Artykuły w czasopismach: „Telemedicine – United States”

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Hyder, Maryam A., i Junaid Razzak. "Telemedicine in the United States: An Introduction for Students and Residents". Journal of Medical Internet Research 22, nr 11 (24.11.2020): e20839. http://dx.doi.org/10.2196/20839.

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Telemedicine refers to the delivery of medical care and provision of general health services from a distance. Telemedicine has been practiced for decades with increasing evidence proving its potential for enhanced quality of care for patients, reduction in hospital readmissions, and increase in savings for both patients and providers. The COVID-19 pandemic has resulted in a significant increase in the reliance on telemedicine and telehealth for provision of health care services. Developments in telemedicine should be structured as complements to current health care procedures, not with the goal of completely digitizing the entire health care system, but rather to use the power of technology to enhance areas that may not be working at their full potential. At the same time, it is also clear that further research is needed on the effectiveness of telemedicine in terms of both financial and patient benefits. We discuss the current and rapidly increasing knowledge about the use of telemedicine in the United States, and identify the gaps in knowledge and opportunities for further research. Beginning with telemedicine’s origins in the United States to its widespread use during the COVID-19 pandemic, we highlight recent developments in legislation, accessibility, and acceptance of telemedicine.

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Cruz, Michael J., Edwin Nieblas-Bedolla, Christopher C. Young, Abdullah H. Feroze, John R. Williams, Richard G. Ellenbogen i Michael R. Levitt. "United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons". Neurosurgery 89, nr 3 (16.06.2021): 364–71. http://dx.doi.org/10.1093/neuros/nyab185.

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Abstract Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons’ familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.

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Brova, Monica, Krislyn M. Boggs, Kori S. Zachrison, Rachel D. Freid, Ashley F. Sullivan, Janice A. Espinola, Tehnaz P. Boyle i Carlos A. Camargo. "Pediatric Telemedicine Use in United States Emergency Departments". Academic Emergency Medicine 25, nr 12 (8.11.2018): 1427–32. http://dx.doi.org/10.1111/acem.13629.

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Kahn, Jeremy M., Brandon D. Cicero, David J. Wallace i Theodore J. Iwashyna. "Adoption of ICU Telemedicine in the United States". Critical Care Medicine 42, nr 2 (luty 2014): 362–68. http://dx.doi.org/10.1097/ccm.0b013e3182a6419f.

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Merrell, Ronald C., i Charles R. Doarn. "Congressional Earmarks and Telemedicine in the United States". Telemedicine and e-Health 14, nr 8 (październik 2008): 731–32. http://dx.doi.org/10.1089/tmj.2008.8486.

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Scheans, Patricia. "Telemedicine for Neonatal Resuscitation". Neonatal Network 33, nr 5 (2014): 283–88. http://dx.doi.org/10.1891/0730-0832.33.5.283.

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Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety. Telemedicine for neonatal resuscitation involves the addition of remote, expert NRP leadership (a NICU-based neonatal nurse practitioner) via camera link to augment effectiveness of the low-risk birth center team. Unanticipated outcomes to report include faster times to transfer initiation and neuroprotective cooling. The positive impact of remote NRP leadership could lead to use of telemedicine to support teams at birthing centers throughout the United States as well as around the world.

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Luciano, Edimara, M. Adam Mahmood i Parand Mansouri Rad. "Telemedicine adoption issues in the United States and Brazil: Perception of healthcare professionals". Health Informatics Journal 26, nr 4 (19.02.2020): 2344–61. http://dx.doi.org/10.1177/1460458220902957.

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Telemedicine has recently garnered more attention from healthcare professionals because it provides access to health services to patients in rural areas while making patient healthcare information more vulnerable to security breaches. The objective of this research is to identify factors that play a critical role in possible adoption of telemedicine in the United States and Brazil. A model with eight hypotheses was used to establish a research framework. A survey was conducted involving healthcare professionals in the aforementioned countries. The results show that telemedicine adoption is influenced by policies and culture in both countries and influenced by security and privacy in the United States. It can be inferred from the research that perceptions of the American and Brazilian healthcare professionals are similar in telemedicine issues covered in this research. These healthcare professionals, however, disagree on how patients’ privacy should be preserved in the two countries.

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김항중. "Physician Licensing Issue on Telemedicine in the United States". KYUNGPOOK NATIONAL UNIVERSITY LAW JOURNAL ll, nr 47 (sierpień 2014): 543–70. http://dx.doi.org/10.17248/knulaw..47.201408.543.

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Holt, Brennen, Iris Faraklas, Lou Theurer, Amalia Cochran i Jeffrey R. Saffle. "Telemedicine Use Among Burn Centers in the United States". Journal of Burn Care & Research 33, nr 1 (2012): 157–62. http://dx.doi.org/10.1097/bcr.0b013e31823d0b68.

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DOARN, CHARLES R., ARNAULD E. NICOGOSSIAN i RONALD C. MERRELL. "Applications of Telemedicine in the United States Space Program". Telemedicine Journal 4, nr 1 (styczeń 1998): 19–30. http://dx.doi.org/10.1089/tmj.1.1998.4.19.

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Scholastica Ijeh, Chioma Anthonia Okolo, Jeremiah Olawumi Arowoogun i Adekunle Oyeyemi Adeniyi. "Theoretical insights into telemedicine and healthcare ICT: lessons from implementation in Africa and the United States". World Journal of Biology Pharmacy and Health Sciences 18, nr 2 (30.04.2024): 115–22. http://dx.doi.org/10.30574/wjbphs.2024.18.1.0168.

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This review paper explores the theoretical insights and practical lessons learned from the implementation of telemedicine and healthcare Information and Communication Technology (ICT) in Africa and the United States. By comparing the challenges, strategies, and outcomes of telemedicine initiatives in these diverse healthcare settings, the paper highlights the importance of context-specific solutions, supportive policy frameworks, and the role of technology in overcoming barriers to healthcare access. The analysis reveals key theoretical frameworks such as the adaptive model of telemedicine implementation and the ecosystem approach, emphasizing the necessity for flexibility, interoperability, and equity in telemedicine services. The paper concludes with implications for healthcare providers, policymakers, ICT developers, and recommendations for future research, aiming to enhance the global understanding and deployment of telemedicine.

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Nirisha, P. Lakshmi, Srinagesh Mannekote Thippaiah, Rachel E. Fargason, Barikar C. Malathesh, Narayana Manjunatha, Suresh Bada Math, Badari Birur i Channaveerachari Naveen Kumar. "Telepsychiatry and Medical Insurance: Comparative Perspectives Between India and the United States". Indian Journal of Psychological Medicine 42, nr 5_suppl (październik 2020): 92S—97S. http://dx.doi.org/10.1177/0253717620963274.

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Telepsychiatry is a cost-effective alternative to in-person psychiatric consultations. The COVID-19 pandemic brought about a sharp spike in the utilization of telepsychiatry due to ongoing restrictions on gatherings and traveling. In recognition of the importance of telemedicine in general, and telepsychiatry specifically, telemedicine practice guidelines and telepsychiatry operational guidelines have been released. Due to the rising trend in telemedicine, the Insurance Regulatory and Development Authority of India (IRDIA) incorporated teleconsultation health insurance coverage at a level on par with regular in-person consultations. In contrast, in the United States of America, private insurance coverage for telepsychiatry has been in vogue for some time. In this paper we draw comparisons between India and the United States on telepsychiatry and health insurance. We compare the evolving regulatory policies of these two countries in relation to existing insurances plans that are available, the challenges in implementation of new regulations and the possible ways to overcome the challenges to make telepsychiatry affordable to all.

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Molfenter, Todd, Roger Brown, Andrew O’Neill, Ed Kopetsky i Alexander Toy. "Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics". International Journal of Telemedicine and Applications 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/3932643.

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Telemedicine applications offer innovative approaches for treating and reducing the effects of substance use disorders (SUDs). This analysis assessed the interest in and use of 11 telemedicine applications in a sample of 363 SUD organizations in the United States of America. Fifty percent of the organizations expressed high rates of interest in seven of the telemedicine applications, demonstrating the appeal of telemedicine within this field. The top three self-reported telemedicine applications being used were (1) computerized screening/assessments (44.6%), (2) telephone-based recovery supports (29.5%), and (3) telephone-based therapy (28.37%). The greatest gaps between interest and use were for (1) texting appointment reminders (55.2% differential), (2) mobile apps for posttreatment recovery (46.6% differential), and (3) recovery support chats (46.6% differential). A Latent Class Analysis (LCA) of the organizations’ telemedicine use behavior identified three groupings: “Innovators” that were using a range of technologies (n=27, 7.4%); “Technology Traditionalists” that limited their use to telephone, video, and web portal technologies (n=101, 27.8%); and “Low Tech” that had low overall technology use (n=235, 64.7%). Future studies should build on how telemedicine could be applied in SUD settings, organizational behaviors towards its adoption, and telemedicine’s effect on treatment adherence and clinical outcomes.

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Lopez, Ana Maria, Kenneth Lam i Ramya Thota. "Barriers and Facilitators to Telemedicine: Can You Hear Me Now?" American Society of Clinical Oncology Educational Book, nr 41 (marzec 2021): 25–36. http://dx.doi.org/10.1200/edbk_320827.

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In its most direct interpretation, telemedicine is medical care provided at a distance. Although telemedicine’s use had been steadily increasing, the COVID-19 pandemic prompted an unprecedented interest and urgency among patients, health care professionals, and policymakers to facilitate health care devoid of the need for in-person contact. The growth in personal access to telecommunications technology meant an unprecedented number of people in the United States and around the world had access to the equipment and technology that would make virtual care possible from the home. As the mass implementation of telemedicine unfolded, it became quickly apparent that scaling up the use of telemedicine presented considerable new challenges, some of which worsened disparities. This article describes those challenges by examining the history of telemedicine, its role in both supporting access and creating new barriers to access in trying to get everyone connected, frameworks for thinking about those barriers, and facilitators that may help overcome them, with a particular focus on older adults and patients with cancer in rural communities.

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Whitten, Pamela, i Lorraine Buis. "Private Payer Reimbursement for Telemedicine Services in The United States". Telemedicine and e-Health 13, nr 1 (luty 2007): 15–24. http://dx.doi.org/10.1089/tmj.2006.0028.

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Bashshur, Rashid. "Telemedicine and State-Based Licensure in the United States, Revisited". Telemedicine and e-Health 14, nr 4 (maj 2008): 310–11. http://dx.doi.org/10.1089/tmj.2008.9977.

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Crossen, Stephanie S., Crystal C. Romero, Lindsey A. Loomba i Nicole S. Glaser. "Patient Perspectives on Use of Video Telemedicine for Type 1 Diabetes Care in the United States during the COVID-19 Pandemic". Endocrines 2, nr 4 (1.11.2021): 449–56. http://dx.doi.org/10.3390/endocrines2040040.

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The COVID-19 pandemic has resulted in widespread adoption of telemedicine for management of chronic conditions such as type 1 diabetes (T1D), but few data have been collected about the patient experience and perceived quality of care during this time. We surveyed members of the T1D Exchange patient registry and online community regarding their experiences with and opinions about telemedicine care during the pandemic. Among 2235 survey respondents, 65% had utilized telemedicine. The most common reasons for adopting telemedicine were providers not offering in-person care (66%), concerns about the health risks of in-person care (59%), providers offering (52%) or insurance covering (19%) telemedicine for the first time, and local or state orders to stay home (33%). Among telemedicine users, 62% felt video care was as effective as or more effective than in-person care, and 82% hoped to use telemedicine in the future. The most-cited reason for non-use of telemedicine was that providers were not offering it (49%). Our findings highlight the role of telemedicine in maintaining access to T1D care during the COVID-19 pandemic. Respondents’ satisfaction with telemedicine and interest in its continued use signifies the need for ongoing access to this care modality and for the development of telemedicine best practices within T1D care.

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Josh Chandra, Abdoul Mbaye i Merve Gokgol. "Analyzing the Effectiveness of Non-remote Monitoring Telemedicine Within the United States After 2019, Including Future Implications as a Healthcare Medium, Regarding Its Statistical and Analytical Disciplines: A Systematic Review". Proceedings of London International Conferences, nr 10 (4.06.2024): 116–34. http://dx.doi.org/10.31039/plic.2024.10.216.

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Telemedicine is the utilization of healthcare services remotely via numerous applications that connect the patient with a qualified physician. Telemedicine plays a vital role in providing accessible healthcare to individuals who are unable to do an in-person visit, and its involvement in healthcare is analyzed through the analytical/statistical lens, financial lens, and ethical lens. Telemedicine systems have demonstrated their potential to serve as a functional healthcare medium, but many barriers to an increase in its implementation and efficacy still exist after the COVID-19 pandemic. Despite the importance of telemedicine, knowledge of its implied efficacy and efficiency in providing healthcare is poor, and already existing research doesn’t address solutions to the barriers of telemedicine. The research aims to address this gap by doing a comprehensive, systematic literature review on the efficacy, barriers to implementation, practicality, and future implications of telemedicine’s utilization in the healthcare sphere. Furthermore, by adding a unique perspective on this topic and consolidating research data for the general healthcare field to utilize, this further addresses missing medical knowledge regarding telemedicine consultations. This research screened 737 different articles and papers to gather information regarding telemedicine and its efficacy. Results were filtered and screened using the PRISMA method to maintain a standard of high-quality, impartial, and accurate data throughout the research paper. Only the sources which pertained to the research question were chosen to be included in the paper. Trends were identified in the chosen articles, which were viewed by the contributors and referenced in the paper. Telemedicine has demonstrated profound evidence of benefits for both patients and healthcare administrations. However, concerns regarding its accessibility and efficacy remain. Suggestions are made for medical administrations and for public knowledge to provide solutions for these concerns.

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Hartzell, Sarah YT. "Telemedicine in a primary care clinic in Fairbanks, Alaska: Not a magic bullet for providing treatment during COVID-19". Journal of Medicine Access 6 (styczeń 2022): 275508342210858. http://dx.doi.org/10.1177/27550834221085878.

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Stay-at-home orders due to the COVID-19 pandemic have increased patients’ reliance on virtual physician visits, via telemedicine. Telemedicine has benefits of use during the pandemic and has benefits outside of the pandemic. It is underutilized in certain types of medical organizations, providers, and among specific populations in the United States. It is important to understand the barriers to incorporating telemedicine effectively in the areas that it is underutilized, especially in rural locations. The researcher discussed the telemedicine expansion for two family practice doctors in Fairbanks, Alaska (AK). The family practice doctors experienced barriers that partially echo what has been stated in research. Research suggests that changes to Medicare and Medicaid telemedicine policies may not be enough to address these barriers. Other supports to expand telemedicine where it is needed includes providing more incentives to providers, waivers from insurance companies for patients to purchase equipment, and more education to patients about when, how, and where to receive telemedicine. More supports need to be provided to those underserved by telemedicine, especially for clients who are on Medicaid, living in low-income areas, and/or living in rural locations.

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Lyu, Qixin. "Analyze the Effectiveness of Telemedicine in Providing Healthcare Services in the United States". Advances in Economics, Management and Political Sciences 78, nr 1 (18.04.2024): 134–41. http://dx.doi.org/10.54254/2754-1169/78/20241660.

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The United States (US) government spending on the healthcare system is one of the highest in the world. However, the US healthcare outcome compared to other OECD countries is below average. This is caused by the number of patients visiting healthcare services remain low compared to the OECD countries due to the following reasons: affordability, allocation of healthcare services, and accessibility. The lack of universal coverage in the US healthcare system poses a challenge of affordability to patients. This led to a high out-of-pocket spending on healthcare services and patients will choose to skip or delay the treatment. Allocation of healthcare services such as the lack of patients and the hospital beds caused a high waiting time and caused patients unwillingly to access to healthcare services. The long-distance travel in the rural area led to low accessibility to healthcare services. Telemedicine is a method that allows the delivery of healthcare services remotely using technology that can solve the US healthcare problems. The adoption of telemedicine in the US healthcare system has experienced a substantial increase during the period of Covid. The analysis on the effectiveness of using telemedicine to provide healthcare services in the US healthcare system will be conducted based on factors related to the existing challenges.

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Paterick, Timothy. "Telemedicine: Physicians Would Be Prudent to Mitigate Liability Risk". Healthcare Administration Leadership & Management Journal 1, nr 2 (8.06.2023): 78–80. http://dx.doi.org/10.55834/halmj.3514899307.

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The COVID-19 pandemic resulted in the widespread introduction and use of telemedicine in academic and private practices across the United States. Physicians were introduced to telemedicine without an understanding of how their fiduciary duties were to be handled in this new paradigm of a doctor–patient relationship over video-conferencing. The learning curve is steep, and there are many medical, legal, and ethical issues that need to be understood for physicians to meet the new duties of telemedicine and avoid the potential for liability.

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Uscher-Pines, Lori, i Jeremy M. Kahn. "Barriers and Facilitators to Pediatric Emergency Telemedicine in the United States". Telemedicine and e-Health 20, nr 11 (listopad 2014): 990–96. http://dx.doi.org/10.1089/tmj.2014.0015.

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Guthrie, Jennifer D., i Jennifer A. Snyder. "Improving access to care for underserved communities through telemedicine". JAAPA 36, nr 9 (wrzesień 2023): 41–44. http://dx.doi.org/10.1097/01.jaa.0000947040.98500.2e.

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ABSTRACT Telemedicine use expanded rapidly during the COVID-19 pandemic, giving patients access to quality care while reducing the spread of infection. Although beneficial changes were made to reimbursement and privacy guidelines to increase the ease of telemedicine for clinicians, the lack of digital devices, Internet, digital knowledge, and trust in this method of delivery are potential barriers to telemedicine for healthcare visits, and may have widened the care gap for underserved patients. To ensure that patients of all socioeconomic levels have access to telemedicine requires education, expanding broadband Internet access across the United States, and offering free or reduced Internet services to patients in need.

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Betancourt, Jose A., Matthew A. Rosenberg, Ashley Zevallos, Jon R. Brown i Michael Mileski. "The Impact of COVID-19 on Telemedicine Utilization Across Multiple Service Lines in the United States". Healthcare 8, nr 4 (1.10.2020): 380. http://dx.doi.org/10.3390/healthcare8040380.

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The impact of COVID-19 on the U.S. healthcare industry cannot be overstated. Telemedicine utilization increased overnight as all healthcare providers rushed to implement this delivery model to ensure accessibility and continuity of patient care. Our research objective was to determine measures that were implemented to accommodate community and individual patient needs to afford access to critical services and to maintain safety standards. We analyzed literature since 2016 from two databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We compared observations, themes, service lines addressed, issues identified, and interventions requiring in-person care. From 44 articles published, we identified ten effectiveness themes overall and drew conclusions on service line successes. COVID-19 has caused rapid expansion in telemedicine. Necessary and required changes in access, risk mitigation, the need for social distancing, compliance, cost, and patient satisfaction are a few of the driving factors. This review showcased the healthcare industry’s ability to rapidly acclimate and change despite the pervasive spread of COVID-19 throughout the U.S. Although imperfect, unique responses were developed within telemedicine platforms to mitigate disruptions broadly and effectively in care and treatment modalities.

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Shin, Tiffany M., Pilar Ortega i Karol Hardin. "Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency". Challenges 12, nr 2 (15.12.2021): 34. http://dx.doi.org/10.3390/challe12020034.

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The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

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Santen, Richard J. "Recruiting retired specialists back into part-time practice via telemedicine". Open Access Government 43, nr 1 (8.07.2024): 182–83. http://dx.doi.org/10.56367/oag-043-10840.

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Recruiting retired specialists back into part-time practice via telemedicine Richard J. Santen, MD, Emeritus Professor of Medicine at the University of Virginia in Charlottesville, Virginia, U.S., looks at how to recruit retired specialists to practice part-time via telemedicine. Patients living in rural, underserved areas in the United States (U.S.) lack access to specialists for care of complicated medical problems. Specialists generally practice in cities and choose not to live in rural areas based on several financial, geographical, and social reasons. A potential solution to this problem involves convincing retired specialists to go back into practice part-time and use telemedicine to fill the need in these rural, underserved areas.

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Sterling, Ryan, i Cynthia LeRouge. "On-Demand Telemedicine as a Disruptive Health Technology: Qualitative Study Exploring Emerging Business Models and Strategies Among Early Adopter Organizations in the United States". Journal of Medical Internet Research 21, nr 11 (15.11.2019): e14304. http://dx.doi.org/10.2196/14304.

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Background On-demand telemedicine is increasingly adopted by health organizations to meet patient demand for convenient, accessible, and affordable services. Little guidance is currently available to new entrant organizations as they consider viable business models and strategies to harness the disruptive potential of on-demand telemedicine services (in particular, virtual urgent care clinics [VCCs] as a predominant and catalyst form of on-demand telemedicine). Objective We recognized on-demand telemedicine as a disruptive technology to explore the experiences of early adopter organizations as they launch on-demand telemedicine services and deploy business models and strategies. Focusing on VCC service lines, this study addressed the following research questions: (1) what is the emerging business model being deployed for on-demand telemedicine?; (2) what are the core components of the emerging business model for on-demand telemedicine?; and (3) what are the disruptive business strategies employed by early adopter organizations as they launch on-demand telemedicine services? Methods This qualitative study gathered data from 32 semistructured phone interviews with key informants from 19 VCC early adopter organizations across the United States. Interview protocols were developed based on noted dissemination and implementation science frameworks. We used the constant comparison method to transform study data into stable dimensions that revealed emerging business models, core business model components (value proposition, key resources, key processes, and profit formula), and accompanying business strategies. Results Early adopters are deploying business models that most closely align with a value-adding process model archetype. By and large, we found that this general model appropriately matches resources, processes, and profit formulas to support the disruptive potential of on-demand telemedicine. In total, 4 business strategy areas were discovered to particularly contribute to business model success for on-demand disruption among early adopters: fundamental disruptions to the model of care delivery; outsourcing support for on-demand services; disruptive market strategies to target potential users; and new and unexpected organizational partnerships to increase return on investment. Conclusions On-demand telemedicine is a potentially disruptive innovation currently in the early adopter stage of technology adoption and diffusion. On-demand telemedicine must cross into the early majority stage to truly be a positive disruption that will increase accessibility and affordability for health care consumers. Our findings provide guidance for adopter organizations as they seek to deploy viable business models and successful strategies to smooth the transition to early majority status. We present important insights for both early adopters and potential early majority organizations to better harness the disruptive potential of on-demand telemedicine.

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WATSON, NINA, DORIS G. ACUNA, JANA L. WARDIAN, ELLEN C. COBB, DAVID BEAVERS i TOM J. SAUERWEIN. "Diabetes Self-Management Education via Telemedicine in the United States Air Force". Diabetes 67, Supplement 1 (maj 2018): 650—P. http://dx.doi.org/10.2337/db18-650-p.

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Whitten, Pamela, i Beverly Davenport Sypher. "Evolution of Telemedicine from an Applied Communication Perspective in the United States". Telemedicine and e-Health 12, nr 5 (październik 2006): 590–600. http://dx.doi.org/10.1089/tmj.2006.12.590.

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Ohannessian, Robin, Tu Anh Duong i Anna Odone. "Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action". JMIR Public Health and Surveillance 6, nr 2 (2.04.2020): e18810. http://dx.doi.org/10.2196/18810.

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On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine.

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Zdravkovic, Svetozar. "Could telemedicine generate.med as top-level domain name?" Archive of Oncology 12, nr 2 (2004): 124–26. http://dx.doi.org/10.2298/aoo0402124z.

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The article presents a consideration of top-level domain names and possibility that telemedicine generates top-level domain name for medicine itself. Using the United States of America domain, the article has tried to explain all the most important facts about top-level domain names. It has also presents a current situation about responsibility in this sector and the mode to adopt new top-level domains.

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Mann, Devin M., Ji Chen, Rumi Chunara, Paul A. Testa i Oded Nov. "COVID-19 transforms health care through telemedicine: Evidence from the field". Journal of the American Medical Informatics Association 27, nr 7 (29.05.2020): 1132–35. http://dx.doi.org/10.1093/jamia/ocaa072.

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Abstract This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and nonurgent healthcare delivery from one large health system (NYU Langone Health) at the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 102.4 daily to 801.6 daily. (683% increase) in urgent care after the system-wide expansion of virtual urgent care staff in response to COVID-19. Of all virtual visits post expansion, 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19–related. Telemedicine usage was highest by patients 20 to 44 years of age, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.

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Taha, Anas, Bara Saad, Bassey Enodien, Marta Bachmann, Daniel M. Frey i Stephanie Taha-Mehlitz. "The Development of Telemedicine and eHealth in Surgery during the SARS-CoV-2 Pandemic". International Journal of Environmental Research and Public Health 18, nr 22 (15.11.2021): 11969. http://dx.doi.org/10.3390/ijerph182211969.

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SARS-CoV-2 has hampered healthcare systems worldwide, but some countries have found new opportunities and methods to combat it. In this study, we focused on the rapid growth of telemedicine during the pandemic around the world. We conducted a systematic literature review of all the articles published up to the present year, 2021, by following the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The data extracted comprised eHealth and telemedicine in surgery globally, and independently in Europe, the United States, and Switzerland. This review explicitly included fifty-nine studies. Out of all the articles included, none of them found that telemedicine causes poor outcomes in patients. Telemedicine has created a new path in the world of healthcare, revolutionizing how healthcare is delivered to patients and developing alternative methods for clinicians.

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Sukhov, Renat, Afua Asante i Gavriil Ilizarov. "Telemedicine for pediatric physiatry: How social distancing can bring physicians and families closer together". Journal of Pediatric Rehabilitation Medicine 13, nr 3 (23.11.2020): 329–38. http://dx.doi.org/10.3233/prm-200747.

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The coronavirus (COVID-19) pandemic triggered wide scale implementation of telemedicine in the United States. The government response, Coronavirus Aid, Relief, and Economic Security (CARES) Act, permitted loosening of existing restrictions on telemedicine enabling its rapid incorporation into the delivery of medical care for children and adults. Prior to COVID-19, few pediatric physiatrists had opportunities to access high fidelity telemedicine platforms to provide health care for patients with special needs, mobility impairments, developmental delays, neuromuscular disorders or other complex medical conditions. This literature review will explore how telemedicine can optimize health care delivery options for pediatric physiatrists in various inpatient and outpatient settings such as consultations, acute inpatient units, outpatient clinics and long-term care facilities. Detailed analysis of the current research in telemedicine applications as well as a critical review of the limitations and barriers for its use offers a plethora of opportunities for enhancement of continuity and coordination of care. Telemedicine may decrease healthcare disparities and increase access of care for children with special needs. Additional research is needed to assess the efficacy of telemedicine when addressing complex medical conditions in children.

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Julesz, Máté. "Health equity and health data protection related to telemedicine amid the COVID-19 pandemic". Információs Társadalom 22, nr 2 (31.08.2022): 27. http://dx.doi.org/10.22503/inftars.xxii.2022.2.2.

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The correlation between health equity and health data protection in the area of telemedicine has been put into relief during the COVID-19 pandemic. Indeed, the right to health data protection is not only a personal right but also a human right. Health equity cannot be maintained without an adequately functioning system of health data protection in telemedicine, yet, in many countries, health equity remains a mere dream. The United States and the European Union are the flagships of both health equity and health data protection, with HIPAA (in the US) and the GDPR (in the EU); however, some gaps do exist, as demonstrated by the practice of telemedicine during the COVID-19 pandemic. While US and EU regulations on telemedicine do provide legal certainty, fighting the COVID-19 pandemic has created a new legal climate, with new priorities superseding health data protection, which had been paramount beforehand.

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Siegler, Aaron, i Patrick Sullivan. "The PrEP Laboratory Service Gap: Applying Implementation Science Strategies to Bring PrEP Coverage to Scale in the United States". Journal of Law, Medicine & Ethics 50, S1 (2022): 40–46. http://dx.doi.org/10.1017/jme.2022.34.

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AbstractUsing an implementation science framework, we detail how a national system for covering both standard and telemedicine laboratory testing would support a national PrEP program. Implementation strategies that will facilitate success include minimizing provider burden through uncomplicated billing systems and minimizing patient burden through centralized, online access systems. We anticipate that providing telemedicine and in-person laboratory testing options will optimize PrEP care by making it less burdensome, leading to cost-effective healthcare and improved population health.

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김항중. "Privacy, Confidentiality, and Informed Consent Issues Relating to Telemedicine in the United States". kangwon Law Review 43, nr ll (październik 2014): 199–235. http://dx.doi.org/10.18215/kwlr.2014.43..199.

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Kahn, Elyne N., Frank La Marca i Catherine A. Mazzola. "Neurosurgery and Telemedicine in the United States: Assessment of the Risks and Opportunities". World Neurosurgery 89 (maj 2016): 133–38. http://dx.doi.org/10.1016/j.wneu.2016.01.075.

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Person, Donald A., Johnny S. Hedson i Kamal J. Gunawardane. "Telemedicine Success in the United States Associated Pacific Islands (USAPI): Two Illustrative Cases". Telemedicine Journal and e-Health 9, nr 1 (marzec 2003): 95–101. http://dx.doi.org/10.1089/153056203763317701.

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Cwiek, Mark A., Azhar Rafiq, Aamna Qamar, Charles Tobey i Ronald C. Merrell. "Telemedicine Licensure in the United States: The Need for a Cooperative Regional Approach". Telemedicine and e-Health 13, nr 2 (kwiecień 2007): 141–47. http://dx.doi.org/10.1089/tmj.2006.0029.

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Engelbrecht, R., A. Hasman, J. Mantas i L. Nicholson. "INTERNATIONAL ASPECTS OF EDUCATION AND TRAINING IN TELEMEDICINE". Bulletin of Siberian Medicine 14, nr 3 (28.06.2015): 63–67. http://dx.doi.org/10.20538/1682-0363-2015-3-63-67.

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Health care is based on patient data. The doctor, nurse or medical assistant are able by education, training, knowledge and experience to interpret patient data needed for diagnosis and treatment. Health care is dependent on a good education with respect to the management of data, information and knowledge. International activities point to ways to achieve a good level of education. These include criteria for curriculum development and accreditation, quality of information systems, further experience with a comprehensive training concept in England and the 10X10 approach in the United States.

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Hung, Man, Monica Ocampo, Benjamin Raymond, Amir Mohajeri i Martin S. Lipsky. "Telemedicine among Adults Living in America during the COVID-19 Pandemic". International Journal of Environmental Research and Public Health 20, nr 9 (28.04.2023): 5680. http://dx.doi.org/10.3390/ijerph20095680.

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Background and Objectives Telemedicine can expand healthcare access to populations, but relying on technology risks a digital divide. Therefore, it is important to understand who utilizes telemedicine. This study explores telemedicine usage across socio-demographic groups in the United States during COVID-19. Methods Data came from the Household Pulse Survey (HPS) between 14 April 2021, to 11 April 2022. HPS is a rapid online response survey that assesses household experiences during COVID-19. We calculated descriptive statistics and used cross-correlation to test each pair of the time series curves. Results High school graduates used the least telemedicine (20.58%), while those with some college (23.29%) or college graduates (22.61%) had similar levels, and those with less than a high school education fluctuated over time. Black people had higher levels of use (26.31%) than Asians (22.01%). Individuals with disabilities (35.40%) used telemedicine more than individuals without disabilities (20.21%). Individuals 80 years or over (27.63%) used telemedicine more than individuals 18 to 29 years old (18.44%). Cross-correlations for the time series pairs across demographics revealed significant differences in telemedicine use for all demographic groups over time. Conclusions Overall, elderly, Black people, individuals with some college, and persons with disabilities report higher levels of telemedicine use. Telemedicine may improve healthcare access post-pandemic, but more research is needed to understand factors that drive differences among groups.

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Hong, Young-Rock, John Lawrence, Dunc Williams Jr i Arch Mainous III. "Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data". JMIR Public Health and Surveillance 6, nr 2 (7.04.2020): e18961. http://dx.doi.org/10.2196/18961.

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Background As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation’s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. Objective We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. Methods We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. Results We found that US population–level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=–0.073, P=.61). Conclusions As the number of COVID-19 cases increases, so does the US population’s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge.

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Zhang, Chen, Kevin Fiscella, Shelby Przybylek, Wonkyung Chang i Yu Liu. "Telemedicine Experience for PrEP Care among PrEP-Eligible Women and Their Primary Care Providers during the First Year of the COVID-19 Pandemic in the United States". Tropical Medicine and Infectious Disease 7, nr 10 (2.10.2022): 280. http://dx.doi.org/10.3390/tropicalmed7100280.

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(1) Background: During the two-year-long siege from the COVID-19 pandemic, a significant proportion of doctor visits transitioned from in-person to virtual. Scare evidence is available to assess the quality of patient-provider communication via the platform of telemedicine, especially for PrEP care within primary care settings. (2) Methods: Participants included 18 primary care providers and 29 PrEP-eligible women. Through content analysis and thematic analysis, facilitators and barriers embedded at different levels of telemedicine were identified and assessed. (3) Results: Women and providers reported pros and cons regarding their telemedicine experiences during the initial wave of COVID-19. Both groups of participants agreed that telemedicine visits were more convenient, efficient, and comfortable than in-person visits. However, without face-to-face interactions, some women felt less empathy, caring, and connected with their providers during virtual visits. Health providers expressed concerns with telemedicine, including patients’ privacy, lack of intimacy between patients and providers, and delayed lab work. (4) Conclusions: Our data indicate multi-level factors may affect telemedicine experience among PrEP-eligible women and health providers. Participants expressed concerns that may further entrench these long-existing health disparities in healthcare. Proactive efforts from policymakers, health professionals, researchers, and stakeholders are urgently required to tackle identified barriers and to pave the way for the new infrastructure that ensures health equity in society.

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Khairat, Saif, Erin Wallace, Aaron Bohlmann, Ashlyn Zebrowski, Kaitlyn Stabile, Yuxiao Yao, Adnan Lakdawala, Barbara Edson i Terri Catlett. "Digital Health Experiences of Incarcerated Populations Using Telemedicine in North Carolina Prisons". Journal of Patient Experience 9 (styczeń 2022): 237437352210926. http://dx.doi.org/10.1177/23743735221092611.

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More than 1.2 million adults are incarcerated in the United States and hence, require health care from prison systems. The current delivery of care to incarcerated individualss is expensive, logistically challenging, risk fragmenting care, and pose security risks. The purpose of this study was to evaluate the association of patient characteristics and experiences with the perceived telemedicine experiences of incarcerated individuals during the pandemic. We conducted a cross-sectional study of incarcerated individuals in 55 North Carolina prison facilities seeking medical specialty care via telemedicine. Data collection took place from June 1, 2020 to November 30, 2020. Of the 482 patient surveys completed, 424 (88%) were male, 257 (53.3%) were over 50 years of age, and 225 (46.7%) were Black or African American and 195 (40.5%) were White, and 289 (60%) no prior telemedicine experience. There were 3 strong predictors of how patients rated their telemedicine experience: personal comfort with telemedicine ( P-value < .001), wait time ( P-value < .001), and the clarity of the treatment explanation by the provider ( P-value < .001). There was a relationship between telemedicine experiences and how patient rated their experience. Also, patients who were less satisfied with using telemedicine indicated their preference for an in-clinic visit for their next appointment.

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Eichberg, Daniel G., Gregory W. Basil, Long Di, Ashish H. Shah, Evan M. Luther, Victor M. Lu, Maggy Perez-Dickens, Ricardo J. Komotar, Allan D. Levi i Michael E. Ivan. "Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond". Neurosurgery 88, nr 1 (20.07.2020): E1—E12. http://dx.doi.org/10.1093/neuros/nyaa306.

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Abstract BACKGROUND Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era. OBJECTIVE To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience. METHODS A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty. RESULTS A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes. CONCLUSION Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.

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Tolulope O Olorunsogo, Obe Destiny Balogun, Oluwatoyin Ayo-Farai, Oluwatosin Ogundairo, Chinedu Paschal Maduka, Chiamaka Chinaemelum Okongwu i Chinyere Onwumere. "Reviewing the evolution of U. S. telemedicine post-pandemic by analyzing its growth, acceptability, and challenges in remote healthcare delivery during Global Health Crises". World Journal of Biology Pharmacy and Health Sciences 17, nr 1 (30.01.2024): 075–90. http://dx.doi.org/10.30574/wjbphs.2024.17.1.0010.

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This study provides a comprehensive analysis of the evolution, growth, acceptability, and challenges of telemedicine in the United States, particularly in the post-pandemic era. The primary objective was to understand the impact of telemedicine on healthcare delivery, technological advancements, and policy implications. Utilizing a systematic literature review and content analysis methodology, the study sourced data from electronic databases such as PubMed, Scopus, and Web of Science, focusing on peer-reviewed articles published between 2010 and 2023. Key findings indicate that telemedicine experienced significant growth during the COVID-19 pandemic, transitioning from a supplementary healthcare service to a primary mode of healthcare delivery. This growth was facilitated by advancements in digital technologies and necessitated by the need for remote healthcare services. The study identified challenges in telemedicine, including technological barriers, regulatory issues, and concerns regarding equitable access. Despite these challenges, telemedicine has shown potential in enhancing healthcare accessibility, efficiency, and patient-centered care. The study concludes that telemedicine is poised to play a crucial role in the future of healthcare, with opportunities for further integration into routine healthcare practices. However, this requires robust regulatory frameworks, stakeholder engagement, and continued technological innovation. Recommendations for healthcare leaders and policymakers include developing comprehensive telemedicine policies and investing in infrastructure to support telehealth services. Future research directions involve exploring long-term outcomes of telemedicine interventions and its economic impact on healthcare systems.

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Houtchens, Bruce A., Terry P. Clemmer, Harry C. Holloway, Alexander A. Kiselev, James S. Logan, Ronald C. Merrell, Arnauld E. Nicogossian i in. "Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge". Prehospital and Disaster Medicine 8, nr 1 (marzec 1993): 57–66. http://dx.doi.org/10.1017/s1049023x00040024.

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AbstractIntroduction:The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.Methods:During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.Results:Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.Conclusion:These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

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Basu, Anindya, i Lopamudra Bakshi Basu. "A COMMENTARY ON SHIFT IN BUSINESS STRATEGIES OF INDIAN HEALTH CARE INDUSTRY WITH COVID-19 AS A TRIGGER". ENSEMBLE SP-1, nr 1 (14.04.2021): 81–93. http://dx.doi.org/10.37948/ensemble-2021-sp1-a010.

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Medical tourism has become a booming industry in the recent past. People from all around the world cross the borders for better medical treatment. The leading destinations with markets for medical tourism include Malaysia, Thailand, India, Singapore, Turkey, and United States. Latest medical technology, high-quality services, insurance are a few of the criteria medical tourists seek for. As public-funded well-being insurance is unable to keep pace with the increasing demands of a growing aging population, patients from the United Kingdom and Canada travel to India to beat the huge waiting period for the routine procedures. The unprecedented COVID-19 outbreak has forced the market to observe diminishing growth. The pandemic is predicted to have a negative impact on this growing industry. The organizations, involved in the development of the medical tourism, stare at a dark future. It is, therefore, necessary to streamline the industry in view of this dismal scenario. However, with the growing technological development, one such platform that can bridge the distance in the health sector is telemedicine. This paper is an attempt to study the growing importance of telemedicine in a developing country like India. The research is based on both primary and secondary data along with a thorough literature review. Post lockdown telemedicine is likely to grow, and telemedicine is probably the future of the healthcare industry.

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Gregory, Timothy, i Jerome Graber. "EPID-27. GEOGRAPHIC BURDEN OF CNS TUMORS AND DENSITY OF NEURO-ONCOLOGISTS IN THE UNITED STATES". Neuro-Oncology 23, Supplement_6 (2.11.2021): vi91. http://dx.doi.org/10.1093/neuonc/noab196.360.

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Abstract CNS cancer care relies heavily on exam and imaging interpretation skills distinctive to a neurology-trained oncologist, and access to this subspecialty is increasingly more essential as targeted molecular therapies evolve. We sought to explore the supply of neuro-oncologists in terms of geographic CNS tumor incidence. Using the UCNS online directory, we generated a heat map representing the location (set to 75-mile radius) and density of active neuro-oncologists. We overlaid this data upon yearly incidence of CNS tumors per neuro-oncologist for each state using most recent CBTRUS data. We highlight the significant distance Americans outside of urban areas must travel for care and that isolation from academic centers and exclusion from clinical trials are substantial barriers to cancer care for a significant proportion of the population. Telemedicine may in part improve patient access to care and clinical trial participation, but significant state-to-state legal variability for providing telehealth services across state lines remains a national challenge. Short-term strategies for equitably meeting this subspecialty need may require policy changes that optimize employment of telemedicine, and long-term must ensure a robust fellowship pipeline with thoughtful incentivization and allocation of resources.

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