Telemedicine in a Rural Tertiary Care Medical Center.ppt

telemedicineafadorthefuture juliej mcgowan phdregenstriefinstituteapril2000 telemedicinedefined theuseofelectronicinformationandcommunicationstechnologiestoprovideandsupporthealthcarewhendistanceseparatestheparticipants from instituteofmedicine telemedicine aguidetoassessingtelecommunicationsinhealthcare whatistelehealth videoconferencingdistancelearningtelemedicineasynchronous providertoprovidersynchronous providertopatient providersynchronous providertopatient briefhistoryoftelemedicine late1950 snebraskapsychiatricinstituteinstallsmicrowavevideolinkbetweenundept ofpsychiatryinomahaandstatementalhospitalinnorfolk dartmouthanduvmmedicalschoolsestablishinteractsystemusingmicrowavetechnology briefhistoryoftelemedicine late1950 scont starpahc spacetechnologyappliedtoruralpapagoadvancedhealthcare programusingnasatechnologieslinkedpapagoindianreservationtopublichealthhospitalinarizona briefhistoryoftelemedicine 1960 sand1970 smicrowavelinkestablishedbetweenloganairportandmassachusettsgeneralhospitaltoservepassengers airportemployees alaskasatellitebiomedicaldemonstrationprojectusednasatechnologiestolink26sitesacrossalaska briefhistoryoftelemedicine 1980 sand1990 sdevelopmentofdifferentapplicationsatprimarilyruralsitesfacilitatedbygrowthoftelecommunicationstechnologiesandstaterebates federallegislationtelecommunicationsactof19961997balancedbudgetact hcfarules whyprogresstotelemedicne orifitworksfinenow therationale just in timecareimprovedqualityenhancedefficiencybetterprofessionalcommunicationpatientsatisfactionenlargedcatchmentareacostsavings challengesoftelemedicne culture medical sometimesifeelthat togettotheinformationhighway ineedtotakeadirtroad re engineeringpracticecrossingreferrallinescomfortwithandunderstandingoftechnologyasatool licensure wheredoesthetelemedicineconsulttakeplace multi statepracticescompactslinkingstatesifyouusealaptoptoconsultovertheweb malpractice wheredoesconsultationtakeplaceandisrelationshipbetweenphysician patientorphysiciantophysicianconsultation whoisliable referringorconsultingphysician whichsitedeterminesstandardsofcare whatabouttechnology reportcard oftelemedicneeffectiveness reportcardandtheeducationalmodel definedesiredoutcomesqualityimprovementreducedcostsreferringprovidersatisfactionpatientsatisfactiondevelopevaluationtoassessdesiredoutcomes reportcardandtheeducationalmodel disseminatefindingsselectappropriaterecipientscombinefindingswithmarketingstrategybewillingtomodifyprogramasnecessaryre evaluatefrequently evaluatingtelemedicine needforevaluation administrativejustificationsociologicalconsultingandreferringproviderspatientspoliticalpublic concompetitivehealthcaremarketplace typesofevaluation technologyproviderandpatientsatisfactioneconomicissues technology imagevs usestoreandforwardhumaninteractionpatient providerconsultationpsychiatry orthopedicsimagequalitycolorreliabilitymovementartifacts technology reliabilityoftechnologyconnectionseaseandreliabilityofcontactinterfacestandardsperipheralequipmentquality digitalvs digitizedtransmissionprotocols providersatisfaction referringproviders assess comfortlevelwithtechnologycomfortlevelwithprocesscomfortlevelwithpatientcommunicationcomfortlevelwithconsultingproviderinteractionunanticipatedbenefitsunanticipatedproblems providersatisfaction consultingproviders assess comfortlevelwithtechnologycomfortlevelwithprocesscomfortlevelwithpatientcommunication comfortlevelwithreferringproviderinteractionunanticipatedbenefitsunanticipatedproblems patientsatisfaction patientsfollowimagesthevalueequationhomeiswhere comfortissuesenvironmentalissueseconomicissues economicanalysisoftelemedicine 4waystolookat prospectiveinmanagedcareenvironmentretrospectiveinmulti payerenvironmentalternativesavings training patients cost plusincaptivepatientpopulations prospectiveinmanagedcaretele endoscopy prospectiveinmanagedcaretele endoscopy sixmonthschartreviewofendoscopicproceduresintertiarycarecenter tcc determinationofpreferablelocusofproceduresincapitatedmarketappropriatelyreferredtotccinitiallydoneattcc couldbedoneatlocalsiteunnecessaryrepetitionofprocedureattcc tele endoscopystudydesign determinationofcostofproceduretertiarycarecenterruralsite pcofficeorlocalhospital costoftelecommunicationsamortizationofequipmentendoscopisttimementoringtimesavingsontraveltime missedappointment formulaforprojectedsavingsfortele endoscopy actualcurrentendoscopycostsless costsavingsfromproceduresdonelocallycostsavingsfromproceduresnotrepeatedcostsavingsofendoscopyspecialisttimetravelmissedappointmentsaddcostsoftelemedicine equipment linecharges endoscopisttime tele endoscopy realdatasixmonthsprojectedsavings 27 381savingsonlocallydoneprocedures 44 438savingsonsingleprocedures 5 563savingsontravel missedappts 9 930costsoftelecommunications 4 775costsofequipmentamortization 9 625costsofendoscopisttime6mos projectedsavingsof 68 962 retrospectivewithmulti payersvascularsurgery retrospectivewithmulti payersvascularsurgery telemedicinestudyassumptions patientsavings travel childcare lostworktime notaccountedforinmodelcostssuchasmileageandindirectcostsnotincludedinanalysessavingsnotequivalenttorevenuegenerated vascularsurgerytelemedicinecosts realdata systemcost 11 000eachmonthlyisdn vt 375persitemonthlyisdn ny 90persitetel commcharges 50perhourtechsupport 35 000peryearprovidertime 50 150perhouroutreachtraveltime 1 4hours vascularsurgery realdatatelemedicinefindings 26months107telemedicineuseseducationalconferences 4 3 7 clinicaluses 103 96 3 8externalsites 4ny 4vt 1fahcsite14 2 ofalltelemedicinesystemuses30 6 ofallclinicaluses vascularsurgerytelemedicineclinicaluse realdata vascularaccessf u45 42 1 follow upvisits42 39 3 x rayreview10 9 3 consults3 2 8 emergencyevaluation2 1 9 real timesurgery1 0 9 vascularsurgery realdata26monthscostanalysis expenses103clinicalusesoftelemedicine 14 oftotal 33 976 telecommunications equipment etc savings87clinicalvisits 3consultations 35 413 personnelcosts vascularsurgerytelemedicinesummary savingsaccrueprimarilyasaresultofdecreasedneedforphysiciantravel break even forvascularsurgeryuseoftelemedicineat 2years surgicalfollow upsdonotgenerateadditionalrevenue thussavingsmaybemoreappropriateevaluationtool alternativesavingstele dialysis alternativesavingstele dialysis realdata 2externaldialysisunits 1fahcsite9usesinaone monthauditperiodeducational administrative 4technicaltroubleshooting 3clinicaluses 216 ofalltelemedicinesystemsusessamerealcostsusedinvascularsurgery tele dialysisprojections realdata 3externaldialysisunitsinruralareasextrapolatedusetoone yearperiodeducational administrative 72technicaltroubleshooting 54clinicaluses 36withouttelemedicinesystem eachoftheabovewouldrequirein personvisitstoeachofthreesites tele dialysis12monthcostanalysis realdata expenses162usesoftelemedicine 16 oftotal 38 020 telecommunications equipment etc savings 34 200 personnelcosts tele dialysispatientsavings realdata externaldialysisunitssavepatienttravel3timesweekly savingsingas 1 15pergallon is 182 85perweekor 9 508peryear additionalsavingsforpatientsaccruedinlowerfoodcosts lesslossofworktime tele dialysistelemedicinesummary projected break even pointfortele dialysiswiththreeexternaldialysisunitsis 14months dialysiscareiscapitatedbymedicaresorevenuesarenotgeneratedbyin personvisitsorlostbytelemedicineuse telemedicinetimeandtravelsavingsallowmoreefficientdeliveryofcare tele dialysistelemedicinesummarycont providertrainingandsupportcostscanbeminimizedthroughtelemedicineuse inchronicdisease qualityoflifeissues includingcostsavingstopatients mustbeweighedagainstactualcostoftelemedicineuse captivepatientpopulations prisonsnursinghomesemergencyroomsmilitary prisontelemedicine captivepatientpopulationcontractsnegotiatedon personnel out of pocket andamortizedcostsqualityofprogramreasonablenessofofferingbasedonneedsofcontractinginstitutionabilitytogarner extra benefitsforbothofferingagencyandcontractors nursinghometelemedicine on demandpatientpopulationsupportcontractsnegotiatedon personnel out of pocket andamortizedcostsoftenminimalstaffing technologyrequirementsqualityofprogram value addedreasonablenessofofferingbasedonneedsofbothofferingandcontractinginstitutions emergencyroomtelemedicine on demand captivepatientpatientcontractsnegotiatedon personnel out of pocket andamortizedcostsofferingbasedonlinkingemergencyroomsspecialiststooff sitepatientsabilitytogarner extra benefitsforemsofferemergencycriticalcarestabilizepatientspriorto duringtransport militarytelemedicine captivepatientpopulationrefertoprisontelemedicinenocontracts federallyfundedanddirected pushingfrontiers inspace underoceans onbattlefield samebasicprecepts provideremotepatientswithhighestqualitymedicalcare reimbursementup