title: The Vermont Telemedicine Project: initial implementation phases.
abstract: OBJECTIVE
  A comprehensive rural telemedicine system was implemented between Fletcher-Allen Health Care (FAHC) and a number of community hospitals in three distinct phases. We sought to describe each phase of its implementation to date and evaluate the technology and provider acceptance, as well as overall usage.
  
  
  METHODS
  A room-based video conferencing system with T-1 connections to two rural hospitals was initiated. The primary use of this system was telepathology, which underwent a rigorous evaluation. The system was well accepted by both referring and consulting pathologists, and the diagnostic accuracy was high, 91.2%.
  
  
  METHODS
  A desktop telemedicine system utilizing ISDN transmission at 384 kbps was implemented to six additional hospitals. Continuing medical education as well as consultative services for virtually every medical specialty were offered. Evaluation included tracking usage logs at each site, review of forms filled out for conferences, and (3) review of forms filled out by providers for medical consultations and clinical care delivered over the system. Technology failure represented the most frequent source of problems, particularly with multipoint calls. Usage increased steadily so that by 6 months, there was an average of one documented use per day. The principal use was for care delivered by pathology, surgery, nephrology, and obstetrics and gynecology. Video quality was judged excellent (62%) or satisfactory (15%) in most cases, while audio quality was excellent in 31% of cases and satisfactory in 46%. Overall, referring providers felt that the system improved patient care in 85% of cases, while 100% of the consultants felt this.
  Because of technology problems encountered in Phase II, a new system was designed and implemented. The network was expanded to additional sites, including physicians' offices. Evaluation is continuing.
  Implementation of a regional information system, including video teleconferencing to every to provider's office in the region, is in the initial stages.
  
  
  CONCLUSIONS
  Problems with video conferencing technology hamper use, but once providers utilize telemedicine as a clinical tool, use increases steadily. Clinical use across multiple specialties is possible in a manner that most providers feel improves patient care.
authors.affiliation: Fletcher-Allen Health Care, Burlington, VT, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Ricci
authors.forename: P W
authors.initials: PW
authors.lastname: Callas
authors.forename: W L
authors.initials: WL
authors.lastname: Montgomery
mesh_terms: D001291:Attitude of Health Personnel; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D010865:Pilot Projects; D015397:Program Evaluation; D012423:Rural Health; D013685:Telecommunications / Q000458:organization & administration; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration*; D014707:Vermont; D014741:Video Recording