A review of audiovisual telemedicine utilization and satisfaction assessment during the COVID-19 pandemic.

INTRODUCTION: The use of telemedicine has broadened as technology that both restores continuity of care during disruptions in healthcare delivery and routinely provides primary care alone or in combination with in-person care. During the Covid-19 outbreak, the use of telemedicine as a routine care modality further accelerated. METHODS: A review of scientific studies that used telemedicine to provide care from December 2019 to December 2020 is presented. From an initial set of 2,191 articles, 36 studies are analyzed. Evidence is organized and evaluated according to the country of study, the clinical specialty, the technology platform used, and satisfaction and utilization outcomes. RESULTS: Thirty-one studies reported high patient satisfaction scores. Eight studies reported satisfaction from both providers and patients with no uniformly accepted assessment instrument. Eight studies conducted a descriptive analysis of telemedicine use and patient adoption patterns. Less than one-third of studies were controlled before/after studies. Most studies were conducted in the USA followed by Europe. CONCLUSIONS: Reported satisfaction rates are high, consistent with previously documented research, whereas utilization rates increased significantly compared with the prepandemic period. Future work in developing standardized uniform assessment instruments, embedded with each telemedicine system, would increase versatility and agility in the assessment, boosting statistical power and the interpretation of results.

Interoperable electronic patient records for health care improvement.

Pressing needs of cost-effectiveness in healthcare and opportunities of emerging electronic health record technologies offer unprecedented chance for progress. Ongoing health care improvement and patient safety initiatives demand new information collection and communication technologies (e.g., Centers for Medicaid and Medicare Services, Joint Commission, National Patient Safety Foundation, public health surveillance). Particularly, desire for faster action and cost-effective health care drive unprecedented investments in electronic patient records worldwide. Recognizing these opportunities, many countries and the World Health Organization have launched several major health care improvement initiatives that are driven by new electronic record technologies. In the United States, historic $19 billion investment is provided through the American Recovery and Reinvestment Act of 2009. Models of sharing electronic patient data and citizen expectations for personal electronic health records will be reviewed. Regional health information networks and other information sharing initiatives depend on the interoperability of systems. Ultimately, the recent flood of health information standards needs to be balanced with actual interoperability opportunities. It is anticipated that the current policy discussions on the "meaningful use" of electronic health records will have major beneficial technical and also reimbursement implications.

Biosurveillance evaluation of SNOMED CT's terminology (BEST Trial): coverage of chief complaints.

The current United States Health Information Technology Standards Panel's interoperability specification for biosurveillance relies heavily on chief complaint data for tracking rates of cases compatible with a case definition for diseases of interest (e.g. Avian Flu). We looked at SNOMED CT to determine how well this large general medical ontology could represent data held in chief complaints. In this experiment we took 50,000 records (Comprehensive Examinations or Limited Examinations from primary care areas at the Mayo Clinic) from December 2003 through February 2005 (Influenza Season). Of these records, 36,097 had non-null Chief Complaints. We randomly selected 1,035 non-null Chief Complaints and two Board-certified internists (one Infectious Diseases specialist and one general internist) reviewed the mappings of the 1,035 chief complaints. Where the reviewers disagreed, a third internist adjudicated. SNOMED CT had a sensitivity of 98.7% for matching clinical terms found in the chief complaint section of the clinical record. The positive predictive value was 97.4%, the negative predictive value was 89.5%, the specificity was 81.0%, the positive likelihood ratio was 5.181 and the negative likelihood ratio was 0.016. We conclude that SNOMED CT and natural language parsing engines can well represent the clinical content of chief complaint fields. Future research should focus on how well the information contained in the chief complaints can be relied upon to provide the basis of a national strategy for biosurveillance. The authors recommend that efforts be made to examine the entire clinical record to determine the level of improvement in the accuracy of biosurveillance that can be achieved if we were to incorporate the entire clinical record into our biosurveillance strategy.