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Biomedical subjects

B L Crowe

Publications and source records attributed to B L Crowe.

18 recordsLinked to original sources
PubMed2001

A review of the experience with teleradiology in Australia.

Because of the geographical dispersion of the Australian population (25-30% of the total population of 20 million live outside metropolitan areas), there has been considerable interest in the use of teleradiology. In general, the provision of teleradiology by private radiology practices has been successful. However, as regards the provision of publicly funded, statewide teleradiology services, progress has been slower than expected, following enthusiastic support for the technology in the early 1990s. While there have been some notable successes in the implementation of publicly funded teleradiology services, given the delays that have been experienced in Australia, there is a case for a closer connection between the conduct of teleradiology evaluation studies and the incorporation of the results into health policy. This link would ensure that the benefits of technology are made available to the public in as short a time as possible.

Australia↗
PubMed1998

Cost-effectiveness analysis of telemedicine.

There are a number of different costs associated with the development and operation of telemedicine services. A model is proposed in order to assist in strengthening the evidence base for telemedicine. It includes the following components: project establishment costs; equipment costs; maintenance costs; communication costs; staffing costs. All need to be considered in arriving at an annual cost figure for operating a telemedicine service. The inclusion of all these costs, prepared in the standard manner outlined in the model, will ensure that a realistic cost figure is available when evaluating the cost-effectiveness of a telemedicine service.

Australia↗
PubMed1997

Telemedicine in Australia. Recent developments.

There have been a number of important developments in Australia in the area of telemedicine. At the national level, the House of Representatives' Standing Committee on Family and Community Affairs has been conducting the Inquiry into Health Information Management and Telemedicine. The Australian Health Ministers' Advisory Council has supported the establishment of a working party convened by the South Australian Health Commission to prepare a detailed report on issues relating to telemedicine. State governments have begun a number of telemedicine projects, including major initiatives in New South Wales and Victoria and the extensive development of telepsychiatry services in Queensland. Research activities in high-speed image transmission have been undertaken by the Australian Computing and Communications Institute and Telstra, and by the Australian Navy. The matter of the funding of both capital and recurrent costs of telemedicine services has not been resolved, and issues of security and privacy of medical information are subjects to discussion. The use of the Internet as a universal communications medium may provide opportunities for the expansion of telemedicine services, particularly in the area of continuing medical education. A need has been recognized for the coordinated evaluation of telemedicine services as cost-benefit considerations are seen to be very important.

Australia↗
PubMed1996

Initial qualitative evaluation of computed radiography in an intensive care unit.

The first computed radiography (CR) unit in Australia was installed at St Vincent's Hospital, Melbourne, in February 1994. An initial qualitative evaluation of the attitude of the intensive care unit (ICU) physicians to the CR unit was conducted in June 1994 by use of a survey. The results of the survey of ICU physicians indicated that images were available faster than under the previous system and that the use of the CR system was preferred to evaluate chest tubes and line placements. While it is recognized that a further detailed radiological evaluation of the CR system is required to establish the diagnostic performance of CR compared with conventional film, some comments on the implementation of the system and ICU physician attitudes to the CR system are put forward for consideration by other hospitals examining the possible use of CR systems.

Attitude of Health Personnel↗
PubMed1996

Teleradiology at a children's hospital: a pilot study.

A pilot teleradiology project was conducted between the Royal Alexandra Hospital for Children in Camperdown, central Sydney, and Nepean Hospital in Penrith, about 48 km away. Over three months 575 paediatric radiographs were transmitted at full resolution. The results demonstrated that it was possible to transmit paediatric chest images of diagnostic quality in a reliable and secure manner. Mean transmission time per image was 3.26 min using ISDN, which was considered to be acceptable. Costs were calculated in terms of transmission, equipment, maintenance and staff components. The cost per image transmitted would vary from A$80 for 2500 images per year to A$34 for 10,000 images per year. The experience of the pilot study suggested that more widespread introduction of high-quality paediatric telemedicine in Australia would be feasible. Adoption of the technique would have major implications for paediatric health care, including potential improvements in patient management due to quicker diagnosis and earlier intervention, and potential savings through avoiding transfer of some emergency cases.

Confidentiality↗
PubMed1993

The influence of health technology assessment on the diffusion of MRI in Australia.

A major assessment of magnetic resonance imaging (MRI) in Australia influenced the early use of this technology and informed policy decisions on future MRI services. However, the impact of the assessment, and of government policy, on the subsequent diffusion of MRI has been more modest, reflecting the limitations of the evaluation process in a complex health care system.

Australia↗
PubMed1993

The effect of magnetic resonance imaging in a teaching hospital on patient management.

An observational study was undertaken to obtain measures of the impact of magnetic resonance imaging (MRI) on diagnosis, patient management and patient outcome. A minimum data set at the time of examination was used for 1119 consecutive patients referred by specialists for MRI of the brain or spine. Three month follow up of 707 brain examinations and 235 spinal examinations was undertaken using a questionnaire on diagnosis and patient management. Magnetic resonance imaging made a dominant contribution to final diagnoses of neoplasia and vascular disorders, but was less significant for white matter disease. In a high proportion of cases other types of examination also influenced the final diagnosis. Magnetic resonance imaging affected patient management in a high proportion of spinal examinations and in cases of cerebral neoplasm, with lesser contributions to cases of cerebrovascular disorder and white matter disease. While MRI was considered superior to other imaging methods, which it could often replace, in practice it will form only one input to the diagnostic decision.

Brain Diseases↗
PubMed1992

Overview of some methodological problems in assessment of PACS.

The purpose of technology assessment of picture archiving and communications systems (PACS) is to establish the need for the technology, provide a measure of functionality and to establish the costs and benefits associated with the introduction of the system. Given concerns about the clinical acceptability of PACS, it is unlikely that radiologists will change from existing film based systems until a clear demonstration of costs and benefits has been performed. The major need at present is to quantify the benefits which may flow from the introduction of PACS system in a standard manner which can be accepted by all parties involved.

Cost-Benefit Analysis↗
PubMed1992

Assessment of costs and benefits in the introduction of digital radiology systems.

A discussion is presented of cost and benefit considerations in establishing digital radiology systems and an approach to assessment of such factors. Costs of digital radiology systems need to be defined and compared appropriately. Assessments should consider capital and replacement costs, but also less tangible items such as effects on staff and training requirements, hospital infrastructure, productivity, file integrity and diagnostic accuracy. Benefits of digital radiology systems could be assessed using cost-benefit and social audit analysis techniques, yielding a matrix of monetary items and also summaries of non-monetary benefits. Such analysis would define the major participants in the digital radiology process and the nature of their interests and assess the costs and benefits impacting on each of them. Economic evaluation of digital radiology to date has focused on the cost side of the appraisal. Analyses of benefits of digital radiology systems have been limited and have given inconclusive results. There is a need for better definition of comparative costs and benefits to inform interested parties, including hospital staff and health policy makers. Such economic analysis is an important way of asking the right questions about resource usage and could usually be carried out in a pilot setting before there is wider diffusion of digital radiology systems.

Cost-Benefit Analysis↗
PubMed1992

CT and MRI scanning. Specialised imaging techniques.

Advanced diagnostic imaging methods, while offering many benefits to patients, have caused concern because of the additive nature of the technologies and their costs. The authors outline the indications for the use of computed tomography and magnetic resonance imaging, discuss costs, availability and major indications for use, and recommend increased use of imaging algorithms in the selection of diagnostic tests.

Costs and Cost Analysis↗
PubMed1991

The introduction and evaluation of magnetic resonance imaging in Australia.

The introduction of magnetic resonance imaging (MRI) into Australia was linked to a formal assessment of the technology in public hospitals associated with restrictions on government funding. The assessment produced comprehensive data on the usage, cost and efficacy of MRI in the hospital setting. This paper summarises the major results of the assessment and considers issues related to the methodology used and the impact on the policy process.

Australia↗
PubMed1991

Cost considerations in the provision of magnetic resonance imaging services.

Data from the Australian MRI Assessment Program, which involved five public hospitals, are presented covering the second year of operation at each MRI unit when stable conditions of service provision had become established. The data relate to two 1.5T superconductive units, one 1.0T superconductive unit and two 0.3T resistive magnetic resonance imaging units. A review of the cost data suggests the need for the operation of expensive facilities for extended periods with careful patient selection in order to reduce the average cost per scan and to maximise the clinical benefit to patients. There were variations in the conditions of use of the equipment between the differing centres and there will be a need for a consensus on optimum levels of matters such as operating times and staffing levels. As the results from the MRI Assessment Program were obtained in a teaching hospital environment with a particular referral pattern, the benefits of the technology in other situations will need further consideration.

Australia↗
PubMed1991

Health technology assessment: an Australian perspective.

Like many other countries, Australia has placed increasing emphasis on the assessment of medical technologies over the past decade. This emphasis is shaped in part by financial constraints, and in part by the organization of the health care system and its dominance by publicly-funded hospitals. Two committees, the Superspecialty Services Subcommittee of the Australian Health Ministers' Advisory Council, and the National Health Technology Advisory Panel have been particularly influential in developing guidelines for technology assessment. These guidelines emphasize not only the accumulation of primary data during the implementation of a new technology, but also a follow-up process for on-going evaluation of the contributions of a particular technology to clinical care. Presently the two committees are being merged into one agency named the Australian Health Technology Advisory Committee. This agency will be given enhanced authority to guide the diffusion and utilization of new technologies into the delivery process for health care.

Australia↗
PubMed1990

Costs of magnetic resonance imaging services in public hospitals.

Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.

Australia↗