Telemedicine: Re-envisioning The Telephone Consultation  Julie J. McGowan, Ph.D., FACMI IU School of Medicine Regenstrief ...
Coming to You through the Miracle of Modern Technology – The Telephone
The Consultation <ul><li>In Person </li></ul><ul><li>Letter </li></ul><ul><li>Express Delivery </li></ul><ul><li>Telegraph...
TELEMEDICINE DEFINED <ul><li>“ ...the use of electronic information and  </li></ul><ul><li>communications technologies to ...
What is Telehealth? <ul><li>Video Conferencing </li></ul><ul><li>Distance Learning </li></ul><ul><li>Telemedicine </li></u...
Early History of Telemedicine 1950s and 1960s <ul><li>Nebraska Psychiatric Institute - UN & state mental hospital & Intera...
WHY PROGRESS TO TELEMEDICNE
The Rationale <ul><li>Just-in-time Care </li></ul><ul><li>Improved Quality </li></ul><ul><li>Enhanced Efficiency </li></ul...
Culture – Medical & <ul><li>Re-engineering practice  </li></ul><ul><li>Crossing referral lines </li></ul><ul><li>Comfort w...
“REPORT CARD” OF TELEMEDICNE EFFECTIVENESS <ul><li>Define Desired Outcomes </li></ul><ul><ul><li>Quality Improvement </li>...
The Report Card Continued <ul><li>Disseminate Findings </li></ul><ul><ul><li>Select appropriate recipients </li></ul></ul>...
EVALUATING TELEMEDICINE
Need for Evaluation <ul><li>Administrative Justification </li></ul><ul><li>Sociological </li></ul><ul><ul><li>Consulting a...
Types of Evaluation <ul><li>Technology </li></ul><ul><li>Provider and Patient Satisfaction </li></ul><ul><li>Economic Issu...
Technology <ul><li>Image vs. Use </li></ul><ul><ul><li>Store and Forward </li></ul></ul><ul><ul><li>Human Interaction </li...
Technology <ul><li>Reliability of Technology </li></ul><ul><ul><li>Connections </li></ul></ul><ul><ul><ul><li>Ease and Rel...
Provider Satisfaction <ul><li>Comfort level with technology </li></ul><ul><li>Comfort level with process </li></ul><ul><li...
Patient Satisfaction <ul><li>Patients Follow Images </li></ul><ul><li>The Value Equation </li></ul><ul><li>Home is Where… ...
Economic Analysis of Telemedicine
4 Ways to Look at $$$ <ul><li>Managed Care Environment </li></ul><ul><li>Multi-Payer Environment </li></ul><ul><li>Alterna...
Crossing the Quality Chasm <ul><li>Application of standard quality measures to health care using a new tool </li></ul><ul>...
For More Information <ul><li>http://www.va.gov/occ/THinVA.asp </li></ul><ul><li>http:// healthit.ahrq.gov/portal/server.pt...
???  QUESTIONS  ???
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  1. 1. Telemedicine: Re-envisioning The Telephone Consultation Julie J. McGowan, Ph.D., FACMI IU School of Medicine Regenstrief Instutute
  2. 2. Coming to You through the Miracle of Modern Technology – The Telephone
  3. 3. The Consultation <ul><li>In Person </li></ul><ul><li>Letter </li></ul><ul><li>Express Delivery </li></ul><ul><li>Telegraph </li></ul><ul><li>Telephone </li></ul><ul><li>Telehealth </li></ul><ul><li>In Person, Virtually </li></ul>
  4. 4. TELEMEDICINE DEFINED <ul><li>“ ...the use of electronic information and </li></ul><ul><li>communications technologies to provide </li></ul><ul><li>and support health care when distance </li></ul><ul><li>separates the participants...” </li></ul>from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care
  5. 5. What is Telehealth? <ul><li>Video Conferencing </li></ul><ul><li>Distance Learning </li></ul><ul><li>Telemedicine </li></ul><ul><ul><li>Asynchronous – Provider to Provider </li></ul></ul><ul><ul><li>Synchronous – Provider to Patient & Provider </li></ul></ul><ul><ul><li>Synchronous – Provider to Patient </li></ul></ul>
  6. 6. Early History of Telemedicine 1950s and 1960s <ul><li>Nebraska Psychiatric Institute - UN & state mental hospital & Interact System - Dartmouth and UVM Medical Schools [Microwave] </li></ul><ul><li>STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in Arizona </li></ul><ul><li>Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites across Alaska. </li></ul>
  7. 7. WHY PROGRESS TO TELEMEDICNE
  8. 8. The Rationale <ul><li>Just-in-time Care </li></ul><ul><li>Improved Quality </li></ul><ul><li>Enhanced Efficiency </li></ul><ul><li>Better Professional Communication </li></ul><ul><li>Patient Satisfaction </li></ul><ul><li>Enlarged Catchment Area </li></ul><ul><li>Cost Savings? </li></ul>
  9. 9. Culture – Medical & <ul><li>Re-engineering practice </li></ul><ul><li>Crossing referral lines </li></ul><ul><li>Comfort with and understanding of Technology as a Tool </li></ul>There are no problems…. just insurmountable opportunities
  10. 10. “REPORT CARD” OF TELEMEDICNE EFFECTIVENESS <ul><li>Define Desired Outcomes </li></ul><ul><ul><li>Quality Improvement </li></ul></ul><ul><ul><li>Reduced Costs </li></ul></ul><ul><ul><li>Provider Satisfaction </li></ul></ul><ul><ul><li>Patient Satisfaction </li></ul></ul><ul><li>Develop Evaluation to Assess Desired Outcomes </li></ul>
  11. 11. The Report Card Continued <ul><li>Disseminate Findings </li></ul><ul><ul><li>Select appropriate recipients </li></ul></ul><ul><ul><li>Combine findings with marketing strategy </li></ul></ul><ul><li>Be Willing to Modify Program as Necessary </li></ul><ul><li>Re-Evaluate Frequently </li></ul>
  12. 12. EVALUATING TELEMEDICINE
  13. 13. Need for Evaluation <ul><li>Administrative Justification </li></ul><ul><li>Sociological </li></ul><ul><ul><li>Consulting and Referring Providers </li></ul></ul><ul><ul><li>Patients </li></ul></ul><ul><li>Political </li></ul><ul><ul><li>Patient Safety </li></ul></ul><ul><ul><li>Competitive Health Care Marketplace </li></ul></ul>
  14. 14. Types of Evaluation <ul><li>Technology </li></ul><ul><li>Provider and Patient Satisfaction </li></ul><ul><li>Economic Issues </li></ul><ul><li>Quality Improvement </li></ul>
  15. 15. Technology <ul><li>Image vs. Use </li></ul><ul><ul><li>Store and Forward </li></ul></ul><ul><ul><li>Human Interaction </li></ul></ul><ul><ul><ul><li>Patient / Provider Consultation </li></ul></ul></ul><ul><ul><ul><li>Psychiatry; Orthopedics </li></ul></ul></ul><ul><ul><li>Image Quality </li></ul></ul><ul><ul><ul><li>Color Reliability </li></ul></ul></ul><ul><ul><ul><li>Movement Artifacts </li></ul></ul></ul>
  16. 16. Technology <ul><li>Reliability of Technology </li></ul><ul><ul><li>Connections </li></ul></ul><ul><ul><ul><li>Ease and Reliability of Contact </li></ul></ul></ul><ul><ul><ul><li>Interface Standards </li></ul></ul></ul><ul><ul><li>Peripheral Equipment </li></ul></ul><ul><ul><ul><li>Quality – Digital vs. Digitized </li></ul></ul></ul><ul><ul><ul><li>Transmission Protocols </li></ul></ul></ul>
  17. 17. Provider Satisfaction <ul><li>Comfort level with technology </li></ul><ul><li>Comfort level with process </li></ul><ul><li>Comfort level with patient communication </li></ul><ul><li>Comfort level with provider interaction </li></ul><ul><li>Unanticipated Benefits </li></ul><ul><li>Unanticipated Problems </li></ul>
  18. 18. Patient Satisfaction <ul><li>Patients Follow Images </li></ul><ul><li>The Value Equation </li></ul><ul><li>Home is Where… </li></ul><ul><ul><li>Comfort issues </li></ul></ul><ul><ul><li>Environmental issues </li></ul></ul><ul><ul><li>Economic issues </li></ul></ul>
  19. 19. Economic Analysis of Telemedicine
  20. 20. 4 Ways to Look at $$$ <ul><li>Managed Care Environment </li></ul><ul><li>Multi-Payer Environment </li></ul><ul><li>Alternative Savings [Training, Patients] </li></ul><ul><li>Cost-Plus in Captive Patient Populations </li></ul>
  21. 21. Crossing the Quality Chasm <ul><li>Application of standard quality measures to health care using a new tool </li></ul><ul><li>Consider: </li></ul><ul><ul><li>QOL </li></ul></ul><ul><ul><li>Unintended Consequences </li></ul></ul><ul><ul><li>Unintended Confounders </li></ul></ul><ul><li>Grand Canyon of Research Opportunities </li></ul>
  22. 22. For More Information <ul><li>http://www.va.gov/occ/THinVA.asp </li></ul><ul><li>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 </li></ul>
  23. 23. ??? QUESTIONS ???

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