Telemedicine: Re-envisioning The Telephone Consultation Julie J. McGowan, Ph.D., FACMI IU School of Medicine Regenstrief Instutute

Coming to You through the Miracle of Modern Technology – The Telephone

The Consultation In Person Letter Express Delivery Telegraph Telephone Telehealth In Person, Virtually

TELEMEDICINE DEFINED communications technologies to provide “...the use of electronic information and communications technologies to provide and support health care when distance separates the participants...” from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

What is Telehealth? Video Conferencing Distance Learning Telemedicine Asynchronous – Provider to Provider Synchronous – Provider to Patient & Provider Synchronous – Provider to Patient

Early History of Telemedicine 1950s and 1960s Nebraska Psychiatric Institute - UN & state mental hospital & Interact System - Dartmouth and UVM Medical Schools [Microwave] STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in Arizona Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites across Alaska.

WHY PROGRESS TO TELEMEDICNE

The Rationale Just-in-time Care Improved Quality Enhanced Efficiency Better Professional Communication Patient Satisfaction Enlarged Catchment Area Cost Savings?

Culture – Medical & Re-engineering practice Crossing referral lines Comfort with and understanding of Technology as a Tool There are no problems…. just insurmountable opportunities

“REPORT CARD” OF TELEMEDICNE EFFECTIVENESS Define Desired Outcomes Quality Improvement Reduced Costs Provider Satisfaction Patient Satisfaction Develop Evaluation to Assess Desired Outcomes

The Report Card Continued Disseminate Findings Select appropriate recipients Combine findings with marketing strategy Be Willing to Modify Program as Necessary Re-Evaluate Frequently

EVALUATING TELEMEDICINE

Need for Evaluation Administrative Justification Sociological Consulting and Referring Providers Patients Political Patient Safety Competitive Health Care Marketplace

Types of Evaluation Technology Provider and Patient Satisfaction Economic Issues Quality Improvement

Technology Image vs. Use Store and Forward Human Interaction Patient / Provider Consultation Psychiatry; Orthopedics Image Quality Color Reliability Movement Artifacts

Technology Reliability of Technology Connections Peripheral Equipment Ease and Reliability of Contact Interface Standards Peripheral Equipment Quality – Digital vs. Digitized Transmission Protocols

Provider Satisfaction Comfort level with technology Comfort level with process Comfort level with patient communication Comfort level with provider interaction Unanticipated Benefits Unanticipated Problems

Patient Satisfaction Patients Follow Images The Value Equation Home is Where… Comfort issues Environmental issues Economic issues

Economic Analysis of Telemedicine

4 Ways to Look at $$$ Managed Care Environment Multi-Payer Environment Alternative Savings [Training, Patients] Cost-Plus in Captive Patient Populations

Crossing the Quality Chasm Application of standard quality measures to health care using a new tool Consider: QOL Unintended Consequences Unintended Confounders Grand Canyon of Research Opportunities

For More Information http://www.va.gov/occ/THinVA.asp http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5554&mode=2&holderDisplayURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/communities/k_o/knowledge_library/key_topics/health_briefing_01242006121308/telemedicine.html

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