Telemedicine Cost and Clinical Efficiency Issues – Experience from a Pilot Project Between the Rikshospitalet- Radiumhospitalet HF (RR) Oslo, Norway and Methodist Rural Public Care Center (MPCH) Mursan India Vinod Mishra, PhD Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway TTeC2006 conference 2006 Tromsø

Overview Brief Norway and India equity and diversity Goal telemedicine / telediagnostic project Experience –Patient –Clinical efficiency –Cost efficiency Barriers Conclusion

Population 4,604,800 Life expectancy Male 76 year Female 82 year GDP per capita USD Unemployment rate 4.4% Health expenditures Health & social services 30 billion USD, 10.4 % of GNP Hospitals expenses11 billion USD 1 USD = 6.50 NOK

Population billion Life expectancy Male 63.9 year Female 65 year GDP per capita USD Unemployment rate 9.9 % est Health expenditures Health & social services 5.3 % of total budget, 0.9 % of GNP 60 millions mobiles telephone in 2005 (increasing 100% each year) 12 millions new TV each year 1.6 million new cars each year

Telemedicine

Main goals Web based Telemedicine project MURSAN Provide expert opinion for under privileged patients Facilitate medical consultation Educational activities Introduction of two-ways, interactive telecommunication between university hospital and primary health center

Web based Telemedicine project - MURSAN Image management and secure storage system Future plan for real time tele-communication and education sessions Web based system an economic mode of providing expert services to the primary center at remote site in India Better management of patients since this system allows fast diagnosis, fast opinion and inter-consultation among specialist located not only at our hospital but around the world.

Web based Telemedicine project – MURSAN Patients Better access to care Access to a multidisciplinary network of skills and competences More relevant indication of patients- reduce transfers between primary- secondary and tertiary care Societal benefits improved cost-effectiveness of treatment

Web based Telemedicine project – MURSAN Clinical efficiency Keep more patients to local providers Major assets in favor of a network-organized professional practice Professionals feel less lonely they are fellow worker Ongoing learning and daily practice are interrelated Effects on patient management- changes in clinicians decisions making

Web based Telemedicine project – MURSAN Cost efficiency Cost effective (direct cost, direct non medical cost and indirect cost, opportunity cost) –Cost of consultation a major issue –Patient non-emergent transport expenses –Standard hospitalization cost –Standard ancillary cost Cost of specialists can be shared by low incidence users Time reduction in work flow Automatic and intelligent solution Cost effective only if a certain threshold is achieved

Web based Telemedicine project – MURSAN barriers No institutional strategic plan for telemedicine The technology is not as affordable as we think it is The technology is not so easy to employ as we would like to believe The technology is not as universally useful as we want The infrastructure is not as ubiquitous as it needs to be Clinicians are reluctant to use

Conclusion Web based telemedicine- telediagnostic is a win win situation for partners Systems can be used as a tool for distance learning program between tertiary Sand primary level Web based telemedicine- telediagnostic is JUST A TOOL Experience shows that one must have –focus on clinical efficiency –focus on cost efficiency –use of cost-benefit analysis

Telemedicine

Thank you for attention

Vinod Mishra Special advisor Rikshospitalet- Radiumhospitalet University Hospital Oslo Norway Tl Fax