8 Specialist to PCP Education/General Scenario/Case based Grand Rounds Provider education (CME) International Journal of Telemedicine and Applications Table 2: Summary of the three types of telemedicine services. Specialist to Patient (Specialist can also take the place of APN: RN, CNL, CNS, NP, PA) Specialist to PCP & Patient (Post patient “hand oﬀ ” by PCP) Education/General Scenario based in Group format Clinical/Diagnostic/Real-time Consultation Chronic Disease Management (HIV/Diabetes) Group Visits with patients in preparation for speciﬁc diagnostic procedure (Ex. Informed consent for colonoscopy, Cardio tests, other procedures) Disease speciﬁc—based on case by case basis “Patient Rounds” “Hands-free” specialties “Does not require touch” Ex: Psychiatry and Dermatology Although mixed opinions were voiced regarding the possibility of using videoconferencing technology as part of the e-referral process, this type of technology is already in use in the safety net via the language interpretation service (VMI) which is currently being expanded to diﬀerent areas of the public healthcare system. Based on existing data, 40 percent of the patients seen in our system would require some sort of language interpreter service In the words of one of the providers, “We could start with VMI technology as a starter since we have a group of patients who would beneﬁt tremendously from having another person interpret language and the potential to build on its existing infrastructure to provide access to more services would be beneﬁcial.” The safety net is already becoming familiar with this type of technology, which means an easier transition in utilizing this type of technology for telemedicine. In addition, major- ity of the revenue for this purpose could be invested in the videoconferencing technology itself, and building technical capacity for the purpose of education and training with utilisation of the new technology could be made earlier under the auspices of VMI scale up within the safety net. “We have made it clear that we could provide consultation that is not patient Speciﬁc, as in general question. . .” 8.4. Types of Telemedicine Services. The interviews revealed that providers, both primary care and specialists, favored the use of education-based activities as a key service for the use of telemedicine technology. Such education-based activities would span the following domains: Specialist to PCP, Specialist to patient, and Specialist to PCP and Patient (real time). (A summary of the types of telemedicine services can be found in Table 2.) 8.4.1. Specialist to Primary Care Provider Telemedicine. One of the key rationales for education-based activities as a key service for the use of telemedicine technology was not having enough specialists to span the entire system to meet demand, and as such the idea of sharing the knowledge base over a vast catchment area would prove to be the most beneﬁcial use of telemedicine technology. One idea discussed was having the usual “Grand Rounds” broadcasted throughout the safety-net clinics. Since grand rounds encompass the wide spectrum of general scenario-based disease-speciﬁc case studies, broadcasting these sessions would prove to expand the knowledge base across the safety net without reinventing the wheel. Quotes to illustrate: “Grand rounds getting funnelled into a conference room (Carr Auditorium), sitting in front of a TV in our clinic and having providers remotely watch could be very helpful.” “I think it’s a great idea to be able to have our providers and staﬀ at the clinic assembles in the conference room to be able to watch grand rounds during lunch time.” “Webcast lectures would be great, anyone being able to log in and connect to Carr Auditorium” “We (PCP) could be hooked up to a conference room and cases could be brought to them (special- ists).” “Educating the providers on all fronts, PCP and specialists as to we oﬀer and what services and what specialty services are necessary and to really assist them in making these types of decisions.” “Assisting the PCP in managing their patients and potentially avoiding the referrals where they could have been addressed should they have had the information, simplifying the referral process so that PCP and their eligible patients have easier access to care, and the process of the referral is simpler.” Some of the PCPs supported this idea, and in fact a few primary care providers were ready to enlist a speciﬁc area of the clinic for such to occur as a “noon time lunch activity.” Although, not all of the providers supported this idea, they were optimistic that such access to specialist provider and education would prove beneﬁcial in the long run. 8.4.2. Specialist to Patient Telemedicine. Primary care pro- viders felt that patients in the primary care setting would beneﬁt from a specialist education session in the group