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Telemedicine at East Carolina University (ECU) began with the first consults with Central Prison (Raleigh) in 1992. Over the subsequent eleven years, services and infrastructure grew and evolved through the support of the University, University Health Systems (UHS), rural health facilities, and several grants and contracts. Along the way, the ECU telemedicine program achieved national recognition through participation in the American Telemedicine Association's leadership (both as board members and Special Interest Group Chairs), receiving telehealth-related grant and contract awards, and publishing peer-reviewed journal articles. In 1999, the University of North Carolina General Administration awarded the program "Center" status, and it was recognized as one of the "Top 10" telemedicine programs by Telehealth Magazine.

Currently, telehealth transactions conducted via our network comprise initial patient assessment/primary diagnosis, management/follow-up of patients that were initially seen in-person or via telemedicine, and referred specialty consultation. Generally, our telehealth services fall into one of three categories - scheduled, urgent, or emergent. Scheduled services are planned in advance and involve either an individual patient case or group of cases from a single site or specific specialty "clinics" that can be from one or more sites. For example, a scheduled dermatology clinic might involve several UHS-affiliated hospitals, a state institution(s), and a federal site (e.g. a prison). Urgent services are not scheduled in advance and are conducted upon request. A common urgent request is for a pediatric cardiologist at ECU to read an echocardiogram from a remote site via the telemedicine network. Emergent services involve using 24/7 links between the PCMH Emergency Department (ED) and ED's at Chowan (Edenton) and Bertie Memorial (Windsor) Hospitals.

The Center develops and maintains standard operating procedures (SOP's) for telehealth, which are used by the telemedicine coordinators at the Center, the Rural Telemedicine Coordinators (RTC's), and physicians. The RTC's act as the primary facilitator for telemedicine and distance learning activities at their site, and are responsible for patient scheduling; operating the equipment during telehealth encounters; training other local clinical staff; obtaining patient consent; and reporting issues and new ideas to the Center. Engineers are on site at the Center during normal business hours for technical support, troubleshooting, and setting up telemedicine calls and bridging for telehealth and distance learning applications.

The most frequently used clinical applications of telehealth at ECU are: dermatology; cardiology (pediatric and adult); pediatrics (general and neonatal); psychiatry (mostly pediatric, some adult); rehabilitation medicine; radiology; and home care, which is operated by University Home Care.