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

“...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 Telemedicine1950s 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” OFTELEMEDICNE 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
        - 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

???   QUESTIONS   ???

# UNKNOWN-0.xls

# UNKNOWN-1.xls