american telemedicine association 2008 poster ...193263/ata_2008_poster... · headminder, inc, new...

DOI: 10.1089/tmj.2007.9983.supp © MARY ANN LIEBERT, INC. • VOL. 14 SUPPLEMENT 1 • MARCH 2008 TELEMEDICINE and e-HEALTH 99

P24 FEASIBILITY OF THE HEADMINDER CSI FOR SCREENING OF BLAST-INJURY RELATED COGNITIVE IMPAIRMENT IN A COMBAT FIELD HOSPITAL

David Erlanger, PhD, ABPP, Tanya Kaushik, PsyD HeadMinder, Inc, New York, NY

Background This study examined feasibility of using a computerized cogni-tive screening for fi eld assessment of concussive blast injuries. The HeadMinder Cognitive Stability Index (CSI) is a cognitive battery useful for telemedicine ap-plications. This 30-minute performance-based objective assessment of memory, attention and reaction time instantly produces standardized reports facilitating triage and clinical decision-making: As needed, physicians/neuropsychologist teams in the U.S. viewed reports to direct treatment in Iraq in real time via an Internet based, HIPAA-compliant testing and medical records platform.

In 2006, 81 male members of the armed services who were involved in blast-concussive type injuries were administered the CSI within 48 hours of injury at a combat fi eld hospital in Iraq. Injured personnel wore sound-masking headphones to decrease potential distractions. The mean age of subjects was 26.2 (sd=6.1). Approximately 65% were Caucasian, 10% African American, and 15% Hispanic. Sixty-four percent had high school degrees, and 34% had completed some or all of college.

Results Valid test results were obtained for all 81 patients. Of a total of 324 potential factor scores (4 per patient), 312 (96%) were considered statistically valid. Patients were triaged according to the presence of/severity of cognitive disorder in a fi eld hospital setting. In addition the measure helped identify persons who were cognitively ready to return to duty.

Conclusion The CSI appeared to be a feasible computerized cognitive assess-ment system for telemedicine applications.

P37 MULTITASKING A TELEMEDICINE TRAINING UNIT IN EARTHQUAKE DISASTER RESPONSE: PARAPLEGIC REHABILITATION ASSESSMENT

Asif Zafar, MD,FCPS,FRCS,1,2 Shahzad Gul, MD,1 Hirra Ghaffar, MD,1 Shirin Mirza, MD,1 Syeda Fizza Tauqir, MD,1 Faisal Murad, MD,1,2 Qasim Ali, MD,1,2 Ronald C. Merrell, MD3

1Rawalpindi Medical College, Rawalpindi, Pakistan; 2Telemedicine & E-Health Training Center, Holy Family Hospital, Rawalpindi, Pakistan; 3Virginia Commonwealth University, Richmond, VA

Objective To provide computer and telecommunications skill training for paraplegics using a telemedicine training center in a curriculum that would

support connectivity and offer new skills for career applications in the reha-bilitation phase and beyond.

Design This was a hospital-based, cross sectional study.

Place and Duration The study was conducted from October 10, 2005 to May 10, 2006 in the hospitals of Rawalpindi Medical College and the Melody Re-habilitation Center. These centers provided care for casualties of the October, 2005 earthquake in Pakistan.

Patients and Methods 194 paraplegics were admitted to Rawalpindi Medical College allied hospitals following injuries in the rural mountains near the epicenter. Surveys assessed the education level of the patients and a sample of 12 patients was enrolled in computer training classes.

Results Of the 194 patients 144 were females and 50 were males. 78% (151) of the patients were 16-39 yrs of age. Although only 60% were literate the overall literacy rate of Pakistan is just 48.7%. Telephone service at home was available after discharge for 40% of patients. Only 8% patients had basic computer skills. All patients participated in the survey and sought to take the course. All the enrolled patients demonstrated full competence in the skills taught.

Conclusion The social disruption of disaster plus the new challenge of a neu-rological defi cit in paraplegia did not deter a remarkable number of patients from a rural area from engaging in computer and telemedicine training. Their personal goals included long term rehabilitation and perhaps fi nding a new career opportunity supported by computer skills. This study dem-onstrates the feasibility of educating rural paraplegics in computer skills for telemedicine. The telemedicine training center can be used for this task without special equipment or personnel and such a task can increase the utilization of the facility.

P45 TELEMEDICINE INSTRUCTION IN THE CURRICULUM: EXPANDING PERSPECTIVES ON CLINICAL PRACTICE

Robert J. Bulik, PhD University of Texas Medical Branch, Galveston, TX

Much has been written about the potential for telemedicine to increase access to care. As the need for telemedicine increases, medical schools and residency programs must prepare graduates to participate in this approach to delivery of care. We developed a telemedicine elective for fourth year medical students to learn about the delivery of primary care telemedicine, with the fol-lowing objectives: 1) Describe the technology involved in providing telemedi-

* The Presenter is underlined.

P O S T E R P R E S E N T A T I O N S A B S T R A C T S

American Telemedicine Association 2008 Poster Presentations Abstracts*

cine. 2) Describe the differences and similarities between a face-to-face and a telemedicine encounter. 3) Describe the affect of technology and distance on the doctor-patient relationship. 4) Describe the cost savings for a corporation in having acute care telemedicine services available onsite. 5) Summarize the capabilities and limitations of telemedicine in providing primary care services to patients. Students are involved in telemedicine on campus and at distant sites, and experience it from three perspectives: provider, patient, and organi-zation. A refl ective essay is required at the completion of the four-week course in which students integrate their experiential exposure to telemedicine with a research topic focused on their eventual area of practice. Feedback from our fi rst seven students has been very positive. Comments include: 1) “Exposure has been the best teacher for me over the past four decades of my life. It was an awesome experience to see telemedicine in action...." 2) “UTMB is the largest telemedicine provider in the state of Texas, but the medical students are not getting any exposure to it. It is only offered as a fourth-year elective course. None of our third-year clinical rotations requires us to see even one session of telemedicine, and this should change." While connectivity issues and cost effectiveness will continue to be necessary discussion areas, physician un-derstanding of the functioning of telemedicine across disciplines and patient populations may be the lynchpin for determining effective practice.

P46 HOME TELEHEALTH USE AS A CLINICAL EXTENSION OF GERIATRIC PRIMARY CARE 2004–2007

Margaret A. Griffin, MD, MPH, FACP, Judith Jensen, BSN,CCM, Octavita Ghioalda, BSN,CC Loma Linda VA Health Care Systems, Loma Linda, CA

Loma Linda VA Medical Center was able to successfully implement a Care Coordination Home Telehealth( CCHT) program for complex medical Geriat-ric Primary Care patients beginning in 2004. This program was initially start-ed with 5 veterans 65 years of age and older. These veterans had 5 or more on going chronic medical problems and signifi cant functional impairments that also required caregivers to maintain their health in the home setting. The (CCHT) program used one of the fi ve (5) Veterans Administration approved Clinical Practice Council disease management algorithms, ie. Hypertension, Diabetes, Congestive Heart Failure, Chronic Obstructive Pulomnary Disease, Depression to measure and monitor patients blood pressure, blood glucoses and weights in the home setting. The Home Telehealth Equipment also pro-vided educational dialogues to enrolled veterans to improve their self knowl-edge understanding and compliance with the designated medical treatment plans. The program was also used for medication reconciliation since most veterans enrolled in Geriatric Primary Care are on 9 or more drugs.

VA DSS Inpatient and Outpatient cost was tracked every 6 months over the last 3 years and no correlation of cost avoidance or cost savings related to the use of CCHT could not be determined using this data base. Veterans satisfaction with care, medication compliance and instutional care use were tracked over this time period and showed a positive correlation. The CCHT program currently has 29 veterans enrolled, 6 who have been enrolled for more than 2 years without any acute hospitalizations and 1 veteran placed in a nursing home. This program continues to enroll and track veteran out-comes and compare outcomes using this program with outcomes using tra-ditional care.

P53 IMPROVING ADHERENCE TO TOPICAL MEDICATIONS: USING ELECTRONIC MONITORING AND REMINDERS TO CHANGE BEHAVIOR

April Armstrong, MD,1,2 Alice Watson, MD MPH,1 Jeffrey Brown,1 Douglas McClure,1 David Rosa,3 Alexa Kimball, MD MPH,2 Joseph Kvedar, MD1 1Center for Connected Health, Massachusetts General, Boston, MA; 2Harvard Clinical Unit for Research Trials in Skin, Boston, MA; 3Clinical Technology Advisors, Boston, MA

Adherence to topical medications is poor among patients suffering from der-matological diseases. This leads to persistence of disease and increasing health-

care costs. The estimated 30% adherence to topical agents is even lower than adherence to chronic, oral medications; however, few interventions have been designed to address this issue. In this project, our aims were two fold: 1) to devel-op a novel, accurate, and reliable monitoring device, and 2) to create electronic reminders to enhance adherence to topical agents. We developed a detachable, electronic monitoring device specifi cally designed to be used to track adherence to topical agents (SIMCream). The device could be adapted to fi t tubes of varying shapes and sizes. Each time a tube cap was removed, the electronic monitor de-livered an SMS text message to a central server. The SMS message provided date and time-stamped information about when an individual unit was used; along with information on battery status and signal strength of the device. In order to deliver electronic reminders to patients, we employed an automated cellular phone text-messaging system to send timely, brief reminders over a secured net-work. In addition to reminding patients to use topical medications, the messages contained daily weather information, customized to each patient’s location, to maintain interest in the message content. The messages could be delivered at a time pre-specifi ed by each patient. This electronic reminder system also tracked when each message is delivered, received, and read by the patient. In this project, we developed innovative monitoring and reminder technology to tackle a previ-ously overlooked problem: the issue of poor adherence to topical medications. Our electronic monitoring and reminder system offers physicians an insight into their patient’s behavior, and provides patients feedback, reinforcement and re-minders. We believe this system will improve patient adherence rates to topical medications and positively impact their overall health states.

P55 ROLE OF TELEMEDICINE IN FOLLOW-UP AND MONITORING OF PEOPLE WITH HAEMOPHILIA IN NORTHERN PAKISTAN

Asif Zafar, MD, FRCS, FCPS,1,2,3 Tahira Zafar, MD, DCP, MRCPath, FRCPath(Lond)4,5 1Rawalpindi Medical College, Rawalpindi, Pakistan; 2Holy Family Hospital, Rawalpindi, Pakistan; 3Telemedicine & E-Health Training Center, Rawalpindi, Pakistans; 4Pakistan Institute of Medical Sciences, Islamabad, Pakistan; 5Thalassemia & Haemophilia Treatment Center, Islamabad, Pakistan

Pakistan Haemophilia Welfare Society is the national member organization looking after persons with Haemophilia in Pakistan (PWH). It’s Rawalpindi/Islamabad chapter is providing care to 230 registered patients in Northern Pakistan and Azad Jammu Kashmir. The absence of medical facilities cou-pled with fi nancial constraints and lack of transport facility in remote areas leads to immense problems in care and follow up. Telemedicine is a unique way of overcoming these barriers in management. This is a preliminary ex-perience to reach out to PWH spread out in different geographic locations. Ten PWH with access to and having basic computer skills have been identi-fi ed. Telemedicine and E-health training center, at Holy family hospital has trained both staff of PHPWS and PWH. Customized user friendly software has helped in seeking urgent and prompt consultations with specialists, and avoiding unnecessary travel. This initial experience will be utilized to extend these services to PWH in other areas of the country.

P58 OPHTHALMOLOGIC ELECTRONIC HEALTH RECORDS USING HL7 AND DICOM STANDARDS

Isabel de la Torre Díez, BSc,1 Roberto Hornero Sánchez, PhD,1 Miguel López Coronado, PhD,1 María Isabel López Gálvez, PhD2 1University of Valladolid, Valladolid, Spain; 2University Institute of Applied Ophthalmobiology, Valladolid, Spain

Electronic Health Records (EHR) are a necessary component in telemedi-cine applications and services. An EHR refers to an individual patient's health record in digital format. EHR systems are believed to increase physician effi -ciency and reduce costs. The EHR standardization is a very important aspect to exchange health information. It allows the reduction in duplication of services because EHR can be available at many locations at once, and it fa-cilitates clinical trials. There are several international institutions concerned

100 TELEMEDICINE and e-HEALTH MARCH 2008

POSTER PRESENTATIONS ABSTRACTS

© MARY ANN LIEBERT, INC. • VOL. 14 SUPPLEMENT 1 • MARCH 2008 TELEMEDICINE and e-HEALTH 101

with EHR standardization. Health Level Seven (HL7) and Digital Imaging and Communications in Medicine (DICOM) are intensively infl uencing in this process. In this study, we developed a web-based application (TeleOftalWeb 3.2) to store and exchange EHR in ophthalmology by using HL7 Clinical Doc-ument Architecture (CDA) and DICOM standards. The EHR have been built on Java Servlet and Java Server Pages (JSP) technologies. The EHR are stored in the native Extensible Markup Language (XML) database, dbXML 2.0. Its architecture is a typical three-layered with two database servers (MySQL 5.0 and native XML) and one application server (Tomcat 5.0). The applica-tion is platform-independent thanks to use XML and Java technologies. The physicians can access and retrieve patient medical information and images through Web browsers as Mozilla Firefox, Microsoft Internet Explorer and others. Furthermore, they can view, modify and store all type of medical images in different formats like JPEG, GIF, DICOM, etc. For security, all data transmissions were carried over encrypted Internet connections such as Se-cure Sockets Layer (SSL) and HyperText Transfer Protocol over SSL (HTTPS). The application verifi es the standards related to privacy and confi dentiality. The application is being tested by physicians from the Instituto Universitario de Oftalmobiología Aplicada (IOBA), Spain.

P60 TOWARDS OPTIMISING REMOTE HOME SUPPORT FOR CHRONIC CONDITIONS

Simon Brownsell, Hazel Aldred, Steven Blackburn, Fabien Cardinaux, David Bradley, Mark Hawley Barnsley Hospital NHS Foundation Trust, Barnsley, United Kingdom

Research evidence suggests deployment of telemedicine applications for people with chronic conditions is somewhat inconclusive. We conducted a controlled 12-month study with community based participants who had clini-cally stable chronic heart failure but had seen the heart failure specialist or been admitted to hospital during the previous 12 months. The intervention consisted of the Docobo health hub supplemented with blood pressure and weight readings. From a eligible sample pool, participants were randomised to control or intervention group at a ratio of 1:2 resulting in groups of 16 and 36 respectively who completed all data acquisition. During each 3 month period the following daily data entry rates were obtained 95%, 92%, 87%, and 78%; 199 key medical interventions were made, providing numerous case studies where medication was changed, support given and even an elective admission to hospital; understanding of medical condition improved over time (� = 12.1, p = 0.007). However the study was unable to answer questions relating to hos-pital resources, GP consultations and participants Quality of life. Concurrently, we conducted a controlled study of older people living in sheltered housing (retirement housing) comparing 28 people in a control group against 24 people provided with telecare. The intervention consisted of 2nd generation telecare equipment such as automatic fl ood detectors; a 3rd generation lifestyle reas-surance system; and an Internet café. These studies suggest the interventions showed promise but greater efforts are required particularly to (1) understand the context within which data is gathered; and (2) provide self care/education-al programmes. We conclude by presenting a long-term vision and strategy for optimising remote home support for people with chronic conditions which is the subject of ongoing research.

P62 ONLINE PORTAL AS A SOLUTION TO DELIVER RICH COLLABORATION FEATURES IN TELEREHABILITATION

Andi Saptono, MS, Bambang Parmanto, PhD University of Pittsburgh, Pittsburgh, PA

Traditional telerehabilitation (TR) approaches usually relies only on a single communication channel, mostly over a videoconferencing channel. Applying Web 2.0 technologies in the TR fi eld provides practitioners (such as physical and occupational therapists) with richer collaboration possibilities, including automatic data archiving, online reporting, and online discussion. Research-ers applied Web 2.0 technologies in an online portal to support a remote wheelchair teleassessment project within the Rehabilitation Engineering and

Research Center on Telerehabilitation (RERC-TR) at the University of Pitts-burgh. The online portal was designed as a site to integrate lightweight mod-ules customized to meet specifi c task requirements for the remote wheelchair teleassessment project. The portal allows management of data and documents generated by the teleassessment. The portal also facilitates communication through videoconference and discussion forum. Researchers found that the online portal plays a signifi cant role in this particular research project as it provides effortless access to advanced collaboration features necessary to sup-port the teleassessment activities. The ease of access invites more individuals to actively contribute and participate in the project, and in turn, allows the system to actively connect the collective intelligence of the TR community.

P63 ONE-HUNDRED CASE STUDIES OF ASIA-PACIFIC TELEMEDICINE USING A DIGITAL VIDEO TRANSPORT SYSTEM

Shuji Shimizu, MD,1 Naoki Nakashima, MD,1 Koji Okamura, PhD,2 Masao Tanaka, MD2 1Kyushu University Hospital, Fukuoka, Japan; 2Kyushu University, Fukuoka, Japan

Background Although the use of videos in telemedicine is very helpful, the transmission of high-quality moving images was diffi cult by conventional system. We have established a new system via academic broadband Internet, which can preserve original quality at wide areas of Asia-Pacifi c region. Here we report our 100 case studies and discuss lessons we learned.

Methods Kyushu University Hospital in Fukuoka, Japan, was linked to 52 medical institutions and meeting venues in Korea, China, Taiwan, Thailand, Singapore, Vietnam, Malaysia, Indonesia, Phillipines, India, Australia, and USA over Asia-Pacifi c Advanced Network (APAN), an international research and education consortium. Digital video transport system (DVTS), free soft-ware which transforms digital video signals directly to Internet Protocol, was installed in a regular personal computer with network bandwidth of 30 Mbps per channel. Security software was used to protect patients privacy.

Results Between February 2003 and June 2007, 100 telecommunications were performed, 94 of which were international and 6 were domestic use, where 47 were real-time demonstrations of surgery or endosccopy and 53 were interac-tive teleconferences using videos or PC presentations. Multiple stations were connected in 37 events, and number of connected stations in total reached 269. The frame rate of transmitted pictures was 30/sec, and the time delay was restricted to 0.3-1.0 sec between the stations. With respect to image quality, 509 (68.3%) participants reported in the questionnaires ‘very good’, 206 (27.7%) reported ‘good’, 19 (2.6%) reported ‘poor’, and 11 (1.5%) reported ‘very poor’.

Conclusions DVTS is economical and easy to set-up, and this is the fi st time to use this advanced system in such a wide range of Asia-Pacifi c area. Be-cause high-speed academic network is also available worldwide, we believe our cutting-edge system will facilitate the medical standardization beyond geographic borders. Close cooperation between medical doctors and engi-neering staff is essential for the success.

P73 OCULAR PATHOLOGY DETECTED BY THE VHA VISN 16 TELERETINAL IMAGING PROGRAM

Glenn Saxon, OD, Robert Crammer, OD, Richard Harper, MD Central Arkansas Veterans Healthcare System, Little Rock, AR

In August 2006, Veterans Health Administration (VHA), Veterans Inte-grated Service Network 16 (VHA VISN 16) began the Teleretinal Imaging Program (TRIP) in order to accomplish timely, cost-effective evaluation of those veterans at risk for diabetic retinopathy. In year one of the program, utilizing a network of seven cameras installed at six facilities, VISN 16 TRIP completed 9193 screening consultations. The screenings revealed both dia-betic and non-diabetic ocular pathology. In addition to sight threatening pathology that was identifi ed, a few cases of potentially life-threatening systemic conditions were also discovered.


Conclusion Diabetic Teleretinal screening has proving not only valuable in fi nding diabetic ocular changes, but also in discovering a variety of systemic and ocular pathology.

P79 BIDIRECTIONAL WIRELESS PHYSIOLOGICAL MONITORING OF HOMECARE CLIENTS

Masako Miyazaki, PhD,1 Marguerite Rowe, MSN,2 Toshio Ohyanagi, PhD,3 Lili Liu, PhD,1 Caroline Clark, MSc,2 Albert Cook, PhD,1 Randy Duguay, MBA4 1University of Alberta, Edmonton, Canada; 2Capital Health, Edmonton, Canada; 3Sapporo Medical University, Sapporo, Japan; 4Wellness in Motion Research Inc, Edmonton, Canada

Health sector has been tethered with wires and cables with increasing adop-tion of sophisticated medical and information and communication technologies to increase their effi ciencies and effectiveness in healthcare business. Medical devices such as diagnostic and therapeutic equipment, physiological monitoring equipment and drug delivery are often attached to patients through wires and cables. Although sophisticated and reliable yet static clinical monitoring doesn't always reveal the full picture of a patient, in regards to certain physiological conditions such as fl uctuation of blood pressure, blood glucose level, pulse and reaction to medications. Continuous 24-hour wireless ambulatory monitoring may be more revealing as it allows the patient to be assessed under active condi-tions. It also enables patient mobility, opening up a wide range of ambulatory, mobile and remote patient monitoring, diagnostics and even e-care.

The purpose of this clinical trial was to examine the effectiveness of the wire-less wearable physiological monitor (WWPM) for home care clients and health professionals; and for remote monitoring of pulse and blood glucose levels.

Data on users’ experience of the pulse monitoring, messaging and glucose monitoring functions of the WWPM were collected using a semi-structured ques-tionnaire with 98 Home Care clients, and a survey questionnaire with 20 health professionals and 8 Community Care Access professionals. For the secondary purpose, pulse data was collected before, during and after exercise or activity in 25 community residing clients of two outpatient programs and in 26 healthy older adults. Data collection occurred between July and November 2006.

In summary, the WWPM system can be used to remotely monitor blood glucose levels of clients in their homes. Improvements to the software can better allow bidirectional messaging to be used between health professionals and clients.

P80 PHYSIOLOGICAL MONITORING IN EXTREME ENVIRONMENT INCLUDING IN SPACE

Masako Miyazaki, PhD,1 Martin Lebeuf, MSc.,2 Tatsuaki Ataka, MSc,3 Steven Sutphen, MSC1 1University of Alberta, Edmonton, Canada; 2Canadian Space Agency, Montreal, Canada; 3Olympus Future Research Laboratory, Tokyo, Japan

Mr. Martin Lebeuf A Manager, Canadian Space Agency and Mr. Steve Sutphen, WWPM, University of Alberta climbed Mount Kilimanjaro, which is the Africa's highest peak (5985m). It is considered to be an extreme al-titude and one of the best places to monitor global warming trend. It is an ideal location to fi eld testing physiological monitoring equipment for an extreme environment. The weather changes rapidly in extreme and human body may not adjust so rapidly. Why to test e-heath monitoring equipment in an extreme environment? It is because; Canada has communities under similar weather conditions and we need to overcome healthcareinforma-tion transmission barriers in remote areas which resemble being in the outer space. Where e-health can be a great value on earth, can be a great help to living in the space. In this presentation, we will discuss our experience in use of telehomecare equipment from Mount Kilimanjaro to Canada.

P82 REPORTS FROM NLM SCALEABLE INFORMATION INFRASTRUCTURE PROJECTS IN HEALTHCARE HPCC

Charles Sneiderman, MD, PhD, Michael Ackerman, PhD National Library of Medicine, Bethesda, MD

The Scaleable Information Infrastructure initiative of the U.S. National Library of Medicine (NLM) encouraged the development of health-related ap-plications of Advanced Network Infrastructure in Health and Disaster Man-agement. Applications include scaleable, network aware, real-time technol-ogy applications dependent on wireless technology, geographic information systems, and authentication technologies in a networked environment. The initiative focused on situations that require or greatly benefi t from the appli-cation of these technologies in health care, medical decision-making, public health, large-scale health emergencies, health education, and biomedical, clinical and health services research.

Projects used test-bed networks linking one or more of the following: hos-pitals, clinics, health practitioners' offi ces, patients' homes, health professional schools, medical libraries, universities, medical research centers and laboratories, or public health authorities. Eleven awards totaling almost $40 million over 3 years were made by NLM in October 2003. (http://www.nlm.nih.gov/research/si-iawards.html). Most awards involved advanced telemedicine applications.

A reverse site visit reporting progress on these projects was held at NLM in August 2007.

Archived video of the principal investigators presentations are available at the OHPCC Collaboratory website (http://collab.nlm.nih.gov/webcastsand-videos/siirsv/siirsv.html) along with presentation slides, and public fi nal re-ports for those projects completed. Selected information from these progress reports relevant to telemedicine, both present and future, will be presented in poster format.

P89 ENABLING EHR PORTABILITYShean McMahon, PhD, Andrew Kostrzewski, PhD Physical Optics Corporation, Torrance, CA

Electronic medical records promise to usher in a new era in healthcarequality. Existing paper based methods yield reported error rates approaching 30%, while handwriting errors alone are estimated to account for 5000 deaths annually in the U.S. While electronic records can eliminate many of these problems, record portability is still a fi eld of signifi cant study. One particular area is that of en-abling the portability of records on the battlefi eld, where access time and record integrity are crucial factors. To address this critical need, Physical Optics Corpo-ration (POC), in cooperation with the U.S. Army’s Telemedicine and Advanced Technology Research Center (TATRC), has developed the Wireless Personal In-formation Carrier (WPIC). Slightly larger than a standard dogtag, WPIC provides U.S. Army personnel with a portable, life-long medical record archive. WPIC can be accessed wirelessly via an 802.11b link with an operational range of up to 10 m, and can operate over two years on a single battery charge. Memory capacities of up to several gigabytes are available, and data rates of several megabits per second are natively supported. The WPIC is fully interoperable with the Army’s AHLTA Mobile (BMIST-J) platform. Current work will address HIPAA and FIPS 140 2 compliance. WPIC is now a third-generation device, and is being evalu-ated for fi eld use by TATRC. Future development work will address form factor, manufacturing cost reductions, and battery life improvements.

P93 EVALUATION OF DIAGNOSTIC ACCURACY OF TELECONSULTA-TIONS IN SURGICAL PRACTICE

Muhammad F. Murad,1 Farhat Jehan,1 Qasim Ali,1 Athar Sadiq,1 Asif Zafar2 1Telemedicine & E-Health Training Center, Rawalpindi, Pakistan; 2Rawalpindi Medical College, Rawalpindi, Pakistan

Pakistan is a densely populated country with limited specialized healthcare facilities. There exists a major rural-urban disparity in healthcare delivery services of the country. Use of telemedicine in medically underserved areas is extremely helpful in providing care to patients who might not otherwise have access to specialist institutions. The surgeon at tertiary care hospitals can interact with patients at remote hospitals using telecommunication link and telemedicine tools. These patients can be assessed and managed remote-ly or can be scheduled for surgery in tertiary care hospitals without being previously transferred to these centers. Teleconsultations are effective way to reduce the psychological and fi nancial stress of the patient being referred





from remote hospital to tertiary care hospital for specialized treatment. Our department, Surgical Unit II, Holy Family Hospital (HFH) has played a

pioneering role in establishment of telemedicine at the national level in Paki-stan. Currently it is linked to its step down hospitals, District Headquarter (DHQ) Hospital Attock and Tehsil Headquarter (THQ) Hospital Pindi Gheb for telemedicine training and teleconsultations in pre and post operative evalu-ation of referred surgical patients. This study was carried out to establish the diagnostic accuracy of these teleconsultations before incorporating them in practice of surgery.

One teleconsultations room was established in surgical OPD and second in surgeon’s offi ce of ward. Both the centers were equipped with video-conferencing system, ISDN link and telemedicine tools. A nurse trained in telemedicine applications used to present the patient profi le and examina-tion fi ndings via teleconsultations and then the same patient was reviewed for face to face consultation and both diagnoses were compared. The results showed that teleconsultations have comparable diagnostic accuracy with face-to-face consultations; it reduces physical, psychological and fi nancial stress of the patient and can be safely incorporated in evaluation of remote preoperative surgical patients with head and neck swellings.

P106 UNDERSERVED DOES NOT NECESSARILY MEAN RURAL: REMOTE TELEPRESENCE IN DOWNTOWN BALTIMORE

H. Neal Reynolds, MD1,2

1Bon Secours Hospital of Baltimore, Baltimore, MD; 2University of Maryland Shock Trauma Center, Baltimore, MD

Background Demand for critical care services will rise due to aging popula-tion. Critical care physician supply will not increase proportionately. The LeapFrog Group recommends patients receive care in intensive care units (ICUs) staffed by intensivists (physicians trained in critical care) optimally 24 hours a day. Currently, less than a third of ICUs in the U.S. have intensivists and less than half of those remain on-site 24 hours a day. The intensiv-ist shortage impacts rural as well as metropolitan areas such as downtown Baltimore, where certain medical facilities are underserved during off hours. The Remote Presence (RP) telemedicine solution can help optimally distribute and extend intensivist coverage.

Methods At an urban facility, two miles from a major university medical cen-ter, intensivists work 7–21 days sequentially. The intensivists provide daytime on-site service and continued coverage from home 24 hours a day. The RP solution (InTouch Health, Inc., Santa Barbara, CA) was deployed June 2006. RP uses internet, wireless and robotics to enable a physician to be virtually present at the bedside. With RP the intensivist made preemptive nightly 10:00 PM ICU rounds from home to detect early physiologic change, intervene pre-emptively, perform nursing education, and police therapeutic protocols.

Results RP enabled: extended intensivist coverage, promoted continuity of care and improved physician satisfaction.

Data includes: • 535 sessions (8/20/06-8/20/07); 178 total hours; average session 18

minutes• Off hour sessions (9pm-12am or weekend) comprised 60%; average ses-

sion 27 minutes• Physician nocturnal beeping was approximately halvedSince 50% of the physician staff participated, data represents 26 of 52 weeks.

Conclusion RP enhanced delivery of intensivist expertise to the right place at the right time in off hours (an additional half hour of virtual bedside time per day) whilst promoting intensivist quality of life.

P108 NURSE-PRACTITIONER LEVEL OF COMFORT WITH TELEHEALTH IN TRANSPLANT CLINICAL CARE

Renata Leimig, BA, Gayle Gower, RN, Denise Thompson, PhD, Rebecca P. Winsett, PhD The University of Tennessee Health Sciences Center, Memphis, TN

Introduction Detecting and implementing treatment for transplant rejection and infection is critical for recipients of transplanted organs. It is also essen-tial that providers feel comfortable with their ability to assess, diagnose and treat using telehealth in this medically fragile population. As one objective of a longitudinal prospective study of transplant outcomes; infection events between subjects randomized to telehealth (TH) or standard care (SC) were evaluated at 6 and 12 months post study entry. Nurse practitioner level of comfort in the TH equipment for diagnosis was also evaluated. Only subjects followed primarily by nurse practitioners (NP) for follow-up care were eli-gible to enter this study. The TH visits were conducted via live interactive sessions with digitized equipment for physical exam.

Main Outcomes Infection incidents were summarized for each of the groups at 6 and 12 month time points. Gender, race, age, time since transplant and transplant type were evenly distributed between groups. Preliminary results show no statistical difference between groups for infection. Subgroup analy-ses were performed by gender, transplant type and time from transplant. Preliminary results showed an association between gender and number of infections. In these analyses, group assignment did not have an effect. Nurse practitioners involved in transplant care indicated TH was convenient for the patient, but they still had concerns with their own ability to perform cardiac assessment with confi dence. There was a moderate level of comfort with diagnosing skin, ear and upper respiratory infections.

Conclusion Using TH technology in a stable, but medically fragile transplant population has shown that care can be provided in a safe and effective man-ner. However, further evaluation of the diagnostic capability in transplant care is indicated.

P109 TELEDERMATOLOGY IN THE AMAZON, BRAZIL: INITIAL EXPERIENCE

Cleinaldo A. Costa, PhD, MD,1 Pedro E. Souza, MD,1 Jonas Ribas, MD,1 Roberto O. Lages, MD,1 Marcia G. Costa, MD,1 Chao L. Wen, PhD, MD,2 Gyorgy M. Böhn, PhD, MD,2 Francisco Tussolini, MD1

1Universidade do Estado do Amazonas, Manaus, Brazil; 2Universidade de São Paulo, Manaus, Brazil

Objective Dermatological diagnosis and treatment through telemedicine in a remote area in the Amazon.

Methods Charts from 58 patients with dermatological lesions, fi rst evaluated by interns from Universidade do Estado do Amazonas in the city of Parintins-AM, analized retrospectively after they’d been presented to the Amazonia Telemedi-cine Center in Manaus-AM between March 9th and April 27th 2007. Elements as gender, race, study level, treated water, sewering, house structure, diagnostic hypothesis, fi nal diagnosis and also the need for biopsy were studied.

Results Twenty-one males (36,21%) and 37 females (63,79%) were assessed using teleconference. From these 58 patients, 5 were caucasian (8,62%), 3 were african-brazillian (5,18%) and 50 were native brazillians (86,20%). The study level was: 10 unalphabatized (17,24%), 13 completed fourth grade, sixteen completed 8th grade (27,59%), 15 fi nished high school (25,86%) and four had already completed college (6,90%). Most patients had treated wa-ters (81,03%). The majority did not have sewering sistems in their house (67,24%). Patient’s houses were made with wood (62,07%), bricks (27,59%) or both (6,90%), also wood and palm leaf, and others (1,72%). Initial diagnosis included 25 different diseases, and only in 9 cases (15,53%) initial diagno-sis was inconclusive. During teleconference with dermatologists, 16 of the initial diagnostics were altered (27,59%) and 30 were confi rmed (51,72%). Another 12 cases did not receive a fi nal diagnosis because the patient missed the appointment (83,33%) or the expert opinion was inconclusive (16,67%). In this case, biopsy was required in order to reach a diagnosis. In total, 4 biopsis were required (6,90%) and the results were sent to Parintins-AM.

Conclusions Telemedicine in the amazon is vital to keep healthy all popula-tions who live in distant places far from medical centers. Through teleconfer-

ences we’ll be able to offer health-care to people who dwell near the Amazon river, previously neglected or mistreated.

P114 WEB-BASED TELECARDIOLOGY AND EPIDEMIOLOGICAL SURVEILLANCE IN UNDERSERVED REGIONS IN COLOMBIA

Leonardo Yunda, MSEE,1,2 Jorge Millan, PhD,1,3 Andres Alarcon, MSCS,1 Luis Gomez,1 Diana Victoria1 1Universidad Santiago de Cali, Cali, Colombia; 2Sigma Biomedical, Hialeah, FL; 3Hialeah Technology Center, Hialeah, FL

A web-based Telecardiology system for remote diagnosis, disease reg-istration, e-education and epidemiological surveillance of cardiovascular diseases in endemic and underserved regions of Colombia is presented. The fundamental hypothesis formulated during this work is that an integrated telemedicine and disease surveillance platform improves healthcare access and quality of treatment, and leads to the design of more effective and ef-fi cient health control policies. The developed system provides online and offl ine (store and forward) display of 8-channel ECG traces and audio play of stethoscope sounds, along with blood pressure and weight information. An electronic health records (EHR) module with image storage and retrieval allows web management of medical images with image and physiological variable display and analysis functions. A data analysis module allows dy-namic and interactive analysis, classifi cation and display of recorded disease information by age, gender, geographical region, disease condition, referring physician, and other relevant demographical variables. An authentication solution for data integrity, security and privacy is achieved via e-token and user level secured and restricted access to the system. A modular and scal-able kiosk-client-server architecture is implemented for portability to other clinical modalities and for deployment in a wide area telemedicine network. The system is being used in a research university hospital setting with a remote kiosk station in a participating rural clinic in an underserved and diffi cult to access town in the Colombian Pacifi c Coast. Results on the use of the system demonstrate usage and benefi ts for patients, healthcare providers, public health researchers and cardiologists in academic settings.

P116 EVALUATION OF TELEPSYCHIATRY IN PSYCHIATRIC RESIDENCY PROGRAMS

Jena Worley, MD1,2

1University of Hawaii Department of Psychiatry, Honolulu, HI; 2Queen's Medical Center, Honolulu, HI

Introduction This study examined how psychiatry residents are being pre-pared to provide psychiatric services using interactive videoconferencing, also known as telepsychiatry. Recent studies have shown that using tele-psychiatry helps provide services more effi ciently to remote geographic re-gions with high patient satisfaction. However, it has not been examined how or if telepsychiatry is being incorporated into general psychiatry training programs. We hypothesized that telepsychiatry is not being widely taught in general psychiatry programs, thus resident psychiatrists are not getting adequate experience and training in this area.

Methods Program directors of all general psychiatry residency programs in the U.S. were surveyed to determine if telepsychiatry is a part of their train-ing programs and they were asked to rate the importance of telepsychiatry. If telepsychiatry was a part of their training program, they were also asked how they incorporated it and to what extent.

Results Anecdotally, the majority of general psychiatry training programs do not have telepsychiatry integrated into their programs. Preliminary fi nd-ings indicate that when training programs do incorporate telepsychiatry not all residents are included in the training and many do not have set guidelines on how to train residents in using telepsychiatry.

Conclusions Lack of emphasis on telepsychiatry in general psychiatric train-ing programs has implications for public psychiatry and rural health care. Telemedicine’s importance is highlighted in recent research and telepsychia-

try has been shown to facilitate decreasing health disparities in underserved populations. Psychiatry residents are not being adequately trained in tele-psychiatry, which may imply one factor that hinders the proliferation of telepsychiatry’s utilization to rural and underserved populations.

P120 IMPROVING ADHERENCE–USER FEEDBACK ON NOVEL APPLICATIONS OF COMMUNICATIONS TECHNOLOGY

Alice J. Watson, MBChB, MRCP, MPH,1,2,3 Basmah Rahman, MPH,1 Kimberly Harris, MM,1 Thomas Munkascy,1 Joseph C. Kvedar, MD1,2,3 1Partners Healthcare, Boston, MA; 2Massachussetts General Hospital, Boston, MA; 3Harvard Medical School, Boston, MA

Objective Medication non-adherence is a complex, multi-factorial issue that leads to 125,000 deaths annually in the U.S. Technology tools may be an ef-fective way to tackle this problem but to maximize the impact of these solu-tions, it is essential to understand existing barriers to adherence and assess usability of technology applications.

Methods We developed a reminder system to improve adherence comprising a feedback loop between an electronic pill bottle and a desk lamp linked to a pager system. Opening the bottle triggered an SMS message, which was relayed via the pager system, to the desk lamp. The lamp glowed green when medication had been taken and red when it was overdue. We interviewed study subjects to assess self-reported adherence, satisfaction with this tech-nology and suggestions for improvement.

Results The mean age of subjects was 54 (range 52-60). The majority were white, college-educated, employed full-time and comfortable using technol-ogy. All participants reported frequent non-adherence to their medications at the time of enrollment, despite high levels of health literacy and knowledge. Frequently reported reasons by subjects for non-adherence included “forget-ting”, lacking an effective system to manage medications, or subjects felt they “didn’t need” the medication and opted not to take it against medical advice. Following the study, 65% of subjects felt this technology was effec-tive in improving their adherence and 46% would enthusiastically recom-mend it to others. Suggestions for technology improvements to enhance the value included better reliability, increased portability and addition of email or cell phone reminders.

Conclusions Our system was well received by patients but had room for improvement. Obtaining feedback from users throughout the design and de-velopment of our adherence platform has allowed us to make enhancements, thus enabling us to offer a more valuable tool for patients and physicians to address the issue of poor medication adherence.

P121 TELEMEDICINE MODALITIES WITHIN NATO MILITARY FORCES—DATA ANALYSIS OF CAPABILITIES

David M. Lam, MD, MPH,1,2 Ronald K. Poropatich, MD1

1United States Army Medical Research & Materiel Command, Ft. Detrick, MD; 2University of Maryland Medical School, Baltimore, MD

Introduction Various Telemedicine modalities are increasingly being used within the NATO medical structure to provide optimum medical care to de-ployed military personnel. We report the results of a multinational survey of current and projected availability of various telemedicine modalities within the NATO medical services.

Methods The NATO Telemedicine Expert Team is a body of national tele-medicine experts who meet regularly to encourage the development of the use of Telemedicine (TMED) within the NATO multinational medical com-munity. A matrix questionnaire was developed and completed by national representatives represented in this group. The aggregate results provide the fi rst reported analysis of the current status of NATO telemedicine capabilities within a multinational group of military forces.

Results Questionnaire results provided within a group of 16 national mili-tary forces will be presented in a consolidated format along with proposed





recommendations to NATO. Communication systems now in place at the lowest levels of medical support enable the use of web-based teleconsul-tation modalities. Teleradiology shows a signifi cant penetration. Most re-sponding nations do not have a formal organizational structure for remote consultation and rely on informal clinical relationships. Electronic health records are in use by a minority of military nations and fewer are capable of civilian interface. Less common TMED capabilities (e.g. Tele-Microbiology, Tele-Medical Maintenance), are being increasingly used.

Conclusions Recommendations arising from the analysis of this data have been developed, and passed to NATO authorities for inclusion into the NATO medical planning process.

P125 TELEMEDICINE IN PEDIATRIC RHEUMATOLOGY AS A MEDICAL EDUCATION TOOL

Christi J. Inman, MD,1 George Demiris, PhD2 1Children's Hospital & Regional Medical Center, Seattle, WA; 2University of Washington, Seattle, WA

Telemedicine has been used extensively in medical education, primarily in the format of video-conferenced lectures. This study will evaluate the use of telemedicine in pediatric rheumatology as a tool for precepting in the medical education of fellows. There is a severe shortage of pediatric rheumatologists, with only 239 board certifi ed practitioners in the U.S. residing primarily in large urban areas to care for the estimated 350,000 children with rheumatic diseases. In this study, the technology is used to allow an attending physician in pediatric rheumatology to evaluate through a real-time audio-visual link a pediatric rheumatology fellow who conducts a history and physical exam of a patient with a known rheumatic disease at a remote site. Subjects are English speaking patients and their parents who provide consent to participate in the study. Qualitative measures (interviews, surveys and observations) are used to assess physicians’ and fellows’ perceptions of this modality and whether it pro-vides adequate supervision and enhances the education of fellows. Additional-ly, patient satisfaction questionnaires are used to assess parents’ and children’s acceptance and level of comfort with telemedicine. As pediatric rheumatology is one of the most under-represented sub-specialties, it is imperative to explore ways to improve access to care. This initial study explores the use of telemedi-cine in medical education in this domain and ultimately aims to improve the clinical health of children with rheumatologic diseases.

P127 ASSISTING DISABLED PERSONS TO CONQUER OBESITY AND OBTAIN HEALTHY LIFESTYLES

Eric S. Muncert, BS, Jay B. Roberts, BS, MA, Barbara R. Demuth, BS, RN, MSN, Gina L. Litziinger, RN, MSN Saint Francis University, Loretto, PA

Obesity is an abnormal accumulation of body fat, being more than 20% above ideal body weight, frequently resulting in an impairment of health. Assisting Disabled Persons to Conquer Obesity and Obtain Healthy Lifestyles was a pilot research study designed to educate obese students with disabili-ties about proper nutrition and healthy living habits that could decrease body mass weight and improve the student’s mental health and academic performance. Students who experience problems such as anxiety, sadness, low self-esteem, and anger, as well as score lower grades on standardized tests could achieve success in weight loss. Saint Francis University’s Cen-ter of Excellence for Remote and Medically Under-Served Areas and the National Telerehabilitation Service System’s partnered with a comprehen-sive rehabilitation facility, Hiram G. Andrews Center, (HGAC), in Johnstown, Pennsylvania. The Allied Health Division within HGAC assisted in the imple-mentation of the twelve week telehealth research project that utilized dis-tance education through video teleconferencing to educate nine disabled students who volunteered to participate in the pilot study. Certifi ed nutri-tionists and physical therapists from the Center assisted in educating and instructing students. The study was designed to augment the development of a life skills course initiated at HGAC for students who desire to improve their

health through education and nutrition. Monitoring of the student’s progress in body mass weight reduction, as well as blood pressure levels, were tracked using telerehabilitation technology, including the recording of weight and blood pressure measurements into diary software. Telecommunications and computing technologies were used to enhance the education between the student and a professional instructor or licensed healthcare provider. Study results indicated students preferred nutrition and healthy living informa-tion shared through technology and utilize this knowledge to maintain or decrease their body mass weight and blood pressure.

P135 CHALLENGES IN DEVELOPING A REAL-TIME, IN-FLIGHT PATIENT, VITAL-SIGNS DATA COLLECTION SYSTEM

Peter F. Hu, MS, CNE,1 Christopher Handley, MS EMT-P,2,4 Steve Seebode, BA,1 Anne Conway, RN, MS,3 Ryan Gens, BA,3 Colin Mackenzie, MD,1,2 Danny Ho, MS,1 Gregory Defouw, MSCS,5 Phil Davies, MS,5 Douglas Floccare, MD4

1Program in Trauma and Department of Anesthesiology, Baltimore, MD; 2National Study Center for Trauma and EMS, Baltimore, MD; 3Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; 4Maryland Institute for Emergency Medical Services, Baltimore, MD; 5Inovamar LLC, Moffett Field, CA

Introduction Developing a reliable real-time in-fl ight patient vital-signs data collection system (VSDC) presents many challenges, but is necessary to understand fi eld management issues. We report the challenges and some solutions for design and deployment of such system.

Methods VSDC uses a PDA (HP-iPAQ) to collect real-time patient vital signs (VS) data from a commonly used VS monitor (Propaq-Encore206EL). VSDC can store up to 350 hours (1 GB) of continuous patient VS waveform (ECG at181Hz, SPO2/ETCO2 at 90Hz) and numerical trended data (HR/SpO2/ETCO2/NIBP/Temp at 1Hz) for evaluation, data analysis and data mining.

Results Challenges: Observed unreliability of consumer grade PDA under high-speed live serial (RS232) data collection; high maintenance; interface design issues; short battery life; PDA required protective fi eld packaging; multi-site fi eld system deployment required effective communication with the fi eld care provides. Solutions: A data interface box was built to im-prove serial data communication; a real-time error detection, self recovery algorithm corrected the frequent occurrence of PDA power disruptions dur-ing fi eld operation; patient monitor connection status, SPO2 and BP value display, and events marker buttons simplifi ed the user interface; a secure web interface for information dissemination, patient information collection, remote training, and user feedback facilitated multi-site deployment. The two VSDC systems in Medevac helicopters which transfer patients to a major trauma hospital have collected 116 in-fl ight patient VS data sets with the average case length of 25.9 minutes (1.38 MB fi lesize).

Discussion Efforts to build a reliable and user-friendly data collection device is essential to successful system deployment. Remote user training, support, and feedback through the web interface were well received. Great support and instant feedback from the State police aviation division made the rapid system updates possible. Also, the PDA battery life remains a challenge for long-term service free operation.

Supported by DoD-TATRC#W81XWH-05-0374, SBIR-W81XWH-06-C-0034 and State Maryland Police Aviation Command.

P142 DERM-ED TELEMEDICINE SYSTEM: AN APPLICATION OF LEAN THINKING TO HEALTHCARE

A. Hasan Sapci, MD,1 H. Aylin Sapci, MD,2 Sewon Kang, MD,1 John Voorhees, MD,1 Eric Kratochwill, MHSA,1 Jocelyn Dewitt, PhD1 1University of Michigan Health System, Ann Arbor, MI; 2(no affiliation pro-vided), Ann Arbor, MI

Advances in telecommunication technology have resulted in proliferation of distributed systems in healthcareenvironment and this evolution created unpredicted challenges. Today's telemedicine systems have unique and high-



ly sophisticated interoperability requirements. Institutional policies, practices and programs to encourage scientifi c and technological creativity determine success of innovative healthcareapplications.

At the University of Michigan Health System we have been using “Lean Thinking" approach to develop custom healthcaredelivery systems and eliminate waste of resources. Many integrated Academic Health Systems are distributed accross multiple locations and this might cause to complex, fragmented, one-dimensional, and noncontinuous service delivery systems. In order to improve quality of care and increase performance, we redesigned clinical workfl ows and developed more effi cient ways to provide referral and consultation services. This presentation will feature “derM-ED System”, a Teledermatology System that has been developed to automate multi-stage processes and facilitate sharing of in-formation to save time for the entire care team, to provide clinical decision support that enables health-care staff to make better informed decisions, and to provide reliable performance in real-time. The imaging system and custom ap-plication has been designed and developed by the Telemedicine Resource Center of the UMHS. derM-ED Teledermatology System consist of an automated image processing and programmable task manager module that is integrated with on call schedule, pager and secure communication servers, and educational mod-ules about disease specifi c dermatological photography. This clinician-friendly application performs all predefi ned tasks with “One-Click” approach and does not require training. The presentation will discuss the planning steps, engineer-ing challenges, the benefi ts and lessons learned from this innovative project.

P173 CONNECTING HIGH SCHOOL SCIENCE STUDENTS WITH MEDICAL STUDENT MENTORS

Kathleen Tyler Davis, PhD,1,2,3 Ryan Spaulding, PhD,1 David Cook, PhD1 1Kansas University Medical Center: Center for Telemedicine, Kansas City, KS; 2Department of Pediatrics, Kansas University Medical Center, Kansas City, KS; 3Unified School District #500, Kansas City, KS

The federal government predicts that by 2020, nurse and physician retire-ments will contribute to a shortage of approximately 24,000 doctors and nearly 1 million nurses. Rural areas are especially vulnerable to shortages of health-care providers, especially in rural and urban areas. Kansas has a signifi cant rural area, with nearly half of its population living in rural. As a result, many Kansas schools use interactive distance learning in order to extend limited education resources. It is believed that rural and urban students often do not have opportunities to learn about careers in healthcare or to do job shadowing with a physician or other healthcare provider. The presumption is that young people from rural and urban settings may be more likely to pursue careers in healthcareif they have exposure to such and may then return to the rural or urban community to practice medicine, thus decreasing the healthcareprovider shortage. The current study investigated the viability of a collaborative model of e-mentoring between KUMC and public schools throughout the state of Kansas. Second through fourth year medical students were paired with juniors and seniors enrolled in advanced science high school courses at high schools in urban and rural areas. Mentors and mentees met over telemedicine (hos-pital) and distance learning (school) equipment. Mentors shared information with their mentees about classes to take to prepare for college; courses to take in undergraduate programs to prepare for medical school; how to write an entrance essay for college; what medical school is like; and discussed informa-tion/answered questions which arose in their advanced science curricula. This presentation will offer results of a survey which assessed satisfaction of high school students, medical students and science teachers.

P176 FINE-TUNING RESIDENTS’ INTERPERSONAL PATIENT SKILLS THROUGH TELEMEDICINE

Samantha McKelvey, MD, Joseph Banken, PhD, William Greenfield, MD, Paul Wendel, MD, Rachel E. Ott, BAUniversity of Arkansas for Medical Sciences, Little Rock, AR

Residency training is the fi nal stage in cultivating physicians for indepen-dent medical practice. As such, life-long interpersonal skills and profession-alism must be fi ne-tuned in this fi nal stage, a task being achieved through

telemedicine. Previously, interpersonal skills were cumbersome to evaluate in their natural setting, as observing providers shadow resident-patient interac-tion during the routine visit. Telecommunication allows observation of the resident-patient interaction in its natural context, without the physical pres-ence of an observing evaluator. Utilizing telemedicine, a non-biased third party behavioral psychologist remotely observes interaction during the rou-tine patient interview. The behavioral psychologist uses a Likert fi ve-point scale to evaluate residents in seven areas:

• Preparation and Greeting—reviews history and uses appropriate eye contact and body language.

• Establishing Focus—elicits reason for visit and facilitates a prioritized listing of concerns.

• Gathering Information—asks questions when appropriate, refl ects, clari-fi es, and summarizes.

• Understanding Perspectives—explores problems in the context of family, work, culture, spirituality, and development.

• Sharing Medical Knowledge—presents simplifi ed medical information about pathologic fi ndings and diagnoses.

• Reaching Agreement and Plan—reaches diagnosis and develops an opti-mal plan through patient collaboration.

• Providing Closure—confi rms comprehension of plan and follow-up. Following observation, the resident reviews the recorded patient inter-

action, making observations on their strengths and weaknesses via DVR telemonitor interface. The behavioral psychologist develops an individual-ized plan for improvement, and progress is tracked by repeating assessments twice yearly for four years.

This evaluation method fuses expert observation, self-refl ection, and tar-geted refi nement in interpersonal relations as achieved through telemedicine, a strategy that can replicate to any discipline or level of learning. Residents receiving telemedicine evaluation have described their experiences as posi-tive, widening their views on how they may better their patient interaction. Further, residents largely welcome the timely, non-intrusive observation, a feature previously unavailable before telemedicine observation.

P188 CHRONIC DISEASE MANAGEMENT (HIV): TELEMEDICINE VERSUS ONSITE CLINIC CARE

Jonathan Katz, Jane Settle, MS, MED, Vladimir Lavrentyev, MD, MBA, Bernhardine M Ammons, RN, BSNVirginia Commonwealth University Health System, Richmond, VA

Introduction There is a lack of information in the literature comparing telemedicine care to onsite clinic care for individuals infected with HIV. At VCUHS care has been provided to HIV infected inmates and inner city pa-tients for over 20 years. VCUHS has been providing care to Department of Corrections inmates with HIV through a telemedicine program for 10 years. VCUHS HIV Telemedicine clinic uses state of the art equipment. The telemed-icine technology gives the ability to care for over 400 HIV infected inmates within the Virginia DOC at 18 different prison facilities. In the telemedicine encounter an HIV specialist examines the patient, reviews lab work and pre-scribes the antiretroviral therapy. The medications are then shipped from the hospital to the correctional facilities.

Background This is a retrospective study of HIV patients who were treated with antiretroviral therapy. All patients were being treated by the same nurse practitioner. The viral loads collected were taken using a retrospective chart review from a period of November 1 2006 until February 28, 2007. Patients that were not receiving antiretroviral therapy during the chart review period were excluded from the results. This is an outcome comparison of treatment effectiveness measured by viral load for onsite care versus patient care through telemedicine.

Results The results of the study showed that of inmates seen on telemedi-cine, 122 of 153 or 79.7% had a HIV RNA level below 400 copies/ml. The study also showed of the patients in the VCU clinic, 87 of 115 or 75.7% had a HIV RNA level below 400 copies/ml.



Conclusion Based on the data obtained in this retrospective study we con-clude that the quality of care provided to HIV infected inmates through the telemedicine program is as effective as onsite clinic care.

P190 NSC PROJECT (NEW SONGDO CITY: A NEWLY DEVELOPED CITY AS A FREE ECONOMIC ZONE IN SOUTH KOREA): DEVELOPING A PROSPECTIVE HEALTH MANAGEMENT MODEL, AND INTEGRATING AN ON-LINE AND OFF-LINE HEALTHCARE SERVICE

Dae Hyun Yoon, MD,1 Belong Cho,2 Jin Ho Park,1 Cheol Min Lee,1 Hyuk Tae Kwon,1 Dong Hee Kim,1 Seung Ho Choi,1 Chan Soo Shin,1 Sang Heon Cho1 1Seoul National University Hospital, Gangnam Center, Seoul, South Korea; 2Seoul National University Hospital, Department of Family Medicine, Seoul, South Korea

Introduction We are developing and will operate advanced Information Technology based health management program for 10,000 families at NSC, and want to share our idea and experience with members of ATA.

Background Ubiquitous Healthcare Service is a Mega Trend 1. Increasing interest of consumers toward health & well-being2. High speed—innovation of IT environment 3. Rapid progress to Aging Society & Increasing prevalence of Chronic

Disease4. Cost-benefi t issues about traditional healthcare

Conclusion—Service Outline and Anticipated Benefi t 1. U-Healthcare service is composed of U-Healthcare device and Service

Application. U-Healthcare device gather customer’s vital sign and it transmit that information to IDC Center Server.

2. Intelligent Healthcare system, which is installed On IDC Server, check the information periodically, and give some advices, code of conduct and many contents.

3. U-Healthcare Service consist of Online Service and Offl ine Service. 4. Online Services are measurement and response Service and Contents

Service. Offl ine services support Online Service 5. We expect our experience will contribute to developing “ prospective

healthmanagement model “ and might increase health status of our subjects.

P195 TELEREHABILITATION TECHNOLOGY: A WEB-BASED TOOL FOR CLINICIANS AND CONSUMERS

Michael Pramuka, PhD, Linda VanRoosmalen, PhD University of Pittsburgh, Pittsburgh, PA

In the fi eld of telehealth and telemedicine, technology such as remote monitoring, remote visits using phone and/or video has been successfully integrated and continue to grow in acceptance and application. In the fi eld of tele-rehabilitation it is less obvious how the use of various technologies can modify rehab service accessibility, effectiveness, quality and usefulness, due to the complexity and variety of clinical services provided in the fi eld of “rehabilitation".

To clarify how telerehabilitation can benefi t clinicians and clients that respectively provide and receive rehabilitation services, a framework is pre-sented on the complex network of potential technologies and how they link to various rehabilitation applications, practices and reimbursement policies.

A web-based database on telerehabilitation was developed by the RERC on Telerehabilitation at the University of Pittsburgh, which provides clini-cians and potential consumers with applied research knowledge to effec-tively select and match a specifi c service application (e.g. speech therapy, seating assessment) or population (e.g. traumatic brain injury, chronic pain) with an applicable technology (e.g. video conferencing, virtual reality) or vice versa, based on state-of-the art research and literature, case studies and existing and innovative technologies. The web-based tool will also guide clinicians on the varying reimbursement policies across states that have ad-dressed telerehabilitation reimbursement issues.

P200 THE REMODELING OF PATIENT CARE PATHWAYS FOR E-HEALTHKaren Jones, MSc, BSc, Malcolm Clarke, PhD Brunel University, London, United Kingdom

The research focuses on the re modelling of Patient Care Pathways specifi -cally for the demands of implementing ehealth projects. The foundation of the work is the development of Patient Care Pathways for the pre implemen-tation phase of a teleradiology project in Thailand.

Case studies have shown that there are benefi ts to the healthcare industry of adapting approaches from industry and this work will present an ehealth pre implementation model based on the integration of specifi c Systems En-gineering tools into the standard Patient Care Pathway.

Engineering and healthcare could be considered as polar activities, how-ever, the research will demonstrate the synergy and common denominators of two disciplines which have historically been considered as separate entities.

P212 IMPACT OF T-CARE ON QUALITY OF LIFE IN DIABETIC PATIENTS Stuti Dang, MD, MPH,1,2 Ranjy Basa, MD,1,2 Emory Olive, PhD,3 Hermes J. Florez, MD, MPH, PhD,1,2 Enrique J. Aguilar, MD,1,2 Nicole Nedd, EdD, ARNP,1 Bernard A. Roos, MD1,2 1VAMC GRECC, Miami, FL; 2University of Miami Miller School of Medicine, The University of Miami, Miami, FL; 3Care Coordination Community Services, VISN 8, VHA, Tampa, FL

Diabetes and its complications create an enormous burden in morbid-ity, mortality, and healthcare cost. In the Miami VAMC’s outpatient T-Care program, care coordination is assisted by an in-home messaging device to monitor a patient’s daily parameters and provide education about diabetes. We collected data on the QoL of the 67 (out of 138) diabetic patients who completed QoL forms at baseline and at the end of 1 year, using the SF-36V, a modifi cation for use in the VA system of a well-established, widely used in-strument, the SF-36 (from the Medical Outcomes Study). The SF-36 assesses 8 dimensions of health status with measures of physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, role-emotional aspects, social functioning, and mental health. Paired t-test was performed to look for any difference in the scores before and after 12 months in the program. 97% of the patients were men. 34% were African Americans, 16% were Hispanics, and 43% were White non-Hispanics. 95% had other comorbid illnesses. 33% had a high school education, and 16% had a college degree or more. Only 2 scale scores (role-emotional aspects and mental health) showed a statistically signifi cant decrease at the 0.05 alpha level. While these results are subjective, based on patients’ perceptions, they do indicate that the patients believed that few signifi cant changes in QoL had occurred after 12 months. The emotional health of these diabetic patients ap-parently slightly deteriorated, in line with the expectation that chronically ill patients decline over time. Indeed, the lack of decline in all the other scales may signal a better-than-usual outcome for this population and supports further exploration of the impact of telecare coordination on trends in QoL and the relationship among different QoL domains in this population.

P213 UNIVERSITY OF MIAMI TELEMEDICINE INTERNATIONAL OUTREACH

Ivan D. Camacho, MD, Scott C. Simmons, MS, Anne E. Burdick, MD, MPHUniversity of Miami Telemedicine, Miami, FL

University of Miami Telemedicine (UMTM) provides remote patient care in several medical specialties, continuing medical education programs and research opportunities for the advancement of remote medical care. UMTM conducts telehealth activities in many countries.

Multidisciplinary tumor boards are broadcasted monthly from the UM Syl-vester Comprehensive Cancer Center to multiple cancer centers in Brazil through the Rede Brasileira de Combate ao Câncer, with oncology specialists at each par-ticipating institution. Focused Advanced Sonography in Trauma (FAST) courses are provided to the ABC Foundation Medical School in Brazil that are broad-casted via satellite to 260 participants at multiple Brazilian institutions.



Live interactive lectures and grand rounds in the specialties of dermatol-ogy, plastic surgery and urology are provided to the Universidad Autónoma de Nuevo Leon in Monterrey, Mexico, facilitating the interaction of medi-cal experts in different medical fi elds to present current topics and discuss interesting and challenging clinical cases with colleagues from a different institution.

The UM Telemedicine Education and Advice to Improve Military Medicine (TEAMM) offers interactive grand rounds and continuing medical education to military personnel deployed to Landstuhl, Germany, seeking to improve the spectrum of military healthcare delivery in theatre.

Weekly live interactive laboratory research sessions for diabetes studies connect the UM Diabetes Research Institute with China, Italy and Sweden.

Volunteerism is also an important service of UMTM. Multi-specialty store-and-forward consultations are provided through the Swinfen Charitable Trust to 23 countries around the world, including Afghanistan, Bangladesh, Cambodia, Ethiopia, Iraq, Malawi, Mozambique, Nepal, Pakistan, Sri Lanka, Sudan, Uganda and Zambia.

This presentation will focus on the status of international telehealth proj-ects in UMTM’s portfolio, lessons learned, and new projects on the horizon.

Contact information:University of Miami TelemedicineTelephone: (305) 243-8252E-mail: [email protected]: http://www.med.miami.edu/telemedicine

P219 VALIDATION RESULTS OF A NEW TELEHEALTH SYSTEM FOR THE PREVENTION OF CHRONIC DISEASES

Marta Ortega-Portillo, MSc,1 Blanca Villamía-Uriarte,2 Eva del Hoyo-Barbolla, Phd,1 María Teresa Arredondo, Prof1

1Technical University of Madrid—Life Supporting Technologies, Madrid, Spain; 2Nokia Spain S.A., Madrid, Spain

Chronic conditions account for over half of the global disease burden. Hence, including prevention strategies able to motivate and empower citi-zens to be responsible for their own health in public health planning remains a crucial topic. Home telehealth systems providing quality and personalized information can be regarded as a fi t-for-purpose solution to involve users in taking control of their lifestyle and effectively managing their own health-care. This paper presents the development of a training system that provides personalized information in order to incorporate healthy lifestyles to the us-ers’ daily activities. In order to ensure the success and the acceptance of the system, the evaluation and validation processes have been considered a key step in the development and implementation activities.

The developed system is based on information tailoring, adapting it to the specifi c needs and characteristics of the user. Since different stakeholders often have diverse views of telehealth applications, a specifi c evaluation for this kind of system is needed. Despite the great number of the existing evalu-ation methodologies, none of them allows validating a complete telehealth system. Therefore, a new methodology has been designed to serve as a guide for the telehealth sector stakeholders in the validation process of any kind of related projects.

The designed methodology has been applied to different audiences: one for the professionals who have provided their expertise and guidance dur-ing the conception of the system, one for the healthcare professionals, and the last one for the individuals. The feedback obtained from the validation process has reverted into a more usable and sound system. Moreover, ICT has proven an excellent mean to provide complementary support to the health-care professionals’ activity.

P221 DISEASE SURVEILLANCE SYSTEMS FOR DIABETICSTaxiarchis Botsis, PhD,1 Ole Hejlesen,2 Johan Gustav Bellika,1 Gunnar Hartvigsen1 1Department of Computer Science, University of Tromsø, Tromsø, Norway; 2Department of Health Science and Technology, Aalborg, Aalborg, Denmark

Diabetics are rather susceptible to infections and suffer more compared to normal subjects. This study tested the hypothesis that there is a strong correlation between elevated blood glucose (BG) levels and infection. This observation can lead to the development of a system for the early detection of infections in diabetics.

A reliable indicator of BG long-term monitoring is glycosylated hemoglo-bin (HBA1c). So, HBA1c elevation with respect to infections was evaluated. The Diabetes Control and Complications Trial archives were used as the data source. Based on the assumption that a patient was considered ill if he/she had reported disease duration of more than fi ve days, patients older than 20 years of age and similarly treated were selected. Average HBA1c values for specifi c time intervals were assessed: infection, 6-month period before and after in-fection documentation. Males (n=145, age = 29.4 ± 5.3 years) and females (n=130, age = 28.6 ± 5.6 years) were studied separately. All statistical analyses were performed with SPSS, version 14.0. Sample distribution was considered normal and the null hypothesis that HBA1c values during infection are higher was tested with paired t-test for all groups. All p values were based on two-sided testing, and differences were considered signifi cant at p<0.05.

HBA1c values during infection were signifi cantly higher compared to the corresponding values of the 6-month periods before and after infection for both genders (females: mean=0,259 ± 0,633, 95% CI [0,149, 0,369], p<0.001, males: mean=0,232 ± 0,591, 95% CI [0,136, 0,329], p<0.001).

Elevated BG levels and infection occurrence seem to be highly correlated. However, the underlying mechanism requires further investigation through a more accurate study. A disease surveillance system can thus employ biologi-cal sensors for collecting BG data and transmit them to the data repository where a precise mathematical model for patient processing will early detect the infections in diabetics.

P229 A SCREENING PROGRAMME FOR DIABETIC RETINOPATHY IN THE PARIS AREA BY USING A TELEMEDICAL NETWORK (OPHDIAT®)

Ali Erginay, MD,1,2 Agnes Chabouis, MD,2 Alain Gaudric, MD,1,2 Pascale Massin, PhD,MD1,2 1Hôpital Lariboisière, Service d'Ophtalmologie, Paris, France; 2Assistance Publique-Hôpitaux de Paris, Paris, France

Introduction Diabetic retinopathy (DR) is a main cause of visual impair-ment in most industrialized countries. Nonmydriatic fundus photography is an alternative method to ophthalmosocopy to screen for diabetic retinopa-thy. After two pilot studies demonstrating the feasability of telemedecine to screen for diabetic retinopathy in both hospital and primary care settings, we developed a regional telemedical network, OPHDIAT, designed to facilitate access of patients with diabetes to regular annual screening, while saving medical time.

OPHDIAT (Ophthalmology-Diabetes-Telemedecine) is a telemedical network which is aimed at covering the Ile de France area (12 000 KM 2, 11 million inhabitants). Presently, 23 screening centers (11 in diabetology departments, 10 in primary healthcare centers and 2 in prisons ) are linked through a central server to an ophthalmological reading center. Each screening center is equipped with a non mydriatic camera (Topcon TRC-NW6, or Canon CR-DGI).

Results Between September 1st 2004 and September 1st 2007, 22234 DR screening examinations were performed. Retinal photographs were un-gradable in at least one eye in 1992 eyes (8.9 %). Diabetic retinopathy was detected in 5589 patients (25.1%). Among them, 793 patients (3.6%) had undiagnosed severe diabetic retinopathy requiring urgent referral to an oph-thalmologist for laser treatment (severe nonproliferative or proliferative DR, or macular oedema). After the screening examination, 6457 patients (29 %) were referred to an ophthalmologist, either for DR , cataract and/or ungrad-able photographs.

Conclusion Fundus photography combined with telemedecine has the po-tential to improve regular annual screening for diabetic retinopathy. Tele-medecine has the major advantage of increasing patient access to healthcare services, while saving medical time.



232 A RURAL TELEMEDICINE PROGRAM IN PANAMASilvio Vega, MD, MSc.,1,3 Ivette Marciscano, RN, MSc,1,3 Juan R. Arosemena, MD,1,3 Manuel Lobo, MD,1,3 Ronald S. Weinstein, MD2 1Panamanian Telemedicine and Telehealth Program, Panama, Panama; 2Arizona Telemedicine Program, Tucson, AZ; 3YPG Tropic Region Test, Panama, Panama

Rural telemedicine can be used to improve healthcare in Panama. In Pan-ama, we have a lot of communities where rural telemedicine can be useful. One example is on the Indian reservations, where the health system is very basic. The people who live here have very bad access roads making it diffi cult for them to travel to larger cities with bigger hospitals or clinics to get care. Two major problems are helping asthmatic patients control their disease and the high infant mortality rate that is partly due to the lack of prenatal care for many women. To address these problems, we established a rural telemedicine program in an Indian reservation called Ngobe Bugle in Chiriqui, a province neighboring Costa Rica. For the construction of the system, one consulting site was established in a rural hospital in San Felix near the Inter-American highway. This site was connected to two remote sites (Hato Juli and Cerro Igle-sias), located at 10 km away from the hospital, at the top of a mountain in the central cordillera. For telecommunications we used a broad-band radio (Mo-torola WI4) with parabolic antenna having a line of sight. For the contact with patients we used a StarView phone with a digital stethoscope. We started doing real-time telemedicine 18 month ago and have used it every day since. With the implementation of this system, we now can control patients with asthmatic conditions. We also control pregnant patients who are at high risk for compli-cations both during and after the pregnancy (both mother and fetus).

P240 A POWER OPTIMIZATION TECHNIQUE FOR EXTENDED-RANGE WIRELESS PERSONAL HEALTH DEVICES

Josh D. Schilling, BSc, Jayant Parthasarathy, PhDNonin Medical Inc., Plymouth, MN

Wireless Personal Health device manufacturers have long had to contend with two contrasting requirements—(a) extended range to overcome concrete walls, (b) long battery life for a better user experience. Wireless Standards Organizations have noted this and have made some accommodations in their specifi cation and particularly so in Bluetooth. Devices qualifi ed as Bluetooth Class 1 (highest transmit power allowed 20dBm) have to implement power control which optimizes the output power over a physical link by measur-ing the Received Signal Strength Indication (RSSI) and forcing the transmit power to adjust accordingly. Most implementations of Class 1 devices use an external Power Amplifi er to boost the transmit power. A point to consider is that, even though manufactures would desire improved range, there exist certain applications where the devices would be used close to each other (1-10m). In short range usage, the output power required would be low, but, the external Amplifi er approach proves disadvantageous as the circuit would still draw some minimal bias current. This work proposes introducing switches between the Power Amplifi er and controlling the action of the switches with RSSI measurements. The technique would allow the Amplifi er to operate normally in extended ranges, but the switches would bypass the circuit when the devices are close to each other. The architecture has been successfully im-plemented in a Class 1 Bluetooth Pulse Oximeter (Nonin Medical Inc.), with power savings of more than 50% having been observed at short distances (1-10m). The specifi c implementation could however, be universally applied to any wireless transceiver with RSSI measurements. In a Personal Health device, the technique provides a manufacturer with the satisfaction of an enriched user experience by not asking the user to change batteries regularly, but at the same time communicating over longer distances as well.

P252 PEDIATRIC DIABETES EDUCATION AND MANAGEMENT VIA LIVE REMOTE SUPPORT

Candace Shaw, BS, Chris Macha, RD/LD, CDE, Kenneth Copeland, MDUniversity of Oklahoma Health Sciences Center, Oklahoma City, OK

Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY), is a trial designed to evaluate the safety and effi cacy of three treatment re-gimes for adolescents and youth diagnosed less than 2 years. The University of Oklahoma Health Sciences (OUHSC) along with their 3 Native American Tribal partners became one of 13 centers selected to participate in a clinical treatment trial sponsored by The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH).

It was known that TODAY study families would have limited or unreli-able transportation, as many program participants lived greater than 2 ½ hours away, so the OUHSC TODAY site decided to travel where the participat-ing families live. Geographic distribution of program participants over the state’s 2,000 square miles and the requirement for face-to-face sessions was increasingly burdensome for the TODAY staff. Travel was extremely time consuming and costly as the number of program participants increased. Over the past 3 years, the Oklahoma TODAY site has implemented and successfully utilized the Starview Videophone and Polycom Videoconferencing units, as the study Manual of Operation allows, to assist in meeting with program participants and Native American partners.

The Starview Videophones in participant homes and Polycom Videoconfer-encing units available in County Health Depts. and TODAY partner Native Amer-ican Tribal offi ces have provided high quality audio and video, a large image area for presentations, ease of use, and adherence to H.323 industry standards.

The utilization of Starview and Polycom videoconferencing units has al-lowed for greater access, less travel and expanded growth of the TODAY study program. Over 1/3 of the more than 120 eligible TODAY participants have had some level of participation via telecommunication technology. Currently the TODAY study staff is conducting greater than 15 live sessions per month.

P264 A COMMUNICATION TECHNOLOGY-ENABLED DIABETES SELF-MANAGEMENT PROGRAM: EXPLORING PATIENT PERSPECTIVES

Alexandra Pelletier, MBA,1 Ambar Kulshreshtha, MD, MPH,1,2,3,4 Khinlei Myint-U, MBA,1 Alice Watson, MBChB, MRCP, MPH,1,2,3 Doug McClure, MIM,1 Brian Fitzgerald,2 Joseph Kvedar, MD1,2,3

1Center for Connected Health at Partners, Boston, MA; 2Healthcare Information and Management Systems Society, Chicago, IL; 3Massachusetts General Hospital, Boston, MA; 4Harvard Medical School, Boston, MA

Background Information and communications technology (ICT) has been heralded as a means to connect patients and providers, empower patients to proactively manage their diabetes and address the growing diabetes epidem-ic. Our ICT solution automates blood glucose data collection, aggregates and presents this data to patients who can then use a journal feature to record signifi cant lifestyle data. The care team has access to this information and can communicate directly with the patient via this solution.

Methods A 90 minute, professionally facilitated focus group was conducted among 8 respondents and the prototype solution demonstrated. The partici-pants included both newly diagnosed diabetics and those who had managed diabetes for many years. The focus group was video-recorded and thematic qualitative results and summary recommendations were reported.

Results Participants perceived this solution as most valuable during certain stages of their diabetes management: newly diagnosed, or trying to get back in control. Participants agreed that if this solution is offered for a predefi ned time period, and not in perpetuity, they would be more likely to comply. Another factor affecting adoption was the level of involvement of providers; patients viewed the solution as more valuable if the practitioner was moni-toring their information. Moreover, communication between providers and patients outside of scheduled offi ce appointment times was perceived as an important enabler in improving diabetes management.

Conclusion The major benefi t of the program is empowering patients to manage their diabetes by offering education and facilitating communication between care providers. Our focus group refl ected the hypothesized percep-tion of value of creating this ICT gateway to help manage their diabetes.



The information gathered from this initial phase will be used to guide the development of an ICT-enabled diabetes management system for patients and their care team.

P275 A TELEPSYCHIATRY PARTNERSHIP BETWEEN OKLAHOMA UNIVERSITY AND THE DEPT. OF CORRECTIONS

Candace Shaw, BS,1 Cindy Baugh, RN, CNS,BC,2 Robert Powitzky, Ph.D2

1University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2Oklahoma Dept. of Corrections, Oklahoma City, OK

Telepsychiatry, the use of standards based videoconferencing technology in providing medication management and patient consultation in mental health services, has become an accepted practice across correctional institu-tions nationally. The Oklahoma Department of Corrections (DOC) with as-sistance from the Center for Telemedicine at the University of Oklahoma Health Sciences Center implemented a Telepsychiatry pilot project in 2004. The pilot project was to evaluate utilization by DOC clinical staff located at the Oklahoma State Penitentiary to provide timely support for inmates at two correctional locations that were each 2 hours away and reduce the number of hours that DOC staff spent traveling between facilities to provide mental health services.

The pilot included three DOC facilities and associated healthcare staff, a DOC staff psychiatrist, a DOC Advanced Practice Psychiatric Nurse and OUHSC Center for Telemedicine staff. Initial implementation utilized desktop computers with Polycom Via Videos connecting over the Dept. of Corrections secure network for live mental health support and medication management. The computers were utilized for patient recordkeeping, email correspondence and documentation as well as the Polycom Via Video used for live videocon-ferencing to meet with the inmates at other facilities.

Over the 12 month period that statistics on utilization of the Telepsy-chiatry system were documented, there were 32 days of utilization with 696 mental health visits conducted over the system allowing for 113 hours of saved travel time and associated costs. There were approximately 6 non-scheduled instances in which the DOC was able to use the system for han-dling individuals in crisis situation. The utilization of the Telepsychiatry sys-tem allowed for time and money saved as well as provided a continuity of care as DOC staff changed during the pilot project.

P276 R.E.A.C.H FOR DISTANCE EDUCATION TO RURAL FAMILY PRAC-TICE RESIDENTS

Deborah C Hall, MD,1 Javier Aceves, MD,1 Sally Bachofer, MD,2 Mario Pacheco, MD,3 Susan Thomas, MD,4 Karen Vaillant, MD5

1University of New Mexico Department of Pediatrics, Albuquerque, NM; 2University of New Mexico Department of Family Practice, Albuquerque, NM; 3Northern New Mexico Family Practice Residency, Santa Fe, NM; 4Memorial Medical Center Family Practice Program, Las Cruces, NM; 5Eastern New Mexico Family Medicine Residency Program, Roswell, NM

Background Family Practice (FP) physicians provide 30-50 % of pediatric care in rural areas. Use of technology can support access to knowledge in pediatric issues for rural FP residents. Hypothesis: Delivery of educational programs to rural FP residents will show that transmission of information and satisfactory training experience can be accomplished through a telehealth delivery model. Methods: Over six months, a teaching series in four topic areas was deliv-ered over broadband telehealth technology in two multi- and two single-site connections, to 61 participants in three rural FP residencies located in three communities in New Mexico. Pre- and post-satisfaction and -content surveys were completed for each session. An urban FP residency control group com-pleted an identical post-content survey at the end of the six-month period. Data analysis was completed in grouped analysis for overall satisfaction and willingness to use again. Change in knowledge was analyzed for three didactic sessions. Results: On a Likert 5.0 scale, participants were highly satisfi ed with sessions (mean 4.3, range 3.8 – 4.8). They felt able to obtain the same informa-tion as in person (mean 4.1, range 3.5 – 5.0), and were comfortable with their

ability to interact with other participants (mean 4.2, range 3.4 – 5.0). There was no statistical difference in satisfaction or knowledge between multi-site and single-site connections. Post-knowledge increased in three didactic ses-sions; post-knowledge was signifi cantly greater in one of three topic areas (t=-5.98,p<0,0001). Post-knowledge was greater in rural than in urban controls. FP residents with rural experience were signifi cantly more likely to feel able to obtain the same information as in person (p=0,02). All were highly will-ing to use telehealth again (mean 4.5, range 4.3 – 4.7). Conclusions: Delivery of educational programs to rural FP residents over telehealth technology can transmit information and provide a satisfactory training experience. Rural ex-perience may impact perception of telehealth.

P286 EVALUATION OF A CONTINUING EDUCATION PROVIDER’S TELEBEHAVIORAL HEALTH COMPETENCIES TRAINING

Valerie M. Gifford, MSW,1 Britton A. Niles, MA,1 Jodi Polaha, PhD,2 Catherine Koverola, PhD,3 Inna Rivkin, PhD1 1University of Alaska, Fairbanks, Fairbanks, AK; 2East Tennessee State University, Johnson City, TN; 3Antioch University, Seattle, WA

Background The use of two-way video conferencing enables mental health professionals to provide services to clients in rural communities. Given the infancy of telebehavioral health, clinicians are ethically obligated to pursue continuing education in order to develop the necessary skills for the effective delivery of treatment. In most states, the process of continuing education is mandated and a requirement of the clinician (McNamara & Hall, 2005). Rees and Haythornwaite (2004) report the need for psychologists to develop competencies regarding ethical and legal telehealth concerns including con-fi dentiality, informed consent, and client safety.

Objectives The Alaska Rural Behavioral Health Training Academy, continu-ing education provider, delivered a telebehavioral health training, for mental health providers and telehealth coordinating staff within Alaska. The main objective of this research was to assess providers’ success in implementing and applying telebehavioral health competencies in their workplaces.

Methods A three day telebehavioral training institute was conducted tar-geting clinicians and site coordinators. The training was created in order to facilitate participant integration and application of competencies acquired during the training institute. The competencies were conveyed via lecture, role plays, vignettes, and group practice. Participants identifi ed goals and developed an action plan to assist them in applying the competencies upon return to their workplace. Utilizing a self-report survey, participants reported their level of implementation of each goal on their action plan. The self-re-port survey solicited provider responses on a fi ve point scale, one being not at all and fi ve being total implementation.

Findings/Conclusions Results of this study support that participants suc-cessfully implemented their action plan, following the training institute, to varying degrees. In conclusion, results support the need for therapists and site-coordinators to obtain continuing education for telebehavioral health service delivery with follow up in order to facilitate implementation.

P289 DIABETIC SELF-MANAGEMENT: EDUCATING A FRONTIER COMMUNITY

Cindy K. Leenknecht, MS, APRN, BC, CCRP,1 John MacCart, MD,2 Gail Wagnild, RN, PhD,3 Janie F. Meszaros, RN, BSN, CDE,4 Kiran Tyabah,5 Scot Mitchell, MHSA, EMT-P5

1St. Vincent Healthcare, Partners in Health Telemed, Billings, MT; 2Wheatland Memorial Healthcare, Bair Memorial Clini, Harlowton, MT; 3Intermountain Friends Research Institute, Inc., Billings, MT; 4St. Vincent Healthcare, Internal Medicine and Diab, Billings, MT; 5Wheatland Memorial Healthcare, Harlowton, MT

Chronic disease management in rural/frontier communities is usually diffi cult due to geographic barriers and resource limitations. Diabetes is the most common chronic disease among American adults with 5% of



Montanans reported to have the disease. But unlike other places, diabetes is the 6th leading cause of death in Montana versus the 8th leading cause of death in the U.S. The foundation of chronic disease management is self-management. In order for diabetics to self-manage their disease, they must be guided to understand their disease process and suggested treatment plan. Thus with funding provided by the Health Resources and Services Administration, Wheatland Memorial Healthcare, a community hospital in the frontier town of Harlowton, Montana in partnership with St. Vincent Healthcare Diabetes Center in Billings, Montana developed a self-manage-ment program that was presented via telehealth. This program delivered self-management guidance from urban diabetes specialists using group teaching as well as, one-to-one assessment and goal setting sessions. The program was delivered to two groups of diabetics (Fall 2006 and Spring 2007) in Harlowton via interactive videoconferencing facilitated by a local expert within the rural community.

Effectiveness of the intervention was measured using pre- and post-test measurements of attitude, depression, empowerment, self-care attributes, and physiological measures of weight, blood pressure, and hemoglobin A1c. The sample size is small, but signifi cant decreases of weight, hemoglobin A1c, and systolic blood pressure readings were noted. Most participants re-port that they would not travel the 100 miles or more to participate in a similar course.

Lessons learned will be presented to include: 1) the facilitator role, 2) group dynamics, 3) class room design and set up and 4) multi-disciplinary teams. A model will be proposed for chronic disease self-management within frontier communities that currently does not exist that could be applied to other chronic disease processes.

P294 SATISFACTION WITH A DISTANCE CONTINUING-EDUCATION PROGRAM FOR HEALTH PROFESSIONALS

Ann B. Bynum, EdD,1 Cathy A. Irwin, PhD, RN2 1University of Arkansas for Medical Sciences, Little Rock, AR; 2University of Arkansas for Medical Sciences, Little Rock, AR

This study assessed differences in program satisfaction among health professionals participating in a Distance Continuing Education Program by gender, ethnicity, discipline, and community size. A one-group posttest de-sign was used with a sample of 45,996 participants in the University of Arkansas for Medical Sciences (UAMS), Rural Hospital, Distance Continuing Education Program during 1995-2007. This Program provided 2,219 con-tinuing education programs for physicians (n = 7,047), nurses (n = 21,264), allied health (n = 3,230) and dental (n = 305) professionals, pharmacists (n = 4,088), administrators (n = 1,211), and marketing/fi nance/human resources professionals (n = 343). These programs were provided in hospitals; rural, community health, and health department clinics; Area Health Education Centers (AHECs); Migrant, Human Development, and Aging Centers in Ar-kansas. Interactive video technology and the Internet were used to deliver these programs. Two evaluation instruments were used to assess program satisfaction, which demonstrated adequate internal consistency reliability (Cronbach’s alpha = 0.91, 0.95) and construct validity.

Participants in the Program had high levels of satisfaction regarding knowledge and skills, use of the information in practice to enhance patient care, program quality, and convenience of the technology for training (mean total satisfaction scores = 4.44 and 4.51, range 1-5). Eighty-four percent of the participants reported that they would have to travel 50 miles or more to receive this service from the originating site. Results from the t-test for independent samples and 1-way ANOVA indicated that males (p = 0.001), African-Americans (p < 0.01), dental professionals (p < 0.01), and partici-pants in smaller rural communities (population 6,101-15,000) (p <0 .01) had signifi cantly greater satisfaction. Nurses and physicians had signifi cantly greater satisfaction regarding use of the program information in practice to enhance patient care (p < 0.01). The fi ndings suggest that socioeconomic and demographic factors can affect satisfaction with distance continuing education programs.

P310 PRELIMINARY EVALUATION OF A PRACTICAL PROGRAM IN E-HEALTH EDUCATION

Sisira Edirippulige, PhD, Msc, Nigel R. Armfielf, M.Sc, MIEEE, MIET, Mark E. Bensink, Med (Leadership), BNurs, RN, Rohana Marasinghe, MBBS, Richard Wootton, DSc, PhDCentre for Online Health, Brisbane, AL, Australia

Background The potential of e-Health has been widely acknowledged but education in e-Health skills and technologies has been paid scant atten-tion. In semester 1, 2005 we included a practical component to the e-health courses offered at University of Queensland Centre for Online Health. One full day practical was added to the undergraduate elective while students from e-Health graduate programmes (GradCert, GradDip and Masters) were required to attend an intensive fi ve day practical session. During the practi-cal sessions students participated in individual and team-based tasks relating to clinical videoconferencing, clinical digital photography and also attended RCH clinics carried out by telehealth.

Methods We evaluated feedback surveys returned by attendees on completion of their practical component between semester 1, 2005 and semester 1 2007.

Results 86 undergraduates and 16 graduate students completed practical components during the study period.

Asked whether the practical component enabled participants to acquire hands-on skills in e-health 97% (n=99) agreed with the statement. 93% (n=95) agreed that the practical enabled participants to explore ways of us-ing different technology in the delivery of healthcare. 93% (n=94) agreed that the practical raised awareness of the potential and limitations of e-Health technology. 98% (n=99) agreed that the practical covered key areas in the course. Overall, 98% (n=100) of participants rated the practical compo-nent as 4 or 5 on a scale 1-5.

Conclusions We report high student satisfaction with the delivery of the practical e-Health programme. Development of practical hands-on skills is an important and valued element of e-Health education.

P311 MEASURING QUALITY OF LIFE IN ONCOLOGY PATIENTS IN RURAL KANSAS

Ashley O. Spaulding, MA,1 Gary C. Doolittle, MD,1 Ryan J. Spaulding, PhD,2 Arthur R. Williams, PhD3 1University of Kansas Medical Center, Department of, Kansas City, KS; 2University of Kansas Medical Center, Center for Te, Kansas City, KS; 3Mayo Clinic, Health Care Policy and Research, Rochester, MN

The Functional Assessment of Cancer Therapy–General (FACT-G) is one of the most widely utilized and accepted instruments for measuring quality of life (QL) in patients with cancer. While it is frequently administered in face-to-face clinic settings, it is not often administered to patients seen via telemedicine. Data for this study were collected for 12 months, from the beginning of Oc-tober 2004 through the end of September 2005. Patients who participated in this study were seen face-to-face or via telemedicine at Hays Medical Center (HMC) in Hays, Kansas by an oncologist from the University of Kansas Medi-cal Center (KUMC) located in Kansas City, Kansas. During the data collection period, 144 patients completed 426 FACT-G instruments. Patients were asked to complete the FACT-G at every initial and follow-up visit, which accounts for the discrepancy between the number of patients who participated in the study and the number of instruments collected. One hundred sixty-seven (39.2%) FACT-Gs were completed during face-to-face visits, and 259 (60.8%) were completed by patients seen via telemedicine. Over half (58.6%) of the patients who completed FACT-Gs were female; 41.4% were male. Participants ranged in age from 20 years to 91 years; 65 years was the mean age of the patients who completed instruments. Almost two-thirds (65.8%) of the participants were receiving disease-specifi c treatment at the time they completed the FACT-G; 34.2% were under observation only and receiving no treatment at the time the data were collected. Results from the scoring of the FACT-G for this study, including results for specifi c instrument items, will be discussed. Given that



studies have demonstrated that measuring QL during oncology consultations can enhance physician-patient communication and heightens physicians’ un-derstanding and awareness of patients’ well-being, it is essential to make the use of QL instruments more widespread in telemedicine settings.

This research was funded in part by a grant from the Offi ce for the Ad-vancement of Telehealth (OAT).

P313 A PATIENT ASSESSMENT OF COMMUNICATION DURING TELEMEDICINE (PACT) MEASURE

Zia Agha, MD, MS,1,2 Debra Roter, PhD,3 Dale Glaser, PhD,5 Prakash Laud, PhD,4 Ralph Schapira, MD4 1VA San Diego HSRD, San Diego, CA; 2University of California, San Diego, San Diego, CA; 3Johns Hopkins University, Baltimore, MD; 4Medical College of Wisconsin, Milwaukee, WI; 5Glaser Consulting, San Diego, CA

Introduction An important goal of videoconference telemedicine is to enable ef-fective physician-patient communication. Telemedicine’s effect on physician-pa-tient communication is an area of growing interest. However, few validated tools are available that specifi cally measure physician-patient communication during telemedicine. We conducted a RCT of 221 patients at the Milwaukee VA Medi-cal Center to study telemedicine’s effect on physician-patient communication. Patients from pulmonary, endocrine, and rheumatology clinics received consulta-tive care with one of 9 physicians, either in person or via telemedicine at a remote site. Physician-patient communication was evaluated using the Roter Interaction Analysis Scale (RIAS), a widely validated measure of physician-patient commu-nication, and by the “Patient Assessment of Communication during Telemedi-cine” (PACT), a self-report questionnaire. In this abstract, we test the reliability and validity of the PACT questionnaire during telemedicine consultation.

Results We analyzed data from 207 subjects who completed the study (TM = 05 and IP = 104). We used principal component analysis (factor analysis) with varimax rotation to study 207 patient responses to the PACT instrument. Factor analyses of original 45 items yielded a fi nal tool with 33 items with 4 independent factors.

Table 1: Factor Analyses & Reliability Testing Data

Factors Eigen Values

%Variance

Reliability (Cronbach’s

alpha)

Patient-Centered Communication 11 18.95 0.896

Clinical Competence and Skills 2.7 16.98 0.877

Interpersonal Skills 1.8 10.03 0.782

Convenience of Care 1.3 5.73 0.780

Combined, the 33 items had high reliability (alpha 0.93). PACT scores cor-related with physician-patient communication, as measured by the following RIAS categories: patient education/counseling on medical issues (ñ = 0.2, p =0.02), physician rapport building (ñ = 0.2, p =0.00), and physician partner-ship/empathy (ñ = 0.2, p = 0.01).

Conclusions The PACT questionnaire shows promise as a reliable and valid measure of physician-patient communication during telemedicine consul-tation. Further testing and confi rmation of these fi ndings in other patient populations and clinical settings is warranted to test the wider application of PACT questionnaire.

P319 MEASURING THE ARIZONA TELEMEDICINE PROGRAM AT AN ACADEMIC INSTITUTION

Gail Barker, Phd,1 Elizabeth Krupinski, PhD,1 Richard McNeely, MS,1 Ana Maria Lopez, MD,1 Rifat Latifi, MD,1 Sarah Hiteman, MEd,2 Michael Holcomb, BS,1 Sandra Beinar,1 Alison Hughes, MPA,1 Ronald Weinstein, MD1

1Arizona Telemedicine Program, Tucson, AZ; 2College of Medicine, University of Arizona, Tucson, AZ

The Arizona Telemedicine Program (ATP), initiated as a decision package by the Arizona State Legislature, is now 10 years old. What has the State’s investment produced and how do you measure the success of a telemedicine program? Other than fi scal solvency, what other factors help defi ne success? Although the ATP Program reports to the State, the program is based at the University of Arizona in the College of Medicine (COM). In order to measure our success, we started by applying the same measurements used to evaluate COM departments at the University of Arizona. These include:

• Fiscal solvency• Research activities• Clinical service• Education• Community serviceThe University of Arizona uses a fund-based accounting system. So, for

the fi scal solvency category we looked at the FY 06/07 revenues, expenses, fund balance and return on investment for the State. Research was measured by contract and grant dollars and number of publications. Clinical service success was based on billing and collection rates. Education was defi ned as hours spent in educational activities. Community service included national and state committee representation.

We wanted to compare the ATP results with other departments at the Uni-versity of Arizona, College of Medicine (COM). We compiled the results for the ATP, but are waiting for the data from the other COM departments. We plan to analyze these data and compare performance based on the measure-ments described above.

P321 A WEB-BASED TELE-OPHTHALMOLOGY SYSTEM FOR COLLABORATIVE MEDICAL IMAGE ANALYSIS AND DIAGNOSIS

Delia Cabrera Fernández, PhD,1 Gábor M. Somfai, MD, PhD,2 Sudarshan Ranganathan, BSc,1 Zsuzsanna Szepessy, MD,2 William E. Smiddy, MD,1 Mária Ferencz, MD,2 Arpád Barsi, PhD3 1Bascom Palmer Eye Institute, University of Miami, Miami, FL; 2Semmelweis University, Faculty of Medicine. Depart, Budapest, Hungary; 3Budapest University of Technology and Economics, Budapest, Hungary

Computer-based technologies integrated with Internet applications may provide the viable means for low cost tele-ophthalmology systems. Prelimi-nary results on the Internet based cooperative tool applied to diabetic reti-nopathy screening using Optical Coherence Tomography and digital Fundus Photography will be presented. The system enables remote collaboration between two or more client computers located anywhere on the Internet. Each client requires only a PC and a popular internet browser—no special hardware or software is required. A set of tools based on JAVA programming enables to process and analyze the retrieved images, and quantify their fea-tures in different regions of interest. For security, all data transmissions were carried over encrypted Internet connections such as Secure Socket Layer (SSL) and Hypertext Transfer Protocol over SSL. We also tested the system between three remote eye clinics, one in Hungary, one in the U.S. and one in India, using the Internet for communication. Images required 5-25 seconds for display. The core design concept of this system is the usefulness in the aspect of image processing as well as communication. The system enabled experts to share knowledge regardless of geographical displacement, thus it is anticipated that a successful system implementation will result in reduc-tions in vision loss and other eye disease complications. Also, our system would enable an increasing number of ophthalmologists to improve their work by working towards the fi nal target of virtual international image anal-ysis that operate cooperatively through the web-based networks in order to enhance the quality of diagnosis. Additionally, the Internet cooperative tool will help to remove inter-observer variation in quantifi ed parameters and help in follow-up, screening and other routine work. Proposed system can effectively provide a tool for collaboration and discussion about ophthalmic image analysis, diagnosis and medical report.



P332 AUTOMATED ANALYSIS OF LANGUAGE IN BIPOLAR DISORDER: CLINICIANS' ATTITUDES

Rolf Wynn, MD, PhDUniversity of Tromso, Faculty of Medicine, Departm, Tromso, AL, Norway

A core symptom in bipolar disorder is variations in mood, which are ac-companied by other symptoms, including variations in cognitive functioning and language use. Being able to evaluate patients’ current state and changes in mood is important clinically. Unfortunately, moods swings are diffi cult to predict clinically. However, emerging technology, including computer-based analysis of language, may become a useful tool for measuring small early changes in mood (measured through language use) that are diffi cult to notice clinically. Language data may be recorded in-offi ce or remotely by means of telephone.

Although a technology may be promising from the developers’ point of view, the users’ opinions regarding its need and usability are important with regard to a successful implementation.

In this study, ten clinicians with experience in treating patients with bipolar disor-der were interviewed. They were asked about their experiences regarding the predic-tion of mood swings in bipolar disorder and their thoughts about using an applica-tion for the evaluation of the clinical state and the early detection of mood swings.

Eight believed that it is diffi cult to notice mood swings at an early point, two believed they could notice such swings clinically quite early. All felt they easily could evaluate the current clinical state of patients with bipolar disorder. Seven expressed an interest in utilising an application that could detect early mood swings, three were uninterested. Although most were positive, several expressed concerns regarding ease of use, costs and time consumption.

Conclusions A majority of clinicians asked were positive to the application. Some concerns that have to be addressed are ease of use, time consumption and costs. Further research and development of this topic seems warranted.

P335 A SECURE, RFID/SENSOR BASED TELE-CARDIOLOGY SYSTEMFei Hu, PhD,2 Yang Xiao, PhD1

1University of Alabama, Tuscaloosa, AL; 2Institute of Technology Technology, Rochester, NY

Tele-cardiology through RFID-based wireless sensor networks can provide anytime cardiac patient monitoring in large nursing homes. The radio broad-casting nature has the risk of losing confi dentiality (i.e., “privacy”) of pa-tients’ data. This presentation discusses our research on a secure RFID/sensor based tele-cardiology system. It is based on the light-weight encryption and key management algorithms. The RFID helps trace the mobility of patients and manage medical facilities in nursing homes.

P342 AN EDUCATIONAL STRATEGY ON TELE-HEALTH AS A BASIS OF INTERNATIONAL COOPERATION

Jorge A. Vélez, MD,1,3 Marie-Pierre Gagnon, PhD,2 Marta C. Jaramillo, MD,1 Fabiola Martínez, AC,1 María Inés Largo, FTT3 1ICESI University, Cali, Colombia; 2LAVAL University, Québec, Canada; 3Colombian Telemedicine Centre, Cali, Colombia

Introduction Most experiences on international cooperation are consisting of design, development, implementation and deployment of operational programs on telemedicine and telehealth. However, educational strategies are a promising area to integrate scientifi c communities related with telemedicine and telehealth. Through sharing knowledge and technology transfer, this effort aims for a part-nership. The international outreach will be fostered through educational strate-gies involving telemedicine leaders from the worldwide countries.

Background The international relationships established for proposal presen-tation with foreign researchers is presented. The importance of ATALACC in supporting telemedicine teams is discussed. Moreover, a Telehealth Diploma has been launched by the ICESI University of Cali, during the Cartagena Telemedicine Conference, held in September 4-5, 2006.

Objectives To educate healthcare professionals and healthcaremanagers in the application of ehealth technologies.

Contents Modules on Introduction and Backgrounds in Telehealth, Planning and Programs Management, Health Environment, Technologies and Applica-tions, Distance Learning and e-Learning, Clinical Applications and a Workshop section. This version of Diploma counted with the participation of foreign profes-sors from Canada, the U.S., Spain and Argentina. Methodological issues: use of reviews, interactive video conferences, and hands-on sessions on informatics.

Results As a result we had a Telehealth proposals and programs from attend-ing organizations. An active international affaires work to get real agreements for next dissemination of educational training in telehealth with Ecuador, Uni-versidad Tecnológica Equinoccial-UTE. Following those successes, an e-Health Program was established with the purposes of leading educational programs on the application of information and communications technologies, generating international agreements to foster related research on telehealth, and linking academia, government and private sector for e-Health issues.

P349 DIARIES AND SENSORS FOR COLLECTING DATA ON DAILY ACTIVITY, DIET, AND BEHAVIOR

Paul N. Kizakevich, MS, PE,1 Roy Whilmore, PhD,1 Ted Johnson, MS,3 Michael McCartney, ScD,2 Steve Duncan, MS,1 Robert Furberg, BS, EMT-P,1 Yuying Zhang, MS,1 Stacey Weger, BA,1 Randy Ottem, MS,1 Gina Kilpatrick, MED1

1RTI International, Research Triangle Park, NC; 2MLM Technical Services, Durham, NC; 3TRJ Environmental, Chapel Hill, NC

Introduction We developed a data collection platform for various survey, sen-sor, and contextual data for use in week-long longitudinal fi eld studies of daily activities and behaviors. The objectives were to develop low burden methods for recording activity, location, diet, exertion, and product use (e.g., dietary supple-ments, pesticides, and cleaning personal care) during everyday life. Centered on a handheld Pocket PC, the system integrates multiple survey modes (i.e., diaries and questionnaires) and real-time data from wireless, automated physical and physiological monitors. To reduce burden wireless product use event markers and passive in-home location beacons, exertion assessment, and GPS tracking devices were developed. The confi gurable system supports varied study require-ments, investigator needs, and participant preferences. An evaluation was con-ducted in 40 homes to determine burden, compliance, and quality for four diary modes: paper forms, interactive menus, audio prompt/voice answer, and passive periodic photos. User feedback was solicited to assess usability and identify po-tential improvements in our planned development reiteration.

Results Burdens for activity and location entries were <16 seconds (menu) and 60 seconds (paper, voice); and for dietary data 64 seconds (menu). For activ-ity compliance, the median diary entry rate was 1.6/hr (paper), 1.3/hr (menu), 1.2/hr (voice), and 2.8/hr (photo). For location, these were 1.1/hr (paper), 0.9/hr (menu), 0.7/hr (voice), and 7.2/hr (photo). Automated room beacons, heart rate monitoring, and GPS data worked fairly well. Debriefi ng indicated that par-ticipants liked and disliked each of the four diary modes, with several avoiding activities and limiting diet to reduce their diary entries.

Conclusions The burden for data entry was fairly low, in spite of reported problems with certain menus. Compared to previous work, diary entry com-pliance was low. In debriefi ng, compliance improvements were identifi ed, including better participant’s instruction, the need for embedded diary help, and tailoring menus and forms to participant habits and preferences. After completing these and other revisions, we will conduct another fi eld test and reevaluate system performance.

P350 FAMILY-LINK: CONNECTING CRITICALLY ILL PATIENTS WITH THEIR FAMILIES

Kourosh Parsapour, MD,1 Alexander A. Kon, MD,2 Janice Carpenter,2 Javeed Siddiqui, MD, MPH,2 James P. Marcin, MD, MPH2 1Miller Children's Hospital, Long Beach, CA; 2University of California, Davis Medical Center, Sacramento, CA

The admission to the ICU is recognized as a signifi cant stressor for pa-tient and family. Not only does the family have many fears, worries, and



concerns that surround the illness, surgery, or trauma, they are also forced to cope with highly unfamiliar environments where they have little control. The centralization of tertiary or quaternary medical centers may also isolate the family from their social, religious or community support systems because patients are often hospitalized great distances from their homes. All these factors contribute to the different levels of anxiety and stress on family members of patients in the ICU. The recently published American College of Critical Care Task Force guidelines for support during a family member’s ICU admission recommend open visitation in the adult ICU to allow fl exibility for patients and families and that visitation in the pediatric ICU and neonatal ICU be open to parents and guardians 24 hours/day.

Telecommunication technology offers a unique solution to provide hospital-ized patients and their family the opportunity to interact with their spouse, par-ents, siblings, extended families, and friends who are unable to visit the patient in person. The Family-Link technology uses dual video conferencing units that communicate over a simple telephone line so that patients can see and hear oth-er family members and friends. The goal of Family-Link is to provide a low-cost, technically simple technology support to the patient and family during a hospi-talization to reduce the impact of stress during a period of illness or injury.

To date, the Family-Link service has been provided to 19 families to date, all with excellent success. The ultimate goal of this technology will be to pro-vide cost-effective, reliable, and simple to use videoconferencing units with every patient that is admitted to the ICU in order to ensure family presence and patient-centered critical care.

P364 HOW MUCH DO E-HEALTH SYSTEMS SAVE MEDICAL EXPENDITURES?

Masatsugu Tsuji, PhD,1 Yuji Akematsu, MA,1 Fumio Taoka, MA2

1University of Hyogo, Kobe, Japan; 2Kyoto University of Education, Kyoto, JapanThis paper analyzes the relationship between medical expenditures and

the e-heath system, which connects senior people and medical or health institutions via the telecommunications network. Even though the e-health system is simple, it contributes to promote health of senior people. This paper aims to verify empirically this by examining the system of Nishiaizu Town, Fuikushima Prefecture in Japan. The town offi ce has receipts in paper form paid by National Health Insurance for 5 years from 2002 to 2006. The meth-odology of the analysis is to choose two groups (i) users; and (ii) non-user of the e-health system, and compare the medical expenditures. As for the for-mer, we selected 412 from the list owned by the offi ce, and as for the latter, we chose 450 from the list of National Health Insurance. We send question-naires on their personal characteristics and diseases. We obtained 311 from users, while 239 for non-users. When we examined receipts of these 550 people, and made a database on age, diseases, the fi rst dates of visiting medi-cal institutions for the fi rst time, the number of visiting medical institution, and medical expenditures. Based on this database, we examine the hypoth-eses such that (i) whether there is a clear difference in medical expenditures between two groups, and (ii) whether there is negative correlation between medical expenditures and the length of usage of the e-health system. As for (i), total medical expenditures of users are larger than those of non-users, whereas restricting to lifestyle-related illnesses such as high blood pressure, cerebral infarction, strokes, and diabetes, medical expenditures of users are found to be smaller than those of non-users. We also identify the factors which make these differences by the use of OLS. Finally, the suggestions to set up health plans based on this analysis are proposed.

P378 DISEASE MANAGEMENT REDEFINED—A NOVEL APPROACH TO TACKLING HIGH BLOOD PRESSURE AMONG EMPLOYEES USING AN INTERNET-ENABLED AUTOMATED SELF-MANAGEMENT PLATFORM

Alice J. Watson, MD (MB,BCh), MPH,1,2,3 Anshul Mathur, MD (MB, BS), MPH,1,2,3 Joseph C. Kvedar, MD1,2,3

1Partners Healthcare, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Harvard Medical School, Boston, MA

Introduction Chronic diseases, such as high blood pressure, place an enor-mous economic burden on self-insured employers through loss of productiv-ity and high costs of health utilization. Furthermore, high blood pressure ranks among the most expensive diseases for large employers. Previous in-terventions have focused on education, with poor attempts to engage pa-tients or create incentives to change negative behaviors. New approaches are needed to promote self management in an interactive, engaging and sustainable way. We describe the concept and design of an automated self-management program for employees with high blood pressure.

Conceptual Framework Our approach to improving blood pressure in hyper-tensive and pre-hypertensive patients comprises self-management, regular self-monitoring and structured education. Based on this framework we built an automated algorithm that tracks trends in the blood pressure and triggers a sequence of responses to promote lifestyle changes and reinforce positive behaviors.

Implementation The program uses an interactive web based portal that receives blood pressure readings wirelessly from a portable blood pressure device. The automated algorithm analyses blood pressure data and generates messages and reminders for the user at periodic intervals. The algorithm also directs users to an educational module with interactive quizzes on blood pressure control and lifestyle management. In addition the website supports a discussion board for users to discuss aspects of blood pressure control such as diet, stress and medications. The users are given “points” for completing a certain number of blood pressure readings every month which can be re-deemed through the employer for monetary rewards.

Conclusion Large self-insured employers are in unique position to lead such initiatives among their employees and rapid advances in communications technology have made it possible to effi ciently implement and scale such interventions. This program is currently being tested as a randomized control trial at a large self-insured employer in Massachusetts.

P388 INTERNET-BASED TELEMEDICINE: IMPACTS OF NETWORK IMPAIRMENTS ON TELE-PSYCHOMETRIC EVALUATIONS

Bengisu Tulu, PhD, Eleanor Loiacono, PhD, Saurabh Gupta, BSc, Harshal Pandaya, BSc, Archana Goyal, BSc, Justin Odom Worcester Polytechnic Institute, Worcester, MA

The well-being of tomorrow’s patients demands changes in today’s healthcare environment and investment in infrastructure. Providing access to those who cannot receive healthcare services via traditional delivery systems easily is an important goal. In our earlier studies, we have reported the potential of the Internet to deliver healthcare to a wider population as the low cost and ubiquitous delivery option. However, the fi ndings of our early studies, focused on teleophthalmology, also suggested that the unreli-able connection properties of the Internet can result in various impairments that affect the quality of Internet-based telemedicine applications. We have discovered that jitter had the greatest effect on the degradation of the tele-opthalmology video stream. Moreover, we learned that if the impairments happened at the critical frames for decision making, the decision making confi dence level of the specialists were affected even though the objec-tive quality of the video was at an acceptable level. As a follow-up study, we have focused on the tele-psychometric evaluations over the Internet, where video and audio are both important for clinical decision making. Us-ing a low-cost Internet-based telemedicine videoconferencing setting, we are investigating how objective and subjective video quality measures and clinical decision making capability are affected during tele-psychometric evaluations when impairments are introduced. These new results will also be presented at the poster session. The purpose of our experiments is to develop an interactive quality database, which can be used as a capability feedback tool. An early prototype of this capability feedback tool will also be presented at the poster session.



P395 INTEGRATING SCIENTIFIC EVIDENCE TO SUPPORT TELEHOMECARE DEVELOPMENT IN A REMOTE REGION.

Marie-Pierre Gagnon, PhD,1,2 Julie Duplantie, MSc,2 Véronique Bernard-Laliberté, BA2 1Laval University, Faculty of Nursing, Quebec City, Canada; 2Evaluation unit, CHUQ, Quebec City, Canada

Background Little is known about factors and conditions infl uencing the decision-making process relating to the implementation of telehomecare in health services organisation. As so, it is diffi cult to elaborate strategies to support the utilisation of evidence by decision-makers to plan and establish the implementation of this technology. This study aimed to understand fac-tors and conditions infl uencing the decision-making processes based on sci-entifi c evidence regarding the implementation of telehomecare in the Quebec healthcare regional organisation.

Methods A case study was done in order to explore how evidences are inte-grated into the decision-makings process for the implementation of Gaspesie and Magdalene Islands telehomecare system. 10 interviews semi-structured were completed with organisational keys-decision-makers (Regional manag-ers, organisation managers, health professionals and technological manag-ers). Two researchers carried out the analysis of the data, by supporting the iterations and the validation near the participants in the study.

Result The project of telehomecare of Gaspesie and Magdalene Islands in the province of Quebec, in Canada, is based on the solution of intelligent clinical follow-up in residence and constitutes a relevant example of evolution of a solution of e-health. Indeed, the fi rst reports of the experiment of setting to the test infl uenced the decision makers to continue the deployment of the solution. Decision-makers from all groups agreed on the importance to use past experience for avoiding pitfalls, and insure an optimal decision making process. They highlighted the importance of knowledge sharing between sites as well as within sites.

Conclusion Knowledge sharing plaid an important part on the successfull-ness of the project. An effi cient strategy to transfer evidence to organisa-tional decision-makers might be an end-user forum where the researchers are in support more than speakers.

P397 LOW-END VIDEOCONFERENCING FOR VASCULAR ACCESS DEVICE SITE ASSESSMENT IN HOMECARE

Elena V. Khasanshina, MD, PhD, Cynthia Chernecky, RN, PhD, Marlene Rosenkoetter, RN, PhD, Max E. Stachura, MDMecical College of Georgia, Augusta, GA

A signifi cant volume of patient care has shifted from acute in-patient care settings to out-patient and home care settings for reasons of cost sav-ings, decreased hospital length of stay, quality of life for patients and family caregivers, and to lower the risk of infection. Vascular access devices (VAD) represent high technology and are used frequently in infant, pediatric, adult, and geriatric populations for vascular infusion of chemotherapy, immuno-therapy, blood products, biologic response modifi ers, nutrition support, anal-gesics, ionotropics, antibiotics, and other medications, as well as for extrac-tion of pleural fl uid from patients with chronic effusions and for treatment with dialysis. Surveillance of infections in high risk patients such as those with cancer, cardiac conditions, or post-trauma convalescence is essential to avoid adverse events and to offer early treatment. VAD site and blood stream infections are common VAD complications, occurring in up to 50% of home care patients, usually during days 4-25 after hospital discharge. Our literature search for reports of remote home support of VAD patients and their caregivers found none. The use of videoconference technology to assess VAD sites in the post-discharge environment would signifi cantly enhance patient safety, facilitate continuity of care, and meet the Communicable Dis-ease Center’s stated need for the development of surveillance systems to monitor infections in home care settings. Low-cost Internet- or POTS-based videoconferencing technology that could be easily deployed and used during

risk periods would be highly benefi cial. We report criteria-based protocols for remote assessment of VAD status, for monitoring VAD care procedures employed in the home, and for conducting VAD-care teaching. In addition, we report the ability to assess VAD status using low-end videoconferencing technologies.

P398 EVALUATION OF PROVIDER SATISFACTION AND PATIENT OUTCOMES: TELEMEDICINE IN LOUISIANA

Manya Magnus, PhD, MPH,1 Michelle Glaser,1 Tom Winchell, MPA,2 Patty Plant, RN, NP,3 Wayne Wilbright, MD, MS,3 Mike Ross,3 Michael Kaiser, MD3

1The George Washington University, Washington, DC; 2LSU Health Sciences Center, New Orleans, LA; 3LSU Health Care Services Division, Baton Rouge, LA

Background Health information technology including telemedicine offers potential to improve patient care. Hurricanes Katrina and Rita severely dis-rupted the operations of the public hospitals within Louisiana in 2005. As part of the response to those events, the HCSD launched an expansion to its telemedicine program, deploying over 48 video endpoints in eight pub-lic medical centers and 13 prisons. The initial set of services included HIV, ENT, dermatology, cardiology, neurology, and oncology follow-up. Provider satisfaction with telemedicine is critical to its successful use and positive patient outcomes. The purpose of this study was to evaluate provider satis-faction with the telemedicine system and patient care outcomes associated with telemedicine’s use.

Methods Patient clinical, demographic, behavioral, visit, and provider charac-teristics were ascertained in real time using commercial software that managed telemedicine visits. Providers responded to six questions regarding their ex-perience with telemedicine and perception of patient prognosis and outcomes in real-time upon completion of each visit. Questions were adapted from the Computer User Interface Survey questionnaire and standard provider satisfac-tion indices. Statistical methods included uni-, bi-, and multivariable methods to characterize unadjusted and adjusted factors associated with telemedicine use and provider satisfaction with it, as well as patient outcomes. Quantitative data were analyzed using Stata Version 9.0se (College Station, TX).

Results Results of this study are pending completion of accrual through December 2007. Findings presented will include patient and encounter fac-tors associated with satisfaction with telemedicine interface, unadjusted and adjusted correlates of positive patient outcomes, and characterization of bar-riers and facilitators of telemedicine use.

Conclusions Telemedicine is a crucial adjunct to patient care in rural settings and those in which specialty care is not readily available. However, provider satisfaction is necessary in order to observe benefi ts in care.

P410 PEDIATRIC TELE-OCULAR HEALTH SCREENINGS USING A HANDHELD AUTO REFRACTOR

Khadija Shahid, Optometrist, Ben Szirth, PhD The Institute of Ophthalmology and Visual Science, Newark, NJ

Vision problems affect 5% (1 in 20) preschoolers and 25% (1 in 4) school-aged children. Children cannot verbalize their poor vision and just assume that their sight is normal. Today, fewer than 20% of children are adequately screened for vision problems in the United States. Without early detection and treatment, children's vision problems can lead to permanent loss of vi-sion, learning diffi culties and delayed development. Basic tele-screening of vision is a good fi rst step to eye care. The most common cause of visual impairment in children is amblyopia, which results from uncorrected refrac-tive error. Visual acuity measurement can be performed in a child as young as 3 years of age. Under the most current guidelines, the cutoff for referral is 20/40 in the worst eye.

Use of auto-refractors for screening are gaining ground since they are simple to use and are reliable diagnostic tools. In our tele-ocular program, we tested a lightweight handheld auto refractor/keratometer (Retinomax3 K-Plus, RightOn Corporation, Tokyo, Japan) that is user-friendly and can be



used by school nurses, technicians and other trained personnel to administer tests both in schools and in remote, off-site settings. The instrument can perform autorefraction and keratometry (compared with clinical refraction) readings (taking into account head tilts), as well as red refl ex testing to deter-mine the presence or absence of cataracts or ocular media disturbances.

Early detection and treatment of various ocular disorders in children may avoid lifelong permanent visual impairment and may also save lives. The early detection of eye problems impacts not only a child's welfare and devel-opment but also provides direct short-term economic benefi ts to the educa-tional system and society.

P414 MOBILE CARE—ANYONE, ANYTIME & ANYWHERETepei Tang, MD, EMBA, Jen Ku, MD E. King Group, Inc., Taipei, Taiwan

Introduction Telemedicine does not prevail currently for diffi culty to diffuse, and the development is constipated by many factors, such as operation of equip-ment, way of telecommunication, backup of medical resource and reimburse-ment from third party. Nevertheless, we developed a mobile care system that provided a patient-centric solution to focus on the multiple level problems.

Methods The system provided patient and doctor using current telecom wire-less channel to proceed with videoconsultation between off-the-shelf mobile videophone and personal computer, both embedded H.264 codec. A medical platform as a commanding center links patients and many varieties of dis-tributed specialists. Besides, the system also enhances any patient carrying a mobile videophone to fi nd doctor¡¦s help at anytime from anywhere.

Results Two models of teleconsultation, fi xed and mobile connectivity, have been compared as follows: The patient number access videoconsultation in-creased from 18 patients a day in fi xed model up to 28 in mobile model. The response time from a patient¡¦s requirement to arranged doctor¡¦s interview was minimized from 30 minutes down to 4 minutes. Participating physicians at our original medical platform were from 12 specialists in one hospital extended up to 56 specialists at different geographic locations.

Discussion The mobile care system indicated that (1) the diffusion of tele-medicine became easy under the current third generation channel with off-the-shelf mobile videophone, (2) there is no complex operation procedure to access specialists immediately and as needed, (3) it was adequate for con-ducting clinical examinations to convey critical clinical information, and (4) medical human resources can be reallocated more effi ciently.

Conclusion We propose a mobile care model which identifi es the factors to surpass the traditional telemedicine and extend economic scale. We are glad to see an era of pocket personal telemedicine is coming.

P416 THE ILLINOIS DEVELOPMENTAL DISABILITIES TELEHEALTH NETWORK

Rod Curtis, MD,1,2 Deborah E. Seale, MA2 1Illinois Department of Human Services, Springfield, IL; 2Southern Illinois University School of Medicine, Springfield, IL

The Illinois Department of Human Services and Southern Illinois Uni-versity School of Medicine initiated “The Illinois Developmental Disabilities Telehealth Network: A Program Dedicated to Optimizing Health and Support of Community Living” in 2006. This program utilizes telehealth to increase community access to experts specializing in the care of persons with intel-lectual and developmental disabilities. This statewide program links eight privately operated non-profi t Community Based Provider facilities and nine State Operated Developmental Centers. Services provided through telehealth ensure persons with intellectual and related developmental disabilities re-siding in the rural communities have access to physicians, psychologists, and nurses, who specialize in this population’s unique healthcareissues. A comprehensive set of educational services is being provided to assist com-munity healthcareprofessionals in the diagnosis and treatment of the com-plex healthcareissues associated with persons with intellectual and related

disabilities. Persons with intellectual and related disabilities benefi t through prompt intervention by expert clinicians, minimal physical and emotional stress, and decreased response times resulting in optimal treatment benefi ts, fewer hospitalizations and reduced need for institutionalization. This program increases independence and functional abilities while saving transportation and medical costs. Through continuing medical education and staff devel-opment, clinicians, direct care staff and supervisors in the 9 State Operated Developmental Centers and over 340 community providers benefi t through improved knowledge and skills made available through this expanded access to training opportunities specifi c to supporting the needs of persons with intellectual disabilities. The telehealth network provides an education and training opportunities that strengthen service delivery through greater con-sistency in the application of best practices across the Illinois DD system. The Illinois Department of Human Services has received a grant through the U. S. Department of Health and Human Services to implement this project over three years. Results from the fi rst eighteen months will be presented.

P418 TELEULTRASOUND: AN AGREED LANGUAGE FOR TELEMENTORING

Alberto H. Abadia, PhD, Juan M. Trigueros, DrMinistry of Defence, Madrid, Spain

Introduction Nowadays Teleultrasound is one of the most cost-effective techniques applied on Telemedicine. There are different ways of management in this fi eld. This group began fi ve years ago a trial with a Telementoring method in Teleultrasound using an agreed language between the medical specialist provider (radiologist or cardiologist) and the Teleoperator (Nurse or Radiology Technician), on the idea that a well trained human being is a good interface for Teleultrasound.

Methods The agreed language used for the telementoring was developed for a one-year period. All the inputs from the healthcareproviders (Telementors) and from the Teleoperators were analyzed and applied after evaluation. One trial is being carried out comparing real time Teleultrasound applying the agreed language with a store and forward Teleultrasound method.

Discussion There are different approaches about how to use Teleultrasound from the cost-effective perspective and from the accuracy and effi ciency also. From our experience, a real time Teleultrasound examination with a real time Telementoring is better than a store and forward examination car-ried out by a Teleoperator following a protocol and sending the fi xed pic-tures afterwards. Our group has focused on the metrics of this Teleultrasound examination studying parameters as diagnosis success, the specialist´ satis-faction degree with both methods and comparing the costs. One hundred te-leultrasound examinations (abdominal) will be performed with each method with the same Teleoperator and Specialist on everyone.

Results and Conclusions The results and conclusions will be shown at the meeting due that this study is still being developed.

P420 CASE STUDY: CLINICAL TRIAL OF TELEYOGARain Carei, BA,2 Amber L. Fyfe-Johnson, ND,2 Cora Collette Breuner, MD, MPH1,2 1Department of Pediatrics, University of Washington, Seattle, WA; 2Pediatric Clinical Research Center, Children's Hospital, Seattle, WA

Yoga is an Integrative Medicine intervention often recommended for in-dividuals with eating disorders. Few randomized controlled clinical trials exist and none using telehealth as a means to provide distance yoga training. An interventional, randomized controlled clinical trial utilizing a two group comparison design was conducted. The control group (N=25) received stan-dard care. The yoga group (N=29) received 1:1 yoga instruction twice weekly for eight weeks in addition to standard care. Outcome measures administered at baseline, 9 weeks, and 12 weeks included diagnostic clinical interviews, self-report measures, and behavioral evaluations of meals between adoles-cents and parents. In order to provide access for rural adolescents, teleyoga was provided as an option for treatment (N=3). When compared to urban



participants on demographic variables, rural participants differed only in demographic status. Preoccupation with food, eating, and calories were as-sessed with a self report measure before and after yoga for all participants. There were no visible differences in outcome measures between those par-ticipating in teleyoga versus in house yoga. Researchers hypothesized that environmental factors might impact the ability of study participants to create therapeutic relationships. A focus on key environmental factors to decrease this possibility included: exiting study rooms before participants and in-structors arrived, allowing for 30 minutes of pre-session planning for equip-ment adjustments, accounting for the interaction between the participants and their environment by paying attention to lighting, specifi c objects in the visual fi eld, and the noise in the surrounding areas. Study participants and instructors verbalized surprise at how easy it was to create therapeutic rela-tionships. This study provides incentive for further evaluation of telehealth projects involving yoga or other integrative medicine interventions.

P432 TEACHING “NORMAL EYE" TO INCREASE ADEQUATE TELEOPTHALMOLOGICAL REFERRALS

Alexandre C. Taleb, MD,1,2,3 Chao L. Wen, MD, PhD3 1Medical School, Goiania, Brazil; 2Federal University of Goias, Goiania, Brazil; 3Universidade de Sao Paulo, Sao Paulo, Brazil

The role of a General Practitioner (GP) in a Teleophthalmology Service has been previously described. Their support in fi ltering which patients should be referred is well established. The rate of unduly referrals is yet a concern in broad teleophthalmology services. Instead of trying to teach diseases pat-terns, we have designed an online course to teach “Normal Eye” and its vari-ances to GPs in order to prevent the mistaken referrals.

A Computer Designed Eye Model has been created improve knowledge acquisition and pictures of normal eyes in different ages, races, colors and nuances have been selected. General practitioners were tested before and after the online course. The unduly referral rate is to be measured.

P455 A BLENDED APPROACH TO EMERGENCY PREPAREDNESS TRAINING

Jaishree Beedasy, PhD, Rameshsharma Ramloll, PhD, Neill Piland, DrPh, Beth Hudnall Stamm, PhD, Barbara Cunningham, MPA, MBA, Moses Ikeyo, BSInstitute of Rural Health, Idaho State University, Pocatello, ID

We hypothesize that a hybrid model combining face-to-face (F2F) and we-bconferencing distance learning (DL), can augment the opportunities for stu-dent participation and to reach a wider audience. Two courses that meet the community command structure and defi ne an all-hazard command structure within an organization that links to the community structure were delivered using a hybrid (F2F) – (DL) method. 41% of the students accessed the course on-line via DL mode and 59% were in a F2F setting with the instructors. They shared the same instructors and course contents concurrently. The course de-livery included class room activities where students in the F2F setting were required to work in small groups to solve specifi c problems while their DL counterparts were required to do the same but in virtual groups. We discuss the learning technologies used, our own adaptations aimed at making the technol-ogy as user friendly as possible and present a meta-analysis of the feedback obtained from students and instructors. Both qualitative and quantitative ap-proaches were adopted for the evaluation. A feedback questionnaire eliciting the feedback and reaction of the participants and the knowledge assessments were administered at the end of the session. Data was also collected through debriefi ng sessions. There was a 100% pass rate. T-tests showed that the dif-ferences in the responses for the DL and F2F were not statistically signifi cant. The delivery mechanism we adopted gave rise to enhanced interactions among online students and between online and face-to-face students. The perceived effectiveness of the instructor, training content, format, and delivery method was high. Instructors rated the delivery method positively and were eager to integrate it in their work practice. This approach allowed us to accommodate a larger number of participants. The positive results illustrate the effectiveness of this hybrid delivery mechanism.

american telemedicine association 2008 poster ...193263/ata_2008_poster... · headminder, inc, new...

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