In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.
Improving the quality of healthcare, while increasing accessibility and lowering costs, is a complex dilemma facing rural communities around the world. The Center for Rural Pennsylvania believed that telehealth, the use of electronic information and telecommunications technologies to support long-distance clinical healthcare was a viable solution s
Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop.
"An intimate, heart wrenching portrait of one small hospital that reveals the magnitude of America's health care crises. By following the struggle for survival of one small-town hospital, and the patients who walk, or are carried, through its doors, The Hospital takes readers into the world of the American medical industry in a way no book has done before."--Publisher's description.
Long Road from Quito presents a fascinating portrait of David Gaus, an unlikely trailblazer with deep ties to the University of Notre Dame and an even more compelling postgraduate life. Gaus is co-founder, with his mentor Rev. Theodore M. Hesburgh, C.S.C., of Andean Health and Development (AHD), an organization dedicated to supporting health initiatives in South America. Tony Hiss traces the trajectory of Gaus's life from an accounting undergraduate to a medical doctor committed to bringing modern medicine to poor, rural communities in Ecuador. When he began his medical practice in 1996, the best strategy in these areas consisted of providing preventive measures combined with rudimentary clinical services. Gaus, however, realized he had to take on a much more sweeping approach to best serve sick people in the countryside, who would have to take a five-hour truck ride to Quito and the nearest hospital. He decided to bring the hospital to the patients. He has now done so twice, building two top-of-the-line hospitals in Pedro Vicente Maldonado and Santo Domingo, Ecuador. The hospitals, staffed only by Ecuadorians, train local doctors through a Family Medicine residency program, and are financially self-sustaining. His work with AHD is recognized as a model for the rest of Latin America, and AHD has grown into a major player in global health, frequently partnering with the World Health Organization and other international agencies. With a charming, conversational style that is a pleasure to read, Hiss shows how Gaus's vision and determination led to these accomplishments, in a story with equal parts interest for Notre Dame readers, health practitioners, medical anthropologists, Latin American students and scholars, and the general public.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Incorporating and balancing advancing subspecialization is a significant challenge of modern surgery. The changes of surgical education and early subspecialization is a smaller spectrum of experience of graduating surgeons joining the rural workforce. Surgeons working in rural and remote hospitals, however, must be proficient in the great breadth of current surgical practice and face a number of challenges and demands that are specific to rural surgery. This textbook provides an update on the evidence and surgical techniques for the experienced rural surgeon and most importantly is a guideline for younger surgeons and surgical trainees joining the general surgical workforce in rural and remote areas around the world.