Reliability of Telemedicine Examination

Nitzkin, Joel L.; Zhu, Naisu; Marier, Robert L.

doi:10.1089/tmj.1.1997.3.141

Cited by 62 publications

(53 citation statements)

References 27 publications

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“…13 With the adoption of new technology in clinical practice, it is important that the clinician has a good understanding of the strengths and weaknesses of the equipment being used. Nitzkin et al 14 reported that practitioners with little experience of TM and a poor knowledge of the limitations of the systems in use were more likely to miss important clinical findings. A number of studies have examined the limitations associated with the use of TM in various ophthalmic subspecialties.…”

Section: Discussionmentioning

confidence: 99%

Evaluating clinical signs in trabeculectomized eyes

Crowston

Kirwan

Wells

et al. 2004

Eye

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Aim To evaluate interobserver agreement for clinical signs in trabeculectomized eyes when examined face-to-face with slit-lamp biomicroscopy (SL) or by remote examination using telemedicine (real-time remote video imaging; TM). Method A system for examining trabeculectomized eyes was devised and validated. A prospective randomized interobserver agreement study was then undertaken to compare standard SL biomicroscopy and TM. Remote examination was performed using a 384 kbps Sony 5100 videoconferencing system. Three ophthalmologists each examined 40 eyes of 40 patients, who had previously undergone trabeculectomy. In rotation, two examiners used SL biomicroscopy. The third examined the eye remotely by TM. Analysis was performed to determine the variability in clinical signs and the presence or absence of systematic bias between ophthalmologists and examination methods. Results High levels of agreement were observed for paired examinations by SL biomicroscopy (SL/SL) for bleb vascularity (score range 0-10) with no systematic bias. Paired examination by SL and TM (SL/TM) also showed good levels of agreement for bleb vascularity, although the spread of disagreement was wider (95% limits of agreement 2.57 vs 2.98 (P ¼ 0.054)). For anterior chamber depth, observers agreed within 710% of anterior chamber depth for 68% of eyes (SL/SL) and 51% of eyes (SL/TM) (P ¼ 0.68). Agreement was 'good' for wall thickness (j ¼ 0.6370.08), bleb height (j ¼ 0.6770.1), and the existence of bleb leak (j ¼ 0.6370.19), but poor for bleb morphology (j ¼ 0.2670.12). For the SL/TM comparison, agreement was fair for wall thickness (j ¼ 0.3970.13), poor for bleb height (j ¼ 0.1770.12), good for bleb leak (j ¼ 0.5670.19), and fair for bleb morphology (j ¼ 0.3170.12). Microcysts were not reliably detected using either technique. Conclusion SL biomicroscopy and TM telemedicine examination may permit reliable clinical assessment of trabeculectomized eyes. However, remote examination with TM is more limited with respect to assessing bleb height and bleb wall thickness. The assessment of bleb morphology and microcysts was unreliable with both instruments. We propose that TM examination of trabeculectomized eyes appears safe and appropriate in situations where face-to-face examination by an ophthalmologist is not practical.

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Section: Discussionmentioning

confidence: 99%

Evaluating clinical signs in trabeculectomized eyes

Crowston

Kirwan

Wells

et al. 2004

Eye

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“…9 If telemedicine is to be incorporated into a protocol for follow up of pressure equalization tube surgery, then it needs to be established that video otoscope images are an acceptable replacement for the in-person microscope examination. Some studies have adequately addressed image quality and diagnostic accuracy using inter-provider and intra-provider comparisons in the fields of teleophthalmology [10][11][12][13][14][15] and teledermatology. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Few studies have addressed visualization and image capture in the other telemedicine specialties.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of In-Person Examination and Video Otoscope Imaging for Tympanostomy Tube Follow-Up

Patricoski¹,

Kokesh²,

Ferguson³

et al. 2003

Telemedicine Journal and e-Health

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The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.

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“…The clinical reliability of the technology has been established 11. A recent systematic review commented on the poor quality of studies on the economic effectiveness of telemedicine and found no evidence that telemedicine was cost effective 12.…”

Section: Introductionmentioning

confidence: 99%

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

Jacklin

2003

BMJ

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Objectives To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers. Design Cost consequences study alongside randomised controlled trial. Setting Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales. Participants 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments. Main outcome measures NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction. Results Overall six months costs were greater for the virtual outreach consultations (£724 per patient) than for conventional outpatient appointments (£625): difference in means £99 ($162; €138) (95% confidence interval £10 to £187, P=0.03). If the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means £108 (£73 to £142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost £8 (£5 to £10, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost £11 (£10 to £12, P < 0.0001). Conclusion The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported.

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Reliability of Telemedicine Examination

Cited by 62 publications

References 27 publications

Evaluating clinical signs in trabeculectomized eyes

Evaluating clinical signs in trabeculectomized eyes

A Comparison of In-Person Examination and Video Otoscope Imaging for Tympanostomy Tube Follow-Up

Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion

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