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government summarising telemedicine activities as well as the results of federally funded studies In this way, government is kept informed of progress in telemedicine and the need to facilitate it See, for example, the 1999 Congressional telehealth briefing mentioned in Section 121 In spite of the collaborative work of the JWGT much remains to be done to establish a strategic approach to telemedicine development For example in 1996, nine government agencies invested at least $229 million in telemedicine but there was no overall strategy to coordinate activity or maximise benefits These deficiencies were highlighted in a General Accounting Office (GAO) report [213] in 1997 which recommended that the Department of Defense, responsible for over half the 1996 expenditure, should take the lead in devising a national strategy Funding and information gathering continue.

Similarly, eight orthogonal equations can be written on the bits m2, m3, and m4, resulting in the estimate m l = ( k 1 , k 2 , k 3 , k 4 ) . Having estimated m l , we strip it off from the received signal,

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The main issue is the usual one of reimbursement, although the GAO found no evidence to support the Health Care Financing Administration s assertion that offering fee-for-service reimbursement of telemedicine services to Medicare patients would vastly increase expenditure [214] Since January 1999, Medicare reimbursement has been available for telemedicine services in rural counties [2 151 Licensure and accreditation, malpractice and security issues are other common reasons for the slow progress One area in which progress is more visible, however, is the construction of practitioner guidelines For example, the American Telemedicine Association has adopted a set of clinical guidelines for telecare, covering patients, health providers and technology [2 161 An interdisciplinary group has also produced a report [217] on guidelines for telehealth practice for the JWGT as it develops recommendations for Federal and state legislative, regulatory and policy statements.

Pattern1 is the simplest of all patterns, which consists of the word Perl. You can use this pattern to find Perl in any string. Pattern2 searches for two digits followed by a space, which is followed by any character. For example, 55 D and 36 C both fall into Pattern2. Pattern3, Pattern4, and Pattern5 are a bit different. Notice the three additional symbols shown here, namely, *, +, and . The asterisk character searches for zero or more occurrences of a character. Therefore, if you specify a*, then the pattern searches for zero or more occurrences of the letter a. The plus sign searches for one or more occurrences of a character. Therefore, if you have a+, then the pattern would look for one or more occurrences of the letter a. In the same manner, the question mark searches for zero or one occurrence of a character. Table 4.3 lists our explanations.

This latter report is very comprehensive, covering standards of professional conduct and care, as well as clinical and technical standards, effectiveness and evaluation methodologies, confidentiality and documentation issues The USA is of course not alone in having a tension between national and state legislation and practice What is needed, here as elsewhere, is a facilitating policy at national level that encourages knowledge creation and sharing [318] across state boundaries The setting of standards is an indicator that telemedicine is maturing and that healthcare professionals have sufficient experience to be comfortable with its application In general, clinicians in the USA have enthused about telemedicine as a useful adjunct to conventional face-to-face medicine and as a potential cost-saving tool The greatest threats to physician acceptance takeup have been the reimbursement and other legal-ethical issues (again!) and the fear, expressed earlier [73].

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that the technology is too impersonal, not just in teleconsultations with the patient, but because it reduces informal what do you think sharing of information between clinicians In spite of the potential, it seems there is still some way to go before telemedicine is just another way of practising medicine..

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