Telemedicine in an international context: definition, use, and future.

PURPOSE: Use of telemedicine is increasingly prevalent in order to provide better access to expert care, and we examine telemedicine use internationally. DESIGN/METHODOLOGY: Using Donabedian's structure, process outcome framework, we conduct an analysis of published studies in the United States, Europe, and Asia to examine the uses, conditions treated, barriers, and future of telemedicine. FINDINGS: We identify several similarities and challenges to telemedicine use in each region. We find use of videoconferencing between providers or providers and patients for the treatment of acute and chronic conditions. Studies in the United States are more likely to identify applications for the use of chronic conditions, whereas studies in Europe or Asia are more likely to use them for acute access to expertise. Each region reported comparable challenges in reimbursement, liability, technology, and provider licensing. RESEARCH LIMITATIONS: We compare available research articles from three diverse regions, and many of the articles were merely descriptive in nature. Furthermore, the number of articles per region varied. PRACTICAL IMPLICATIONS: Barriers to telemedicine use include a lack of reimbursement, language commonality, technological availability, physician licensure or credentialing, trained support staff and patient privacy, and security assurances. Practitioners and policy makers should work to address these barriers. ORIGINALITY/VALUE: Through this work, a summary of the research to date describes telemedicine use in the United States, Asia, and Europe. Identification of use and barriers may provide impetus for improving access to care by finding ways to increase telemedicine use through standardization.

The impact of the NHS (Charges to Overseas Visitors) regulations (1989).

This article discusses the NHS (Charges to Overseas Visitors) Regulations 1989 and subsequent amendments in relation to refused asylum seekers. It explores the impact of the regulations on the health care experienced by this group. The regulations have been chosen because of their contentious nature in relation to refused asylum seekers (Amnesty International, 2004). First, the evidence and rationale behind the formation of the regulations is examined. The article then considers how the restricted access to health care impacts on the health of refused asylum seekers and how this relates to international law. Lastly, it discusses inconsistencies within the regulations.