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Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
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Index

A

Academic medical centers, 3, 18, 44.

See also individual facilities

Acceptability of telemedicine, 8, 152, 206

Acceptance of telemedicine.

See also Patient and clinician perspectives;

Patient satisfaction data

documented benefits and 80-81

health care restructuring and, 4, 81-82

human factors and, 73-82

patient, 80, 147

payment concerns, 81

professional, 79-80

Access to care

barriers, 173-174

definitions and concepts, 8, 32, 175-176, 205

and development of telemedicine, 2, 53

health information, 174

and quality of care, 192

questions about, 12-13, 176-179, 205

telecommunications rates and, 85

Advanced Research Projects Agency, 120 n.2, 239

Agamemnon, 34

Agency for Health Care Policy and Research, 22, 117

Allina Health care Systems, 52

Ambulatory care clinics, 38-39

American College of Physicians, 22

American College of Radiology, 72

American Medical Association, 98, 103, 106

American Medical Informatics Association, 41

American National Standards Institute, 69

American Society for Testing and Materials, 69

Americans with Disabilities Act, 103

Anesthesiology, 38

Annals of Internal Medicine, 154

Appropriateness of care, 12, 108, 110, 123, 166-167, 175-176, 178

Automated telephone-based services, 45, 129-130

B

Bell, Alexander Graham, 35

Bell Operating Companies, 240

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

Blue Cross and Blue Shield Association, 22, 109

Bowman Gray, 44

Brigham and Women's Hospital, 44

Business plan/project management plan, 3, 6, 148-149, 155, 202-203

C

Cable television

definition, 240

rates, 85

telemedicine applications, 38-39

California, confidentiality of medical records, 92

Cameras, digital, 50, 56

Center for Devices and Radiological Health, 113-114

Center for Health Policy Research, 122-124, 126, 132

Center for Health Services Research, 122

Cleveland State University, 129-130

Clinical applications of telemedicine.

See also specific applications

categories, 29-30

central/consulting site, 30, 58-59

definition, 28

diffusion of, 194

and evaluation, 116-117, 141

examples, 29, 31

remote site, 30, 58-59

Clinical decision support systems, 58

Clinical information systems, 58, 241

Clinical practice guidelines, 22, 98

Clinical Telemedicine Cooperative Group, 124, 133, 135-136

Clinicians. See Patient and clinician perspectives

Cochrane Collaboration, 22

CODEC, 50, 241

Colorado

confidentiality of medical records, 92

prison telemedicine program, 46

teleradiology standards, 100

Columbia University Health Sciences Division (New York), 237

Community effects of telemedicine, 9, 163

Comparison (control) group, 6, 150-151, 198, 203

Compressed video, 42, 241

Computed axial tomography, 42, 56

Computer Aided Diagnosis (CADx) Working Group, 115

Computer conferencing, 241

Computer systems

architecture, 239

compatibility issues, 68-69, 72-73, 77, 195

millennium problem, 73

multimedia, 78

peripheral equipment, 50, 246

regulation as medical devices, 114-115

standards, 98, 122-123

workstations, 35, 49, 50, 63, 77, 78, 115, 250

Conferencing. See Computer conferencing;

Teleconferencing

Confidentiality, 83, 92, 95, 101, 102, 196.

See also Privacy

Continuous quality improvement, 154-155, 166

Costs and cost-effectiveness of care.

See also Economic analyses;

Payment for services

data transmission technology and, 66

definition, 8

emergency services network, 53

prison telemedicine, 46-47

technology, 68, 78, 182, 186

teleconsultations, 52, 53

transportation issues, 180

Costs of technologies, 2, 39-40

Credentialing, 95-96

Croatia, 131

D

Data

bits, 66, 240

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

collection instruments, 133, 161, 171, 178, 187, 188, 207, 240

confidentiality, 102

quality issues, 123

Data security, 102.

See also Privacy

auditing and tracking programs, 107

authentication procedures, 107, 240

authorization procedures, 107

confidentiality agreements, 101

defined, 102

encryption, 107, 243

firewalls, 107, 243

systems, 101, 106-107

Data transmission

asynchronous, 239

bandwidth, 61, 63-65, 240

by coaxial cable, 65-66, 241

compressed, 42, 67, 241, 242

costs, 66

digital/digitizing, 66-67

packet switching, 67, 246

real-time, 65, 76, 129, 246

standards, 72, 123

store-and-forward technologies, 16-17, 50, 65, 77, 247

synchronous, 247

by telephone, 65

T1 (DS1) lines, 62, 63, 242

Demonstration projects.

See also specific projects

diversity, 41

evaluation, 86, 118, 124, 135, 148

funding, 85, 113

HCFA, 109

policies, 83-84, 85, 197

professional education, 39-40

rural economic development, 86

sustainability, 53, 74, 75, 118, 136, 138-139

Department of Commerce, 86, 117

Department of Defense

evaluation of telemedicine, 24, 117, 120-121, 130-131, 142, 204

Hospital Information System, 62, 63

projects, 39, 40;

see also Military telemedicine

Department of Health and Human Services, 86, 106, 117, 199-200.

See also Health Care Financing Administration;

National Library of Medicine;

Office of Rural Health Policy

Department of Health, Education and Welfare, 39

Department of Veterans Affairs, 40, 89, 117,121-122, 204. See also

VA facilities and services

Dermatology. See Teledermatology

Dialysis center, 49, 51

Digital images/imaging

conventional images compared to, 127-129

direct, 242

software, 86

store-and-forward technologies, 16-17

Digital Imaging and Communication in Medicine (DICOM) standard, 72, 242

Digital Imaging Network Project, 39

Digitizing, 42, 66-67, 242

Distance medicine, 28

Documentation of methods and results, 6, 154, 191, 202, 203

Drew Health Foundation, 51

E

East Carolina University School of Medicine, 47

Eastern Montana Telemedicine Network, 230-231

Eastern Oregon Human Services Consortium, 47-48

Eastern Oregon State College, 48

Economic analyses.

See also Costs and cost-effectiveness of care

billed charges, 182-183

capital costs, 181-182

conceptual challenges, 183-184

cost-benefit analysis, 181, 192-193

cost-effectiveness analysis, 181

decision rules, 184-186

definitions and concepts, 32, 180-183, 205-206

discounting, 182

dynamic simulation model, 134-135

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

level and perspective, 179-180

needs, 128, 198

patient vs provider perspectives, 148, 175

principles, 138

productivity assessment, 128

questions about, 13, 184, 185, 206

real-options vs net-present-value, 135

sensitivity analysis, 154, 184

teledermatology, 43 n.6

variable costs, 182

ECRI (formerly Emergency Care Research Institute), 22

Education and training

networks, 47

objectives and effects of telemedicine, 9, 153, 172-173

patient, 29

professional, 29, 36, 39-40, 42-43, 47, 48, 52, 66, 87, 88

radiology and pathology images, 42-43

technical, 58-59

Electrocardiograms, 38, 45, 51

Electronic housecall, 19, 21, 45-46

Electronic mail, 46, 77

Emergency services 911, 1, 36, 45

evaluation of, 167-168

image interpretation, 127-128

network, 52-53

telemetry, 38

Emory University, 44

Evaluation of telemedicine.

See also Research strategies

for access to care, 8, 12-13, 32, 173-179, 192, 205, 207

and acceptance, 8, 80-81, 205-207

assessment studies, 119, 128

business plan/project management plan, 3, 6, 148-149, 155, 202-203

categories, 118, 119, 134

challenges, 4-5, 10, 22, 116, 118, 183-184, 197-199

and continuous improvement, 154-155, 166

controlled vocabulary, 191-192

cooperation among institutions and individuals, 125, 198-199

criteria, 8, 32, 163, 191-192

definitions, 30-33

documentation of methods and results, 6, 154, 191, 202, 203

domains, 147, 162-163

economic analysis, 8, 13, 32, 47, 128, 134-135, 148, 156, 179-186, 192-193, 205-207

effectiveness and cost-effectiveness, 32, 132-136

elements, 144-154, 202-204

feasibility determinations, 140, 142-144, 191

federal role, 7, 117-118, 136, 141-142, 199-200, 204;

see also individual agencies

formative, 134, 193

frameworks, 2, 5-7, 17-18, 30-31, 86, 118-126, 137-161, 162, 173-174, 200-207

human factors assessment, 74-75, 155, 164, 195-196

importance, 137, 207-208

improvement of, 199-200, 207

institutional, 147

lack of evaluation, 17, 116-117

level of, 6, 146-148, 164, 179-180, 203

literature, 7, 126-127

needs assessment, 78-79

objectives, 12, 119, 136, 139-141, 145-146, 154

obstacles to, 118, 132, 137, 138, 184

patient and clinician perspectives, 14-15, 148, 186-190, 206

planning for, 138-144, 156, 201-202

policy-related variables, 84, 87

pooling of information, 124-125

population-directed, 32-33, 47, 164-165, 176, 178

principles, 5, 24-25, 137-138, 155, 200-201

priority-setting, 141-142

private-sector role, 7

processes of care, 6, 13, 151

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

project description, 144-145, 203

purpose, 17, 116, 194

for quality of care, 8, 11, 32, 128, 163, 165-173, 205-207

and reimbursement for services, 117, 123-124, 166

resource issues, 142

strategies;

see Research strategies

summative, 134

system/societal, 147-148, 179

telecardiology, 190

teledermatology, 125, 128-129, 131-132, 143, 144-145, 147

telepsychiatry, 45, 147, 162, 181

teleradiology, 44, 116, 124, 127-128, 147, 168

F

Fair Health Information Practices Act, 105

Fax machines, 77

Federal Communications Commission, 85

Federal Food, Drug, and Cosmetic Act, 114

Federation of State Medical Boards, 94-95

Florida, licensure laws, 90

Fluoroscopy, 38

Food and Drug Administration, medical device regulation, 57-58, 86, 113-115

Fort Detrick Army Medical Research and Materiel Command, 120

Freestanding specialty groups, 18

G

Gastroenterology applications, 47 n.7

General Accounting Office, 87

George Washington University, 40

Georgia, telemedicine reimbursements, 109

Grants, federal, 41, 47-48, 52, 229-238

Greater Oregon Behavioral Health, Inc., 48

H

Haiti, 131

Hardware.

See also Computer systems;

specific devices

compatibility, 77, 241

definition, 244

problems, 75-76

standards, 3, 69-72, 82, 98

Harvard Community Health Plan, 101

Health care administration, telemedicine applications in, 29, 52, 62, 63

Health Care Financing Administration (HCFA) (DHHS)

evaluation of telemedicine, 24, 117, 122, 123-124, 125, 126, 132-133, 134, 140-141, 199-200

grants, 236-237

payment policies, 107-109, 112, 123-124

Health Care Information Infrastructure (HCII), 244

Health care institutions, telemedicine capacity, 20

Health care restructuring, 4, 81-82, 105, 173, 199

Health care technologies, assessment of, 22-24

Health Information Applications Working Group, 74, 86

Health insurance programs, privacy issues, 103

Health Level Seven (HL7) standard, 69-72, 244

Health maintenance organizations (HMOs), 20, 51, 112, 159.

See also Managed care

Health Security Act of 1993, 105

Health Services Research, 154

Healthspan, 52

Hewlett-Packard, 49

High Performance Computing and Communications program, 86, 244

High Plains Rural Health Network, 232

Hippocratic Oath, 103

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

Home health options, 1, 44-46, 168, 184

Human factors in telemedicine

and acceptance of telemedicine, 73-82

assessment, 74-75, 155, 164, 195-196

cultural and socioeconomic, 79-82

needs and preference assessment, 78-79

equipment-related problems, 75-76

incorporation in existing practice, 76-78

recognition of, 74-75

I

Image processing, 244

Implementation of telemedicine, 138, 152, 155

Indiana, licensure laws, 90

Information Infrastructure Task Force Committee on Applications, 74, 86

Information technologies, 28, 60-61.

See also Clinical information

systems

Infrastructure.

See Technical infrastructure

Integrated services digital network (ISDN), 67, 244

Interactive video, 1, 16, 19, 28, 36, 38, 40-41, 48, 49, 50, 53

Interactive voice response systems, 45

Intergovernmental Health Policy Program, 87

International Standards Organizations, 69

Internet, 41, 46, 80, 125, 182, 244-245, 249.

See also World Wide

Web

Interstate telemedicine, 3, 83, 89-95

Iowa

Health System Telemedicine Demonstration, 236

programs and initiatives, 87

J

Jackson Memorial Hospital, Miami, 38

Jean-Talon Hospital, 36

Johns Hopkins University, 127-128

Joint Commission on Accreditation of Health care Organizations, 95, 96, 103, 114

Joint Working Group on Telemedicine, 7, 24, 40, 86, 119, 120, 162, 200

Journal of the American Medical Association, 154

Journals.

See also specific journals

on-line, 20

peer-review process, 20

research documentation guidance, 154

K

Kaiser Permanente of Southern California, 22

Kansas

Board of Healing Arts, 91

telemedicine reimbursements, 109

Kentucky Telecare, 232-233

L

Learning curve, 172

Legislation.

See also Medicare;

Payment for services;

individual topics

malpractice, 100

medical device, 114

national licensure, 93-94

privacy/confidentiality-related, 105-106

telecommunications, 66, 84-85, 132 n.5

Liability. See Malpractice liability

Licensure, professional

credentialing, 95-96

by endorsement, 91

issues, 3, 81, 83, 92

options, 93-95, 105

policies, current, 89-91, 196

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

Literature

buyers guide, 56

evaluation research, 116, 126, 149-150

outcome measures, 171

searches, 50

telemedicine applications, 40, 75

Lockheed Company, 39

Logan Airport, Boston, 38

Louisiana, licensure laws, 90

Lytton Gardens Health Care Center, 49-51

M

Macedonia, 131

Magnetic resonance imaging, 42

Malpractice liability

data security and, 106

issues, 3, 83, 97-99

options, 99-100

organizational, 99

policies, current, 96-97

Mammography, 113, 124, 128

Managed care

cost effectiveness, 180

payment policies, 108, 111

quality-of-care assessments, 163, 164-165

and professional opportunities, 174-175

telemedicine in, 3, 9, 18, 20, 32-33, 52-53

Mary Imogene Bassett Hospital, 231

Maryland

confidentiality of medical records, 92

trauma center, 89

Massachusetts General Hospital, 38

MDTV (Mountain Doctor Television), 229-230, 236-237 md/tv, inc., 49

Medica, 52

Medicaid, 180

Medical Advanced Technology Management Office, 120

Medical College of Georgia, 133-134, 236

Medical Device Amendments of 1976, 114

Medical devices

definition, 114

regulation of, 57-58, 86, 113-115

safety evaluation, 118

Medical Outcomes Study, 189

Medical Outcomes Trust, 22

Medical Privacy in the Age of New Technologies Act, 105

Medical Records Confidentiality Act, 105

Medicare, 3, 42, 43, 81, 102-103, 107-108, 109, 111, 112, 117, 134, 141, 196

Memorial University of Newfoundland, 39-40

Miami Fire Department, 38

Microscopy, 38

Microwave transmission, 34, 38, 66, 245

Mid-Nebraska Telemedicine Network, 231

Military telemedicine

evaluation of, 120-121, 130-131, 147, 168, 200

initiatives, 43, 56-57

interstate activities, 89

payment policies, 107

Minnesota

confidentiality of medical records, 92

telemedicine initiatives, 52

Missouri Telemedicine Network, 233

Mt. Sinai School of Medicine, New York City, 38-39

Multiorganization medical consortia, 18

N

National Academy of Engineering, 38

National Academy of Sciences Computer Science and Telecommunications Board, 102

National Aeronautics and Space Administration, 39

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

National Association of Insurance Commissioners, 106

National Commission on Quality Assurance, 95

National Electrical Manufacturers Association, 72

National Information Infrastructure, 2, 20-21, 60-61, 86, 245

National Institute of Standards and Technology, 117

National Library of Medicine (DHHS), 2

evaluation of telemedicine, 117, 129, 142, 199

Grateful Med, 24

literature on telemedicine, 40

Loansome Doc, 24

Medline, 20, 24

privacy/security initiatives, 102

real-time treatment technology programs, 235-236

testbed networks, 234-235

Uniform Medical Language System Metathesaurus, 192

virtual reality, 235

workshops/conferences on telemedicine, 74

National Naval Medical Center, Bethesda, 59, 62-63

National Telecommunications and Information Administration, 84-86, 117, 237-238

Naval Medical Center, Annapolis, 59

Nebraska programs and initiatives, 87, 89

Networks and networking.

See also specific networks

circuit switched, 241

communications, 72

definition, 61, 245-246

packet switched, 246

peer, 48

privacy and confidentiality issues, 104

professional education, 47, 48

public switched telephone (PSTN), 246

rural area, 52, 135, 247

specialty consultation, 135

switched, 247

teleradiology, 44

wide area, 250

Neurological applications, 36, 47 n.7

Nevada, licensure laws, 90

New York, confidentiality of medical records, 92

Norfolk State Hospital, 36

Norman, Donald, 73-74

North Carolina

Central Prison Telemedicine Project, 46-47

Emergency Consult Network, 168

programs and initiatives, 87, 167-168

Nurse practitioners, 39, 170, 172-173

Nurses, 18-19

emergency services, 53

telephone advisory services, 45

Nursing homes, telemedicine applications in, 38, 49-51

O

Office of Rural Health Policy (DHHS)

evaluation of telemedicine, 117, 135, 140, 142

grants, 41, 47-48, 52, 229-233

role in present study, 24

survey of telemedicine use, 20

workshops and conferences, 74-75

Oklahoma County, Oklahoma, City-County Health Department, 237

Oregon

ED-NET, 48, 88

evaluation research, 129, 131-132

Health Sciences University, 48, 129, 131-132

malpractice legislation, 100

telepsychiatry program, 47-49, 66

Outcomes of care, measures, 6, 9, 11, 32, 128, 134, 146, 152-153, 163, 170-171, 176, 192, 205, 207

P

Pacemaker surveillance, 45

Pacific Bell, 49

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

Paramedics, 38

Patient and clinician perspectives

methods and focus, 188

quality of care, 19, 186-187;

see also Patient satisfaction

questions, 14, 189-190, 206

Patient care, telemedicine applications, 29, 31, 38

Patient information systems

applications of telemedicine, 31, 50

benefits and risks, 104

compatibility, 72-73, 77

computer-based patient record (CPR), 58, 86, 99, 103-104, 121, 171, 204, 207, 241

and evaluation of telemedicine, 7, 160-161, 171, 204

Health Level Seven (HL7) standard, 69-72

and malpractice liability, 99

privacy and confidentiality, 3-4, 78, 83, 92, 95, 99, 101, 103-106, 196

security measures, 101, 105-106

utilization, 20

Veterans Administration, 121

Patient satisfaction data, 8, 14, 147, 163, 176, 186-187, 188, 206

Patients, telemedicine use, 19

Payment for services.

See also Medicare

and acceptability of telemedicine, 81

capitation payment/fixed budget, 108, 111-112, 166, 171-172, 180, 183

commercial organizations, 113

copayments, 112

demonstration projects and, 113

evaluation research and, 117

fee-for-service, 43 n.6, 107-110, 111, 166, 180, 196

per case or other bundled methods, 110-111, 171-172, 183

policies, 83, 196

radiology, 3, 42, 43

Pennsylvania

Keystone State Desktop Medical Conferencing Network, 238

licensure laws, 90

Physician hospital organizations (PHOs), 20

Physician Payment Review Commission, 109

Physicians.

See also Human factors in telemedicine;

Patient and clinician perspectives;

Practitioners

income concerns, 18

information technologies relevant to, 63

surplus, 18

use of telemedicine, 19-20

Picasso, 57

Picture archiving and communications system (PACS), 42, 43, 57, 62, 63, 114-115, 246

Policy issues. See Telemedicine policy

Postsurgical monitoring, 49-51

Practitioner-patient relationships, 18

Practitioners

databases, 92, 135

perceptions of telemedicine, 14-15

Preferred provider organizations (PPOs), 20

Prison telemedicine projects, 43 n.6, 46-47, 88, 89, 107

Privacy.

See also Confidentiality;

Data security

informational, 101-102

issues, 3-4, 83, 101, 103-105, 196

options, 105-106

policies, current, 102-103

technical and administrative options, 106-107

Processes of care, 11, 31, 167, 168-170

Psychiatry. See Telepsychiatry

Public health, telemedicine applications in, 29

Q

Quality of care

definitions and concepts, 8, 32, 165-168, 205

educational effects of telemedicine, 172-173

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

outcome measures, 167-168, 170-171

patient risk and, 171-172

patient satisfaction measures, 163, 206-207

practitioner concerns, 19

process measures, 168-170

questions about, 11, 168-172

severity of illness and, 171-172, 206

teledermatology, 43 n.6

types of problems, 166

volume-outcome hypothesis, 173

R

Radio News, 35-36, 37

Radiology. See Teleradiology

Radiotelemetry, 38

Rapid City Regional Hospital, 230

REACH-TV, 231-232, 237

Regional Bell Operating Companies, 49, 52, 246

Regulation of medical devices, 57-58, 86, 113-115

Research, telemedicine applications in, 29, 36

Research strategies.

See also Evaluation of telemedicine

administrative processes, 6, 151-152, 203

automated telephone-based strategies, 129-130

clinical aspects, 6, 13, 119, 120, 141, 146, 147, 151, 155, 156, 167, 203

clinical practice study, 160

comparison (control) group, 6, 150-151, 198, 203

data collection, 161, 171, 178

with deployed troops, 130-131

design, 6, 7, 10, 119, 139, 142, 143, 149-150, 155, 156-161, 164, 204

digital vs conventional images, 127-129

effectiveness trial, 159, 160

efficacy, 157, 159

event/problem logs, 152, 155

experimental design, 157, 159, 161, 204

experimental group, 6, 150-151, 203

large simple trials, 159

literature on, 149-150, 156-157, 171

nonexperimental, 161, 204

objectives, 6, 145-146, 162

outcome measures, 6, 9, 11, 32, 128, 134, 146, 152-153, 163, 165-166, 167, 168-169, 170-171, 176, 192, 203, 205

patient information systems and, 7, 160-161, 171, 204

processes of care, 11, 31, 167, 168-170

quasi-experimental, 160-161, 204

questions (research), 6, 7-9, 11-15, 119, 124, 125-126, 140, 145, 147, 162, 163-165, 168-172, 176-179, 184, 185, 189-190, 193, 199, 203, 205, 206

randomized clinical trials, 157, 159

retrospective analysis, 161, 168-169

sensitivity analysis, 5-7, 153-154, 156, 164-165, 203

technical infrastructure, 6, 151, 203

teledermatology services for rural areas, 131-132

test-of-concept, 119, 121, 126, 134, 143-144, 148, 150, 193, 201, 202

validity, 157-158, 160, 171, 191, 249

RODEO NET (Rural Options for Development and Educational Opportunities), 47-48

Rural Health Alliance Telemedicine Network, 52

Rural telemedicine

access issues, 173

dermatology, 131-132

cost effectiveness, 66, 85

effects, 9

payment for services, 112

psychiatry, 47-49

radiology, 43

utilization, 40

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

S

Saint Louis University School of Public Health, Missouri, 238

San Jose Medical Group, 51

Satellite systems, 66

Senate/House Ad Hoc Steering Committee on Telemedicine, 85

Sensitivity analysis

economic, 154, 184

research strategies, 5-7, 153-154, 156, 164-165, 203

Social security numbers, private market for, 105

Software

evaluation tools, 125-126

medical, regulation of, 57-58, 86, 115

Somalia, 43 n.6, 121, 131, 168

South Carolina, licensure laws, 90

South Dakota, licensure laws, 90

Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), 39

Speech therapy, 36

St. Paul Fire & Marine Insurance, 100

Standards/standardization

of care, 97, 100

hardware and software, 3, 69-72, 82, 98

medical devices, 113-114

questionnaires, 133, 161, 171, 178, 187

Stanford University Medical Center, 49-51, 129

State

confidentiality provisions, 102, 106

evaluation research, 118

licensure laws, 89-90, 102, 196

malpractice laws, 96-97

programs and initiatives, 40, 87-89

Stethoscope, electronic, 38, 50, 56

Store-and-forward technologies, 16-17, 50, 65, 77, 129, 247

Surgeon General of the Army, 117, 120

Surgery. See Telesurgery

Survey of telemedicine users, 40

Switching, advanced digital, 42

T

Tactile data, 31

Technical infrastructure

compatibility of systems, 3, 27, 67-69, 195

costs, 182

digital technologies, 66-67

equipment and space configurations, 59

information carrying capacity, 61-65

information restructuring, 66-67

innovations, 21

location of units, 77

obsolescence, 4, 72-73, 182, 197-198

projects, 87

service providers, services, and resources, 57

standards for hardware and software, 3, 69-72

technologies, 4, 35, 55-56, 59-73

transmission media, 65-66

user needs and circumstances and, 3, 58-59, 198

Technology training, 48

Telecardiology, 109, 190.

See also Electrocardiograms

Telecommunications.

See also Data transmission;

Telephone communications

costs, 2, 40, 63

definition, 248

evaluation of technology, 120

evolution of, 34-35

in health care sector, 56

infrastructure, 88

legislation, 66, 84-85, 132 n.5

media, 28

policy, 84-86

programs, 87

transoceanic, 38

Telecommunications Bill of 1996, 84-85

Teleconferencing

administrative, 62, 63

audio, 240

clinical, 49, 62, 63

definition, 248

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

educational, 20

interactive video, 16, 28, 48, 49, 62, 63, 249

real-time, 65

store-and-forward systems, 65

workstation, 49, 62, 63

Teleconsultation

cost-effectiveness, 52

definition, 248

diagnostic, 36, 38

equipment and space configurations, 51, 59, 62-63

interstate licensure policies, 90, 91

and malpractice, 98

in nursing homes, 49

payment policies, 107, 109

scheduling problems, 76-77

specialist, 52

utilization, 47 n.7, 131

Teledermatology

applications, 49, 51, 131

evaluation of, 125, 128-129, 131-132, 143, 144-145, 147

imaging, 56, 128-129, 143

rural applications, 131-132

utilization, 43 n.6, 47 n.7

Telediagnosis, 36, 38, 99, 167, 248

Telegraph, 34-35

Telemedicine.

See also Payment for services

applications, 1, 2-3, 7, 16-17, 19-20, 28-31, 40-53

context for, 18-22

definition, 1, 26-29, 248

development, 2-4, 35-40

demand for evidence of effectiveness, 1-2, 22-24, 109, 116

federal projects, 39;

see also Demonstration projects;

individual agencies and projects

growth and diversity, 40-41, 198, 201-202

inventory of projects, 86, 121

obstacles to use, 3-4, 53, 58-59, 67-68, 83, 107, 108, 195-196

status, 19-21

structure of report, 33

study origins and approach, 24-26

Telemedicine Information Exchange, 41, 125 n.3

Telemedicine Journal, 154

Telemedicine policy.

See also Licensure, professional;

Malpractice liability;

Payment for services;

Privacy;

Regulation of medical devices

national communications policy and, 84-86

state programs and initiatives, 87-89

Telemedicine Research Center, 124-126, 129

Telemedicine Testbed, 120

Telementoring, 27, 28, 248

Telemonitoring, 27, 45, 49-51, 130, 133 n.6, 168, 184, 248

Telepathology, 109, 116, 128

Telephone communications

advisory programs, 44-45

automated, 129-130

consultation and triage, 121

emergency 911, 1, 36, 45

evaluation of, 129-130

health risk assessment program, 129-130

history, 35, 77

human factors in, 77

importance, 53

lines, 65

monitoring system, 130

still-image system, 57

Telepresence, 27, 248-249

Telepsychiatry, 27, 36, 38, 45, 47-49, 65, 66, 104, 124, 147, 162, 175, 181

Telequest, 44

Teleradiology

applications of telemedicine, 20, 36, 38, 41-44, 121

digital image management, 39, 42, 57

economic benefits, 181

evaluation of, 44, 116, 124, 127-128, 147

filmless, 43, 243

growth of, 36, 38, 40-41

image quality, 127-128

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
×

networks, 39, 44

payment for services, 3, 42, 43, 109, 196

standards, 72, 100

workstation, 62, 63

Telesurgery, 1, 16, 86, 124

Television, 36, 37, 38.

See also Cable television;

Interactive video

Texas

licensure laws, 90

prison telemedicine program, 46, 88

Texas Tech, 47

Timeliness of care, 12-13, 128, 192

Total quality management, 166

Training effect, 153

Tripler Army Medical Center, 120

U

Uniform State Code for Telemedicine Licensure and Credentialing, 93

University of

California at San Francisco, 44

Colorado Health Sciences Center, 122

Iowa, 43

Miami School of Medicine, 38

Michigan, 133-134, 236

Minnesota Telemedicine Project, 233

Nebraska, 36, 87, 89

North Carolina at Chapel Hill, 230

Pennsylvania, 44

Texas Medical Branch at Galveston, 47

Washington, 135

Urban telemedicine

ambulatory care clinics, 38-39

emergency telemetric, 38

nursing homes, 38, 49-51

U.S. Constitution

Commerce Clause, 93

privacy protection, 102

U.S. Indian Health Service, 39

U.S. Office of Technology Assessment, 58, 105, 159-160, 161

U.S. Public Health Service, 39, 89

U.S. West, 52

Utah, initiatives and programs, 88

Utilization of telemedicine, 20, 40, 43 n.6, 47 n.7, 131, 153, 166, 169-170, 176, 178, 207

V

VA facilities and services

Baltimore medical center, 43, 121, 128

Bedford, Massachusetts, hospital, 38

Decentralized Hospital Computer Program, 43

evaluation of telemedicine, 200

pacemaker surveillance centers, 45

Palo Alto medical center, 121

San Francisco, 45

Washington, D.C., 45

Video technologies.

See also Interactive video

full-motion, 63

teleconferencing workstation, 62, 63

transmission considerations, 63-64

Virginia initiatives and programs, 88

Virtual glove, 31

Virtual reality, 86, 250

Voice mail, 77

W

WAMI Rural Telemedicine Network, 135, 233

West Virginia, evaluation research, 133, 134

West Virginia University, 229-230

Western Governors Association, 87, 93-94

World Wide Web, 20, 41, 42, 46, 47, 113 n.11, 250

X

X-rays, ship-to-shore transmission, 38.

See also Teleradiology

Suggested Citation:"INDEX." Institute of Medicine. 1996. Telemedicine: A Guide to Assessing Telecommunications for Health Care. Washington, DC: The National Academies Press. doi: 10.17226/5296.
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Telemedicine—the use of information and telecommunications technologies to provide and support health care when distance separates the participants—is receiving increasing attention not only in remote areas where health care access is troublesome but also in urban and suburban locations.

Yet the benefits and costs of this blend of medicine and digital technologies must be better demonstrated before today's cautious decision-makers invest significant funds in its development.

Telemedicine presents a framework for evaluating patient care applications of telemedicine. The book identifies managerial, technical, policy, legal, and human factors that must be taken into account in evaluating a telemedicine program. The committee reviews previous efforts to establish evaluation frameworks and reports on results from several completed studies of image transmission, consulting from remote locations, and other telemedicine programs.

The committee also examines basic elements of an evaluation and considers relevant issues of quality, accessibility, and cost of health care.

Telemedicine will be of immediate interest to anyone with interest in the clinical application of telemedicine.

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