The Archway . . . to Telemedicine

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

TelemedicineBackgroundApplicationsBenefits and ChallengesResearchConclusionsRecommendations

Background

The evidence suggest that the conceptdates to 1924.

Coldeways Quadrants

STSPDTSPSTDPDTDP

Quadrants DefinedST/SPSame Time/Same PlaceDT/SPDifferent Time/Same PlaceST/DPSame Time/Different PlaceDT/DPDifferent Time/Different Place

Who is involved with telemedicine?

Telemedicine Networks

Telemedicine Applications1. Remote Consultation2. Remote Monitoring 3. Remote Education 4. Telementoring

1. Remote Consultation

Video Clip #1

1.a Telepsychiatry

1.b. Telemedicine for Children with Disabilities

2. Remote Monitoring

Video Clip #2

2.a Collaboration

2.b Access to Information

3. Remote Education

Video Clip #3

4. Telementoring

Video Clip #4

Whendo we use telemedicine?

When do we use telemedicine?Maldistribution of health resources urban and/or ruralCapitated populationsAccessDistance/Time/TravelPatients and FamiliesOutreach PhysicianIsolation of ProviderNational/International

When do we NOT use telemedicine?

Telemedicine Benefits and ChallengesIt is an amazing invention, but who would ever want to use oneRutherford Hayes, 1882 on the using telephone for the first time

TrendsMarket place reform/managed careShifting site of care Hospital>Clinic>HomeCase Management/Team CareImproved communications between provider and patientHealth care practices and affiliationsDigital convergence

Benefits Patient PerspectiveAccess: Time, Travel, ExpenseHealth Provider CollaborationEnhanced CommunicationsTV & Computer Applications common and non-threateningAdded attention may enhance confidence that all that can be done is being done

BenefitsProvider PerspectiveCommunication/Collaboration with specialistsER front-line supportCME/Life Long LearningSaves time, travel to outreach clinics

ChallengesLack of reimbursementLicensing and Credentialing issuesLiabilityPrivacyInfrastructureEnd-user Issues

RecommendationsConduct a comprehensive telemedicine audit/assessmentExplore Financial Issues Develop a short, mid and long range telemedicine planBuild training initiativesSystematic implementation of plan

Audit and AssessmentMedical Services DataDescriptive elementsCurrent ServicesCurrent technologiesService Opportunities/NeedsMiscellaneous Observations/Comments

Financial IssuesProgram BudgetsFinding FundsMaximizing InvestmentsMeasuring Intangibles

The PlanClarifying GoalsPrioritizing ObjectivesPolicies and ProceduresOperational IssuesPersonnel

Training is essential!

Video Clip #5 : A Typical Telemedicine System

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.