Economic evaluation of telemedicine: review of the literature and research guidelines for benefit-cost analysis.

Telemedicine programs provide specialty health services to remote populations using telecommunications technology. This innovative approach to medical care delivery has been expanding for several years and currently covers various specialty areas such as cardiology, dermatology, and pediatrics. Economic evaluations of telemedicine, however, remain rare, and few of those conducted have accounted for the wide range of economic costs and benefits. Rigorous benefit-cost analyses of telemedicine programs could provide credible and comparative evidence of their economic viability and thus lead to the adoption and/or expansion of the most successful programs. To facilitate more advanced economic evaluations, this article presents research guidelines for conducting benefit-cost analyses of telemedicine programs, emphasizing opportunity cost estimation, commonly used program outcomes, and monetary conversion factors to translate outcomes to dollar values. The article concludes with specific recommendations for future research.

Telehealth technologies and applications for terrorism response: a report of the 2002 coastal North Carolina domestic preparedness training exercise.

Effective response to natural or man-made disasters (i.e., terrorism) is predicated on the ability to communicate among the many organizations involved. Disaster response exercises enable disaster planners and responders to test procedures and technologies and incorporate the lessons learned from past disasters or exercises. On May 31 and June 1, 2002, one such exercise event took place at the Camp Lejeune Marine Corps Base in Jacksonville, North Carolina. During the exercise, East Carolina University tested: (1) in-place Telehealth networks and (2) rapidly deployable communications, networking, and data collection technologies such as satellite communications, local wireless networking, on-scene video, and clinical and environmental data acquisition and telemetry. Exercise participants included local, county, state, and military emergency medical services (EMS), emergency management, specialized response units, and local fire and police units. The technologies and operations concepts tested at the exercise and recommendations for using telehealth to improve disaster response are described.

Evaluation of technical approaches to tele-electromyography via internet protocol networks.

An exploratory study was conducted to determine the feasibility and clinical utility of remote electromyography (EMG) and nerve conduction studies over Internet Protocol (IP) networks. A progression of technical approaches was attempted until a workable solution was discovered. An evaluation form was completed for each tele-EMG session to attempt to quantify the clinical utility of tele-EMG. In all, 73 tele-EMG examinations were conducted over 29 months. Improvements in scores of evaluation survey items corresponded with the technical modifications. The final working model involved the use of contemporaneous developments in commercial videoconferencing systems that allowed simultaneous transmission and remote display of video and EMG computer (video graphics array [VGA]) signals. This exploratory study demonstrated a technical solution that met the clinical needs of rehabilitation medicine physicians for remote assessment of EMG and nerve conduction studies.

Telepsychiatry and e-mental health services: potential for improving access to mental health care.

Reforming mental health care is a focus of many ongoing initiatives in the United States, both at the national and state levels. Access to adequate mental health care services is one of the identified problems. Telepsychiatry and e-mental health services could improve access to mental health care in rural, remote and underserved areas. The authors discuss the required technology, common applications and barriers associated with the implementation of telepsychiatry and e-mental health services.