice Store- and-Forward Telemedicine. • Coates, S. J., Kvedar, J. and Granstein, R. D. (2015) ‘Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice’, Journal of the American Academy of Dermatology. Elsevier Inc, 72(4), pp. 563–574. • Daniel, H. and Sulmasy, L. S. (2015) ‘Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper’, Annals of Internal Medicine, 163(April), pp. 787– 789. • World Health Organization (2010) ‘Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009’, Global Observatory for eHealth series. Geneva • Hailey, D., Roine, R. and Ohinmaa, A. (2002) ‘Systematic review of evidence for the benefits of telemedicine.’, Journal of telemedicine and telecare, 8 Suppl 1, pp. 1–30. MEDICINE Course 2018 - 2019 ICT in Health
  76. 76. Bibliografia 7604/06/2019 • Ekeland, A. G., Bowes, A. and Flottorp, S. (2010) ‘Effectiveness of telemedicine: a systematic review of reviews.’, International journal of medical informatics. Elsevier, 79(11), pp. 736–71 • Nami, N. et al. (2015) ‘Concordance and Time Estimation of Store-and-Forward Mobile Teledermatology Compared to Classical Face-to-Face Consultation’, Acta Dermato-Venereologica, 95(1), pp. 35–39. • Vidal-Alaball, J. et al. (2014) ‘Evaluación del impacto de la teledermatología en la disminución de la lista de espera en la comarca del Bages (2009-2012).’, Aten Primaria, pp. 9–10. • Polinski, J. M. et al. (2016) ‘Patients’ Satisfaction with and Preference for Telehealth Visits’, Journal of General Internal Medicine, 31(3), pp. 269–275 • Kolltveit, B.-C. H. et al. (2016) ‘Telemedicine in diabetes foot care delivery: health care professionals’ experience.’, BMC health services research. BMC Health Services Research, 16(1), p. 13 • Bashshur, R. L. et al. (2016) ‘The Empirical Foundations of Telemedicine Interventions in Primary Care’, Telemedicine and e-Health, 22(5), pp. 342–375 MEDICINE Course 2018 - 2019 ICT in Health
  77. 77. Bibliografia 7704/06/2019 • Armfield, N. R. et al. (2014) ‘Telemedicine - Is the cart being put before the horse?’, Medical Journal of Australia, 200(9), pp. 530–533. • Navarro, A. et al., 2014. Teleúlceres , una alternativa assistencial amb més d’un any d’experiència. ANNALS DE MEDICINA, 97(4), pp.159–162. • Orruño E, Gagnon M-P, Asua J, Abdeljelil A Ben. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011. 2011;17(June 2016):303–7. • Serrano Aguilar P, Yanes López V. Guía de diseño, evaluación e implantación de servicios de salud basados en telemedicina. Vol. 2006/27, Servicio de Evaluación del Servicio Canario de la Salud. Madrid; 2009. • Mounessa JS, Chapman S, Braunberger T, Qin R, Lipoff JB, Dellavalle RP, et al. A systematic review of satisfaction with teledermatology. J Telemed Telecare. 2017;0(0):1–8. • Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F, et al. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv Res. 2018;650(18):1-6. doi:10.1186/s12913-018-3464-4 MEDICINE Course 2018 - 2019 ICT in Health