Telemedicine Commons^™

Assessing Psychophysiological Effects Of Malodorous Pollutants In Residents Of Leandrinho, Bahia, Brazil: A Pilot Study Using A Whatsapp-Based Questionnaire, Shanell Folger, Courtney Woods, Rita Franco Rego, Carlos Henrique Amaral, Washington Ramos, Amanda Northcross

GW Research Days 2016 - 2020

Background: Leandrinho is located in the region that is home to the largest industrial chemical complex in the southern hemisphere that covers approximately 49 km². Leandrinho residents have reported experiencing adverse health effects that co-occur during periods of malodor emitted by the petrochemical industry. However, there is currently no tool for the residents to systematically record incidents of malodor. This pilot study assessed the feasibility of using a questionnaire designed through Whatsapp, a text-messaging application commonly used among residents.

Method: Leandrinho residents were randomly recruited to complete a daily questionnaire using either paper (n=24) or Whatsapp (n=24) over …

How The European Union Is Embracing Cross-Border Telemedicine And What The U.S. State Medical Boards Can Learn From It, Sohyun Laura Chang, Jesse M. Pines, Jane H. Thorpe

GW Research Days 2016 - 2020

Despite the fact that there have been many advances in the field of telemedicine, the United States (U.S.) state and federal laws have not kept pace with these technological advancements and may operate as a barrier to growth in the field of telemedicine. On the other hand, the European Union (EU) has developed a robust legal framework for the practice of telemedicine. The aim of this research project is to evaluate what elements of the EU legal experience could be used to support efforts to better align telemedicine law with the practice of telemedicine in the U.S.

Based on the …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Effects Of An Online Diabetes Self-Management Educational Class On Perceived Self-Efficacy In Patients With Type 2 Diabetes Mellitus, Samantha L. Sugarman, Dnp, Ba, Bsn, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Diabetes is a complex, chronic disease that, without adequate glycemic control, may result in avoidable complications. Without proper diabetes self-management education, achieving good glycemic control is difficult. Furthermore, lacking self-efficacy to perform such tasks may prevent even the most educated patients from achieving good glycemic control. Studies have shown that live diabetes education has improved self-efficacy in patients with diabetes, but few look at the effects of a lecture-style educational format in an online approach.

Objectives: The purpose of this study is to determine if an online, lecture-style diabetes self-management educational class will improve self-efficacy among patients with type …

Predicting Unplanned Transfers To The Intensive Care Unit: A Machine Learning Approach Leveraging Diverse Clinical Elements, Ben Wellner, Joan Grand, Elizabeth Canzone, Matt Coarr, Patrick Brady, Nathan Dean, +Additional Authors

Pediatrics Faculty Publications

Background: Early warning scores aid in the detection of pediatric clinical deteriorations but include limited data inputs, rarely include data trends over time, and have limited validation.

Objective: Machine learning methods that make use of large numbers of predictor variables are now commonplace. This work examines how different types of predictor variables derived from the electronic health record affect the performance of predicting unplanned transfers to the intensive care unit (ICU) at three large children’s hospitals.

Methods: We trained separate models with data from three different institutions from 2011 through 2013 and evaluated models with 2014 data. Cases consisted of …

Mhealth Intervention Is Effective In Creating Smoke-Free Homes For Newborns: A Randomized Controlled Trial Study In China., Shaohua Yu, Zongshuan Duan, Pamela B Redmon, Michael P Eriksen, Jeffrey P Koplan, Cheng Huang

Global Health Faculty Publications

Mobile-phone-based smoking cessation intervention has been shown to increase quitting among smokers. However, such intervention has not yet been applied to secondhand smoke (SHS) reduction programs that target smoking parents of newborns. This randomized controlled trial, undertaken in Changchun, China, assessed whether interventions that incorporate traditional and mobile-phone-based education will help create smoke-free homes for infants and increase quitting among fathers. The results showed that the abstinence rates of the fathers at 6 months (adjusted OR: 3.60, 95% CI: 1.41-9.25; p = 0.008) and 12 months (adjusted OR: 2.93, 95% CI: 1.24-6.94; p = 0.014) were both significantly increased in …

The Living The Example Social Media Substance Use Prevention Program: A Pilot Evaluation., William Evans, Elizabeth Andrade, Sandra Goldmeer, Michelle Smith, Jeremy Snider, Gunilla Girardo

Prevention and Community Health Faculty Publications

Reproduced with permission of JMIR Publications. JMIR Mental Health

Prenatal Care Enhanced With Digital Health Tools Can Reduce Visit Frequency While Improving Patient Satisfaction, Kathryn I. Marko, Nihar Ganju, Anish Sebastian, Joshua Benham

Medicine Faculty Posters and Presentations

100 low-risk obstetric patients were enrolled to evaluate the use of digital health technology in prenatal care. 50 patients were placed on an alternate prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices including a wireless weight scale and blood pressure cuff. The remaining 50 control patients received routine care, without the technology platform. Patients were evaluated for satisfaction and engagement throughout pregnancy.

Removing Barriers To Care For The Underserved: Provider And Patient Perception Of Direct To Consumer Telemedicine, Robert M. Grell, Rachel Hatcliffe, Sean M. Gillen, Craig Sable, Vanessa Grant, Matthew Ledda, Mary Fuska, Shireen Atabaki

GW Research Days 2016 - 2020

Purpose of Study: Lack of access to pediatric subspecialty care is a major barrier to pediatric health for underserved populations in the Washington DC, Virginia and Maryland area. Lack of access to transportation, long office wait times, and missed school and work are barriers that prevent access to subspecialty care. Direct to consumer (DTC) telemedicine provides this service to our underserved population by bringing care into their own home through use of computers, tablets, and smart phones.

Methods Used: Structured interviews of parents and providers were performed prior to implementation of a subspecialty DTC telemedicine program for underserved children in …

Feasibility And Usability Of Tele-Interview For Medical Residency Interview, Ali Pourmand, Hayoung Lee, Malika Fair, Kaylah Maloney, Amy Caggiula

Emergency Medicine Faculty Publications

Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided …

Doodle Health: A Crowdsourcing Game For The Co-Design And Testing Of Pictographs To Reduce Disparities In Healthcare Communication, Carrie Christensen, Doug Redd, Erica Lake, Jean P. Shipman, Heather Aiono, Roger Altizer Jr., Bruce Bray, Qing Zeng

Clinical Research and Leadership Faculty Publications

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming.

We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs.

We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, …

Design And Feasibility Of A Text Messaging Intervention To Prevent Indoor Tanning Among Young Adult Women: A Pilot Study, William Douglas Evans, Darren Mays

Prevention and Community Health Faculty Publications

Background: Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages.

Objective: The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs.

Methods: We conducted a pilot study of indoor tanning prevention messages delivered …

Use Of Telehealth In Nhsc Grantee Sites, Patricia Pittman, Clese Erikson, Xiaoli Wu, Emily Bass

Health Workforce Research Center Publications

Telehealth has long been viewed as an important pathway for increasing access to care for underserved populations, while providing high quality care at low cost. The spread of telehealth in the United States, however, has been hampered by a range of reimbursement, equipment costs, and licensure barriers. In this study we examined the extent to which telehealth is being used in settings that are among the locations most in need: the National Health Service Corps (NHSC) approved grantee sites. Key Questions

1. To what extent and how are NHSC using telehealth and telemedicine services?
2. What are the barriers to adoption and …

Perceptions Of Electronic Health Records Effects On Staffing, Workflow, & Productivity In Community Health Centers, Leah E. Masselink, Clese Erikson

Health Workforce Research Center Publications

Significant Federal investments under the Health Information Technology for Economic and Clinical Health Act of 2009 and the Affordable Care Act have motivated many community health centers (CHCs) to implement electronic health records (EHRs) in the past few years. Evidence suggests that EHR implementation causes significant changes in how primary care clinicians spend their time and may be associated with changes in staff and facility level productivity. However, the mechanisms to explain these changes were mostly speculative. The goals of this project were to understand how, from the perspective of clinicians, support staff, and administrators, CHCs’ implementation of EHRs has …

Testing The Feasibility Of Remote Patient Monitoring In Prenatal Care Using A Mobile App And Connected Devices: A Prospective Observational Trial, Kathryn Marko, Jill M. Krapf, Andrew C. Meltzer, Julia Oh, Nihar Ganju, Anjali Martinez, Sheetal Sheth, Nancy D. Gaba

Obstetrics and Gynecology Faculty Publications

BACKGROUND:

Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed.

OBJECTIVE:

The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone …

Developing And Pretesting A Text Messaging Program For Health Behavior Change, Lorien C. Abroms, Robyn Whittaker, Caroline Free, Judith Mendel Van Alstyne, Jennifer M. Schindler-Ruwisch

Prevention and Community Health Faculty Publications

Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.

Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.

Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input …

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Telepsychiatric Assessment Of A Mariner Expressing Suicidal Ideation., Alexander Lee, Neal Sikka, Francis O'Connell, Allen Dyer, Keith Boniface, James Betz

Emergency Medicine Faculty Publications

This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of …

The Development And Application Of An Oncology Therapy-Related Symptom Checklist For Adults (Trsc) And Children (Trsc-C) And E-Health Applications., Arthur R Williams, David D Williams, Phoebe D Williams, Farrokh Alemi, Hosai Hesham, Blaine Donley, Raya Kheirbek

Medicine Faculty Publications

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations.

PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the …

Provision Of Telemedicine Services By Community Health Centers, Peter Shin, Jessica Sharac, Feygele Jacobs

Health Policy and Management Faculty Publications

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by …

International Telemedicine Consultations For Neurodevelopmental Disabilities, Phillip L. Pearl, Craig A. Sable, Sarah Helen Evans, Joseph Knight, Parker Cunningham, Gaetano R. Lotrecchiano, Andrea L. Gropman, Sheela Stuart, Penny J. Glass, Anne Conway, Issam Ramadan, Tania Paiva, Mark L. Batshaw, Roger J. Packer

Neurology Faculty Publications

Background: A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE.

Materials and Methods: Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews …

Telehealth: Into The Mainstream?, Lisa Sprague

National Health Policy Forum

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat …

Evaluating A Multidisciplinary Approach To Teaching Mobile Healthcare, Dalya N. Elhady, Neal Sikka

GW Research Days 2013

PURPOSE

Mobile healthcare is a rapidly evolving opportunity to leverage technology to improve access and quality of healthcare while reducing costs and increasing the mobility of patients and providers. Innovations are often created by technical experts without adequate knowledge of the interplay between various mobile health agencies (i.e. clinical, business, regulatory, etc.). In order to improve the communication and cross-silo collaboration between mobile health leaders in a variety of fields, a multidisciplinary approach to education is necessary. Integrative teaching has received relatively little recognition in the medical education literature. This study will evaluate the effectiveness of a multidisciplinary format to …

Impacts Of Social Networking Sites On Patient Care In The Emergency Department, Anne Bennett, Ali Pourmand, Robert Shesser, Jesus Sanchez, Joseph Joyce

Emergency Medicine Faculty Publications

The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a “hot topic” in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her …

The Use Of Mobile Phone Cameras In Guiding Treatment Decisions For Laceration Care, Neal Sikka, Michael Pirri, Katrina Norbury Carlin, Ryan Strauss, Faisal Rahimi, Jesse M. Pines

Emergency Medicine Faculty Publications

Objectives: Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone–generated images compared with in-person evaluations.

Subjects and Methods: Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between …

Data Segmentation In Electronic Health Information Exchange: Policy Considerations And Analysis, Melissa M. Goldstein, Alison L. Rein, Melissa M. Heesters, Penelope P. Hughes, Benjamin Williams, Scott A. Weinstein

Health Policy and Management Faculty Publications

The issue of whether and, if so, to what extent patients should have control over the sharing or withholding of their health information represents one of the foremost policy challenges related to electronic health information exchange. It is widely acknowledged that patients' health information should flow where and when it is needed to support the provision of appropriate and high-quality care. Equally significant, however, is the notion that patients want their needs and preferences to be considered in the determination of what information is shared with other parties, for what purposes, and under what conditions. Some patients may prefer to …

Consumer Consent Options For Electronic Health Information Exchange: Policy Considerations And Analysis, Melissa M. Goldstein, Alison L. Rein

Health Policy and Management Faculty Publications

The issue of whether, to what extent, and how individuals should have the ability to exercise control over their health information represents one of the foremost policy challenges related to the electronic exchange of health information. The current landscape of possible consent models is varied, and the factors involved in choosing among them are complex. States and other entities engaged in facilitating the exchange of electronic health information are struggling with a host of challenges, chief among them the establishment of policies and procedures for patient participation in their exchange efforts. While some have adopted policies enabling patients to exercise …

Personal Health Records: The People's Choice?, Lisa Sprague

National Health Policy Forum

Information technology (IT), especially in the form of an electronic health record (EHR), is touted by many as a key component of meaningful improvement in health care delivery and outcomes. A personal health record (PHR) may be an element of an EHR or a stand-alone record. Proponents of PHRs see them as tools that will improve consumers’ ability to manage their care and will also enlist consumers as advocates for widespread health IT adoption. This issue brief explores what a PHR is, the extent of demand for it, issues that need to be resolved before such records can be expected …

Health Information Technology In The United States: The Information Base For Progress, David Blumenthal, Catherine M. Desroches, Karen Donelan, Sara J. Rosenbaum, Timothy Ferris

Health Policy and Management Faculty Publications

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities …