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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 Medicine
Regenstrief 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 - mental hospital & Interact System - Dartmouth and UVM Medical Schools Dartmouth and UVM Medical Schools [Microwave][Microwave]
STARPAHC [Space Technology Applied to STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Rural Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in Indian Reservation & Public Health Hospital in ArizonaArizona
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 Continued
Disseminate FindingsDisseminate FindingsSelect 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 Evaluation
Administrative JustificationAdministrative JustificationSociologicalSociological
Consulting and Referring ProvidersConsulting and Referring ProvidersPatientsPatients
PoliticalPoliticalPatient SafetyPatient SafetyCompetitive Health Care MarketplaceCompetitive Health Care Marketplace
Types of EvaluationTypes of Evaluation
TechnologyTechnology
Provider and Patient SatisfactionProvider and Patient Satisfaction
Economic IssuesEconomic Issues
Quality ImprovementQuality Improvement
TechnologyTechnology
Image vs. UseImage vs. UseStore and ForwardStore and ForwardHuman InteractionHuman Interaction
Patient / Provider ConsultationPatient / Provider ConsultationPsychiatry; OrthopedicsPsychiatry; Orthopedics
Image QualityImage QualityColor ReliabilityColor ReliabilityMovement ArtifactsMovement Artifacts
TechnologyTechnology
Reliability of TechnologyReliability of TechnologyConnectionsConnections
Ease 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 Satisfaction
Patients 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 Chasm
Application 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 Information
http://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
??? QUESTIONS ?????? QUESTIONS ???