2019 HSC Section 2 - Practice Management

had access the all necessary data and information regard- ing this article. The corresponding author takes full responsibility for the accuracy of this work. We would like to thank Fayette County Memorial Hospital and the clini- cal staff for their support setting up and executing this telemedicine pilot clinic. BIBLIOGRAPHY 1. Garritano FG, Goldenberg D. Telemedicine in otolaryngology–head and neck surgery. Ear Nose Throat J 2012;91:226–229. 2. Garritano FG, Goldenberg D. Successful telemedicine programs in otolar- yngology. Otolaryngol Clin North Am . 2011;44:1259–1274, vii. 3. Neuwahi S, Fraher E, Pillsbury H III, et al. Trends in otolaryngology workforce in the U.S. Bull Am Coll Surg 2012;97:30–34. 4. Khor WS, Baker B, Amin K, Chan A, Patel K, Wong J. Augmented and virtual reality in surgery–the digital surgical environment: applications, limitations and legal pitfalls. Ann Transl Med 2016;4:454. 5. Kokesh J, Ferguson AS, Patricoski C. The Alaska experience using store- and-forward telemedicine for ENT care in Alaska. Otolaryngol Clin North Am 2011;44:1359–1374, ix. 6. Smith AC, Perry C, Agnew J, Wootton R. Accuracy of pre-recorded video images for the assessment of rural indigenous children with ear, nose, and throat conditions. J Telemed Telecare 2006;12:76–80. 7. Smith AC, Dowthwaite S, Agnew J, Wootton R. Concordance between real- time telemedicine assessments and face-to-face consultations in paediat- ric otolaryngology. Med J Aust 2008 21;188:457–460. 8. Ullah R, Gilliland D, Adams D. Otolaryngology consultations by real-time telemedicine. Ulster Med J 2002;71:26–29. 9. Hofstetter PJ, Kokesh J, Ferguson AS, Hood LJ. The impact of telehealth on wait time for ENT specialty care. Telemed J E Health 2010;16:551– 556. 10. Arriaga MA, Nuss D, Scrantz K, et al. Telemedicine-assisted neurotology in post-Katrina Southeast Louisiana. Otol Neurotol 2010;31:524–527. 11. Yip MP, Chang AM, Chan J, Mackenzie AE. Development of the Telemedi- cine Satisfaction Questionnaire to evaluate patient satisfaction with telemedicine: a preliminary study. J Telemed Telecare 2003;9: 46–50. 12. Altman D. Practical Statistics for Medical Research. London, UK: Chap- man and Hall; 1991. 13. Taylor P, Kennedy C, Murdoch I, Johnston K, Cook C, Godoumov R. Assessment of benefit in tele-ophthalmology using a consensus panel. J Telemed Telecare 2003;9:140–145. 14. Bhattacharyya N. The increasing workload in head and neck surgery: an epidemiological analysis. Laryngoscope 2011;121:111–115. 15. Vickery TW, Weterings R, Cabrera-Muffly C. Geographic distribution of otolaryngologists in the United States. Ear Nose Throat J 2016;95:218– 223. 16. Barghouthi T, Glynn F, Speaker RB, Walsh M. The use of a camera- enabled mobile phone to triage patients with nasal bone injuries. Tel- emed J E Health 2012;18:150–152. 17. Locatis C, Ackerman M. Three principles for determining the relevancy of store-and-forward and live interactive telemedicine: reinterpreting two telemedicine research reviews and other research. Telemed J E Health 2013;19:19–23. 18. Urquhart AC, Antoniotti NM, Berg RL. Telemedicine—an efficient and cost-effective approach in parathyroid surgery. Laryngoscope 2011;121: 1422–1425.

efficiency, and outcomes as our telemedicine pilot clinic progresses to incorporate a physician extender into a community-based otolaryngology clinic in the future. Demonstration of the success of this approach will be paramount in securing the role of telemedicine in otolaryngology. There are several weaknesses to this study. First, we were unable to statistically analyze the physician diagnoses due to the open-ended nature of the recording process. As such, when assessing agreement between the referring and consulting physician, a kappa coeffi- cient could not be calculated, which is the typical way of assessing interrater agreement. Also, we incorporated only one on-site and remote physician to pilot this sys- tem. Including more providers, and ultimately including a physician extender as the on-site clinician, will help to confirm and solidify the congruency, fidelity, and reliabil- ity of this telemedicine system. Finally, the anterior rhi- noscopy exam was limited by lighting on streamed images, which will need to be addressed moving forward to improve anterior rhinoscopy exam without overuse of endoscopy in routine situations. CONCLUSION A synchronous or real-time pilot otolaryngology telemedicine clinic was found to be equivalent to a stan- dard otolaryngology clinic in terms of diagnostic concor- dance and patient and provider satisfaction. This study provides further evidence that a real-time telemedicine model may be a viable option to expand specialty care to remote or underserved areas. The long-term goal of this project ultimately is to establish a general otolaryngol- ogy clinic run by a physician extender, with remote tele- consultation provided by a board-certified otolaryngologist. As this clinic model develops, further data will be needed regarding feasibility, long-term out- comes, patient and clinician satisfaction, and overall eco- nomic impact. Acknowledgment All authors contributed significantly to the clinical and academic work regarding completion of this report and

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