Telemedicine: Re-Telemedicine: Re-envisioning The Telephone envisioning The Telephone

Consultation Consultation Julie J. McGowan, Ph.D., FACMIJulie J. McGowan, Ph.D., FACMI

IU School of MedicineIU School of MedicineRegenstrief InstututeRegenstrief Instutute

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

The TelephoneThe Telephone

The ConsultationThe Consultation In PersonIn PersonLetterLetterExpress DeliveryExpress DeliveryTelegraphTelegraphTelephoneTelephoneTelehealthTelehealth In Person, VirtuallyIn Person, Virtually

TELEMEDICINE DEFINEDTELEMEDICINE DEFINED

““...the use of electronic information ...the use of electronic information and and

communications technologies to communications technologies to provide provide

and support health care when and support health care when distance distance

separates the participants...”separates the participants...”from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care

What is Telehealth?What is Telehealth?Video ConferencingVideo ConferencingDistance LearningDistance LearningTelemedicineTelemedicine

Asynchronous – Provider to ProviderAsynchronous – Provider to ProviderSynchronous – Provider to Patient & Synchronous – Provider to Patient &

ProviderProviderSynchronous – Provider to PatientSynchronous – Provider to Patient

Early History of TelemedicineEarly History of Telemedicine1950s and 1960s1950s and 1960s

Nebraska Psychiatric Institute - UN & state Nebraska Psychiatric Institute - UN & state mental hospital & Interact System - Dartmouth mental hospital & Interact System - Dartmouth and UVM Medical Schools [Microwave]and UVM Medical Schools [Microwave]

STARPAHC [Space Technology Applied to Rural STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Indian Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in ArizonaReservation & Public Health Hospital in Arizona

Alaska Satellite Biomedical Demonstration Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites Project used NASA technology to link 26 sites across Alaska.across Alaska.

WHY PROGRESS TO WHY PROGRESS TO TELEMEDICNETELEMEDICNE

The RationaleThe Rationale Just-in-time CareJust-in-time Care Improved QualityImproved QualityEnhanced EfficiencyEnhanced EfficiencyBetter Professional CommunicationBetter Professional CommunicationPatient SatisfactionPatient SatisfactionEnlarged Catchment AreaEnlarged Catchment AreaCost Savings?Cost Savings?

Culture – Medical &Culture – Medical & Re-engineering practice Re-engineering practice Crossing referral linesCrossing referral lines Comfort with and understanding of Comfort with and understanding of

Technology as a ToolTechnology as a Tool

There are no problems….There are no problems….just insurmountable just insurmountable opportunitiesopportunities

““REPORT CARD” OFREPORT CARD” OFTELEMEDICNE TELEMEDICNE

EFFECTIVENESSEFFECTIVENESSDefine Desired OutcomesDefine Desired Outcomes

Quality ImprovementQuality ImprovementReduced CostsReduced CostsProvider SatisfactionProvider SatisfactionPatient SatisfactionPatient Satisfaction

Develop Evaluation to Assess Develop Evaluation to Assess Desired OutcomesDesired Outcomes

The Report Card ContinuedThe Report Card ContinuedDisseminate FindingsDisseminate Findings

Select appropriate recipientsSelect appropriate recipientsCombine findings with marketing Combine findings with marketing

strategystrategyBe Willing to Modify Program as Be Willing to Modify Program as

NecessaryNecessaryRe-Evaluate FrequentlyRe-Evaluate Frequently

EVALUATING TELEMEDICINEEVALUATING TELEMEDICINE

Need for EvaluationNeed for EvaluationAdministrative JustificationAdministrative JustificationSociologicalSociological

Consulting and Referring ProvidersConsulting and Referring ProvidersPatientsPatients

PoliticalPoliticalPatient SafetyPatient SafetyCompetitive Health Care MarketplaceCompetitive Health Care Marketplace

Types of EvaluationTypes of EvaluationTechnologyTechnology

Provider and Patient SatisfactionProvider and Patient Satisfaction

Economic IssuesEconomic Issues

Quality ImprovementQuality Improvement

TechnologyTechnologyImage vs. UseImage vs. Use

Store and ForwardStore and ForwardHuman InteractionHuman Interaction

Patient / Provider ConsultationPatient / Provider ConsultationPsychiatry; OrthopedicsPsychiatry; Orthopedics

Image QualityImage QualityColor ReliabilityColor ReliabilityMovement ArtifactsMovement Artifacts

TechnologyTechnologyReliability of TechnologyReliability of Technology

ConnectionsConnectionsEase and Reliability of ContactEase and Reliability of ContactInterface Standards Interface Standards

Peripheral EquipmentPeripheral EquipmentQuality – Digital vs. DigitizedQuality – Digital vs. DigitizedTransmission ProtocolsTransmission Protocols

Provider SatisfactionProvider Satisfaction Comfort level with Comfort level with

technologytechnology Comfort level with Comfort level with

processprocess Comfort level with Comfort level with

patient communicationpatient communication Comfort level with Comfort level with

provider interactionprovider interaction Unanticipated BenefitsUnanticipated Benefits Unanticipated ProblemsUnanticipated Problems

Patient SatisfactionPatient SatisfactionPatients Follow ImagesPatients Follow ImagesThe Value EquationThe Value EquationHome is Where…Home is Where…

Comfort issuesComfort issuesEnvironmental issuesEnvironmental issuesEconomic issuesEconomic issues

Economic Analysis of Economic Analysis of TelemedicineTelemedicine

4 Ways to Look at $$$4 Ways to Look at $$$ Managed Care Managed Care

EnvironmentEnvironment Multi-Payer Multi-Payer

EnvironmentEnvironment Alternative Savings Alternative Savings

[Training, Patients][Training, Patients] Cost-Plus in Cost-Plus in

Captive Patient Captive Patient PopulationsPopulations

Crossing the Quality ChasmCrossing the Quality ChasmApplication of standard quality Application of standard quality

measures to health care using a new measures to health care using a new tooltool

Consider:Consider:QOLQOLUnintended ConsequencesUnintended ConsequencesUnintended ConfoundersUnintended Confounders

Grand Canyon of Research Grand Canyon of Research OpportunitiesOpportunities

For More InformationFor More Informationhttp://www.va.gov/occ/THinVA.asphttp://www.va.gov/occ/THinVA.asp

http://http://healthit.ahrq.gov/portal/server.pt?ophealthit.ahrq.gov/portal/server.pt?openen=514&objID=5554&mode=2&holder=514&objID=5554&mode=2&holderDisplayURL=http://prodportallb.ahrq.DisplayURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/cgov:7087/publishedcontent/publish/communities/k_o/knowledge_library/keommunities/k_o/knowledge_library/key_topics/health_briefing_0124200612y_topics/health_briefing_01242006121308/telemedicine.html1308/telemedicine.html

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