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      Innovative Telemedicine Approaches in Different Countries: Opportunity for Adoption, Leveraging, and Scaling-Up

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          In the age of digitization, a growing percentage of services are becoming available online, and this trend is affecting healthcare too. As evolving technology creates more avenues for physicians to deliver affordable and instant care to their patients, there has been a sharp increase in the number of telemedicine implementations across the world. 1 As in other disciplines, guidelines and regulations on telemedicine lag behind the use of the technology and are still being crafted and modified. For example, the new nationwide policy on telemedicine of the Department of Veterans Affairs (VA) of the US Government became effective in mid-2018 and incorporates the opinion and recommendations made 7 years earlier. In recent years, the VA spent over $1 billion a year on transportation of veterans to and from hospitals; now with telemedicine, this amount can be used increasingly for other purposes. This cost-saving experience at the national scale should alert industry actors, national governments, and consumers of the growing urgency to address the policy and regulatory aspects of telemedicine to provide healthcare services with greater speed, quality, and safety to rapidly increasing percentages of citizens of their respective countries.

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          Most cited references 17

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          Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial

          Background Telemedicine consultations using real-time videoconferencing has the potential to improve access and quality of care, avoid patient travels, and reduce health care costs. Objective The aim of this study was to examine the cost-effectiveness of an orthopedic videoconferencing service between the University Hospital of North Norway and a regional medical center in a remote community located 148 km away. Methods An economic evaluation based on a randomized controlled trial of 389 patients (559 consultations) referred to the hospital for an orthopedic outpatient consultation was conducted. The intervention group (199 patients) was randomized to receive video-assisted remote orthopedic consultations (302 consultations), while the control group (190 patients) received standard care in outpatient consultation at the hospital (257 consultations). A societal perspective was adopted for calculating costs. Health outcomes were measured as quality-adjusted life years (QALYs) gained. Resource use and health outcomes were collected alongside the trial at baseline and at 12 months follow-up using questionnaires, patient charts, and consultation records. These were valued using externally collected data on unit costs and QALY weights. An extended sensitivity analysis was conducted to address the robustness of the results. Results This study showed that using videoconferencing for orthopedic consultations in the remote clinic costs less than standard outpatient consultations at the specialist hospital, as long as the total number of patient consultations exceeds 151 per year. For a total workload of 300 consultations per year, the annual cost savings amounted to €18,616. If costs were calculated from a health sector perspective, rather than a societal perspective, the number of consultations needed to break even was 183. Conclusions This study showed that providing video-assisted orthopedic consultations to a remote clinic in Northern Norway, rather than having patients travel to the specialist hospital for consultations, is cost-effective from both a societal and health sector perspective. This conclusion holds as long as the activity exceeds 151 and 183 patient consultations per year, respectively. Trial Registration ClinicalTrials.gov NCT00616837; https://clinicaltrials.gov/ct2/show/NCT00616837 (Archived by WebCite at http://www.webcitation.org/762dZPoKX)
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            Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study

            Background Norway has a long history of using telemedicine, especially for geographical reasons. Despite the availability of promising telemedicine applications and the implementation of national initiatives and policies, the sustainability and scaling-up of telemedicine in the health system is still far from accomplished. The main objective of this study was to explore and identify the multi-level (micro, meso and macro) factors affecting telemedicine utilization in Norway. Methods We used a mixed methods approach. Data from a national registry were collected to analyze the use of outpatient visits and telemedicine contacts in Norway from 2009 to 2015. Interviews with key stakeholders at national, regional and local level helped complete and contextualize the data analysis and explore the main issues affecting the use of telemedicine by health authorities and hospitals. Relevant national documents were also used to support, contradict, contextualize or clarify information and data. Results Telemedicine use in Norway from 2009 to 2015 remained very low, not exceeding 0.5% of total outpatient activity at regional level and 0.1% at national level. All four regions used telemedicine. Of the 29 hospitals, 24 used it at least once over the 7-year period. Telemedicine was not used regularly everywhere, with some hospitals using it sporadically. Telemedicine was mostly used in selected specialties, including rehabilitation, neurosurgery, skin and venereal diseases. Three major themes affecting implementation and utilization of telemedicine in Norway emerged: (i) governance and strategy; (ii) organizational and professional dimensions; (iii) economic and financial dimensions. For each theme, a number of factors and challenges faced at different health care levels were identified. Conclusions This study allowed shedding light on multi-level and interdependent factors affecting utilization of telemedicine in Norway. The identification of the main implementation and utilization challenges might support decision makers and practitioners in the successful scaling-up of telemedicine. This work provides a knowledge base useful to other countries which intend to implement telemedicine or other digital health services into their healthcare systems. Electronic supplementary material The online version of this article (10.1186/s12911-017-0576-4) contains supplementary material, which is available to authorized users.
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              An Innovative Mobile Health System to Improve and Standardize Antenatal Care Among Underserved Communities: A Feasibility Study in an Italian Hosting Center for Asylum Seekers


                Author and article information

                Telehealth and Medicine Today
                Partners in Digital Health
                22 November 2019
                : 5
                [1 ]Massachusetts Institute of Technology, Cambridge, MA, USA
                [2 ]Wellesley College, Wellesley, MA, USA
                [3 ]SOAR Management Consulting Group, Brookline, MA
                [4 ]Mallya Aditi International School, Bengaluru, Karnataka, India
                Author notes
                Corresponding Author: Amar Gupta, Massachusetts Institute of Technology, Cambridge, MA, USA. agupta@ 123456mit.edu .
                © 2019 Amar Gupta

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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