Browsing by Author "Wootton, Richard"
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- ItemAdoption of routine telemedicine in Norway: the current picture.(2014-01-17) Zanaboni, Paolo; Knarvik, Undine; Wootton, RichardTelemedicine appears to be ready for wider adoption Although existing research evidence is useful the adoption of routine telemedicine in healthcare systems has been slow
- ItemThe application of telemedicine to geriatric medicine.(2007-07-19) Brignell, Michael; Wootton, Richard; Gray, LenTelemedicine has the potential to improve access to the specialty of geriatric medicine particularly in rural and remote settings While telemedicine is widely used in some specialities this is not yet the case in geriatric medicine
- ItemAssessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network - Long-Term Monitoring Taking into Account Differences between Cases.(2014-11-12) Wootton, Richard; Liu, Joanne; Bonnardot, LaurentWe have previously proposed a method for assessing the quality of individual teleconsultation cases this paper proposes an additional step to allow the long term monitoring of quality The basic scenario is a teleconsultation system aka an e referral system or a tele expertise system where the referrer posts a question about a clinical case the question is relayed to an appropriate expert and the chosen expert provides an answer The people running this system want assurances that it is stable i e they want routine quality assurance information about the output from the process This requires two things It needs a method of assessing the quality of individual patient consultations And it needs a method for taking into account differences between patients so that these quality assessments can be compared longitudinally Building on the previously proposed methodology the present paper proposes two techniques for measuring the difficulty posed by a particular teleconsultation The first is an indirect method similar to a willingness to pay economic estimation The second is a direct method Using these two methods with real data from a telemedicine network showed that the first method was feasible but did not produce useful results in a pilot trial The second method while more laborious was also feasible and did produce useful results Thus when output quality is measured an allowance can be made for the characteristics of the case submitted This means that fluctuations in output quality can be attributed to variations in the process network or to variations in the raw materials queries submitted to the network Long term quality assurance should assist those providing telemedicine services in low resource settings to ensure that the services are operated effectively and efficiently despite the constraints and complexities of the environment
- ItemAssessing the quality of teleconsultations in a store-and-forward telemedicine network.(2014-07-31) Wootton, Richard; Liu, Joanne; Bonnardot, LaurentStore and forward telemedicine in resource limited settings is becoming a relatively mature activity However there are few published reports about quality measurement in telemedicine except in image based specialties and they mainly relate to high and middle income countries In 2010 M decins Sans Fronti res MSF began to use a store and forward telemedicine network to assist its field staff in obtaining specialist advice To date more than 1000 cases have been managed with the support of telemedicine from a total of 40 different countries We propose a method for assessing the overall quality of the teleconsultations provided in a store and forward telemedicine network The assessment is performed at regular intervals by a panel of observers who independently respond to a questionnaire relating to a randomly chosen past case The answers to the questionnaire allow two different dimensions of quality to be assessed the quality of the process itself and the outcome defined as the value of the response to three of the four parties concerned i e the patient the referring doctor and the organization It is not practicable to estimate the value to society by this technique The feasibility of the method was demonstrated by using it in the MSF telemedicine network where process quality scores and user value scores appeared to be stable over a 9 month trial period This was confirmed by plotting the cusum of a portmanteau statistic the sum of the four scores over the study period The proposed quality assessment method appears feasible in practice and will form one element of a quality assurance program for MSF s telemedicine network in future The method is a generally applicable one which can be used in many forms of medical interaction
- ItemA comparison of telepaediatric activity at two regional hospitals in Queensland.(2003-03-28) Smith, Anthony C; Williams, Michael; Van Der Westhuyzen, Jasper; McCrossin, Robert; Isles, Alan; Wootton, RichardWe conducted a 15 month feasibility study of telepaediatrics A novel service was offered to two hospitals in Queensland Mackay and Hervey Bay We used data from all other hospitals throughout the state as the control group Although both intervention hospitals were provided with the same service the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region In addition there was an increase in the number of Mackay patients treated locally as outpatients In contrast little change was observed in Hervey Bay We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary centre We believe that the screening method used for patient referrals was the most important determinant of the use of the telepaediatric service
- ItemConcordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology.(2008-04-23) Smith, Anthony C; Dowthwaite, Samuel; Agnew, Julie; Wootton, RichardTo determine agreement between diagnoses and management plans made during an initial videoconference appointment and subsequent face to face consultations in paediatric ear nose and throat ENT surgery DESIGN AND SETTING AND PARTICIPANTS A paediatric ENT clinic servicing patients from Bundaberg Queensland was conducted through the Centre for Online Health at the Royal Children s Hospital RCH in Brisbane Between January 2004 and February 2006 152 consultations with 97 patients were carried out We retrospectively audited patients charts to compare the diagnosis and management plan formulated at the initial videoconference and the eventual diagnosis and surgical management after face to face consultation The clinical outcomes for children who were not recommended for surgery at the RCH were ascertained by telephone survey
- ItemA cost minimisation analysis of a telepaediatric otolaryngology service.(2008-03-27) Xu, Cathy Q; Smith, Anthony C; Scuffham, Paul A; Wootton, RichardPaediatric ENT services in regional areas can be provided through telemedicine tele ENT using videoconferencing or with a conventional outpatient department ENT service OPD ENT in which patients travel to see the specialist The objective of this study was to identify the least cost approach to providing ENT services for paediatric outpatients
- ItemThe cost of allied health assessments delivered by videoconference to a residential facility for elderly people.(2003-09-03) Hassall, Stacey; Wootton, Richard; Guilfoyle, ClareWe calculated the cost of providing allied health assessments to high dependency residents of a rural facility for elderly people The costs of conducting assessments via videoconferencing were compared with the costs of conducting assessments face to face The observed costs in a three month pilot trial were used to estimate the annual costs Given an annual workload of 1000 occasions of service each videoconference assessment would cost dollar 84 93 compared with dollar 90 25 for face to face assessments Allied health assessments delivered by videoconferencing became cheaper at workloads of approximately 850 occasions of service annually Additional increases in the workload further improved the financial viability of this approach to service delivery
- ItemThe costs and potential savings of a novel telepaediatric service in Queensland.(2007-03-14) Smith, Anthony C; Scuffham, Paul; Wootton, RichardThere are few cost minimisation studies in telemedicine We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person
- ItemDesign and implementation of an automatic message-routing system for low-cost telemedicine.(2003-09-03) Wootton, RichardEmail has been used for some years as a low cost telemedicine medium to provide support for developing countries However all operations have been relatively small scale and fairly labour intensive to administer A scalable automatic message routing system was constructed which automates many of the tasks During a four month study period in 2002 485 messages were processed automatically There were 31 referrals from eight hospitals in three countries These referrals were handled by 25 volunteer specialists from a panel of 42 Two system operators located 10 time zones apart managed the system The median time from receipt of a new referral to its allocation to a specialist was 1 0 days interquartile range 0 7 2 4 The median interval between allocation and first reply was 0 7 days interquartile range 0 3 2 3 Automatic message handling solves many of the problems of manual email telemedicine systems and represents a potentially scalable way of doing low cost telemedicine in the developing world
- ItemDeveloping a protocol for the use of telenursing in community health in Australia.(2002-09-09) Guilfoyle, Clare; Perry, Lesley; Lord, Bev; Buckle, Karen; Mathews, Jenny; Wootton, RichardAs the first step in developing a protocol for the use of video phones in community health we carried out a feasibility study among clients with a range of health needs Clients were equipped with a commercially available video phone connected using the client s home telephone line A hands free speaker phone and a miniature video camera for close up views were connected to the video phone Ten clients participated five required wound care two palliative care two long term therapy monitoring and one was a rural client All but two were aged 75 years or more Each client had a video phone for an average of two to three weeks During the six months of the study 43 client calls were made of which 36 84 were converted to video calls The speaker phone was used on 24 occasions 56 and the close up camera on 23 occasions 53 Both clients and nurses rated the equipment as satisfactory or better in questionnaires None of the nurses felt that the equipment was difficult to use including unpacking it and setting it up only one client found it difficult Taking into account the clients responses including their free text comments a judgement was made as to whether the video phone had been useful to their nursing care In seven cases it was felt to be unhelpful and in three cases it was judged helpful Although the study sample was small the results suggest that home telenursing is likely to be useful for rural clients in Australia unsurprisingly because of the distances involved
- ItemThe Development of a Multilingual Tool for Facilitating the Primary-Specialty Care Interface in Low Resource Settings: the MSF Tele-Expertise System.(2014-09-10) Bonnardot, Laurent; Liu, Joanne; Wootton, Elizabeth; Amoros, Isabel; Olson, David; Wong, Sidney; Wootton, RichardIn 2009 M decins Sans Fronti res MSF started a pilot trial of store and forward telemedicine to support field workers One network was operated in French and one in English a third Spanish network was brought into operation in 2012 The three telemedicine pilots were then combined to form a single multilingual tele expertise system tailored to support MSF field staff We conducted a retrospective analysis of all telemedicine cases referred from April 2010 to March 2014 We also carried out a survey of all users in December 2013 A total of 1039 referrals were received from 41 countries of which 89 were in English 10 in French and 1 in Spanish The cases covered a very wide range of medical and surgical specialties The median delay in providing the first specialist response to the referrer was 5 3 h interquartile range 1 8 16 4 The survey was sent to 294 referrers and 254 specialists Of these 224 were considered as active users 41 Out of the 548 users 163 30 answered the survey The majority of referrers 79 reported that the advice received via the system improved their management of the patient The main concerns raised by referrers and specialists were the lack of support or promotion of system at headquarters level and the lack of feedback about patient follow up Because of the size of the MSF organization it is clear that there is potential for further organizational adoption
- ItemDiagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients.(2004-07-26) Smith, Anthony C; Kimble, Roy; Mill, Julie; Bailey, Deborah; O'Rourke, Peter; Wootton, RichardVideoconferencing has become a routine technique for the post acute burns care of children in Queensland We compared the agreement between clinical assessments conducted via videoconference and assessments conducted in the conventional face to face manner FTF A total of 35 children with a previous burn injury were studied Twenty five children received three consecutive assessments first FTF by a consultant in the outpatient department then by a second consultant who reviewed the patient via videoconference and then by the second consultant in person The second consultant also reviewed another 10 children twice At each review the following variables were measured scar colour scar thickening contractures range of motion the patient s level of general activity any breakdown of the graft site and adequacy of the consultation Agreement between the two consultants when seeing patients FTF was moderately high with an overall concordance of 85 When videoconferencing was used the level of agreement was almost the same at 84 If one consultant reviewed patients FTF first and then via videoconference the overall concordance was 98 if the process was reversed the overall concordance was 97 This study confirms that the quality of information collected during a videoconference appointment is comparable to that collected during a traditional FTF appointment for a follow up burns consultation
- ItemThe diagnostic reliability of Internet-based observational kinematic gait analysis.(2004-01-19) Russell, Trevor G; Jull, Gwendolen A; Wootton, RichardWe investigated the accuracy and reliability of observational kinematic gait assessments performed via a low bandwidth Internet link 18 kbit s and a higher speed Internet link 128 kbit s Twenty four subjects were randomized to either bandwidth group Gait was assessed with the Gait Assessment Rating Scale GARS in the traditional manner which is from video recordings and with repeated measurements via the online method Online assessment was found to provide as accurate a measure of gait performance as the traditional assessment limits of agreementUnder1 GARS point intraclass correlation coefficient ICC 0 96 regardless of the speed of the Internet connection The online assessment also demonstrated high intra rater ICC 0 96 and inter rater ICC 0 92 reliability Low bandwidth telerehabilitation applications appear to be feasible via the Internet
- ItemE-health and the Universitas 21 organization: 2. Telemedicine and underserved populations.(2005-07-22) Wootton, Richard; Jebamani, Laurel S; Dow, Shannon ATelemedicine activities in underserved communities were reviewed as part of the Universitas 21 U21 e health project A SWOT analysis strengths weaknesses opportunities threats was conducted on 12 articles identified in a literature review supplemented by expertise from U21 members The analysis showed that threats include the reluctance of populations to use telemedicine services and a general absence of infrastructure and resources to sustain them Opportunities centre around potential research including cost effectiveness analyses and quantitative assessments of existing telemedicine services The great strength of telemedicine is that it can improve access to health services among those most in need However its greatest weakness is the lack of evidence supporting its clinical and cost advantages relative to traditional services This represents an important opportunity for research on telemedicine initiatives among underserved populations
- ItemAn e-health needs assessment of medical residents in Cameroon.(2005-12-26) Scott, Richard E; Ndumbe, Peter; Wootton, RichardMedical residents from Yaounde I University in Cameroon are required to spend periods of time in rural or remote locations to complete their training To determine if e health might lessen their isolation and enhance patient care a needs assessment of the residents was performed using a brief questionnaire five items about the situation in which residents found themselves outside their medical school environment We gave the questionnaires to 45 residents Seventeen questionnaires had been returned at the time of the site visit a response rate of 38 Most residents indicated that the ability to contact a mentor would have either made them feel more confident 16 or 94 or altered their handling of recent cases 15 or 88 All residents had access to a mobile phone and many 11 or 65 had used it to contact a medical colleague for guidance A low cost and technologically simple telemedicine solution that maximized use of mobile phone capability provided access to medical and health care information and permitted exchange of images would be an appropriate response to the identified needs
- ItemAn editor's view of telemedicine.(2004-12-17) Wootton, RichardShould an editor hold a view about telemedicine or should an editor be entirely disinterested The editorial role has been defined by the International Committee of Medical Journal Editors and a long list of editorial responsibilities has been set out by the World Association of Medical Editors This represents something of a counsel of perfection although clearly an editor should not have a personal view in the sense of promoting telemedicine or dismissing it Since telemedicine editors are almost bound to be active in research they should take particular care with manuscripts involving their own work for example standing aside from the editorial process and delegating editorial decisions to other members of the editorial staff At the beginning of the 1990s there were few publications about telemedicine in the peer reviewed literature The subsequent years have seen a rapid growth in numbers of articles and the emergence of two specialist journals These are all healthy signs However there have been remarkably few studies of telemedicine s cost effectiveness which must represent a sign of its immaturity On balance the evidence seems to indicate that telemedicine research is in a healthy state
- ItemThe family costs of attending hospital outpatient appointments via videoconference and in person.(2004-01-19) Smith, Anthony C; Youngberry, Karen; Christie, Fiona; Isles, Alan; McCrossin, Robert; Williams, Michael; Van Der Westhuyzen, Jasper; Wootton, RichardWe compared the costs incurred by families attending outpatient appointments at the Royal Children s Hospital RCH in Brisbane with those incurred by families who had a consultation via videoconference in their regional area In each category 200 families were interviewed The median time spent travelling for videoconferences was 30 min compared with 80 min for face to face appointments Families interviewed in the outpatient department had travelled a median distance of 70 km while those who had a videoconference at the local hospital had travelled only 20 km It cost these families much more to attend an appointment at the RCH than to attend a videoconference Ninety six per cent of families 193 reported at least one of the following types of expense 150 families had expenses related to parking median A 10 dollars 156 had fuel expenses median A 10 dollars and 122 reported costs related to meals purchased at the RCH median A 10 dollars Only 21 families who had their appointment via local videoconference reported any additional costs Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane
- ItemA feasibility study of email communication between the patient's family and the specialist burns team.(2004-12-17) Johansen, Monika Alise; Wootton, Richard; Kimble, Roy; Mill, Julie; Smith, Anthony; Hockey, AndrewWe investigated whether the parents of burns patients could capture suitable clinical images with a digital camera and add the necessary text information to enable the paediatric burns team to provide follow up care via email Four families were involved in the study each of whom sent regular email consultations for six months The results were very encouraging The burns team felt confident that the clinical information in 30 of the 32 email messages 94 they received was accurate although in 11 of these 30 cases 37 they stated that there was room for improvement the quality was nonetheless adequate for clinical decision making The study also showed that low resolution images average size 37 kByte were satisfactory for diagnosis Families were able to participate in the service without intensive training and support The user survey showed that all four families found it easy and convenient to take the digital photographs and to participate in the study The results suggest that the technique has potential as a low cost telemedicine service in burns follow up and that it requires only modest investment in equipment training and support
- ItemHow can teleneurology improve patient care?(2006-08-25) Patterson, Victor; Wootton, Richard