Telemedicine Defined

• Diagnosis, consultation, treatment, education and the transfer of medical data using interactive audiovisual and data communications

• Use of electronic communication and information technologies to provide or support clinical care at a distance

• Telehealth

The Progress of Telemedicine

Dennis O’Brien

ISM 6021

December 9, 2002

Health Care Revolution

• Information technology progress is not as rapid as other industries – financial and human resources deficiencies in

health care

• Most dollars are directed toward medical resources – attracting and keeping IT talent is particularly

difficult for the health care industry

Health Care Revolution

• Most medical establishments spend only 2 to 3 percent of the operations budget on IT functions – traditional attitudes about IT and care giving.

• Most now operate a public web site and intranets – 92% have informational sites on the web– 20% are participating in extranets or supply chain

networks– 15% are offering only enterprise portals

Source: Transformation of the Enterprise Survey; Internet Week, 2000.

Health Care Revolution

• Use of the Web by health care consumers will increase – WebMD and DrKoop.com

• Consumers are more likely to consult their local doctor or hospital than to seek advice online

• Opportunity for regional health care providers – Partners HealthCare System Inc

Health Care Revolution

• Don’t expect to turn a profit on their web based patient services. – to improve service to the provider’s community

• Hospitals and physicians are using web technology to communicate with one another – Amicas Inc– Second-Opinion.com

Establishing A Telemedicine Program• Successful telemedicine programs

– careful planning, – sound management, – dedicated health care professionals, support

staff– commitment to appropriate funding

Establishing A Telemedicine ProgramProgram objectives of telemedicine need to be

well defined(1) Improve access to health care

(2) Enhance a competitive position

(3) Reduce costs

Establishing A Telemedicine ProgramProgram objectives of telemedicine need to bewell defined

(1) Improve access to health care • service availability in remote or difficult to operate

environments • improving access to specialty services • Allows development of local primary care health

centers supported by regional diagnostic centers and hospitals

– State of Alaska north of the Artic Circle

Establishing A Telemedicine ProgramProgram objectives of telemedicine need to bewell defined

(2) Enhance a competitive position• Expand the sponsors market zone to increase

business opportunities • Academic medical centers to support local health

care providers• Increase loyalty of high-volume physicians, e.g.

with ease of access to data from their homes while on-call or in their practice

Establishing A Telemedicine ProgramProgram objectives of telemedicine need to be

well defined(3) Reduce costs

• home care providers

• Prisons

Technology Required

• Integration of medical devices – interface between the caregiver and the patient

• Network computing – permit the storage of data– facilitate the transfer of the desired data

• Video conferencing – transmit sound and data on a real time basis

Source: Family Practice Conference, Annual Session; Philadelphia 2000.

Technology Required

• Software issues – application software

• Device interfaces – assure the flow of information

• Telecommunications options – originating site (live vs. storage) – high bandwidth

Technology Required

• Selecting technology vendors – expertise/experience with telemedicine– provide support– firm that will be around

Can Telemedicine Deliver?

• Many projects underway– emergency telemedicine - video images, audio,

vital signs and ECG rhythm strips transmitted – Yordano - deformed skull with only one eye,

mild MR, and swallowing difficulties; met every other month through videoconferencing

– better digital stethoscopes, and haptic glove not far ahead

Telepathology Transmission

Teleradiology Transmission

Can Telemedicine Deliver?

• Northeast Maine Telemedicine Network – 22 chronic heart and lung disease, terminal

cancer – examine the patients with a camera and

transmitted stethoscope sounds as needed – problems reported by the users were minor

technical glitches

Source: Family Practice Conference, Annual Session; Philadelphia 2000.

Can Telemedicine Deliver?

• Perhaps telemedicine’s most powerful use is international – dramatically speed up the process of spreading medical knowledge.

• Example: Medical Missions has sessions in auditoriums where hundreds of doctors can hear from a US physician

The Cost of Telemedicine

• Cost– Large sponsor

• $134,378 for "spoke" sites to $287,503 for "hub"

• annual transmission costs $18,573 for spokes to $80,068 for hubs

• costs, combined with low utilization in the early years of operation, yielded high unit costs

– Small sponsor• $15000 to $50000

The Cost of Telemedicine

Capital Item

Organizational Expense Legal Consulting Accounting Personnel

Equipment Telecom Video Conferencing Medical Devices Computers Monitors/Image Display Computer - Misc. Storage Devices Miscellaneous Equip. Office Equipment Maintenance

Software Software Maintenance

Installation Telecom Video Conferencing Computer Networking Medical Devices

Training

Occupancy Land Buildings Improvements Lease Leasehold Improvements

Your Telemedicine Program

Capital Budget

Implementation Date

The Cost of Telemedicine

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10Revenue

Government Medicare Medicaid SSI Other

Insurance Fee for Service PPO HMO Worker's Comp. Auto/Casualty Other Private Pay Other

Expenses

Personnel Program Director Site Coordinator Medical Director Professional Clerical Tech Support Tech Services Training Other

Benefits Payroll Taxes - Fed. Payroll Taxes - State Payroll Taxes - Local Health/Dental Ins. Life Ins. Disability Ins. Pension Parking Other

Your Telemedicine Program

Operating Budget

The Cost of Telemedicine

• Additional personnel to the typical provider-patient encounter (engineer)

• Higher volume of data make securing the data more problematic

The Cost of Telemedicine

• Lack of guidelines and protocols can affect the safety and efficacy – technical - equipment needs to communicate

with other sites with image quality – educational – clinical practice standards - no specialty

generated standards, protocols or guidelines

The Cost of Telemedicine

• Telemedicine equipment is not as reliable– transmission must be foolproof

• Privacy– who has access to medical information and how

it is protected – unauthorized intrusion

The Cost of Telemedicine• Effectiveness of medical diagnoses

• Legal issues – Which states law governs teleconferencing

activities – Licensure – Sharing of liability in medical malpractice – Documentation

• control of the corresponding medical record

• what format (e.g., video, audio, paper, etc.)

The Cost of Telemedicine

• Reimbursement rules need to be clarified

• Joint Working Group on Telemedicine is a government-wide entity – developing specific actions to overcome

barriers to the effective use of telemedicine technologies.

Conclusion• Healthcare is in the midst of a technology

revolution, but it lags other industries.

• The are many forms of telemedicine

• Establishing a program requires thorough planning– especially cost and technologic considerations

• Many hurdles to overcome

Questions?