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The Archway . . . to The Archway . . . to TelemedicineTelemedicine

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What is Telemedicine?What is Telemedicine?

. . . the use of electronic . . . the use of electronic information and communications information and communications technologies to provide and support technologies to provide and support health care when distance separates health care when distance separates the participantsthe participants..

Institute of Medicine, 1996Institute of Medicine, 1996

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TelemedicineTelemedicine

• BackgroundBackground• ApplicationsApplications• Benefits and Benefits and

ChallengesChallenges• ResearchResearch• ConclusionsConclusions• RecommendationsRecommendations

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BackgroundBackground

The evidence suggest that the conceptdates to 1924.

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Coldeway’s QuadrantsColdeway’s Quadrants

STST

SPSPDTDT

SPSPSTST

DPDPDTDT

DPDP

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Quadrants DefinedQuadrants Defined

• ST/SPST/SP– Same Time/Same PlaceSame Time/Same Place

• DT/SPDT/SP– Different Time/Same PlaceDifferent Time/Same Place

• ST/DPST/DP– Same Time/Different PlaceSame Time/Different Place

• DT/DPDT/DP– Different Time/Different PlaceDifferent Time/Different Place

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Who…Who…

… is involved with telemedicine?

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Telemedicine NetworksTelemedicine Networks

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Telemedicine ApplicationsTelemedicine Applications

1. Remote Consultation

2. Remote Monitoring

3. Remote Education

4. Telementoring

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1. Remote Consultation1. Remote Consultation

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Video Clip #1

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1.a Telepsychiatry1.a Telepsychiatry

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1.b. Telemedicine for Children 1.b. Telemedicine for Children with Disabilitieswith Disabilities

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2. Remote Monitoring2. Remote Monitoring

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Video Clip #2

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2.a Collaboration2.a Collaboration

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2.b Access to Information2.b Access to Information

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3. Remote Education3. Remote Education

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Video Clip #3

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4. Telementoring4. Telementoring

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Video Clip #4

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When…When…

…do we use telemedicine?

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When do we use telemedicine?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 When do we ‘NOT’ use telemedicine?telemedicine?

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Telemedicine Telemedicine Benefits and ChallengesBenefits 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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TrendsTrends

•Market place reform/managed care

•Shifting site of care Hospital>Clinic>Home

•Case Management/Team Care

•Improved communications between provider and patient

•Health care practices and affiliations

•Digital convergence

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Benefits Benefits Patient PerspectivePatient 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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BenefitsBenefitsProvider PerspectiveProvider Perspective

•Communication/Collaboration with specialists

•ER ‘front-line’ support

•CME/Life Long Learning

•Saves time, travel to outreach clinics

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ChallengesChallenges

• Lack of reimbursementLack of reimbursement• Licensing and Credentialing issuesLicensing and Credentialing issues• LiabilityLiability• PrivacyPrivacy• InfrastructureInfrastructure• End-user IssuesEnd-user Issues

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RecommendationsRecommendations

• Conduct a comprehensive telemedicine Conduct a comprehensive telemedicine audit/assessmentaudit/assessment

• Explore Financial Issues Explore Financial Issues • Develop a short, mid and long range Develop a short, mid and long range

telemedicine plantelemedicine plan• Build training initiativesBuild training initiatives• Systematic implementation of planSystematic implementation of plan

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Audit and AssessmentAudit and Assessment

• Medical Services DataMedical Services Data– Descriptive elementsDescriptive elements– Current ServicesCurrent Services– Current technologiesCurrent technologies

• Service Opportunities/NeedsService Opportunities/Needs• Miscellaneous Miscellaneous

Observations/CommentsObservations/Comments

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Financial IssuesFinancial Issues

• Program BudgetsProgram Budgets• Finding FundsFinding Funds• Maximizing InvestmentsMaximizing Investments• Measuring IntangiblesMeasuring Intangibles

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The PlanThe Plan

• Clarifying GoalsClarifying Goals• Prioritizing ObjectivesPrioritizing Objectives• Policies and ProceduresPolicies and Procedures• Operational IssuesOperational Issues• PersonnelPersonnel

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Training is essential!Training is essential!

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Video Clip #5 : A Typical Telemedicine System

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Mere VehiclesMere Vehicles

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