Background: There is a shift towards increased use of telemedicine applications for healthcare service provision and delivery.Thus, awareness among healthcare practitioners of telemedicine policies is critical for proper implementation and utilization of telemedicine technology.Objective: This study assesses the level of computer access and literacy, knowledge of telemedicine policies and technology, perceptions, and willingness to use telemedicine among healthcare practitioners working in ambulatory care clinics.Methods: An observational cross-sectional study was conducted at King Fahad Armed Forces Hospital in Jeddah.Data were collected between February and March 2021 using a self-completed online survey.Results: Of 136 healthcare practitioners surveyed, we found that over half had average to high knowledge about telemedicine technology, tools, guidelines, security, and privacy policies within the hospital.95% were willing to use telemedicine to consult with large centers in their medical or clinical specialty and support further implementation of telemedicine technology in the hospital.90% expressed a need for continuous training in the use of telemedicine. Conclusion:The current study shows that there is inadequate computer access and knowledge of telemedicine, but there were very positive perceptions and willingness related to telemedicine among healthcare practitioners working in the ambulatory care clinics.There is an urgent need for orientation and training programs that focus on the technology and applications of telemedicine, as well as current policies.

Business models for telehealth in the US: analyses and insights Francis Pereira Data Sciences and Operations, Marshall School of Business, University of Southern, Los Angeles, CA, USA Abstract: A growing shortage of medical doctors and nurses, globally, coupled with increasing life expectancy, is generating greater cost pressures on health care, in the US and globally. In this respect, telehealth can help alleviate these pressures, as well as extend medical services to underserved or unserved areas. However, its relatively slow adoption in the US, as well as in other markets, suggests the presence of barriers and challenges. The use of a business model framework helps identify the value proposition of telehealth as well as these challenges, which include identifying the right revenue model, organizational structure, and, perhaps more importantly, the stakeholders in the telehealth ecosystem. Successful and cost-effective deployment of telehealth require a redefinition of the ecosystem and a comprehensive review of all benefits and beneficiaries of such a system; hence a reassessment of all the stakeholders that could benefit from such a system, beyond the traditional patient–health provider–insurer model, and thus “who should pay” for such a system, and the driving efforts of a “keystone” player in developing this initiative would help. Keywords: telehealth, business model framework, stakeholders, ecosystem, VISOR business Model

Telehealth has the potential to improve access and outcomes for patients and to reduce health care costs across a wide range of health conditions and situations. The wide adoption of telehealth requires, however, a strong legal and financial foundation. In this article, we compare the evolution of American and Brazilian telehealth legislations and reimbursement schemes. The detailed analysis in this article shows many differences between these two countries that help to explain why telehealth in the USA has a much faster adoption rate than that in Brazil.

Siew Sun Wong,1 Yu Meng,1 Paul D Loprinzi,2 Nobuko Hongu3 1School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA; 2Department of Exercise Science, Donna and Allan Lansing School of Nursing and Health Sciences, Bellarmine University, Louisville, KY, USA; 3Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA Abstract: The primary purpose of this review is to answer three research questions: 1) What are the most popular features of physical activity (PA) tracking and recording mobile applications (apps); 2) what features drive the app cost, peak rank, or gross sales; and 3) to what extent are evidence-based weight loss recommendations used in PA apps? Two hundred top grossing iOS health care and fitness apps were screened using a systematic review method. Fifty-five apps met the criteria as PA tracking and recording apps. Nearly half of these iOS PA apps are also available in Android. Two separate reviewers evaluated each PA app using 48 features. The top three most popular features are the use of behavioral strategies, use of the FITT Principles (frequency, intensity, time, type), and the use of the Principles for Physical Fitness. Free apps contain a mean of nine of the ten most popular features in paid apps, making them good bargains in PA promotion. Better peak rank is associated with the use of Fitness Principles, weight loss goal setting, or training videos. Ten PA apps met at least four of eight of the American College of Sports Medicine (ACSM) recommendations for weight loss and prevention of weight regain for adults. The least popular features were PA safety and workouts for special need populations. Implications for obesity treatment are discussed in relationship to individual end-users, health care providers, and app developers. Because current PA apps still lack validity and compliance to standards for PA safety and data security, medical consultation for weight loss is recommended. The quality of PA apps on the market will improve through innovative support from the government, industry, and academia. The future of PA apps is bright, especially with the potential of using emerging technologies that involve low-cost wearable sensors, global information systems, and immersive technology such as virtual worlds and virtual reality. Keywords: Android, exercise, iOS, mHealth, self-monitoring, technology

Abstract: With the aging of the world's population and the rise of chronic illness such as heart failure (HF), the economic burden, number of hospitalizations, and penalties imposed for failure to meet hospital readmission expectations will continue to rise, thus increasing pressure on clinicians to utilize successful HF monitoring interventions to improve these measures. Telephone monitoring in patients with chronic HF utilizes a proactive approach in the care of such patients, and for this review is grouped into three categories, ie, structured telephone support, telemonitoring, and remote implantable device monitoring. Earlier studies on structured telephone support and telemonitoring suggested a clear benefit on mortality and HF admissions, although several recent large, randomized controlled studies have been neutral. Optimizing medical therapy requires an accurate assessment of volume status by the clinician; therefore, symptom report and weight monitoring alone are often challenging in the identification of true HF decompensation because they are not very sensitive markers. The use of remote monitoring technology for follow-up of patients with implantable devices, including implantable cardiac defibrillators and cardiac resynchronization therapy devices, can aid in identifying HF decompensation. Self-care or self-management is an essential component of a chronic illness such as HF, and it is important for such patients to be engaged in their health care to best utilize the telephone monitoring intervention. System design, adequate staffing, patient satisfaction, and treatment adherence are important for success of the telemonitoring system. Telephone monitoring seems to be an effective approach in the chronic HF population. In the future, large-scale telemonitoring programs may come into place as well as additional remote implantable monitoring devices. Keywords: heart failure, telemonitoring, remote monitoring, disease management, patient satisfaction, mortality