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Telehealth network for hospital services: New methodologies

Authors : Vincenzo Gulla, Angelo Rossi Mori, Francesco Gabrielli, Pietro Lanzafame



The real innovative cultural step for medicine is the overcoming of current generic conceptualization of the field (involving together medical, ICT technical, administrative and legal problems) towards a new model of Telematic-Medicine and Surgery and a new health organization, Tele-Health. The provisioning of healthcare in homes, de- hospitalization, specialist medical care in remote areas and so on, needs new rules and management models in addition to other technologies.

Furthermore , tele-health, as an organizational process, don’t lend itself to existing medical activities but it contributes to work share-out and collaboration within a hospital context and between hospitals and territories. Hospitals can extend into a patient’s house, and, conversely, then patient is made virtually present in hospitals. So represented, the relationship between professionals, patients, and information is transformed.


The purpose of this book is to provide evidence of how researchers and practitioners understand the health market and to describe key points to health professionals (or health organizations) that should know when planning and implementing new tele-health services or improving existing telemedicine systems to provide value-added medical services. It will underline the methodologies needed to optimize resources and to manage telemedicine projects. Tele-health and its applications are considered as a “socio-technical” or “relational” system, one that doesn’t ponder devices, users and usage context separately, but evaluates them in their mutual interaction. A brief survey about “technology-in-use”, a term that identifies technology and its potentiality when they are employed, modalities in which they are actually used on-the-field by users and their community in connection with other devices, techniques and practices already in use. Studying tele-health as a technology-in- use (i.e. as a sociological problem) will make it possible to bring to light all the hidden work done by users to make the technology usable and reveal the work done by technology to incorporate user needs. Experiences and case studies reported using this approach—that technologies are not born usable and reliable but only become so with their users and their usage in real environments. The exploitation of telemedicine models is a challenging task which this book attempts to explore . In doing so, many models and country experiences have been collected in order to allow the readers to analyse the main features of the design and identify its own applicable model . It is not intended here to give a unique solution but guidelines, rules and elements which should be addressed to cope with the lack of resources coordination to provide cost effective health management tools , meeting the expectation of an integrated efficient healthcare system available anywhere anytime .


About the ISfTeH


Philosophy and vision

Promotion & Support of Telemedicine/eHealth activities worldwide

Primarily an umbrella for national Telemedicine and eHealth organizations

Assisting the start-up of new national organizations

Non governmental and non for profit society with close ties to WHO and ITU

Supporting developing countries in the field of Telemedicine and e-Health

Neutral & Democratic (established under Swiss law)




The seed of the International Society for Telemedicine  was planted at the First International Conference on the Medical Aspects of Telemedicine, held in Tromsø, Norway in 1993. A group of experts at the meeting met to discuss the possibility of forming an international society. The field was as yet in its infancy, and, owing to the varied interests and contrasting ideas of the participants, agreement on a course of action could not be reached and the proposal was unsuccessful.

A second attempt was made at the Second Conference, held at the Mayo Clinic in 1995 in conjunction with the 2nd Mayo Telemedicine Symposium. Similar problems arose, and the proposal was again unsuccessful.

Third time lucky. The Third International Conference on the Medical Aspects of Telemedicine was held in Kobe, Japan in May 1997. In the leadup to the meeting, the Secretary, Guy Harris, embarked on an aggressive plan to found a society. Luminaries from around the world were recruited to join a Founder’s Committee, many of whom were able to attend the conference. The Committee also included the members of the conference’s Japanese organizing committee.

The members of the Founders’ Committee were:
Drs DeBakey, Goldberg, Koop, Nicogossian and Satava, (USA), Castellano (Mexico), Medvedev (Russia), Hjelm (HK), Rossing (Denmark), Alexander and Yellowlees (Australia), Michaelis (Israel), Kvist (Finland), Lareng (France), Lun (Singapore), Meme (Kenya), Filler, Elford, Picot and Lacroix (Canada), Bracale (Italy), Padeken (Germany), Ashihara, Barron, Fujino, Fukuda, Harris, Inamoto, Inamura, Kiyotani, Koike, Maeda, Matsuoka, Mizushima, Nakajima, Ohtsuki, Shimosato, Tanaka, Tsuda, Ueda, Yamauchi (Japan) and International Advisory Board (Allen, Brugal, Ferguson, Gitlin, Lemke, McGee, Preston and Wold) of the 3rd International


Conference on the Medical Aspects of Telemedicine


The meetings were held over two days. Discussion was spirited as each of the thirty participants sought to establish their view on what all sensed was an groundbreaking occasion. About halfway through the first meeting it seemed history would repeat itself, with the predominance of a particular view that sought to see the new group founded along political lines. A deadlock ensued, Finally, as the meeting approached its scheduled conclusion, relief came in the form of a particularly impassioned speech, so cleverly crafted and forcefully delivered that none dared contradict it. The meeting chairman, a canny veteran of a dozen similar battles, seized the moment and forced the vote. The motion was carried - the International Society for Telemedicine was formed along the lines its original promoters had sought. Officers were empanelled and the future was mapped out.

Subsequent activity focussed on development of the biannual conferences, The host country for the first conference of the new society was Jerusalem, Israel, as the Fourth International Conference on the Medical Aspects of Telemedicine. At that meeting the decision was made to hold the conferences on annual basis. The Fifth Conference was held in 2000 in Montreal, Canada, the Sixth in 2001 in Uppsala, Sweden, the Seventh in Regensburg, Germany. The Eighth Conference, in 2003, fittingly returned on the 10th anniversary of the First to the place of its founding, to Tromsø, Norway. The meetings were all very well attended and admirably served the purpose of the International Society for Telemedicine in furthering the knowledge about telemedicine.


In the run-up to the Regensburg meeting, the decision was made that the International Society for Telemedicine needed to be reformulated. Although the meetings had been greatly successful, the society had found it difficult to fulfill its other goals, and so a new way forward was sought. After discussion at Regensburg, it was decided to reestablish the Society more along the lines of a federation of national bodies. The decision was endorsed and in September 15th, 2003 ‘ISfT 2’ was officially established as Not-for-profit organization under the Swiss law.
All those involved in ‘ISfT 1’ are immensely proud of their efforts in keeping the Society operational, under sometimes difficult conditions. Newly invigorated and with new purpose,  the new International Society for Telemedicine looks set to fulfill all of the Society’s original goals, and many more.



Spencer, Thomas & Noyes, Elizabeth & Biederman, Joseph. (2019). Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. Journal of Attention Disorders. 108705471985908. 10.1177/1087054719859081.


Objective: Telemedicine has been used successfully in several medical specialties with favorable patient outcomes, satisfaction, in a cost-effective manner. However, its use in the context of ADHD remains unclear. Our main aim was to investigate what is known about the use of telemedicine in ADHD. Method: We conducted a systematic search of the literature assessing telemedicine in ADHD in PubMed, PsycINFO, and Medline. Included were original articles published in English with the main aim to assess the use of telemedicine in ADHD. Results: Only 11 articles met our inclusion and exclusion criteria, coming from only three systematic trials of telemedicine in ADHD. The studies suggest that telemedicine is valued by its users, is well accepted, and is associated with improved outcomes. Conclusion: The limited research indicates that telemedicine has potential to expand the delivery of clinical services to patients with ADHD. More work is needed to further evaluate this finding.

Bowe, Theodore & Ung, Cindy & Campbell, John & Yonekawa, Yoshihiro. (2019). Telemedicine for Retinopathy of Prematurity in 2020. Journal of VitreoRetinal Diseases. 247412641986763. 10.1177/2474126419867634.

Retinopathy of prematurity (ROP) is the leading cause of visual impairment in premature infants, and middle-income nations are currently experiencing the “third epidemic” of ROP. Screening programs are essential to prevent negative visual outcomes, but screening efforts require a great amount of resources from healthcare systems and are difficult to marshal, particularly in geographically isolated or resource-limited settings. Telemedical screening programs using remote digital fundus imaging (RDFI) systems hold the promise of alleviating many of the burdens that currently make screening for ROP logistically challenging.

Literature review of the current evidence for RDFI telescreening for ROP, with editorial discussion and recommendations.

In this review, we summarize the robust body of literature regarding the efficacy of RDFI, the feasibility of telescreening programs, and experiences from current live telescreening programs. We discuss the strengths and limitations of the current evidence and of the screening programs and consider the best practices in developing de novo telemedical screening programs for ROP. The review concludes with a discussion of promising future areas of research and development.

RDFI ROP screening programs can be accurate and reliable. They show promise in improving many current challenges in screening infants for ROP, may be able to improve some aspects of care, and have been demonstrated to be cost-effective.


Souza, Claudinalle & Oliveira, Dulcineide & Santana, Alef & Mulatinho, Letícia & Cardoso, Mirian & Pereira, Emanuela & Aquino, Jael. (2019). Evaluation of nurse’s performance in telemedicine. Revista Brasileira de Enfermagem. 72. 933-939. 10.1590/0034-7167-2018-0313.


Describe the nurse's role in the Telemedicine Program in Cardiology implanted in Pernambuco, Brazil.

Qualitative study, with a target audience of nurses, performed between July and December 2016 at the Emergency Care Units. Data were collected through an online instrument, consisting of open and closed questions, performed with 19 professionals. The data were analyzed through the discourse of the collective subject by QuantiQualisoftware.

The sample consisted of 19 nurses, mostly female (80%), with a mean age of 30 years old. Two central ideas were constructed: nurses' knowledge about the Telemedicine Program in Cardiology; and actions developed by nurses. Also, a flow of the program's assistance was built.

Final considerations: 
The nurse in Telecardiology performs functions of assistance and continuing education of monitoring and training for patients.