Fyi,

FYI,
Interesting article via the Benton Foundation
Bob

------------
Message:

Telemedicine lifeline for villages

------------

*Telemedicine lifeline for villages*
http://news.bbc.co.uk/go/em/fr/-/1/hi/technology/2288619.stm

Rural doctors in Bangladesh are to be connected to the internet in an
attempt to help them provide better care for the sick.

Les,
As  far as I know, there has been no documented problems or interference
reported at least  in the states.

Bob ,

"the best journeys are the ones that answer questions that at the outset
you never even thought to ask." Rick Ridgeway

repyke@infionline.net
Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html

Editor, John Hopkins Pediatric Point of Interest
http://derm.med.jhmi.edu/poi/

Coordinator, International Pediatric Chat, Case University/
Rainbow Babies and Children’s Hospital
http://www.pedschat.org/

                        

"Pyke, Robert" wrote:

Fyi,
This was sent along from David Walker out in California, and as most of
you know, that I have a interest in children in the developing world and
I feel this deserves a look at?

Thanks David,
Bob
 (Per David) I have been very interested in the recent discussion re:CHD
in countries of less resources and how we should take care of these
children. The world bank has a great document titled Making Services work
for poor people. The section on health and related services describes
some of the problems for maintaining adequate health care in specific
countries. As the report briefly describes, newer technologies such as
telemedicine may be beneficial for bringing the expert practioners to
these areas on an as needed basis. Perhaps training clinicians with a
hands on approach could be further enhanced by the use of telemedicine
technology after the expert leaves for his/her country. You can find the
World Bank report at the following link:

http://econ.worldbank.org/wdr/wdr2004/text-18786/

ttp://webmail.atl.earthlink.net/a1b6a1f8d5116ab6228e120e2ada4c94/smdnld/18849_Chapter9.pdf?fv_sid=a1b6a1f8d5116ab6228e120e2ada4c94&fv_folder=INBOX&fv_id=22868&fv_partno=2&fv_action=d&fv_filename=18849_Chapter9.pdfersion
of recommendations

David H. Walker MA RRT RCP Fresno, CA
My Web Sites: http://home.earthlink.net/~firstbreath/ <http:
http://www.fresnoheartrt.com

Bob Pyke Jr.,RN,CPNP
Nurse Practitioner
Pediatric Cardiology
Rainbow Babies and Children's Hospital
11000 Euclid Ave
Cleveland, Ohio, 44106
1-216-844-7918
Beeper 31952

Fyi

LIVE from Beth Israel's Cancer Center

October is National Breast Cancer Awareness Month. Please feel free to
send this to anyone you think may be interested....

October 15, 2003 - Breast Surgeons at Beth Israel's Cancer Center
Perform Ductoscopy in the Doctor's Office Rather Than in the Operating
Room

            Most breast cancers originate in the milk ducts of the
breast and thanks to an outpatient procedure called ductal lavage, early
lesions that might grow into cancers can be found at a much earlier
stage before invasive cancer begins. Breast surgeons at Beth Israel
Medical Center are taking ductal lavage one step further with a new
technique called mammary ductoscopy with intraductal biopsy. This
procedure can be seen live via the internet on Wednesday, October 15, at
6:00 pm EDT.

            Susan K. Boolbol, M.D., breast surgeon at Beth Israel's
Cancer Center explains, "With ductal lavage, a tiny catheter is placed
into the nipple and fluid is aspirated from the milk duct and then is
sent to the laboratory and analyzed. With ductoscopy, a fiberoptic
endoscope is inserted into the milk duct, enabling the physician to
actually visualize the inside of the milk ducts and biopsy any
abnormalities seen at that time. Ordinarily, what would require several
procedures and doctor or hospital visits, can now be done in one visit
in the doctor's office as an outpatient procedure."

            Sheldon Feldman, M.D., Chief of the Louis Venet, MD
Comprehensive Breast Service at Beth Israel says, "Ductoscopy allows us
to obtain real-time information about changes in the milk ducts. This
incredibly exciting new technology allows us to access the source of
most breast cancer. Intraductal evaluation has the potential to
revolutionize the diagnosis and treatment of breast disease." CME Credit
Available.

            To Access Broadcast:  www.or-live.com/bethisrael/1144

Thank you.
Carol Green

                


Bob,

"the best journeys are the ones that answer questions that at the outset you never even thought to ask."  Rick Ridgeway

Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html
Editor, John Hopkins Pediatric Point of Interest
http://derm.med.jhmi.edu/poi/

            

Hmm?,
If anyone wants to send me, I am available?
Bob
The Caribbean Telemedicine Association invites your participation in the
2nd
Annual CARTMA Conference: Come Play in the Sandbox, November 17-19, 2002,
held at the Inter-Continental Hotel in San Juan, Puerto Rico.

The Caribbean region has a unique place in the medical world - a core group

of island inhabitants, a highly transient population of visitors from
around
the globe, a remote setting relative to traditional multi-tier medical
facilities, all contained in a chain of small islands, accessible by air or

boat.   Telemedicine can improve the medical care and provide a more
effective delivery of care to patients in this region and reduce isolation
and geographic challenges.

This CARTMA/2 Conference will feature live demonstrations of emerging
health
technologies, presentations on topics highlighting real-world telemedicine
applications, and interactive focused discussions.

Registration is limited.  Deadline for early registration is October 16,
2002.

For additional information, visit the CARTMA website at www.cartma.org or
call Jo Ann Shupe at 1(888) 872 8712.

                   

A taste of things to come?
-------------------------------------------------------------

Nowhere to plug in? Hook up to the sky
By Tim Phillips

http://www.iht.com./articles/113352.htm

A taste of things to come?


MULTI-SITE IP VIDEOCONFERENCING SOLUTION FOR ADVANCED COLLABORATION



WASHINGTON, D.C. ??? October 6, 2003 ??? Internet2(R) today announced the launch of the first videoconferencing service from the Internet2 Commons, making group collaboration through videoconferencing as simple as traditional phone conferencing. Network technologies and H.323 video and audio standards combine to create an affordable and accessible service for Internet2???s members and partners.
http://archives.internet2.edu:8080/guest/archives/i2-news/log200310/msg00001.html

Bob,

"the best journeys are the ones that answer questions that at the outset you never even thought to ask."  Rick Ridgeway

Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html
Editor, John Hopkins Pediatric Point of Interest
http://derm.med.jhmi.edu/poi/

                        

That's a terrific resource, Bob. Muchas gracias. No, I didn't knkow that
peds is your area of expertise, but that's good to know for future
reference. In what capacity, if I may ask?

Judith Broadhurst
www.polishedprose.com
Santa Cruz, California, USA

                        

This is one of my favorite web sites for Kids with chronic conditions.
http://www.faculty.fairfield.edu/fleitas/contents.html
As most of you know Peds is my area of expertise??

Bob,


Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html
Editor, John Hopkins Pediatric Point of Interest
http://derm.med.jhmi.edu/poi/
Media Reviews Editor
http://www.bcsnsg.org.uk/itin/index.html

                       

I would start by searching in Homework Help websites. They have exhaustive
lists of web content written for kids of all ages and on all topics.  My 11
year old read a science article the other day she found on the evolution of
human primates.  I'm sure their is content there on hemophelia.

On the subject of parents and internet, we have tried all the software and
use AOL kids only and I have spent time within these parameters myself to
survey if anything gets through and it definitely does.  Our solution is
restricted access to the internet.  The kids can only get on the net in one
place in the house, the family room, and only with permission and direct
supervision (we are in the room).  They just don't need to be online
unsupervised.  Good luck with your endeavors.

Samantha Maplethorpe, MD, MPH


----- Original Message -----
From: "Judith Broadhurst" <judith@POLISHEDPROSE.COM>
To: <TELEHEALTH@MAELSTROM.STJOHNS.EDU>
Sent: Wednesday, October 08, 2003 10:00 AM
Subject: [TH] Online info and support for kids with bleeding disorders


I'm writing an article for the National Hemophelia Association about where
kids (through high school age) can get:
a) authoritative info on hemophelia and other bleeding disorders online,
b) online support groups they can participate in -- preferably with a
trained moderator, and
c) ways parents can protect them from predators.

Finding Web sites with authoritative info is no problem, but I'm looking for
sites with info written specifically for elementary, middle school and high
school kids, if anyone can point me to any (I know about the CDC already).

I've found a few Yahoo and Topica groups, have checked MSN and am checking
AOL. But most of the groups are for parents. A study or two announced
earlier this year said that BOYS are more likely to participate in online
support groups for depression, so I'm thinking that peer support groups
online for bleeding disorders might work, too. Anyone know of any from
sources I haven't already checked?

Finally, on the issue of online predators, I can find filtering software,
but I'm wondering if the larger issue isn't parents teaching and monitoring
their children, rather than relying on such things. As most of us know,
spam, ad, and pop-up blockers aren't very effective, so I would think
content and instant-messaging filters would be about the same, and it simply
makes more sense to teach children how to protect themselves, too.

I'll welcome any suggestions or comments.

Judith Broadhurst
Santa Cruz, CA
www.polishedprose.com

                        

                        

I'm writing an article for the National Hemophelia Association about where
kids (through high school age) can get: 
a) authoritative info on hemophelia and other bleeding disorders online, 
b) online support groups they can participate in -- preferably with a
trained moderator, and 
c) ways parents can protect them from predators.

Finding Web sites with authoritative info is no problem, but I'm looking for
sites with info written specifically for elementary, middle school and high
school kids, if anyone can point me to any (I know about the CDC already).

I've found a few Yahoo and Topica groups, have checked MSN and am checking
AOL. But most of the groups are for parents. A study or two announced
earlier this year said that BOYS are more likely to participate in online
support groups for depression, so I'm thinking that peer support groups
online for bleeding disorders might work, too. Anyone know of any from
sources I haven't already checked? 

Finally, on the issue of online predators, I can find filtering software,
but I'm wondering if the larger issue isn't parents teaching and monitoring
their children, rather than relying on such things. As most of us know,
spam, ad, and pop-up blockers aren't very effective, so I would think
content and instant-messaging filters would be about the same, and it simply
makes more sense to teach children how to protect themselves, too.

I'll welcome any suggestions or comments.

Judith Broadhurst
Santa Cruz, CA
www.polishedprose.com

                        

Dear Telehealth Professionals:

I am looking for recent or current articles or white papers covering
telecommunications trends in mental health (especially focused on IP
telephony and broadband internet access). If you have any links please
forward them at your convenience.

Thank you,

Ryan Thurman
Account Executive, Business Partners
ICG Communications
620 3rd Street
San Francisco, CA 94107
707.480.5920 cell
www.icgcomm.com

                        

Ryan,

The American Telemedicine Association has a special interest group dedicated
to this topic.  You can find contact information for the group's POC at
http://www.atmeda.org/ICOT/sigtelemental.htm.

Rick Craft
Sandia National Labs
Advanced Concepts Group

v) 505-844-8873
f) 505-284-4778



-----Original Message-----
From: Ryan Thurman [mailto:rypanic@SONIC.NET]
Sent: Tuesday, October 07, 2003 3:51 PM
To: TELEHEALTH@MAELSTROM.STJOHNS.EDU
Subject: [TH] Communications in Mental Health Care


Dear Telehealth Professionals:

I am looking for recent or current articles or white papers covering
telecommunications trends in mental health (especially focused on IP
telephony and broadband internet access). If you have any links please
forward them at your convenience.

Thank you,

Ryan Thurman
Account Executive, Business Partners
ICG Communications
620 3rd Street
San Francisco, CA 94107
707.480.5920 cell
www.icgcomm.com

                        

                        

Interesting article on a nurse led telehealth program.
>From our friends at TIE, http://tie2.telemed.org/
Bob
http://www.jcn.co.uk/journal.asp?MonthNum=09&YearNum=2002&ArticleID=506

                        

************************************************
Telehealth List Guidelines             October 2002
*************************************************

The Telehealth Guidelines are regularly posted to the list.

CONTENTS
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Excerpt from the PRIMARY LIST OWNER RESPONSIBILITIES

3) The Primary List Owner is the only person authorized
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--
Marlene M. Maheu, Ph.D.
drm@telehealth.net
http://telehealth.net
http://shpm.com
Telehealth Administrator

Bob Pyke Jr.,RN,CPNP
mailtp:repyke@akron.infi.net
Telehealth Co-administrator
Telehealth List is Owned by
Pioneer Development Resources, Inc.

*****
     Telehealth Netiquette Guidelines and Subscription Information:
                  http://shpm.com/ppc/telehealth1.html
        The posts to Telehealth are the opinions of the authors.
*****

Dear Colleagues

eHealth 2003 will focus on International strategies to implement
technology in Healthcare. In association with the NHS Confederation, we
have several special sessions looking at the NHS Plan. we also have
representative from all over the world. Gill Morgan, Chief Executive of
the NHS Confederation and President of the International Hospital
Federation, Richard Granger, Director General of NHS Information
Technology, Prime Minister Pascoal Mocumbi from Mozambique, and Nicolaus
Henke Principal for McKinsey and Co are amongst the speakers at this
important event. Please see www.eHealth2003.org to register now for your
discount.

                        

I found this by accident, but Apple continues to get an A+ for innovation
 http://seminars.apple.com/seminarsonline/medicalimaging/index.html?s=203
 My question the other big players out there, HP,IBM,DELL, why can't you do
the same?
I am not a MAC Head, my first computer a Apple II C and I have 2 HP'S at
home running XP, which I like.
At work I have new Dell desktop running Window NT 2000, it really plays my
CD's nicely.
If Apple  can do it, again why isn't the major players looking at this?
Any comments out there?

                        

Fyi,
>From Ruth Johnson at
http://www.mdlinx.com/NPLinx/thearts.cfm?artid=710368&specid=33

Once users clearly recognize the power of IT, investments will
Much of healthcare delivery doesn't work very well and could be improved
significantly with thoughtful application of IT. Yet experts agree that
provider adoption is low. Depending on the study, only 3 to 13 percent of
hospitals have implemented computerized physician order entry (CPOE), and
only 15 to 28 percent of outpatient organizations have computerized medical
records. In aggregate, healthcare's IT investment should be increased
significantly. The outcome would be higher-quality, more-efficient and
safer healthcare

http://www.healthcare-informatics.com/issues/2003/09_03/glaser.htm

Bob Pyke Jr.

repyke@infionline.net
Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html





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Fyi,
>From Ruth Johnson at
http://www.mdlinx.com/NPLinx/thearts.cfm?artid=710368&specid=33

Once users clearly recognize the power of IT, investments will
Much of healthcare delivery doesn't work very well and could be improved
significantly with thoughtful application of IT. Yet experts agree that
provider adoption is low. Depending on the study, only 3 to 13 percent of
hospitals have implemented computerized physician order entry (CPOE), and
only 15 to 28 percent of outpatient organizations have computerized medical
records. In aggregate, healthcare's IT investment should be increased
significantly. The outcome would be higher-quality, more-efficient and
safer healthcare

http://www.healthcare-informatics.com/issues/2003/09_03/glaser.htm

Bob Pyke Jr.

repyke@infionline.net
Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html

                        

Dear All,

re: eHealth 2003 - How to Implement Your eHealth Strategy  - first ever
summit 16-17 October, London Olympia www.eHealth2003.org

We are pleased to announce eHealth 2003, the third annual conference and
exhibition of the International eHealth Association this year at London
Olympia.  This event will be the first ever international Summit of
Implementing eHealth Strategy at a national, Local and Hospital level.
Learn how the approach in the UK compares with how things are done in
other countries.  What are the successes and lessons learned from others
implementing eHealth Plans?

Dr. Pascoal Mocumbi prime minister of Mozambique and Dr. Gill Morgan will
headline this event along with Richard Granger. Dr. Pascoal Mocumbi, Prime
Minister of Mozambique is known throughout the world for his innovative
approach and vision with respect to using technology in Healthcare to
improve quality of care. Other Dignitaries, Ministries of Health and
Experts will be meeting to discuss the best approach to implementing an
eHealth Strategy in healthcare.

For the Full Programme and Registration, go to www.ehealth2003.org


You will also hear about:
The NHS Black Box and other key strategies to prevent Medical Error in
your hospital in the UK
Best Practice in eHealth Strategies'
Key Mistakes to avoid in following the NHS Plan or any strategy
implementing technology into healthcare
Healthcare applications of the new machine that can read your mind
Using Virtual Reality and Brain Computer Interfaces
What you need to know right now about the NHS Plan for your hospital
How does the NHS Plan compare with similar plans in Europe, Australia,
Canada, Latin America.......?
How will Grid computing completely change the practice of healthcare
management and clinical care?
What is it that will be replacing the Internet and revolutionize
healthcare in this country?
What are the practical implications of integrating technology into a
clinical service?
How do you engage clinicians in implementing eHealth strategies?
How can eLearning integrate into clinical information systems?
How is eHealth now preventing further outbreaks of SARS and other epidemics?

                        

Subject: [CAPIC] Program newly APA accredited

ANNOUNCEMENT

The Psychology Department of the University of La Verne is pleased to
announce that the Psy.D. Program in Clinical-Community Psychology is now
accredited in Clinical Psychology by the American Psychological
Association. The University of La Verne's secular doctoral program
follows a scholar-practitioner training model and integrates clinical
psychology with a community psychology model. The clinical-community
model provides an ecological perspective that emphasizes that behavior
can be best understood within the context of interactive systems that
are multi-level, multi-dimensional and multi-directional. This model
assumes the importance of diversity, prevention, intervention, advocacy
and empowerment of stakeholders and clients. The program involves a
multidisciplinary and diverse faculty who reflect a range of clinical,
research and professional activities. The program requires an empirical
dissertation in addition to the course work, practica and internship
requirements. The cohort-based program offers small class sizes,
state-of-the-art training sites and facilities, and a scenic campus for
location in Southern California east of Los Angeles. The deadline for
applications is January 15th. Please visit our web page at
ulv.edu/~psych.

++++++++++++++++++++++++++++++

California Psychology Internship Council

2728 Durant Avenue

Berkeley, CA 94704

P: 510/841-9230. x 131

F: 510/841-0167

Maia Alpern

CAPIC Executive Assistant

malpern@wrightinst.edu


Confidential Notification:  The information transmitted within this
message is intended only for the person or entity to which it is
addressed and may be privileged and/or confidential.  Any review,
retransmission, dissemination, or other use of this information by
persons or entities other than the intended recipient is prohibited.  If
you receive this in error, please contact the sender and delete or
destroy the material from your computer.  Thank you.

Email may be altered electronically;  the integrity of this
communication cannot be guaranteed.

                        

With apologies for cross posting!

*****************************

CALL FOR ABSTRACTS
 

Med-e-Tel

 

April 21-23, 2004

Luxembourg
 

Dear Colleague,

 

 

You are cordially invited to join us at the Med-e-Tel exhibition and its educational and information program of interactive seminars on ehealth, telemedicine and other ICT applications in medicine, which will cover the results of recent pilot projects, product presentations, and training sessions by exhibitors. 

 

Organized by Foires Internationales de Luxembourg (FIL) and supported by a wide range of national and international associations and institutions, this three day meeting will bring together leading specialists to present recent achievements and developments in the field. 

 

Scope and topics

The event will focus on a wide range of medical ICT applications and on the convergence of information and communication technology with medical applications, leading to higher quality of healthcare, 24 hours a day accessibility of healthcare services, cost reductions and workflow efficiency. 

Med-e-Tel will bring manufacturers and suppliers of equipment and services, as well as service providers in the field of ehealth, together with buyers, healthcare professionals and institutional decision and policy makers. It will provide a unique forum in which clinical and basic researchers will participate in transdisciplinary discussions of the latest advances and future directions of ehealth. Thus, Med-e-Tel will not only offer a broad view on the present status of ICT applications in medicine but will explore new ways to improve the efficiency of the utilized state-of-the-art technology in healthcare provision and will define a roadmap for further development of the market. The meeting will therefore provide a highly beneficial forum for advancing international collaboration. 

The areas covered will include:

-         bio-informatics and intelligent clothing

-         blood pressure and other vital signs monitoring

-         broadband and wireless networks

-         cost-benefit studies

-         current ehealth realizations and projects

-         developing countries and ehealth

-         distance education

-         ehealth for prison systems

-         ehealth and telemedicine integration into routine medical practice

-         electronic health cards and electronic medical records

-         home monitoring and homecare applications

-         legal and ethical aspects

-         military telemedicine

-         reimbursement issues

-         satellites and ehealth

-         secure data transmission

-         standardization and interoperability

-         telemedicine and psychological impact including e-therapy 

-         telemedicine and transport systems (air, rail, road, sea, space)

-         telemedicine applications in cardiology, radiology, wound care and other medical disciplines

 

Attendees are invited to submit abstracts related to these themes so they may have an opportunity to discuss their own work with leaders in the field. Abstracts will be published on the Med-e-Tel website and in the Med-e-Tel exhibition guide.



Guideline for abstract preparation 

The abstract must be prepared according to the guidelines which can be found at www.medetel.lu within days.



Language

The official language of the event and the conferences will be English.

 

Important dates

 

8 September 2003

Call for abstracts

 

12 December 2003

Abstract submission deadline

 

5 January 2004

Notification of acceptance

 

12 January 2004

Publication of abstracts on the Med-e-Tel website

 

21-23 April 2004

Med-e-Tel 

 

Authors should submit a one page abstract by 5 December 2003 by e-mail to Med-e-Tel's Educational Program Coordinator, Dr. Malina Jordanova at education@medetel.lu. 

 

More information

 

For further information about Med-e-Tel, to register as a visitor, for information about special hotel deals, and more, please visit www.medetel.lu.

 

Visitors registration for Med-e-Tel (at EUR 50,-) includes:

ž        unlimited access to Med-e-Tel (3 days)

ž        participation in the educational and information program

ž        exhibition guide (including copy of abstracts)

ž        invitation to social events being held in conjunction with Med-e-Tel (receptions) 

 

The educational and informational program will take place in the morning and afternoon during the three exhibition days. Detailed schedule will be available on www.medetel.lu.

 

For questions regarding the submission of abstracts and the educational program, please feel free to contact Dr. Malina Jordanova, tel/fax: +359 2 979 70 80 or email: education@medetel.lu.

 

For general information regarding Med-e-Tel, please contact Frank Lievens, International Coordinator, at tel: +32 2 269 84 56, fax: +32 2 269 79 53 or e-mail info@medetel.lu.

 

We look forward to welcoming you to Luxembourg in April 2004!

 

Sincerely yours

 

Malina Jordanova

Educational Program Coordinator


 

 ********************************************
Malina Jordanova, MD, PhD
Coordinator Educational Program
Med-e-Tel (Formerly Telemedicine & Telecare International Trade Fair)
Tel/Fax: + 359 2 979 70 80

education@medetel.lu and mjordan@bas.bg
www.medetel.lu 

                        

UNSUB - no longer at this email address

Donald Denney, Ph.D.
Chief, Psych Svc
USP Leavenworth

LISTSERV@MAELSTROM.STJOHNS.EDU 09/09/03 23:36 PM >>>

There is one message totalling 211 lines in this issue.

Topics of the day:

  1. Medicine by Phone

                        

----------------------------------------------------------------------

Date:    Tue, 9 Sep 2003 10:05:45 -0400
From:    "Bob Pyke Jr.,RN,CPNP" <repyke@INFIONLINE.NET>
Subject: Medicine by Phone

Hmm?
Calling Doctokr Dappen
A Family Physician Delivers Most Care by Phone. Patients Like What They
Hear

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, September 9, 2003; Page HE01


For Alan Dappen, practicing medicine had become an exercise in
frustration.
=20

Hamstrung by limits on the time he could spend with patients, confronted
by
monthly reports documenting the number of visits he had billed, and
beset
by
insurers' increasingly skimpy payments, the board-certified family
practitioner figured there had to be a better way.

So did Robert Wickham. The 56-year-old bank executive said he found
visits
to his family doctor a burdensome and often unnecessary chore that
consumed
a valuable chunk of his workday. After wangling an appointment at the
least
inconvenient time, he'd have to battle the traffic that chokes the area
around his Tysons Corner office, then cool his heels in a waiting room
that
was, in his words, "full of screaming kids." That was followed by a
hurried
encounter with a physician who handed Wickham a prescription on his way
out
the door to treat a simple problem he already suspected he had.

Earlier this year, after Dappen left a large medical group to launch
Doctokr
("Doc Talker") Family Medicine, a solo practice that relies heavily on
telephone and e-mail communication, Wickham became one of his first
patients. In the past six months he has used Dappen's services three
times
without having to schedule any office visits.

"He diagnosed and prescribed very quickly, and he's saved me loads and
loads
of time," said Wickham, who deposited $150 in a prepaid Doctokr account
shortly after it opened in January. Each of his calls to Dappen -- for a
lingering cough, a rash and an infection -- cost about $35 in telephone
time
and were covered by his initial payment. The balance can also be applied
toward an office visit and e-mail consultations.

For the cough and rash, Dappen prescribed medicines for Wickham and
called
in prescriptions. He sent Wickham to a lab for a test to diagnose the
infection, then called him with the results.

He Makes House Calls

To Dappen, 51, scrapping office visits for routine problems and being
available to talk with patients directly is "more efficient, less
expensive
and more personal" than the typical arrangement in which, he noted, "the
last person you get to talk to is the doctor." He estimates that 70
percent
of the calls he receives are for conditions that can be handled over the
phone, without an office visit. Dappen also sees patients at their homes
or
at a medical office he leases on a limited schedule. "I'm available
24/7,"
he said.=20

The goal of most doctors, he said, is to funnel patients into their
offices,
because those visits, unlike most telephone and e-mail communication,
are
reimbursable by insurers. Dappen said his practice is different: He does
not
participate with insurance plans and bills for his time and expertise,
"like
a lawyer or accountant." His telephone charge is $5 per minute, and the
average cost of his services is roughly $30 -- "not much more than a
co-pay," he said.=20

"I decided that many of the problems that drive patients to doctors'
offices
are straightforward," Dappen said. "Patients usually know what they need
and
I know what they need in a few minutes. Why should I demand that they
ruin
the rest of their day" by coming into an office?

Patients' records are stored in his omnipresent laptop computer, a
system
that Dappen said is protected by a firewall; only he has access to
medical
records, he added. He carries a cell phone that alerts him to calls to
his
answering service. Most days he works from his Oakton home, a few miles
from
the medical office that he sublets from a gastroenterology practice in
Vienna. Because his access to the office is limited, Dappen says he
grabs
his black medical bag and makes a few house calls each week if a patient
needs to be seen outside his regular office hours.

To ensure that he knows his patients, Dappen requires that they see him
for
one office visit, for which he charges $40 to $50, before prescribing
medication or providing more than basic treatment.

The Other Hand=20

While Dappen insists that he is streamlining care, some other physicians
express concerns about his approach. While they applaud his efforts to
forge
a new, more responsive model of medical practice, they are leery about
some
of his methods -- particularly his reliance on telephone contact. "It's
very
obvious that the current system is dysfunctional -- patients hate it and
doctors hate it -- or this kind of thing wouldn't be happening now,"
said
Jim Martin, a San Antonio family physician who is president of the
94,000-member American Academy of Family Practice. "But prescribing a
new
medication for a patient I haven't examined, especially an antibiotic,
isn't
something I would do. I would require an office visit, even if I knew
the
patient."=20

Martin said that one drawback to Dappen's approach is its reliance on
patients' descriptions of what's wrong, which may not be accurate. A
patient
might fail to adequately convey the problem to a physician, or the
doctor
might not ask the questions that elicit the proper information. A cough,
for
example, could signal a number of problems that may be difficult to
pinpoint
on the phone, including allergies, sinusitis, bronchitis, tuberculosis,
asthma or lung cancer, which require different treatments.

Michael Hattwick, a Northern Virginia internist active with the American
College of Physicians, questioned Dappen's contention that many patients
know what is wrong with them -- or that the patient's problem can be
diagnosed after a few minutes' conversation.

"I'd want to know what medical school the patient graduated from,"
Hattwick
said. "Usually there's a lot of wishful thinking in patients, the notion
that, 'If I take an antibiotic, it will go away.' "

"A doctor who guesses wrong and prescribes something could make things
worse," he added. "If you're a patient and you're not seen, you don't
have
the opportunity for the physician to use his full skill set." Hattwick
said
he and his partners require that a person who calls with a problem come
in
for a visit if the patient hasn't been seen in the previous three
months.

To Dappen, the emphasis on office visits belies a reality of medical
care.
"This is how medicine is practiced every night and every weekend," he
said,
noting that when he was on call for his large group practice, he
routinely
fielded more than 60 calls on a weekend, prescribing drugs and other
treatments for patients, most of whom he did not know and never saw. "I
don't think I'm doing something that's really crazy."

Dappen's philosophy appeals to Meg Hyland, an emergency room nurse who
is
one of his newer patients. "He has taken telephone triage to the next
logical step," she said. "I think Dr. Dappen is a pioneer, a creative
guy
who's trying to make a difference and come up with a better system."

So far, Dappen said, about 300 patients have signed up with Doctokr.

Most, like Wickham, were patients Dappen met when he was affiliated with
Vienna Family Practice and later the 120-physician Fairfax Family
Practice
Center.=20

To make his practice work, Dappen said, he needs to attract many more
patients -- about 20 to 30 each month just to break even. To curb
expenses,
he has relinquished his privileges at Inova Fairfax Hospital because he
so
rarely treats inpatients.

Dappen said he is recouping some of the money he is losing in his new
practice by working several night shifts at Kaiser Permanente and
another
urgent care clinic. He is also relying on the salary of his wife, an
agricultural economist.

While several doctors have expressed interest in his new venture, he
said,
"there has been a quietness among my colleagues."

One of the biggest obstacles he faces, he said, is the reluctance of
patients to spend money for his services rather than fork over the $10
or
$15 co-payments to which they are accustomed.

"I've been trying to convince some patients to use me for the little
stuff
and to use their [insurance] plans for the big stuff," he said, noting
that
this appeal doesn't seem to have caught on.

"The marketing challenge," he said, "has been a bigger obstacle than I
thought."=C3=A2=E2=80=9A=C2=AC=20


=C3=82=C2=A9 2003 The Washington Post Company


   =20


Bob Pyke Jr.,RN,CPNP

------------------------------

End of TELEHEALTH Digest - 8 Sep 2003 to 9 Sep 2003 (#2003-136)
***************************************************************

                        

Hmm?
Calling Doctokr Dappen
A Family Physician Delivers Most Care by Phone. Patients Like What They
Hear

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, September 9, 2003; Page HE01


For Alan Dappen, practicing medicine had become an exercise in
frustration.
 

Hamstrung by limits on the time he could spend with patients, confronted
by
monthly reports documenting the number of visits he had billed, and beset
by
insurers' increasingly skimpy payments, the board-certified family
practitioner figured there had to be a better way.

So did Robert Wickham. The 56-year-old bank executive said he found visits
to his family doctor a burdensome and often unnecessary chore that
consumed
a valuable chunk of his workday. After wangling an appointment at the
least
inconvenient time, he'd have to battle the traffic that chokes the area
around his Tysons Corner office, then cool his heels in a waiting room
that
was, in his words, "full of screaming kids." That was followed by a
hurried
encounter with a physician who handed Wickham a prescription on his way
out
the door to treat a simple problem he already suspected he had.

Earlier this year, after Dappen left a large medical group to launch
Doctokr
("Doc Talker") Family Medicine, a solo practice that relies heavily on
telephone and e-mail communication, Wickham became one of his first
patients. In the past six months he has used Dappen's services three times
without having to schedule any office visits.

"He diagnosed and prescribed very quickly, and he's saved me loads and
loads
of time," said Wickham, who deposited $150 in a prepaid Doctokr account
shortly after it opened in January. Each of his calls to Dappen -- for a
lingering cough, a rash and an infection -- cost about $35 in telephone
time
and were covered by his initial payment. The balance can also be applied
toward an office visit and e-mail consultations.

For the cough and rash, Dappen prescribed medicines for Wickham and called
in prescriptions. He sent Wickham to a lab for a test to diagnose the
infection, then called him with the results.

He Makes House Calls

To Dappen, 51, scrapping office visits for routine problems and being
available to talk with patients directly is "more efficient, less
expensive
and more personal" than the typical arrangement in which, he noted, "the
last person you get to talk to is the doctor." He estimates that 70
percent
of the calls he receives are for conditions that can be handled over the
phone, without an office visit. Dappen also sees patients at their homes
or
at a medical office he leases on a limited schedule. "I'm available 24/7,"
he said. 

The goal of most doctors, he said, is to funnel patients into their
offices,
because those visits, unlike most telephone and e-mail communication, are
reimbursable by insurers. Dappen said his practice is different: He does
not
participate with insurance plans and bills for his time and expertise,
"like
a lawyer or accountant." His telephone charge is $5 per minute, and the
average cost of his services is roughly $30 -- "not much more than a
co-pay," he said. 

"I decided that many of the problems that drive patients to doctors'
offices
are straightforward," Dappen said. "Patients usually know what they need
and
I know what they need in a few minutes. Why should I demand that they ruin
the rest of their day" by coming into an office?

Patients' records are stored in his omnipresent laptop computer, a system
that Dappen said is protected by a firewall; only he has access to medical
records, he added. He carries a cell phone that alerts him to calls to his
answering service. Most days he works from his Oakton home, a few miles
from
the medical office that he sublets from a gastroenterology practice in
Vienna. Because his access to the office is limited, Dappen says he grabs
his black medical bag and makes a few house calls each week if a patient
needs to be seen outside his regular office hours.

To ensure that he knows his patients, Dappen requires that they see him
for
one office visit, for which he charges $40 to $50, before prescribing
medication or providing more than basic treatment.

The Other Hand 

While Dappen insists that he is streamlining care, some other physicians
express concerns about his approach. While they applaud his efforts to
forge
a new, more responsive model of medical practice, they are leery about
some
of his methods -- particularly his reliance on telephone contact. "It's
very
obvious that the current system is dysfunctional -- patients hate it and
doctors hate it -- or this kind of thing wouldn't be happening now," said
Jim Martin, a San Antonio family physician who is president of the
94,000-member American Academy of Family Practice. "But prescribing a new
medication for a patient I haven't examined, especially an antibiotic,
isn't
something I would do. I would require an office visit, even if I knew the
patient." 

Martin said that one drawback to Dappen's approach is its reliance on
patients' descriptions of what's wrong, which may not be accurate. A
patient
might fail to adequately convey the problem to a physician, or the doctor
might not ask the questions that elicit the proper information. A cough,
for
example, could signal a number of problems that may be difficult to
pinpoint
on the phone, including allergies, sinusitis, bronchitis, tuberculosis,
asthma or lung cancer, which require different treatments.

Michael Hattwick, a Northern Virginia internist active with the American
College of Physicians, questioned Dappen's contention that many patients
know what is wrong with them -- or that the patient's problem can be
diagnosed after a few minutes' conversation.

"I'd want to know what medical school the patient graduated from,"
Hattwick
said. "Usually there's a lot of wishful thinking in patients, the notion
that, 'If I take an antibiotic, it will go away.' "

"A doctor who guesses wrong and prescribes something could make things
worse," he added. "If you're a patient and you're not seen, you don't have
the opportunity for the physician to use his full skill set." Hattwick
said
he and his partners require that a person who calls with a problem come in
for a visit if the patient hasn't been seen in the previous three months.

To Dappen, the emphasis on office visits belies a reality of medical care.
"This is how medicine is practiced every night and every weekend," he
said,
noting that when he was on call for his large group practice, he routinely
fielded more than 60 calls on a weekend, prescribing drugs and other
treatments for patients, most of whom he did not know and never saw. "I
don't think I'm doing something that's really crazy."

Dappen's philosophy appeals to Meg Hyland, an emergency room nurse who is
one of his newer patients. "He has taken telephone triage to the next
logical step," she said. "I think Dr. Dappen is a pioneer, a creative guy
who's trying to make a difference and come up with a better system."

So far, Dappen said, about 300 patients have signed up with Doctokr.

Most, like Wickham, were patients Dappen met when he was affiliated with
Vienna Family Practice and later the 120-physician Fairfax Family Practice
Center. 

To make his practice work, Dappen said, he needs to attract many more
patients -- about 20 to 30 each month just to break even. To curb
expenses,
he has relinquished his privileges at Inova Fairfax Hospital because he so
rarely treats inpatients.

Dappen said he is recouping some of the money he is losing in his new
practice by working several night shifts at Kaiser Permanente and another
urgent care clinic. He is also relying on the salary of his wife, an
agricultural economist.

While several doctors have expressed interest in his new venture, he said,
"there has been a quietness among my colleagues."

One of the biggest obstacles he faces, he said, is the reluctance of
patients to spend money for his services rather than fork over the $10 or
$15 co-payments to which they are accustomed.

"I've been trying to convince some patients to use me for the little stuff
and to use their [insurance] plans for the big stuff," he said, noting
that
this appeal doesn't seem to have caught on.

"The marketing challenge," he said, "has been a bigger obstacle than I
thought."€ 


© 2003 The Washington Post Company


    


Bob Pyke Jr.,RN,CPNP

                        

And the answer to the quiz is, Kameda Hospital in Kamogawa, Japan
Doesn't anyone know Jimmy Buffet's song about changes in latitude?
If you have any places you want to recommend for this quiz, let me know?
Thanks to Guy Harris for the question!
And,Btw, I am talking real beer!

Bob Pyke Jr.

repyke@infionline.net
Co administrator Telehealth List Serve and roving editor at large.
http://www.telehealth.net/interviews/pykebio.html

                        

You know, I could build a nice network for 10 million and take everyone out on the list for dinner with the left over change?

Bob Pyke Jr.,RN,CPNP

                        

Opps,
I met to edit out the politcal comments.
Sorry,
Bob

Bob Pyke Jr.,RN,CPNP

                        

Let me know, I can help deploy it.

Paul Pazzaglini

----- Original Message -----
From: "Bob Pyke Jr.,RN,CPNP" <repyke@INFIONLINE.NET>
To: <TELEHEALTH@MAELSTROM.STJOHNS.EDU>
Sent: Monday, September 08, 2003 2:05 PM
Subject: Re: [TH] 10 M for Telemedicine

You know, I could build a nice network for 10 million and take everyone

out on the list for dinner with the left over change?

Bob Pyke Jr.,RN,CPNP

                       **************************
To end your subscription at any time, send email to

LISTSERV@MAELSTROM.STJOHNS.EDU

           In the BODY of your message type: UNSUB Telehealth
                       **************************

Fyi,
Edwards Calls for $10M for Telemedicine
By MIKE GLOVER
ASSOCIATED PRESS
Edwards Calls for $10M for Telemedicine

DES MOINES, Iowa (AP) -

Democratic presidential candidate John Edwards, seeking crucial support in Iowa, is calling for spending $10 million to improve a medical system in which computer technology allows doctors to virtually examine patients over long distances.

"Iowa has so many small towns and rural areas," the North Carolina senator said. "This will allow people to live in small towns and rural areas and still access the highest quality health care."

Edwards planned to discuss his proposal during a nine-city swing through rural northwest Iowa, the most sparsely populated corner of the state. He previewed the proposal in an interview with The Associated Press.

Under the plan, the money would be used to help local hospitals purchase telemedicine computer hardware, which can be too expensive for small rural hospitals that need it most.

Edwards also would create 10 regional telemedicine centers to aid inexperienced providers. Large existing hospitals that offer telemedicine could apply for the regional center designation and seek federal funding.

The package also would cut through the red tape that occasionally blocks access to telemedicine. For example, Edwards said, a patient in Iowa might not have access to a doctor in another state because of licensing requirements.

Edwards pointed out that Iowa already has a statewide fiber-optic communications network that links major hospitals on a communications network.

"Small-town America should have the same care that is available in big cities and if we use new technology we can help make that happen," Edwards said.

Iowa holds its precinct caucuses Jan. 19.

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More people said they would vote against President Bush in 2004 than support him, according to a CNN-Time poll released Friday.

The nationwide survey found that 41 percent said they would definitely vote against Bush while 28 percent said they would back the incumbent president. Twenty-five percent said they could vote either way.

The same poll found people evenly split on the question of whether a Democrat can unseat the president. Last fall, 36 percent said they could see a Democrat winning the presidency and 49 percent said they could not.

Among the Democratic candidates, John Kerry, Joe Lieberman and Howard Dean were bunched at the top of the poll that showed more people undecided - 21 percent.

Kerry, the Massachusetts senator who formally announced his candidacy Tuesday, had 16 percent; Lieberman, the Connecticut senator, was at 13 percent and Dean, the former Vermont governor, was at 11 percent.

Rep. Dick Gephardt of Missouri and Sen. John Edwards of North Carolina were at 7 percent. Al Sharpton was at 5 percent, Sen. Bob Graham of Florida was at 4 percent and Carol Moseley Braun was at 4 percent. Rep. Dennis Kucinich of Ohio was at 3 percent.

In mid-July, Lieberman, Kerry, Dean and Gephardt were in a virtual tie.

The poll of 883 registered voters conducted Sept. 3-4 had a margin of error of plus or minus 3 percentage points.

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One of the nation's largest unions will wait until November to decide which Democrat to endorse in next year's presidential race.

Gerald McEntee, president of the American Federation of State, County and Municipal Employees, said Friday the most important criteria will be finding the candidate with the best chance of winning the White House.

"We are ready to support a Democrat who supports our issues most of the time, if not all of the time, but who is electable, who is capable of defeating George Bush," McEntee said.

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