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

TELEMEDICINE DEFINED “...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 Video Conferencing Distance Learning Distance Learning Telemedicine Telemedicine Asynchronous – Provider to Provider Asynchronous – Provider to Provider Synchronous – Provider to Patient & Provider Synchronous – Provider to Patient & Provider Synchronous – Provider to Patient 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] 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 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. Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites across Alaska.

WHY PROGRESS TO TELEMEDICNE

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

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

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

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

EVALUATING TELEMEDICINE

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

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

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

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

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

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

Economic Analysis of Telemedicine

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

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

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