"军卫网"的建设与应用

随着通信技术的不断发展,卫星通信远程医学系统的应用领域正在逐步拓展.我院卫星站点开通运行以来,不断健全组织管理,加强机构建设,加大宣传力度,提升业务能力,拓展应用领域,使远程医学工作形式更加多样,服务内容更加丰富,服务质量不断提高.     

远程医学体制的建立对军队卫生建设的影响

50年代末 ,美国学者 Wittson首先将双向电视系统用于医疗 ,同年 ,Jutra等人创立了远程放射医学。此后 ,美国相继不断有人利用通讯和电子技术进行医学活动 ,并出现了Telemedicine这一词汇 ,现在国内专家统一将其译为“远程医学”。1　远程医学的含义及发展现状远程医学 (Telemedicine)从广义上讲是使用远程通信技术和计算机多媒体技术提供医学信息和服务。它包括远程诊断、远程会诊及护理、远程教育、远程医学信息服务等所有医学活动。从狭义上讲 ,是指远程医疗 ,包括远程影像学、远程诊断及会诊、远程护理等医疗活动。1.1　远程医学在国外…     

远程医疗的发展及应用

始于五十年代末期远程医疗是医学、通讯计算机及多媒体多媒体等技术的相互结合，国外这方面的研究正方兴未艾。远程医疗在我国的研究虽然虽然起步较晚，但近年来也受到了越来越多的关注，本文综述了远程医疗的发展历程、国内外研究的现状及其应用领域，同时也指出了它所带来的一些不容忽视的问题。     

智能手机在现代医学应用中的最新进展

随着智能手机的出现,手机的功能日益丰富,软件、硬件、配件功能不断增强,在人们日常生活中发挥的作用也愈加重要。作为一种新的医疗模式,手机医学顺应而生,在辅助医疗诊断、重大疾病检测与筛查,以及资源有限地区实施基本医疗保障等方面具有深远影响,因此其相关科学和技术问题日益受到国内外关注。本文综述了智能手机在医学诊断应用中的最新进展,以期拓展手机医学为全民提供医疗服务的应用领域,促进我国医疗卫生信息化事业的发展,引领我国进入一个新的医疗保健时代。     

远程医学的发展现状与展望

本文介绍了远程医学的概念、国外远程医学的概况以及国内远程医学的现状,阐述了远程医学系统的主要组成和技术基础,并就远程医学系统的建设、标准化及数据的安全性等问题作了探讨,最后对远程医学的前景做了展望。     

远程医学在野战医疗中的应用

在进入信息时代和生命科学世纪的今天,远程医学的发展具有重大而深远的意义.本文主要介绍了远程医学的基本概念、远程医学系统的基本模式、以及远程医学在军队野战医疗中的实际应用情况及发挥的作用等,并提出未来远程医学在部队信息化建设中的发展.     

远程医学信息网的应用和体会

远程医学(Telemedicine)从广义上讲是使用远程通信技术和计算机多媒体技术提供医学信息和服务。它包括远程诊断、远程会诊及护理、远程教育、远程医学信息服务等所有医学活动。     

发挥远程医学作用促进医院创新发展

我院是全军最北部的一所部队医院,地域偏僻,经济欠发达,医疗卫生资源不足。全军远程医学信息网站点建立后,拉近了我们与发达中心城市和全军名家名院的距离。近几年,我们开拓思路,把握机会,充分利用远程医学这一新的医学服务模式,以全军最先进的医学技术和信息资源,为我院医疗技术建设和发展服务,取得了较好的社会效益和经济效益。现将我院的具体做法和体会作一介绍。1远程医学信息网站点建设概况我院远程医学信息网站点建设于2003年7月。由远程医学会诊室、远程医学教室和电子阅览室三部份组成。远程医学会诊室是进行站点网络管理和远程医学…     

远程放射学与远程医学

远程放射学受益于广泛的研究和试验而成为远程医学中最为成熟的系统。本文就远程放射学相关技术，如图像获取、图像读释、传输速度、数据压缩以及与远程医学相关的医学法律、偿付和管理问题等作一介绍。     

我国远程医学发展中的障碍与对策

我国远程医学发展中在政府支持与监督管理方面、技术及标准方面、经济方面、医务人员与患者对远程医学的接受度方面、对远程医学的评价评估方面及相关法律法规方面遇到了较多的不足与障碍。在应对这些障碍时,国外已经取得了相当多值得我们借鉴的经验,国内可以在政府提高对远程医学的支持力度等几个方面采取措施。     

Telemedicine in support of peacekeeping operations overseas: an audit.

BACKGROUND AND OBJECTIVE: Since 1993, the Department of Defense has augmented the medical support for Army units on peacekeeping operations in Macedonia through the medium of telemedicine. This project, known as Operation Primetime 1, was the first satellite-based telemedicine system deployed in support of remote primary-care physician in the U.S. military. Its declared aims are: (1) to improve the standard of care; (2) to reduce evacuations; (3) to support junior physicians in the field; and (4) to improve the military effectiveness of the deployed units. This paper audits the success in attaining those goals for the period January 1994 to April 1995. METHODS: A log was collated from the referring units and questionnaires completed by both referring and consulting physicians. The referring physicians were interviewed on their return from Macedonia, and a more detailed study was undertaken of cases in which a change in outcome was noted. Follow-up interview of consultants was not possible. RESULTS: A total of 53 consults were undertaken on 47 patients. The use of telemedicine affected the decision to evacuate 13 times (13/47), with a net reduction of 9 evacuations. Management of individual cases was changed in 30 of the 47 cases in which telemedicine was used. Physician confidence and military effectiveness were also improved. The level of utilization of the system was largely dependent on a training and sustainment program. Units and General Medical Officers who were trained in the clinical use of telemedicine and the technical sustainment of the equipment used the system; those who were not, did not. Most patients (45/47) were treated satisfactorily with a single consult. Telemedicine under these circumstances seems to be cost effective. The deployed sites chose the referral centers that provided the best service. CONCLUSIONS: Telemedicine is a valuable tool capable of augmenting medical support to deployed military units. A successful deployed telemedicine project requires an integrated support package that includes adequate provision for training and equipment sustainment at both ends of the link. Experience with telemedicine in Operation Primetime indicates the potential for substantial cost savings as well as cost-effective medical care. Further application of telemedicine should be encouraged. Successful deployment of telemedicine projects may hinge on an integrated support package.     

Tertiary telemedicine support during global military humanitarian missions.

OBJECTIVE: The U.S. military medical units face the challenge of delivering the latest medical knowledge and advances to remote areas of the world. This study details the tertiary care telemedicine support by Walter Reed Army Medical Center (WRAMC) for these humanitarian missions in several locations worldwide. METHODS: This study encompasses data from all clinical consults received at WRAMC, from the earliest deployment of a satellite-based system in February 1993 through February 1996. The analysis of the consultations include type of consult, medical specialty consulted, response time, and technology used. RESULTS: Two hundred forty consults were received from 12 remote telemedicine sites supporting military medical missions. The consults used a combination of "store-and-forward" technologies and interactive video conferencing systems. Establishment of a telemedicine service at WRAMC, including medical and technical support personnel, facilitated the delivery of telemedicine consultations. Several concurrent missions were supported. The distribution of consults included medicine (40%), surgery (36%), radiology (21%), and dentistry (3%). The most frequently consulted medical subspecialty was dermatology (29%) followed by orthopedic surgery (16%). Most consults were routine (88%). Ninety-four percent of the consults were completed within the predefined telemedicine response criteria (24 hours for routine consults and 3 hours for emergencies). CONCLUSION: The study illustrates the importance of a responsive telemedicine service at a tertiary facility supporting simultaneous medical missions. Access to the complete spectrum of medical and surgical specialties was essential to enhancing the delivery of medical care. The critical analysis and evaluation of this experience will assist in designing future prospective studies for evaluation of telemedicine.     

Telemedicine in China

Telemedicine has been shown to have a considerable impact in medical education, conferencing and consultation. As a result, the People's Republic of China has been keen to develop telemedicine. In her attempts to further the development of telemedicine, China has looked to the progress of medical services in Western countries such as Europe and North America. The United States of America, however, has exceeded the rest in exchange of health-care information and telemedicine technologies with China. Although China has been enthusiastic about the exchange, telemedicine in China requires development in the technical infrastructure and professional infrastructure.     

Health care providers' perceptions of telemedicine services.

OBJECTIVE: To assess the level of consensus among the administrative and health care leaders at rural Iowa hospitals regarding service gaps and priorities for developing telemedicine services. METHODS: In the summer of 1994, a survey was conducted of all rural hospital chief executive officers, chiefs of medical staffs, and directors of nursing in Iowa concerning their perceptions of telemedicine services. RESULTS: With the exception of teleradiology, few clinical specialties received high ratings as areas of need or priorities for the development of telemedicine. There was a general lack of agreement among respondents from the same hospital on such priorities. In contrast, respondents expressed higher priorities for the development of telemedicine-based educational services. CONCLUSIONS: The interest in teleradiology is consistent with the fact that teleradiology has been more thoroughly tested for medical efficacy than other telemedicine applications. Continuing medical education may represent another potential for widespread successful telemedicine application. Financial issues were reported as the greatest barriers to the development of telemedicine systems.     

Implementation and evaluation of a telemedicine course for physician assistants.

Clinical telemedicine uses interactive video technologies and telecommunications networks to deliver medical consultations to distant patients and their primary care providers. Telemedicine provides real-time access to specialists whose services might not otherwise be available in rural or medically underserved areas. While recently there has been dramatic growth in the use of telemedicine, there is little evidence that telemedicine as a patient care delivery system has been incorporated into the medical school curriculum. The authors describe the current status of telemedicine in medical curricula and report on efforts at the University of Iowa to incorporate telemedicine into the curriculum of its Physician Assistant Program.     

State initiatives to promote telemedicine.

OBJECTIVE: To identify states that have played a key role in promoting, developing, and supporting telemedicine initiatives aimed at improving access to basic health care and to characterize the range of actions and policy-making roles taken by the states. METHODS: State agencies involved in telemedicine initiatives and state-funded telemedicine programs were interviewed by telephone. An informal case study approach was used with a standard, open-ended questionnaire. Twenty-seven states were contacted in early 1995. RESULTS: Sixteen states have been active in telemedicine development since 1989, with the level of activity expanding considerably in the last 2 years. Some states, particularly Georgia, Kansas, Texas, South Dakota, and Louisiana, have well-developed programs. Policy actions taken by the states in support of telemedicine differ considerably. They include planning and coordination, development of networks, more limited program development, funding, building a telecommunications infrastructure for telemedicine, and regulatory support and clarification. A wide array of funding sources has been used, including state tax dollars and state-earmarked federal monies and regulatory judgments. The level of funding by the states has also varied, ranging from less than $100,000 to tends of millions of dollars. CONCLUSION: There are varied roles and policy actions that states have assumed in promoting and supporting telemedicine development. States are investing considerable dollars and effort in telemedicine and appear likely to continue this activity in order to promote its development and improve access to health care.     

Virtual reality and telemedicine: exploring advanced concepts.

Virtual reality (VR) has provided a new methodology for interacting with information. Since telemedicine is principally involved with transmitting medical information, VR has the potential to enhance the telemedicine experience. The two principle ways in which VR can be applied are as an interface, which enables a more intuitive manner of interacting with information, and as an environment that enhances the feeling of presence during the interaction. Since there are no current clinical applications of VR in the telemedicine experience, this report reviews concepts and experiences with the potential to enhance the delivery of telemedicine.     

De la mise à disposition de l'outil télémédecine à la réalisation des objectifs attendus

From 1996 to 2000, the number of telemedicine applications used routinely at the Assistance publique-Hôpitaux de Paris has been increased threefold. The identification of medical needs, telemedicine's impact evaluation and telemedicine services management are key factors in the spread of telemedicine.     

A cost-effectiveness analysis of shipboard telemedicine.

BACKGROUND: The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. OBJECTIVES: To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. METHODS: A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. RESULTS AND CONCLUSIONS: If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost-effective on carriers only. Telemedicine's bandwidth requirement is small-1% of a month's time. However, if the ships' medical departments need to resort to a commercial satellite, E-mail and Internet would be the only telemedicine modality generating enough monetary benefits to offset the costs.     

Rural applications of telemedicine.

OBJECTIVES: To describe the status of telemedicine in rural America, the characteristics of health care facilities using telemedicine technologies to serve rural patients, the volume and scope of services delivered, the costs associated with this care, and the funding sources. METHODS: A screening survey was mailed to all 2472 nonfederal U.S. hospitals located outside metropolitan areas. Nonrespondents were interviewed by telephone. Those who reported some form of telemedicine capability, and all the telemedicine affiliates they named, became the sample for a detailed follow-up survey (N = 558) in January 1996. RESULTS: Ninety-six per cent of all rural hospitals responded to the screener survey, and 89% of the 558 identified telemedicine facilities responded to the detailed follow-up survey (total respondents = 499). In this cross-sectional study, two thirds of the telemedicine respondents (340) were using only teleradiology. Of the 159 telemedicine programs pursuing other clinical applications, 67% had been using telemedicine for 2 years or less. Telemedicine facilities have tried many clinical specialty applications, the most common being radiology, cardiology, and orthopedics. At this early stage of technology diffusion, reported utilization of the telemedicine systems for both clinical and nonclinical applications was very low, and the unit costs of equipment acquisition and operating expenses were corresponding high. Programs most commonly used hospital financial resources and federal grants and contracts for support. Telemedicine networks planned to grow from an average of nine facilities to an average of 13 facilities during 1996. CONCLUSIONS: Investment has been rapid in telemedicine, and the installed base reported in this survey was large, sophisticated, and growing rapidly. Nonclinical uses of the technology (e.g., meetings, training sessions, continuing medical education) were more common than clinical consultations, although the volumes of both were quite low. Investment and expansion to new sites were occurring in the absence of a favorable payor reimbursement environment and in spite of low volume at most operating sites, demonstrating optimism about the future of telemedicine and the potential for nonclinical applications.