安徽省县级公立医院参与远程会诊情况调查分析

目的 分析安徽省县级公立医院信息化基本建设情况、医务人员参加远程会诊的意愿及其影响因素,为推进远程会诊持续发展提供意见。方法 通过文献复习,初步设计了远程会诊调查表,以无记名方式对安徽省8家开展远程会诊的县级公立医院进行调查。结果 （1）8家县级医院的信息化建设各不相同。（2）8家县级医院医务人员对远程会诊知晓率为76.2%。（3）对远程会诊相关问题理解不同,使用远程会诊意愿也不用。结论 从提高县级医院信息化平台建设,加强远程会诊宣传工作,以点带面,推进远程会诊发展,创新远程会诊服务模式等方面入手,提高县级公立医院和医务人员的参与度。     

单日远程会诊突破102例简析与思考

通过对医院单日102例远程会诊病例从地域分布、临床分类和会诊目的3个方面的简单统计分析,讨论远程医学的应用需求、应用方式,探索远程医学在区域医疗协作中的应用模式。     

我院远程医疗会诊情况分析与思考

目的 总结和回顾多年来远程会诊工作开展情况,探索提高远程医疗效率的方法。方法 对完成的139例远程会诊的相关资料统计分析。结果 目前远程会诊主要承担的是偏远地区、不方便外出就诊的患者,近90%是为病情急危患者组织的急诊会诊,60%是常见病、多发病中的复杂难治病例。结论 提高远程会诊质量和效率,有利于节约医疗资源,使更多基层患者得到救治,开展远程疑难病例、死亡病例讨论及远程查房等方式,开辟远程会诊的新领域。     

医院预约挂号模式在远程会诊调度环节的运用与思考

伴随远程会诊在国内的普及和社会接受度的提升,改变影响会诊建立效率的调度方式对于提升服务水平十分必要。研究者通过借鉴医院门诊所采用的预约挂号方式,结合远程会诊与基于互联网的远程会诊平台结合紧密的特点,建立远程会诊预约挂号新模式。新模式缓解了会诊申请量大与医疗资源协调难之间的矛盾,更加适应医患需求。研究不仅形成了有效的远程会诊分诊调度新方法,也为远程医学行业内的平台升级及服务优化提供了新思路。     

远程会诊系统诊断皮肤真菌病

远程医疗会诊作为一种新的医学服务模式,与传统的医疗手段相比较,发展迅速,在医学领域中已充分显示出优越性.我国地域辽阔,医疗资源分布非常不平均,边远地区极其缺乏高端医疗人才和器材.皮肤病有发病率高、直观性强等特点,非常适合开展远程会诊.现通过医院在建设皮肤病远程会诊系统过程中产生的问题,对皮肤病远程会诊进行一些讨论.     

IMPAX PACS在黑龙江省区域化医疗远程会诊中的初步应用

目的:研究黑龙江省不同医疗机构之间新型协同服务模式,加强垦区各级医疗机构的信息化基础建设,建立基于医学影像存档与通信传输系统(Picture Archiving and Communications System,PACS)的数字化医疗区域。方法:将哈尔滨医科大学附属第四医院现有的影像数据归档,集成到IMPAX PACS数据中心(Internet Data Center,IDC),作为整个区域医疗的影像中心。通过IDC交换平台的延伸覆盖,以及医院信息系统(Hospital Information System,HIS)与XERO集成,可经网络调阅IDC中的影像,实现远程影像会诊。结果:建立基于IMPAX PACS的区域医疗;工程覆盖1家省会大医院和垦区2家综合性医院、5家二级医院、11家农场医院,实现联网医院间的影像学远程会诊。结论:PACS区域远程医疗系统的建立为基层百姓就医提供方便,影像学远程会诊可有效避免影像学重复检查,双向转诊、信息共享给患者带来更多的便利和实惠,具有巨大的社会效益。     

统一通信模式下的医疗服务创新探索

作为一种成熟的通信技术,统一通信正逐步被国内大型医院所采用。在医院这个特殊的应用场景里,统一通信在方便医护人员沟通的同时,也能在咨询预约、医疗会诊、远程医疗、护士紧急呼叫、病房探视等面为病患提供帮助。     

远程会诊系统研制成功

一台如缝纫机大小、可方便移动的“非典型肺炎专用专家远程会诊系统,日前由二医大附属新华医院副院长、39岁的孙锟率领的研究小组研制成功,并已分别安放在市传染病医院和肺科医院。该系统是通过应用最新的计算机网络技术和无线通信技术,在高保真的前提下远程获取诊断与鉴别诊断所     

基于省级平台的远程医疗系统设计

提出了一种基于省级平台的远程医疗系统的设计方案,主要从系统整体架构设计、网络结构设计、功能规划以及系统的业务流程设计几个方面进行了详细分析。通过建立省级远程医疗服务平台,可完成省内各医院之间远程医疗服务的统一调度和费用结算,各医院所建立的远程医疗业务平台完成医院间的各种远程医疗服务,系统可实现省内其他医院和省外医院的无缝接入。     

区域远程影像信息系统建设与实践

在基层医疗机构,医学影像学检查存在检测技术水平有限,缺乏人才培养机制等问题。本文基于远程会诊应用模式,针对我市沙坪坝区的医疗资源分布不均的现状,构建区域远程影像信息系统,有效提高了资源利用率,为患者提供了更便捷的区域化医疗服务。     

基于医疗联合体的区域医疗信息平台建设

以医疗联合体为依托,建立区域医疗信息平台。其平台系统集成并共享各医疗机构的诊疗信息,对居民在各医疗机构的诊疗信息进行系统、连贯的有机整合;系统制定规范的分级诊疗流程、上转诊间预约、下转自动推送机制;在区域医疗联合体内部层级医疗机构内,提供远程会诊、在线医学教育、病患健康宣教、区域临床统一知识库、居民电子健康档案、诊疗预约、信息共享服务。     

Recent developments and present status of telepathology.

Telepathology which is the diagnostic work of a pathologist at a distance has been developed to routine application within the last ten years. It can be classified in relation to application, technical solutions, or performance conditions. Diagnostic pathology performance distinguishes primary diagnosis (for example, frozen section statement) from secondary diagnosis (for example, expert consultation) and quality assurance (diagnostic accuracy, continuous education and training). Applications comprise (a) frozen section service; (b) expert consultations; (c) remote control measurements; and (d) education and training. The technical solutions distinguish active (remote control, live imaging) systems from passive (conventional microscope handling, static imaging), and the performance systems with interactive (on-line, live imaging) use from those with passive (offline, static imaging) practice. Intra-operative frozen section service is mainly performed with remote control systems; whereas expert consultations and education/training are commonly based upon Internet connections with static imaging in an off-line mode. The image quality, transfer rates, and screen resolution of active and passive telepathology systems are sufficient for an additional or primary judgment of histological slides and cytological smears. From the technical point of view, remote control telepathology requires a fast transfer and at least near on-line judgement of images, i.e., image acquisition, transfer and presentation can be considered one performance function. Thus, image size, line transfer rate and screen resolution define the practicability of the system. In expert consultation, the pixel resolution of images and natural color presentation are the main factors for diagnostic support, whereas the line transfer rate is of minor importance. These conditions define the technical compartments, especially size and resolution of camera and screen. The performance of commercially available systems has reached a high quality standard. Pathologists can be trained in a short time and use the systems in a routine manner. Several telepathology systems have been implemented in large Institutes of Pathology which serve for frozen section diagnosis in small hospitals located in the local area. In contrast, expert consultation is mainly performed with international connections. There is a remarkable increase of expert consultations by telepathology according to the experiences of the Armed Forces Institute of Pathology or the Department of Pathology, Thoraxklinik, Heidelberg. In expansion of these experiences, a "globalization" of telepathology can be expected. Telepathology can be used to shrink the period necessary for final diagnosis by request for diagnostic assistance to colleagues working in appropriate related time zones. Telepathology is, therefore, not a substitute of conventional diagnostic procedures but a real improvement in the world of pathology.     

Comparison of Remote Versus In-Person Behavioral Consultation for Treatment of Canine Separation Anxiety

To investigate the validity of remote consultation for treatment of canine separation anxiety, this study compared the efficacy of 2 types of behavioral services offered by Tufts Cummings School of Veterinary Medicine (TCSVM): (a) “PetFax,” a remote consultation service in which dog caregivers (owners) and a certified applied animal behaviorist correspond via fax or email and (b) in-person clinic consultation, which requires that owners bring their dogs to the Animal Behavior Clinic at TCSVM to consult with a board-certified veterinary behaviorist, a veterinary behavior resident, or a certified applied animal behaviorist. The study tested 4 variables for significant differences between PetFax users and clinic visitors: (a) pre- and posttreatment anxiety scores; (b) owner-reported improvement; (c) percentage of rehomed dogs, dogs relinquished or euthanized because of separation anxiety; and (d) clarity of communication with owners. The study found no significant differences between the groups. Difference scores and owner reports demonstrated substantial reduction in separation anxiety in both groups. Results indicate remote consultation is a valid way for behavioral professionals to share behavior modification advice with owners regarding canine separation anxiety.     

Comparison of remote versus in-person behavioral consultation for treatment of canine separation anxiety

To investigate the validity of remote consultation for treatment of canine separation anxiety, this study compared the efficacy of 2 types of behavioral services offered by Tufts Cummings School of Veterinary Medicine (TCSVM): (a) “PetFax,” a remote consultation service in which dog caregivers (owners) and a certified applied animal behaviorist correspond via fax or email and (b) in-person clinic consultation, which requires that owners bring their dogs to the Animal Behavior Clinic at TCSVM to consult with a board-certified veterinary behaviorist, a veterinary behavior resident, or a certified applied animal behaviorist. The study tested 4 variables for significant differences between PetFax users and clinic visitors: (a) pre- and posttreatment anxiety scores; (b) owner-reported improvement; (c) percentage of rehomed dogs, dogs relinquished or euthanized because of separation anxiety; and (d) clarity of communication with owners. The study found no significant differences between the groups. Difference scores and owner reports demonstrated substantial reduction in separation anxiety in both groups. Results indicate remote consultation is a valid way for behavioral professionals to share behavior modification advice with owners regarding canine separation anxiety.     

Accuracy of a remote quantitative image analysis in the whole slide images

The rationale for choosing a remote quantitative method supporting a diagnostic decision requires some empirical studies and knowledge on scenarios including valid telepathology standards. The tumours of the central nervous system [CNS] are graded on the base of the morphological features and the Ki-67 labelling Index [Ki-67 LI]. Various methods have been applied for Ki-67 LI estimation. Recently we have introduced the Computerized Analysis of Medical Images [CAMI] software for an automated Ki-67 LI counting in the digital images. Aims of our study was to explore the accuracy and reliability of a remote assessment of Ki-67 LI with CAMI software applied to the whole slide images [WSI]. The WSI representing CNS tumours: 18 meningiomas and 10 oligodendrogliomas were stored on the server of the Warsaw University of Technology. The digital copies of entire glass slides were created automatically by the Aperio ScanScope CS with objective 20x or 40x. Aperio's Image Scope software provided functionality for a remote viewing of WSI. The Ki-67 LI assessment was carried on within 2 out of 20 selected fields of view (objective 40x) representing the highest labelling areas in each WSI. The Ki-67 LI counting was performed by 3 various methods: 1) the manual reading in the light microscope - LM, 2) the automated counting with CAMI software on the digital images - DI , and 3) the remote quantitation on the WSIs - as WSI method. The quality of WSIs and technical efficiency of the on-line system were analysed. The comparative statistical analysis was performed for the results obtained by 3 methods of Ki-67 LI counting. The preliminary analysis showed that in 18% of WSI the results of Ki-67 LI differed from those obtained in other 2 methods of counting when the quality of the glass slides was below the standard range. The results of our investigations indicate that the remote automated Ki-67 LI analysis performed with the CAMI algorithm on the whole slide images of meningiomas and oligodendrogliomas could be successfully used as an alternative method to the manual reading as well as to the digital images quantitation with CAMI software. According to our observation a need of a remote supervision/consultation and training for the effective use of remote quantitative analysis of WSI is necessary.     

Timer: a new objective measure of consultation content and its application to computer assisted consultations.

As part of the research into the effect in the consultation of the use of a computer to prompt opportunistic preventive care a valid, objective, and practical measure of the consultation process was required. After a review of the alternative methods the Time Interval Medical Event Recorder (Timer) was developed, its reliability tested, and applied to 93 control consultations and 49 computer assisted consultations. Timer records, every five seconds, four consultation events: the problems being dealt with, the physical activity, the verbal activity, and the secondary tasks being attempted. Timer showed that control consultations lasted an average of 6 minutes 58 seconds. The doctors spent 35% of their time on administration, and patients and doctors were both conversational for just 33% of the consultation. Giving information was the most common verbal activity (48% of the duration of the consultation) with silence accounting for 21% of the time. When the computer was used the average consultation was longer, at 7 minutes and 46 seconds. The doctor''s contribution to the consultation appeared to have increased. Patient centred speech fell from 36% in controls to 28% of the duration of the consultation when the computer was used, while doctor centred speech rose from 30% to 34.5%. Secondary tasks (exploring patient concepts, education, management sharing, and prevention) were attempted during 28% of the control consultations and 40% of the computer consultations. This was accounted for by the increase in prevention (p less than 0.001). Timer is a reliable and practical tool for researching the consultation, and though it has shown validity in detecting differences between consultations that use a computer and those that do not, further applications are required to establish its full value.