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Innovating Health Care Delivery: The Quest For Effective Telemedicine‐based Services

Politecnico di Milano. Innovating Health Care Delivery: The Quest For Effective Telemedicine‐based Services. Laura Bartoli & Cristina Masella Fausto Colombo. INTERNATIONAL HEALTHCARE CONFERENCE New York City, MAY 11TH‐12TH, 2010. Introduction.

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Innovating Health Care Delivery: The Quest For Effective Telemedicine‐based Services

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  1. Politecnico di Milano Innovating Health Care Delivery: The Quest For Effective Telemedicine‐based Services Laura Bartoli & Cristina Masella Fausto Colombo INTERNATIONAL HEALTHCARE CONFERENCE New York City, MAY 11TH‐12TH, 2010

  2. Introduction • Telemedicine, providing healthcare over a distance by means of telecommunication technologies, has been around for more than half a century Yet it is sometimes still considered to be a new idea or solution to many • Because of • growing aging population • increasing costs of medical care • shortage of healthcare providers • Telemedicine is posed to become a standard in health delivery (Whitten et al., 2010) Within this context, the Italian Ministry of Health promoteda National Research Project aimed at understanding the current state of art in Italy with respect to a specific pathology: COPD.

  3. 1 2 3 4 Goals This National Research Project aimed at: Fast and effective creation of your presentation 1 • Identifying which are the Italian experiences of telemedicine-based service 2 • Identifying who are the Italian experts to be involved for further discussions • Understanding which are the major leverages to enable effective telemedicine-based services 3

  4. The Italian telemedicine-based services (1/2) Nationwide Survey of the Italian Pneumology Hospital Departments Questionnaires Sent n=240; Answer Rate =40% 22 telemedicine-based services for telemonitoring were identified 1 is aborted 7 are concluded 3 are starting • 11 are ongoing The services differ with respect to experience maturity and patients enrolled.

  5. The Italian telemedicine-based services (2/2) CONCLUDED STUDIES 4 studies (Np=10) (Np=15) (Np=16) (Np=26) 2 studies (Np=20) (Np=38) 1 study (Np=6) Drop-out Drop-out Drop-out Drop-out PILOT STUDIES EXPERIMENTATIONS PROOFS OF TECHNOLOGY INSTITUTIONALIZED SERVICES INSTITUTIONALIZED WITHIN HEALTHCARE DELIVERY SYSTEM 1 study (Np=317) 1 study (Np = 3) 4 studies (Np=48) (Np=10) (Np=8) (Np=8) 3 studies (Np=60) (Np=28) (Np=17) 2 studies (Np >1000) (Np=160) ONGOING STUDIES Np = Numberofpatients

  6. Main Italian telemedicine-based services The 8 most paradigmatic and advanced telemedicine-based services have been outlined 2 studies (Np=20) (Np=38) Drop-out Drop-out Drop-out Drop-out PILOT STUDIES EXPERIMENTATIONS PROOFS OF TECHNOLOGY INSTITUTIONALIZED SERVICES INSTITUTIONALIZED WITHIN HEALTHCARE DELIVERY SYSTEM 3 studies (Np=60) (Np=28) (Np=17) 1 study (Np=317) 2 studies (Np>1000) (Np=160)

  7. How to make telemedicine-based service effective Workshop conclusions There was not an easy agreement on how to make telemedicine-based services effective  Lack of EVIDENCE ! Telemedicine should be cost-effective, but the BUSINESS MODEL is largely affected by policy makers’ actions All agreed that the major challenge for telemedicine services are ORGANIZATIONAL One-day Workshop with the 15 physicians involved in these 8 projects (identified as the experts)

  8. How to make telemedicine service Organizationally Sustainable (OS) Actors’ satisfaction (included patients’) Operators need to owe the proper competences and skills Adequate collaboration and mansions distribution between hospitals and territory are requested A proper and sustainable workload distribution is needed within the hospital clinical

  9. Case studies • To validate the dimensions retrieved, the 8 most advanced telemedicine-based services have been deepened • The most interesting evidence enhanced in terms of leverages for sustainability is reported further on 8 case-studies have been conducted

  10. Case 1: The role of nurses In one of the cases, two full-time nurses are dedicated to the provision of the telemonitoring service. In particular, they: • daily check the information transmitted from the patients’ home; • guarantee a teleconsultation service in case of patients’ needs; • go to the patients’ home when necessary. It has been estimated that the clinician intervention is needed only in the 20% of the cases

  11. Case 2: The role of patients In another case: The analysis of patients’ customer satisfaction highlighted they are very satisfied with the service 276 questionnaires Medium answer rate = 4,7 out of 5 points In 1 year unscheduled contacts increased from 0,5 to 0,7 per patient Patients’ attitude to ask for an unscheduled teleconsult increases during the experimentation Telemedicine-based services are appreciated by patients, and they increase their acknowledgement with respect to symptoms recognition and management.

  12. Case 3: The technology suppliers Guarantor In most of the cases The technology suppliers represent the responsible for the technological running of the service TECHNOLOGY SUPPLIERS Service center In one case The technology supplier is directly involved in the provision of the care, guaranteeing the continuity of service during the nights and on weekends

  13. Results (1/2) The onlyexperinceswhichentail business models are the twoinstitutionalizedwithin the system …

  14. Results (2/2)

  15. Research endpoints • Albeit telemedicine-based services have been around for a little more than half a century, there is still a shortage of convincing evidence regarding their effectiveness • Reasons might be partly related to the organization-specific characteristics of these applications, which have been often mentioned, but scarcely addressed (Chiasson and Davidson, 2004) • Larger scale experiences are needed to make policy makers able to proceed for accreditation • Accreditation represents the pre-condition to make healthcare providers able to introduce a proper business model, which will entail indications on nurses mansions and suppliers involvement

  16. Generalizing … Similar evidence has been enhanced with respect to the U.S. scenario Italian National Research Project Whitten et al., 2010 • Empowerment of nurses • Empowerment of patients • Involvement of suppliers • Presence of a business model • Effective organizational design • Attitude and perceptions of telemedicine • Structure of the operations • Financial characteristics Recent researches are converging toward a shared definition of the new healthcare delivery characteristics

  17. Thankyouforyourattention! Laura Bartoli Politecnico di Milano Department of Management, Economics and Industrial Engineering Phone: +39 02 2399 3996 Cell:     +39 340 3955831 Email: laura.bartoli@polimi.it

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