Telemedicine: Re-envisioning The Telephone Consultation

1. Telemedicine: Re-envisioning The Telephone Consultation Julie J. McGowan, Ph.D., FACMI IU School of Medicine Regenstrief Instutute

2. Coming to You through the Miracle of Modern Technology – The Telephone

3. The Consultation • In Person • Letter • Express Delivery • Telegraph • Telephone • Telehealth • In Person, Virtually

4. 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

5. What is Telehealth? • Video Conferencing • Distance Learning • Telemedicine • Asynchronous – Provider to Provider • Synchronous – Provider to Patient & Provider • Synchronous – Provider to Patient

6. 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.

7. WHY PROGRESS TO TELEMEDICNE

8. The Rationale • Just-in-time Care • Improved Quality • Enhanced Efficiency • Better Professional Communication • Patient Satisfaction • Enlarged Catchment Area • Cost Savings?

9. Culture – Medical & • Re-engineering practice • Crossing referral lines • Comfort with and understanding of Technology as a Tool There are no problems…. just insurmountable opportunities

10. “REPORT CARD” OFTELEMEDICNE EFFECTIVENESS • Define Desired Outcomes • Quality Improvement • Reduced Costs • Provider Satisfaction • Patient Satisfaction • Develop Evaluation to Assess Desired Outcomes

11. The Report Card Continued • Disseminate Findings • Select appropriate recipients • Combine findings with marketing strategy • Be Willing to Modify Program as Necessary • Re-Evaluate Frequently

12. EVALUATING TELEMEDICINE

13. Need for Evaluation • Administrative Justification • Sociological • Consulting and Referring Providers • Patients • Political • Patient Safety • Competitive Health Care Marketplace

14. Types of Evaluation • Technology • Provider and Patient Satisfaction • Economic Issues • Quality Improvement

15. Technology Image vs. Use • Store and Forward • Human Interaction • Patient / Provider Consultation • Psychiatry; Orthopedics • Image Quality • Color Reliability • Movement Artifacts

16. Technology Reliability of Technology • Connections • Ease and Reliability of Contact • Interface Standards • Peripheral Equipment • Quality – Digital vs. Digitized • Transmission Protocols

17. Provider Satisfaction • Comfort level with technology • Comfort level with process • Comfort level with patient communication • Comfort level with provider interaction • Unanticipated Benefits • Unanticipated Problems

18. Patient Satisfaction • Patients Follow Images • The Value Equation • Home is Where… • Comfort issues • Environmental issues • Economic issues

19. Economic Analysis of Telemedicine

20. 4 Ways to Look at $$$ • Managed Care Environment • Multi-Payer Environment • Alternative Savings [Training, Patients] • Cost-Plus in Captive Patient Populations

21. 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

22. 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

23. ??? QUESTIONS ???