Post on 23-Apr-2018
Telemedicine: Re-Telemedicine: Re-envisioning The Telephone envisioning The Telephone
Consultation Consultation Julie J. McGowan, Ph.D., FACMIJulie J. McGowan, Ph.D., FACMI
IU School of MedicineIU School of MedicineRegenstrief InstututeRegenstrief Instutute
Coming to You through the Coming to You through the Miracle of Modern Technology – Miracle of Modern Technology –
The TelephoneThe Telephone
The ConsultationThe Consultation In PersonIn PersonLetterLetterExpress DeliveryExpress DeliveryTelegraphTelegraphTelephoneTelephoneTelehealthTelehealth In Person, VirtuallyIn Person, Virtually
TELEMEDICINE DEFINEDTELEMEDICINE DEFINED
““...the use of electronic information ...the use of electronic information and and
communications technologies to communications technologies to provide provide
and support health care when and support health care when distance distance
separates the participants...”separates the participants...”from: Institute of Medicine: Telemedicine: A Guide to Assessing Telecommunications in Health Care
What is Telehealth?What is Telehealth?Video ConferencingVideo ConferencingDistance LearningDistance LearningTelemedicineTelemedicine
Asynchronous – Provider to ProviderAsynchronous – Provider to ProviderSynchronous – Provider to Patient & Synchronous – Provider to Patient &
ProviderProviderSynchronous – Provider to PatientSynchronous – Provider to Patient
Early History of TelemedicineEarly History of Telemedicine1950s and 1960s1950s and 1960s
Nebraska Psychiatric Institute - UN & state Nebraska Psychiatric Institute - UN & state mental hospital & Interact System - Dartmouth mental hospital & Interact System - Dartmouth and UVM Medical Schools [Microwave]and UVM Medical Schools [Microwave]
STARPAHC [Space Technology Applied to Rural STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Indian Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in ArizonaReservation & Public Health Hospital in Arizona
Alaska Satellite Biomedical Demonstration Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites Project used NASA technology to link 26 sites across Alaska.across Alaska.
The RationaleThe Rationale Just-in-time CareJust-in-time Care Improved QualityImproved QualityEnhanced EfficiencyEnhanced EfficiencyBetter Professional CommunicationBetter Professional CommunicationPatient SatisfactionPatient SatisfactionEnlarged Catchment AreaEnlarged Catchment AreaCost Savings?Cost Savings?
Culture – Medical &Culture – Medical & Re-engineering practice Re-engineering practice Crossing referral linesCrossing referral lines Comfort with and understanding of Comfort with and understanding of
Technology as a ToolTechnology as a Tool
There are no problems….There are no problems….just insurmountable just insurmountable opportunitiesopportunities
““REPORT CARD” OFREPORT CARD” OFTELEMEDICNE TELEMEDICNE
EFFECTIVENESSEFFECTIVENESSDefine Desired OutcomesDefine Desired Outcomes
Quality ImprovementQuality ImprovementReduced CostsReduced CostsProvider SatisfactionProvider SatisfactionPatient SatisfactionPatient Satisfaction
Develop Evaluation to Assess Develop Evaluation to Assess Desired OutcomesDesired Outcomes
The Report Card ContinuedThe Report Card ContinuedDisseminate FindingsDisseminate Findings
Select appropriate recipientsSelect appropriate recipientsCombine findings with marketing Combine findings with marketing
strategystrategyBe Willing to Modify Program as Be Willing to Modify Program as
NecessaryNecessaryRe-Evaluate FrequentlyRe-Evaluate Frequently
Need for EvaluationNeed for EvaluationAdministrative JustificationAdministrative JustificationSociologicalSociological
Consulting and Referring ProvidersConsulting and Referring ProvidersPatientsPatients
PoliticalPoliticalPatient SafetyPatient SafetyCompetitive Health Care MarketplaceCompetitive Health Care Marketplace
Types of EvaluationTypes of EvaluationTechnologyTechnology
Provider and Patient SatisfactionProvider and Patient Satisfaction
Economic IssuesEconomic Issues
Quality ImprovementQuality Improvement
TechnologyTechnologyImage vs. UseImage vs. Use
Store and ForwardStore and ForwardHuman InteractionHuman Interaction
Patient / Provider ConsultationPatient / Provider ConsultationPsychiatry; OrthopedicsPsychiatry; Orthopedics
Image QualityImage QualityColor ReliabilityColor ReliabilityMovement ArtifactsMovement Artifacts
TechnologyTechnologyReliability of TechnologyReliability of Technology
ConnectionsConnectionsEase and Reliability of ContactEase and Reliability of ContactInterface Standards Interface Standards
Peripheral EquipmentPeripheral EquipmentQuality – Digital vs. DigitizedQuality – Digital vs. DigitizedTransmission ProtocolsTransmission Protocols
Provider SatisfactionProvider Satisfaction Comfort level with Comfort level with
technologytechnology Comfort level with Comfort level with
processprocess Comfort level with Comfort level with
patient communicationpatient communication Comfort level with Comfort level with
provider interactionprovider interaction Unanticipated BenefitsUnanticipated Benefits Unanticipated ProblemsUnanticipated Problems
Patient SatisfactionPatient SatisfactionPatients Follow ImagesPatients Follow ImagesThe Value EquationThe Value EquationHome is Where…Home is Where…
Comfort issuesComfort issuesEnvironmental issuesEnvironmental issuesEconomic issuesEconomic issues
4 Ways to Look at $$$4 Ways to Look at $$$ Managed Care Managed Care
EnvironmentEnvironment Multi-Payer Multi-Payer
EnvironmentEnvironment Alternative Savings Alternative Savings
[Training, Patients][Training, Patients] Cost-Plus in Cost-Plus in
Captive Patient Captive Patient PopulationsPopulations
Crossing the Quality ChasmCrossing the Quality ChasmApplication of standard quality Application of standard quality
measures to health care using a new measures to health care using a new tooltool
Consider:Consider:QOLQOLUnintended ConsequencesUnintended ConsequencesUnintended ConfoundersUnintended Confounders
Grand Canyon of Research Grand Canyon of Research OpportunitiesOpportunities
For More InformationFor More Informationhttp://www.va.gov/occ/THinVA.asphttp://www.va.gov/occ/THinVA.asp
http://http://healthit.ahrq.gov/portal/server.pt?ophealthit.ahrq.gov/portal/server.pt?openen=514&objID=5554&mode=2&holder=514&objID=5554&mode=2&holderDisplayURL=http://prodportallb.ahrq.DisplayURL=http://prodportallb.ahrq.gov:7087/publishedcontent/publish/cgov:7087/publishedcontent/publish/communities/k_o/knowledge_library/keommunities/k_o/knowledge_library/key_topics/health_briefing_0124200612y_topics/health_briefing_01242006121308/telemedicine.html1308/telemedicine.html