O presente estudo consiste em descrever e analisar a evolução da Telemedicina no Brasil, abrangendo as experiências efetivamente implantadas até dezembro de 2000. Várias instituições no país têm adotado programas de telemedicina, tais como hospitais, laboratórios de análises clínicas, clínicas especializadas em realização de eletrocardiogramas à distância, universidades, o Exército e o próprio Governo. Cada uma das experiências tem diferentes objetivos e não há nenhuma integração entre elas. As aplicações estudadas variam desde aquelas que requerem uma estrutura tecnológica simples como a realização de eletrocardiogramas à distância, até outras mais sofisticadas tecnologicamente como a realização de teleconferências com transmissão de imagens clínicas para segunda opinião médica e monitoração remota de leitos. Para a realização do estudo foram feitas entrevistas com os responsáveis pelos programas e um levantamento de dados em publicações especializadas. As conclusões apontam para a falta de coordenação entre os modelos adotados, para a resistência cultural relativa à informática médica e à telemedicina e para o papel tímido do Governo no fomento da telemedicina. / The present study consists in describing and analyzing the evolution of Telemedicine in Brazil, comprehending the experiences established until December 2000. Several institutions in the country use telemedicine programs, as hospitals, pathology analysis clinics, remote electrocardiograms clinics, universities, the Brazilian Army and the federal Government. Each experience has its own goals and there is no integration among them. The telemedicine programs comprehend a wide range of applications: while some require a plain technological structure as remote electrocardiograms, others demand more sophisticated resources as teleconferences with clinical images transmission and remote bedside monitoring. To accomplish this study it was necessary to conduct interviews with the leaders of the projects and also data mining in specialized publications. The conclusions indicate that there is lack of coordination among the experiences, that there is a cultural resistence both to medical informatics and telemedicine, and the faint Goverment role in stimulating telemedicine.

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Master of Science / Industrial & Manufacturing Systems Engineering / David H. Ben-Arieh / Telemental health systems, a form of telemedicine, use electronic communication media to provide patients in remote locations access to psychological and psychiatric specialists. The structure of telemental health systems has a major impact on their performance. Discrete-event simulations offer useful results concerning capacities and utilization of specific resources. Simulation, however, cannot provide theoretical properties of analyzed systems. Petri net representations of systems can overcome this shortfall, offering a wide range of easily-analyzed and useful properties. Their ability to model resource conflict, parallel activities, and failure modes fits nicely with the reality of telemental health systems. Analysis of behavioral properties of Petri nets can provide meaningful information for system analysts. The most useful properties include net boundedness, liveness, and non-reachability of certain undesirable states. The thesis discusses methods to find all these properties. Specifically, it provides property-preserving net reductions to facilitate analysis of boundedness and liveness and describes an integer programming model to solve reachability and coverability problems. Moreover, this thesis outlines a simulation analysis of synchronous and asynchronous telemental health systems. The paper then describes a Petri net model of a generic telemental health delivery system. The paper subjects the model to an integer programming model and net reduction. The integer programming model indicated that the number of resources in the system remains static, full utilization of resources at a given time is possible, conflict over resources is possible, and improper work prioritization is possible within the model. Net reduction and analysis with open-source software showed that the model is bounded and live. These results can aid telemedicine system architects in diagnosing potential process issues. Additionally, the methods described in the paper provide an excellent tool for further, more granular analysis of telemedicine systems.

Abstract Background: In Sweden self-harm behaviors among young people have been a difficult area to handle in psychiatric care. From the government's efforts have been made to synchronize the knowledge and experience from the local level aiming to prevent, reduce and faster identify self-harm among young people. M-Health refers to technology such as smartphones, notebooks and mobile phones provide.  These mobile devices have come to revolutionize aspects of health care perhaps mostly among young people, live their digital lives by these electronic media. Aim: To illuminate the use of m-Health in the treatment of mental illness and to present a draft of a mobile application that helps professionals in work with young people active in a mild to moderate self-injury. Method: A literature review based on an analysis of twelve scientific articles with qualitative and quantitative approach. We searched in November 2013-January 2014 Ebsco and PubMed databases.  Results: The literature review is presented as gains and losses in use of m-Health in the treatment of mental illness. The focus has been on what is possible to achieve with a mobile application in this area of concern. It appeared that young people show positive attitudes to using an application in monitoring of psychiatric symptoms and gained more control mental health. The professionals sees advantage in terms of more truthful symptom monitoring in real time in comparison with retrospective self-monitoring, expedited handling processes and better treatment outcomes. Conclusion: We interpret the results of the studies about m-Health as an opportunity for nurses to meet young people, active in a mild to moderate self-harm. An m- Health intervention based on an application for young people could make it easier for nurses to improve their communication and treatment outcomes. Care initiatives and relevant actions can then be tailored to young people's cultural values, beliefs and lifestyle.

Thesis (MScEng)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Nystagmus is an eye movement pattern that consists of a drifting gaze component, known as the slow phase, followed by a corrective quick phase component. The presence of nystagmus or the lack thereof under certain conditions can be used for various diagnostic purposes including the diagnosis of physiological, pathological and neurological conditions. The angular velocity of the quick phase can make the detection of nystagmus a challenging task for the untrained eye, since the quick phases are usually comparable with saccadic eye motions. The goal is thus to develop a fully automated diagnostic tool that can identify the presents of nystagmus in a patient’s eye motions. In this thesis, an appropriate eye tracking method was selected from a number of eye tracking methods that are commonly implemented in the literature. A video-oculography goggle concept was chosen based on criteria such as invasiveness, sampling rate, accuracy and telemedicine capability, amongst other nystagmus related necessities. A binocular video-oculography concept was chosen that satisfied the technical requirements and provided a cost-effective design. An automated analysis algorithm was developed for automatic nystagmus identification from eye motion data. The algorithm was validated by testing the performance of the algorithm on an optokinetic nystagmus signal. It proved to provide a reliable automatic identification of nystagmus beats, even in signals that contained nystagmus as well as random motion components. A statistical analysis showed that the algorithm provided a sensitivity of 91.8% and a specificity of 96.5% for pure nystagmus signals, and a sensitivity and specificity of 87.8% and 91.1% respectively for mixed signals. / AFRIKAANSE OPSOMMING: Nystagmus is ’n oogbewegingspatroon wat bestaan uit ’n dwalende tuurkomponent, wat die stadige fase genoem word, gevolg deur ’n vinnige korrigereringsbeweging wat bekend staan as die vinnige fase. Die teenwoordigheid van nystagmus, of afwesigheid daarvan in sekere gevalle, kan gebruik word in ’n verskeidenheid diagnostiese toepassings, onder andere die diagnose van fisiologiese-, patalogiese- en neurologiese kwale. Die hoeksnelheid van die vinnige fase lei daartoe dat nystagmus dikwels moeilik is om te bespeur vir ongeöefende oë, aangesien dit vergelykbaar is met saccade bewegings. Die doel van hierdie navorsing is dus die ontwikkeling van ’n stelsel wat ’n volledige automatiese identifisering van nystagmus kan behartig. ’n Gepaste oogvolgtegniek was gekies vanuit ’n aantal verskillende oogvolgmetodes wat dikwels in die praktyk gebruik word. Die finale keuse was ’n skermbril, video-oogvolgmetode wat gekies was op grond van kriteria soos onder andere, invallendheid, meetfrekwensie, akkuraatheid en geskiktheid vir telemedisyne toepassings. Die ontwikkelde brilkonsep bied ’n koste-effektiewe oplossing, met die moontlikheid om albei oë te volg en bevredig al die bogenoemde tegniese spesifikasies. ’n Geoutomatiseerde nystagmus identifiseringsalgoritme is ontwikkel. Die algoritme se effektiwiteit is getoets op optokinetiese nystagmusseine. Betroubare resultate is vekry vanaf die algoritme, selfs in die geval van gemengde seine wat bestaan uit arbritrêre- en nystagmus komponente. Statistiese analiese het gewys dat die algoritme ’n sensitiwiteit van 91.8% en ’n spesifisiteit van 96.5% kon behaal vir seine met slegs nystagmus inhoud. Vir gemengde inhoud seine het die algoritme ’n sensitiwiteit van 87.8% en spesifisiteit van 91.1% behaal.

Η τηλεϊατρική στηρίζεται στην εφαρμογή της σύγχρονης τεχνολογίας των τηλεπικοινωνιών,της πληροφορικής και τον ηλεκτρονικών υπολογιστών για παροχή υπηρεσιών υγείας, σε απομακρυσμένες περιοχές. Συνδυάζει δηλαδή την τεχνολογία με την ιατρική θέτοντας τις δυνατότητες της πρώτης στην διάθεση της δεύτερης. / The telemedicine is supported in the application of modern technology of telecommunications, information technology and computers for benefit of services of health, in removed regions. It combines that is to say the technology with the medicine placing the possibilities first in the disposal second.

Introduction. The current age structure in Sweden is changing. At the same time, life expectancy is increasing in many parts of the world. This will lead to greater demands of accessible care resources and its application. Well implemented communication is paramount when the healthcare system is as information-intensive as it is. For maintenance of good healthcare, demands will be set on new kinds of services. With eHealth, information and healthpromotion through communication-based technology, healthcare can be performed efficiently with secure output within the healthcare sector. Aim. The aim of this study was to examine challanges for health professionals in the process of patient care through care at a distance. Method. An empirical study of six (6) people was conducted by semistructured interviews. Result. Indicated result show a result of the need of eHealth within the current use of healthcare, and that the technology can be of comparable quality to physical meetings. However, technical solutions should be seen as a complement within healthcare, and not as a substitute of physical interaction. Conclusion. eHealth services is not something that will become relevant within a timeperiod of ten to fifteen years. It is a currently usable service that can be established to be of comparable quality to the person-centered care the nursing profession is striving for. / Indroduktion. Den nuvarande Svenska åldersstrukturen håller på att förändras samtidigt som den förväntade livslängden ökar i många delar av världen. Detta kommer att ställa större krav på tillgängliga vårdresurser och dess tillämpning. God kommunikation mellan olika aktörer är av största vikt då vården är informationsintensiv. För att upprätthålla god vård kommer krav att ställas på nya tjänster. Med eHälsa, informations och hälsofrämjande insatser genom kommunikationsbaserad teknik, kan vården utföras effektivt med säkerställda insatser inom vård- och omsorgssektorn. Syfte. Syftet med denna studie var att undersöka utmaningar för vårdpersonal i arbetet med patientmöten via vård på distans. Metod. En empirisk studie utfördes och sex (6) personer intervjuades med en semistrukturerad intervjuform. Resultat. Resultat visar på ett behov inom vården av eHälsa och att tekniska lösningar kan ha en jämförbar kvalité med fysiska möten. Tekniska lösningar borde dock ses som ett komplement inom vården, och inte som en ersättning till fysiska möten. Konklusion. eHälsotjänster är inte någonting som kommer att bli aktuellt om först tio eller femton år, utan det är idag en brukbar tjänst som kan konstateras vara jämförbar med den personcentrerade vård sjuksköterskor arbetar efter.

Background: Using telemedicine to provide health services for seafarers represents a special case of intersectoral co-operation.Since 2006, several North Sea drilling platforms and internationally operating Norwegian merchant ships have usedonboard telemedicine equipment continuously. Experience gained through this new technology has improvedintersectoral co-operation regarding seafarers’ health care. Aim: This study aimed to analyze the need for intersectoral co-operation and networking in maritime medicine by usingtelemedicine equipment at sea. Various Norwegian maritime organizations and institutions participated in the study. Methods: I conducted a qualitative descriptive survey using a Web-organized interactive interview technique, a new mode ofinteraction based on a semi-structured interview guide for data collection. After conducting exploratory personalinterviews in October 2006, I developed a Web-based questionnaire comprising 53 questions. Participants receivedan e-mail invitation containing an online link to an Internet-based questionnaire. Individuals unable to use the Webbasedlink could return the completed questionnaire as an e-mail attachment. I collected data between April and June2007 and evaluated some questions according to the principles of content analysis and others with simple quantitative analysis, e.g., frequency and distribution. Results: Among 33 persons contacted, 31 (94%) agreed to participate in the study. Respondents represented 11 variousmaritime organizations and companies. Fourteen worked as maritime officers, nine as maritime managers, and eightas medical professionals. Importantly, fourteen respondents (45%) had demonstrated practical working experiencewith telemedicine at sea. According to content analysis, the following categories were developed: communicationandevidence-based telemedicine; maritime e-health standardization and knowledge management; improvingtelemedicine quality management; organizational, technical, and medical competences and intersectoral approach;technical standardization and networking; and communication and information. Four main categories illuminated theparticipants’ demands, i.e., information, communication, standardization, and centralization, and led to thedevelopment of national e-health policy and strategy to support the Norwegian maritime e-health society vianetworking and intersectoral co-operation. Conclusions: Intersectoral co-operation in maritime telemedicine requires interorganizational networking in order to introduceeffective and compatible international maritime e-health standards for seafarers’ healthcare. The Norwegian Centrefor Maritime Medicine (NCMM), a Centre of Excellence in maritime medical research, will participate importantlyin this process. The study also showed that a Web-based survey in maritime research offers an easily managedresearch tool that quickly yields a very good overview of a special situation. / <p>ISBN 978-91-85721-50-4</p>

Shared electronic health record (EHR) systems constitute an important Telemedicine and e-Health application. Successful implementation of shared health records calls for a satisfactory level of security. This is invariably achieved through applying and enforcing strict, and often quite complicated, rules and procedures in the access process. For this reason, information security strategy for EHR systems is needed to be in place. This research reviewed the definition of different terms that related to electronically stored and shared health records and delineated related information security terms leading to a definition of an information security strategy. This research also made a contribution to understanding information security strategy as a significant need in EHR systems. A major case study of the National Programme for IT (NPfIT) in England is used to be the container of other two sub-case studies in two different Acute Trusts. Different research methods used: participant observation and networking, semi-structured interviews, and documentary analysis. This research aimed to provide a comprehensive understanding to the information security strategy of England’s EHR system by presenting its different information security issues such as consent mechanisms, access control, sharing level, and related legal and regulatory documents. Six factors that influence the building of an information security strategy in EHR systems, were identified in this research, political, social, financial, technical, clinical and legal. Those factors are considered to be driving the strategy directly or indirectly. EHR systems are technical-clinical systems, but having other factors (than technical and clinical) that drive this technical-clinical system is a big concern. This research makes a significant contribution by identifying these factors, and in addition, this research shows not only how these factors can influence building the information security strategy, but also how they can influence each other. The study of the mutual influence among the six factors led to the argument that the most powerful factor is the political factor, as it directly or indirectly influences the remaining five factors. Finally, this research proposes guidelines for building an information security strategy in EHR systems. These guidelines are presented and discussed in the form of a framework. This framework was designed after literature analysis and after completing the whole research journey. It provides a tool to help putting the strategy in line by minimising the influence of various factors that may steer the strategy to undesirable directions.

This research of teleconsultation services aims to improve the quality of diagnosis and treatment for rural cardiovascular patients through utilizing distant medical expertise. Equitable access to expert healthcare as well as improved medical management for these patients can assist in modifying cardiovascular disease (CVD) risk and reduce morbidity and mortality in Saudi Arabia. The objectives were to design and develop a new care pathway for cardiovascular disease patients by utilizing teleconsultation technology, investigate factors and issues that might act as barriers to its adoption, and then evaluate the impact of this model on the stakeholders. A small scale pilot project was used to determine the issues of technology, processes and human resources required to deliver an effective service with the context of the research setting. Four primary healthcare centres, two regional hospitals, fifteen patients and sixty other participant stakeholders were included in this study. An approach using (PCP) patient care pathways was used to introduce the teleconsultation technology and integrate it within the healthcare delivery system. Compared to the traditional PCP, the modified PCP utilising teleconsultation technology improved the quality of healthcare through:  Improved access to medical care and quality of diagnosis by obtaining the expertise of a distant specialist.  More efficient medical evaluation and management.  Enhanced role of primary healthcare centres and participating hospitals by providing all levels of health services for patients.  Evidence-based referral (reduced waiting time, reduced burden on outpatient clinics). The telconsultation adoption barriers included:  Inadequacy of finance  Limited infrastructure  Legal and regularity difficulties.  Organization issues.  Literacy on technology. This study recommends the following for telemedicine implementation in the country:  Promote perception and readiness for ICT services with the healthcare community.  Enhance structural readiness including appropriate infrastructure and adequate funding, human resources and equipment.  Proactive policies to encourage growth of the telecommunication sector and to address concerns regarding privacy and security.