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Technology Needs In Telemedicine Rick Craft Lead, Telemedicine Reference Architecture Project Principal Member of the Technical Staff Sandia National Labs.

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Presentation on theme: "Technology Needs In Telemedicine Rick Craft Lead, Telemedicine Reference Architecture Project Principal Member of the Technical Staff Sandia National Labs."— Presentation transcript:

1 Technology Needs In Telemedicine Rick Craft Lead, Telemedicine Reference Architecture Project Principal Member of the Technical Staff Sandia National Labs

2 Telemedicines Past and Immediate Future First WaveSecond WaveThird Wave Timeframe Emphasis Scope Nature 60s-70s Early 90s to present Coming decade Feasibility Clinical Development Industrialization Very limited Fringe populations Mainstream Care Delivery Video links+ Instrumentation+ Informatics Telemedicine is still young and evolving. Maturing it fully will require vision and deliberate attention to the technical foundations on which it rests.

3 Telemedicine Is About More Than Distance Control Status Clinical Data Stimuli Observables Clinical Device Assessment Plan Doctor Patient Traditional Encounter Control Status Clinical Data Stimuli Observables Patient Station Clinical Data Doctor Station Assessment Plan Order Patient Doctor Aide Teleconsultation Stimuli Observables Smart Patient Station Control Status Doctor Station Assessment Plan Assessment Patient Doctor Automated Assessment

4 Telemedicine Technology State of Affairs Systems are too expensive to enable wide-spread diffusion Systems from independent vendors do not interoperate What can be done over the wire falls far short of what can be done in face-to-face encounters Most systems are sold as turnkey capabilities that are not easily customized to meet end user-specific needs Reliance on COTS devices designed for traditional clinical environments limits range of settings in which systems can be used This Way To Anywhere, Anytime UbiquityCapabilityAffordability

5 Key Telemedicine Technology Needs Less expensive Usable in more places by broader range of people Rich set of clinical capabilities Integration with EHRs A New Generation Of Devices Interoperability Mechanisms for Knowledge Diffusion Vendor neutral station-to-station Plug-and-play devices Dynamic federation of distributed components Self-configuring Self-calibrating Education and training for non- traditional actors Tech-embedded, process-specific decision aides Intelligent devices Standardized user interfaces to allow portability of skills Addressing healthcare delivery from a systems perspective Greatest Need

6 Improving Healthcare Delivery Is A Systems Problem Healthcare systems are complex Their performance (cost, access, outcomes, etc.) is affected by many factors –Delivery system organization –Business and clinical processes –External policies and financing –Geography and demography –Technology Small perturbations can yield big changes –Finding the good ones and avoiding the bad can be challenging People Knowledge Geography Laws & Policies Payers Business Processes Facilities Clinical Processes Resources Tools Diseases/ Conditions

7 It Must Involve Both Optimization And Transformation Reengineering Systems Thinking Transformation of Care Delivery Optimization of Care Delivery Current Care Current Care Delivery System Delivery System Current Care Current Care Delivery System Delivery SystemRedesigned Care Delivery SystemRedesigned System Fully Optimized Version of Current Delivery System Fully Optimized Version of Current Delivery System Fully Optimized, Redesigned Care Delivery Structures And Processes Fully Optimized, Redesigned Care Delivery Structures And Processes Quality This sentiment is echoed in the recent IOM/NAE report on the role of engineering in healthcare

8 Optimization Approaches Have Their Limits Fords Woodhaven Stamping Plant Performance Status Assessment Total Overhead Total Product MNT Inventory Reduction Ergonomics Productivity/Yield Hit-to-Hit Training Safety Organizational Dev. Material Utilization Quality Systems Initial Condition = 0 World Class Performance = 10 1 st Survey (4/90) 2 nd Survey (11/91) d ab c AB D C Using Up Slack Among Independent Variables From Systems Thinking by Jamshid Gharajedaghi From Systems Thinking by Jamshid Gharajedaghi

9 Why Is This Important? Courtesy of Kaiser Research and HealthTech Age Distribution of the US Population Source: 2000 US Census 0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000 35,000,000 40,000,000 45,000,000 50,000,000 under 5 5 to to 2425 to 3435 to 4445 to 5455 to 6465 to 7475 to and over Age (in deciles) Population Age groups where care burden is greatest Current workforce shortages pose difficulty with care burden at this level Population shift will increase care burden Big problems at this level !! We have four choices: Reduce demandReduce demand Raise premiums / taxesRaise premiums / taxes Limit benefitsLimit benefits Extract more valueExtract more value

10 Clinical Trials Healthcare System Modeling and Analysis Engineering & Informatics R&D Requirements/Specs for new devices & other components Devices and other components for clinical evaluation New care delivery concepts New products to market Education methods to be evaluated Healthcare Education Research findings Proposed regulatory & financial approaches Policy & Finance Development New care delivery concepts New education methods New policy & finance environment Requirements for new drugs The National Healthcare Delivery Sciences Program Mission: Identify high-payoff care delivery conceptsIdentify high-payoff care delivery concepts Develop resources needed to implement these conceptsDevelop resources needed to implement these concepts Promulgate supporting policiesPromulgate supporting policies Vision: A science of healthcare delivery as advanced as our science of medicine

11 Final Thoughts The medical establishment is not currently equipped to address this final problem –A partnership between medicine, engineering, law, business, economics, social sciences, and other disciplines is required No entity currently owns the problem –Not NIH, NSF, DoD, DOE, nor any private concerns This work could be birthed at the local level and then raised at the national –Workshops / pilot initiatives would help provide insights needed to engender a national dialog If successfully cultivated, healthcare delivery science will necessarily drive industry


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