Low-Bandwidth, Low-Cost Telemedicine Consultations
Low-Bandwidth, Low-Cost Telemedicine Consultations
Background: Telemedicine, based on the use of interactive video consultations, is being used more commonly in rural settings. This development is potentially important to rural patients because there are fewer physicians, particularly specialist physicians, in rural areas. Declining costs of telemedicine equipment and transmission have created increased access to these technologies for rural family physicians and their patients.
Methods: This study considers satisfaction levels of rural family physicians, academic-based specialists, and rural patients in 130 consultations between rural physicians, rural patients, and urban academic specialists. To increase the practicability for rural use, low-cost equipment and low-bandwidth digital telephone transmission lines were utilized. Data were collected using questionnaires that were completed by patients, family physicians, and specialist consultants after each consultation.
Results: All categories of participants noted very high levels of satisfaction.
Conclusion: Telemedicine-based consultations are well accepted by rural patients, rural family physicians, and urban academic specialist consultants. This approach could offer a useful adjunct to rural health care.
Almost one fourth of the population of the United States lives in rural areas, but only 9% of US physicians practice in these locations. Rural populations have several characteristics in common. Among these are low population density, with more distance between people, as well as a commonly held belief that patients are older and sicker than their urban counterparts. The provision of adequate health care to this group of citizens has been, and remains, a challenge.
One promising approach to this rural geographic access problem has been the use of telemedicine as a means of providing health care services to rural patients. The Institute of Medicine defines telemedicine as "the use of electronic information and communications technologies to provide and support health care, when distance separates the participants." A key concept in this definition is distance between the participants, a factor that makes this technology especially useful in rural settings. These systems represent one method of linking urban concentrations of physicians with widely dispersed groups of rural patients and their caregivers.
Efforts to use television as a tool to improve health care are not new. In October 1959, Health, Education, and Welfare Secretary Arthur Flemming spoke to the first meeting of the Council on Medical Television at the National Institutes of Health in Bethesda stating, "The pace of progress in medical science has been matched by advances in communications technology... Television can transcend space and time... Our ever-increasing knowledge of health and disease must be brought into the everyday practice... and to the bedside of every patient."
For many of the next 40 years, the use of telemedicine in rural sites languished, flourishing only when grant funding was available. Recently, technological advances and price reductions both in computing and communications equipment and in transmission charges have made the use of these tools more feasible. As a result of these advances, coupled with new federal grant programs, the use of telemedicine has started to spread rapidly. Unfortunately, assessment of telemedicine, especially of applications of telemedicine to rural sites, has lagged.
The WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Telemedicine Network was established in 1994 (first consultations in 1995) with funding from a grant from the Federal Office of Rural Health Policy. The network was designed to provide remote rural primary care providers with consultative access to specialists based at the University of Washington Academic Health Center. Since its inception, eight sites in five states have been developed. Because many rural communities lack both extensive financial resources and high-bandwidth digital transmission capabilities, the network was designed to use low-bandwidth, low-cost, personal-computer-based systems for its consultations.
The intent of the WWAMI Rural Telemedicine Project was to show the functionality of low-bandwidth, low-cost telemedicine consultations between primary care providers in remote rural settings and academic specialists, and to assess the satisfaction of patients, rural family physicians, and urban specialists with such a system.
Gustke and her colleagues have recently reviewed patient satisfaction with telemedicine. They note that there are only about 12 published studies on patient satisfaction with telemedicine applications. Of the 12 studies reviewed, only 2 dealt specifically with rural populations. Of these 12 studies, the patient satisfaction levels were quite high (average 92.8%). Gustke and colleagues' own study found 98.3% patient satisfaction.
Background: Telemedicine, based on the use of interactive video consultations, is being used more commonly in rural settings. This development is potentially important to rural patients because there are fewer physicians, particularly specialist physicians, in rural areas. Declining costs of telemedicine equipment and transmission have created increased access to these technologies for rural family physicians and their patients.
Methods: This study considers satisfaction levels of rural family physicians, academic-based specialists, and rural patients in 130 consultations between rural physicians, rural patients, and urban academic specialists. To increase the practicability for rural use, low-cost equipment and low-bandwidth digital telephone transmission lines were utilized. Data were collected using questionnaires that were completed by patients, family physicians, and specialist consultants after each consultation.
Results: All categories of participants noted very high levels of satisfaction.
Conclusion: Telemedicine-based consultations are well accepted by rural patients, rural family physicians, and urban academic specialist consultants. This approach could offer a useful adjunct to rural health care.
Almost one fourth of the population of the United States lives in rural areas, but only 9% of US physicians practice in these locations. Rural populations have several characteristics in common. Among these are low population density, with more distance between people, as well as a commonly held belief that patients are older and sicker than their urban counterparts. The provision of adequate health care to this group of citizens has been, and remains, a challenge.
One promising approach to this rural geographic access problem has been the use of telemedicine as a means of providing health care services to rural patients. The Institute of Medicine defines telemedicine as "the use of electronic information and communications technologies to provide and support health care, when distance separates the participants." A key concept in this definition is distance between the participants, a factor that makes this technology especially useful in rural settings. These systems represent one method of linking urban concentrations of physicians with widely dispersed groups of rural patients and their caregivers.
Efforts to use television as a tool to improve health care are not new. In October 1959, Health, Education, and Welfare Secretary Arthur Flemming spoke to the first meeting of the Council on Medical Television at the National Institutes of Health in Bethesda stating, "The pace of progress in medical science has been matched by advances in communications technology... Television can transcend space and time... Our ever-increasing knowledge of health and disease must be brought into the everyday practice... and to the bedside of every patient."
For many of the next 40 years, the use of telemedicine in rural sites languished, flourishing only when grant funding was available. Recently, technological advances and price reductions both in computing and communications equipment and in transmission charges have made the use of these tools more feasible. As a result of these advances, coupled with new federal grant programs, the use of telemedicine has started to spread rapidly. Unfortunately, assessment of telemedicine, especially of applications of telemedicine to rural sites, has lagged.
The WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Telemedicine Network was established in 1994 (first consultations in 1995) with funding from a grant from the Federal Office of Rural Health Policy. The network was designed to provide remote rural primary care providers with consultative access to specialists based at the University of Washington Academic Health Center. Since its inception, eight sites in five states have been developed. Because many rural communities lack both extensive financial resources and high-bandwidth digital transmission capabilities, the network was designed to use low-bandwidth, low-cost, personal-computer-based systems for its consultations.
The intent of the WWAMI Rural Telemedicine Project was to show the functionality of low-bandwidth, low-cost telemedicine consultations between primary care providers in remote rural settings and academic specialists, and to assess the satisfaction of patients, rural family physicians, and urban specialists with such a system.
Gustke and her colleagues have recently reviewed patient satisfaction with telemedicine. They note that there are only about 12 published studies on patient satisfaction with telemedicine applications. Of the 12 studies reviewed, only 2 dealt specifically with rural populations. Of these 12 studies, the patient satisfaction levels were quite high (average 92.8%). Gustke and colleagues' own study found 98.3% patient satisfaction.
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