A web-based communication system for integrated care in cerebral palsy: design features, technical feasibility and usability.

We developed a secure, web-based system for parent-professional and inter-professional communication. The aim was to improve communication in the care of children with cerebral palsy. We conducted a six-month trial of the system in three Dutch health-care regions. The participants were the parents of 30 cerebral palsy patients and 120 professional staff involved in their care. Information about system usage was extracted from the system's database. The experience of the parents and professionals was evaluated by a questionnaire after six months. The system proved to be technically robust and reliable. A total of 21 parents (70%) and 66 professionals (55%) used the system. The parents submitted 111 questions and 59 responses, with a mean of 5 questions (range 1-17) and 3 responses (range 1-9) per parent. The professionals submitted 79 questions and 237 responses, with a mean of 2 questions (range 1-8) and 4 responses (range 1-23) per professional. Most parents (95%) and some professionals (30%) reported value in using the system, which ranged from efficiency and accessibility to flexibility and transparency. The web-based communication system was technically feasible and produced improved parent-professional and inter-professional communication. It may be especially valuable if frequent interventions or consultations about a child's care are required, involving complex care networks of different professionals and organisations.

Video teleconsultation service: who is needed to do what, to get it implemented in daily care?

INTRODUCTION: In telemedicine, technology is used to deliver services. Because of this, it is expected that various actors other than those involved in traditional care are involved in and need to cooperate, to deliver these services. The aim of this study was to establish a clear understanding of these actors and their roles and interrelationships in the delivery of telemedicine. A video teleconsultation service is used as a study case. METHODS: A business modeling approach as described in the Freeband Business Blueprint Method was used. The method brings together the four domains that make up a business model, that is, service, technology, organization, and finance, and covers the integration of these domains. The method uses several multidisciplinary workshops, addressing each of the four domains. RESULTS: Results of the four domains addressed showed that (1) the video teleconsultation service is a store and put-forward video teleconsult for healthcare providers. The service is accepted and has added value for the quality of care. However, the market is small; (2) the technology consists of a secured Internet Web-based application, standard personal computer, broadband Internet connection, and a digital camera; (3) a new role and probably entity, responsible for delivering the integrated service to the healthcare professionals, was identified; and finally (4) financial reimbursement for the service delivery is expected to be most successful when set up through healthcare insurance companies. Pricing needs to account for the fee of healthcare professionals as well as for technical aspects, education, and future innovation. DISCUSSION: Implementation of the video teleconsult service requires multidisciplinary cooperation and integration. Challenging aspects are the small market size and the slow implementation speed, among others. This supports the argument that accumulation of several telemedicine applications is necessary to make it financially feasible for at least some of the actors.

Implementation of a broadband video consultation service for children with posture and movement disorders.

We evaluated the implementation of a video consultation service in a regional community of paediatric physiotherapists. Twenty-two paediatric therapists in primary care settings and a rehabilitation centre participated in this study. The implementation comprised three phases: introduction, learning and consultation. Evaluation of the implementation focused on the participants' satisfaction with regard to the implementation procedure, the education received, the technical helpdesk support and the usage of the application once put into practice. The introduction phase was very short (only two sessions) but the learning phase took much longer; it took 12 months for 21 therapists to complete the learning phase. Only 14 of the 21 therapists entered the actual consultation phase. Participants were generally satisfied with the education received and judged the helpdesk to be sufficient. The helpdesk was contacted 36 times by 14 participants. Within the 12-month study period, the therapists performed 24 video consultations. The average time to compose a question was 115 min and the average time to answer it was 43 min. Implementation of a video consultation service is possible but takes more time than initially foreseen and only about two-thirds of the professionals actually adopted it into routine practice.

Functional status in 5 to 7-year-old children with Down syndrome in relation to motor ability and performance mental ability.

PURPOSE: To examine the contribution of motor ability and 'performance' mental ability on functional skills in children with Down syndrome (DS). METHOD: A structural equation modelling approach was used to test the relation between motor ability, performance mental ability and functional status. Functional status was assessed with the Pediatric Evaluation Disability Inventory (PEDI), motor ability with the Movement Assessment Battery for Children (M-ABC), and performance mental ability was assessed with the Gross-Form Board (GFB). Sixty-five children with DS, selected by the Dutch Down Syndrome Foundation, were asked to participate in the study. Data were analysed with the programme AMOS using the Bollen-Stine bootstrap method. Chi2 and NFI index were used as goodness-of-fit indices. RESULTS: The fit of the model was good (chi2 4 = 1.35, p = 0.85; and NFI = 0.99). 'Functional status' explained 70% of the variance in the model. Standardized regression weights indicated that motor ability was a far better predictor of functional status of children with DS than performance mental ability (0.96 vs. 0.17). CONCLUSIONS: Limitations in functional activities of 5 to 7-year-old children with Down syndrome seem to be more related to the level of motor ability than to the level of performance mental ability.