The Archway . . . to Telemedicine

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The Archway . . . to Telemedicine
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What is Telemedicine?

• . . . the use of electronic information and
  communications technologies to provide and
  support health care when distance separates the
  participants.
• Institute of Medicine, 1996

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Telemedicine

• Background
• Applications
• Benefits and Challenges
• Research
• Conclusions
• Recommendations

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Background
The evidence suggest that the concept dates to
1924.
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Coldeways Quadrants
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Quadrants Defined

• ST/SP
• Same Time/Same Place
• DT/SP
• Different Time/Same Place
• ST/DP
• Same Time/Different Place
• DT/DP
• Different Time/Different Place

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Who
is involved with telemedicine?
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Telemedicine Networks
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Telemedicine Applications
1. Remote Consultation 2. Remote Monitoring
3. Remote Education 4.
Telementoring
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1. Remote Consultation
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Video Clip 1
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1.a Telepsychiatry
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1.b. Telemedicine for Children with Disabilities
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2. Remote Monitoring
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Video Clip 2
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2.a Collaboration
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2.b Access to Information
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3. Remote Education
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Video Clip 3
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4. Telementoring
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Video Clip 4
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When
do we use telemedicine?
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When do we use telemedicine?

• Maldistribution of health resources urban and/or
  rural
• Capitated populations
• Access
• Distance/Time/Travel
• Patients and Families
• Outreach Physician
• Isolation of Provider
• National/International

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When do we NOT use telemedicine?
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Telemedicine Benefits and Challenges
It is an amazing invention, but who would ever
want to use one
Rutherford Hayes, 1882 on the using telephone
for the first time
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Trends

• Market place reform/managed care
• Shifting site of care HospitalgtClinicgtHome
• Case Management/Team Care
• Improved communications between provider and
  patient
• Health care practices and affiliations
• Digital convergence

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Benefits Patient Perspective

• Access Time, Travel, Expense
• Health Provider Collaboration
• Enhanced Communications
• TV Computer Applications common and
  non- threatening
• Added attention may enhance confidence that all
  that can be done is being done

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BenefitsProvider Perspective

• Communication/Collaboration with specialists
• ER front-line support
• CME/Life Long Learning
• Saves time, travel to outreach clinics

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Challenges

• Lack of reimbursement
• Licensing and Credentialing issues
• Liability
• Privacy
• Infrastructure
• End-user Issues

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Recommendations

• Conduct a comprehensive telemedicine
  audit/assessment
• Explore Financial Issues
• Develop a short, mid and long range telemedicine
  plan
• Build training initiatives
• Systematic implementation of plan

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Audit and Assessment

• Medical Services Data
• Descriptive elements
• Current Services
• Current technologies
• Service Opportunities/Needs
• Miscellaneous Observations/Comments

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Financial Issues

• Program Budgets
• Finding Funds
• Maximizing Investments
• Measuring Intangibles

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The Plan

• Clarifying Goals
• Prioritizing Objectives
• Policies and Procedures
• Operational Issues
• Personnel

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Training is essential!
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Video Clip 5 A Typical Telemedicine System
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Mere Vehicles

• Telemedicine and information technologies are
  mere vehicles that permit the delivery of health
  care services but which have no greater impact on
  health care than the truck that delivers our
  groceries has on our nutrition. It is the
  content of the vehicle that permits effective
  health care, not the vehicle.