***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Comprehensive economic evaluations have not been conducted on telemedicine consultations  to children in rural emergency departments ( EDs ) . Objective . We conducted an economic evaluation to estimate the cost , effectiveness , and return on investment ( ROI ) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospect i ve . Methods . We built a decision model with parameters from primary programmatic data , national data , and the literature . We performed a base-case cost-effectiveness analysis ( CEA ) , a probabilistic CEA with Monte Carlo simulation , and ROI estimation when CEA suggested cost-saving . The CEA was based on program effectiveness , derived from transfer decisions following telemedicine and telephone consultations . Results . The average cost for a telemedicine consultation was $ 3641 per child/ED/year in 2013 US dollars . Telemedicine consultations result ed in 31 % fewer patient transfers compared with telephone consultations and a cost reduction of $ 4662 per child/ED/year . Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57 % of simulation iterations . The ROI was calculated to be 1.28 ( $ 4662/$3641 ) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis , suggesting a $ 1.96 return for each dollar invested in telemedicine . Treating 10 acutely ill and injured children at each rural ED with telemedicine result ed in an annual cost-savings of $ 46,620 per ED . Limitations . Telephone and telemedicine consultations were not r and omly assigned , potentially result ing in biased results . Conclusions . From a health care payer perspective , telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving ( base-case and more than half of Monte Carlo simulation iterations ) or cost-effective compared with telephone consultations Background Increasing use of teledermatology should be based on demonstration of favourable accuracy and cost – benefit analysis for the different methods of use of this technique Telehospice ( TH ) utilizes telemedicine technology to provide care at the end of life . A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care . Videophones were deployed for telenursing visits and evaluations by social workers . In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology , we review ed clinical records retrospectively for hospice nurse home visits . Clinical notes documenting home nursing visits were obtained from two large hospices , one based in Kansas , and the other in Michigan . Records were r and omly selected for patients who received hospice nurse visits during the month of January 2000 . The charts were review ed for patient demographic information , patient assessment s , teaching activities , and interventions . Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument . After careful review of the records , the coders also made a subjective observation regarding the suitability of each visit for telemedicine . As part of this analysis , we found that 64.5 % of home hospice nursing visits could be performed by telemedicine . Using TH , it is possible to reduce the number of in-person visits , thereby significantly decreasing the cost of providing hospice care PURPOSE The purpose of this study was to assess the accuracy of a  virtual consultation ( VC ) process  in determining treatment strategy for patients with malignant epidural spinal cord compression ( MESCC ) . METHODS AND MATERIAL S A prospect i ve clinical data base was maintained for patients with MESCC . A virtual consultation process ( involving exchange of key predetermined clinical information and diagnostic imaging ) facilitated rapid decision-making between oncologists and spinal surgeons . Diagnostic imaging was review ed retrospectively ( by R.R. ) for surgical opinions in all patients . The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation . RESULTS After excluding 20 patients who were referred directly to the spinal surgeon , 125 patients were eligible for virtual consultation .  Of the 46 patients who had a VC , surgery was recommended in 28 patients and actually given to 23 . A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical c and i date s. The overall accuracy of the virtual consultation process  was estimated at 92 % . CONCLUSION The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer . This can potentially shorten treatment decision time and enhance clinical outcomes A r and omized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology  compared with conventional outpatient dermatology care for patients from urban and rural areas . One urban and one rural health centre were linked to a regional hospital in Northern Irel and by ISDN at 128 kbit/s . Over two years , 274 patients required a hospital outpatient dermatology referral - 126 patients ( 46 % ) were r and omized to a telemedicine consultation and 148 ( 54 % ) to a conventional hospital outpatient consultation .  Of those seen by telemedicine , 61 % were registered with an urban practice , compared with 71 % of those seen conventionally . The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist . The observed marginal cost per patient of the initial  realtime teledermatology consultation  was 52.85 for those in urban areas and 59.93 per patient for those from rural areas . The observed marginal cost of the initial conventional consultation  was 47.13 for urban patients and 48.77 for rural patients . The total observed costs of teledermatology  were higher than the costs of conventional care in both urban and rural areas , mainly because of the fixed equipment costs . Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal , while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta . Three hundred and twenty palliative home care clients are being recruited to participate in a r and omized controlled trial ( RCT ) to answer three questions about the use of video-phones and their effect on symptom management , quality of life and cost , as well as readiness to use the technology . Both successes and challenges have been identified in three main areas : technology , people/organizational issues and study design . Maintaining study integrity has been the key factor in decision making , as adjustments from the original proposal are made . It is already clear that field-based RCTs are feasible , but require commitment and flexibility on the part of research ers and community partners to work through the study implementation Videotelephony ( real-time audio-visual communication ) has been used successfully in adult palliative home care . This paper describes two attempts to complete an RCT ( both of which were ab and oned following difficulties with family recruitment ) , design ed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane , Australia . To investigate whether providing videotelephone-based support was acceptable to these families , a 12-month non-r and omised acceptability trial was completed . Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘ on-call ’ service already offered . A 92 % participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates . The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis , through outpatient care and support , and for palliative care rather than for palliative care in isolation . Trial registration ACTRN The clinical effectiveness of realtime teledermatology , store- and -forward teledermatology and conventional outpatient dermatological care were evaluated in a r and omized control trial . A total of 204 patients took part – 102 patients were r and omized to the realtime teledermatology consultation , 96 of whose cases were also referred using a store- and -forward technique , and 102 to the conventional outpatient consultation .  There were no differences in the reported clinical outcomes of realtime teledermatology and conventional dermatology . Of those r and omized to the realtime teledermatology consultation , 46 % required at least one subsequent hospital appointment compared with 45 % of those r and omized to the conventional outpatient consultation . In contrast , the dermatologist requested a subsequent hospital appointment for 69 % of those seen by store- and -forward teledermatology . An analysis of costs showed that  realtime teledermatology  was clinical ly feasible but more expensive than conventional care , while the store- and -forward  teledermatology consultation was less expensive but its clinical usefulness was limited . Sensitivity analysis indicated that  realtime teledermatology was as economical as conventional care when less artificial assumptions were made about equipment utilization , costs and travel distances to hospital 
    Output:
    
Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency .
Overall ,  telemedicine programs in Japan were indicated to have a favorable level of economic efficiency .