A Telemedicine Opportunity or a Distraction? By Janis L. Gogan, Bentley University Monica J. Garfield, Bentley University

Case Hospital Structure Partners HealthCare MGH BWH +

Model, Goal and IS Strategy Model: A medical research, teaching and service provider Goal: to enhance medical service quality by distributing and implementing their research and development findings IS Strategy: to extend telemedicine services to hospitals for providing consultations or other medical services over distances. Actual IS implementation: Telestroke service in PH spoke hospitals This part belongs to pre-implementation evaluation.

Value Chain Model for Spoke Hospital Support Activities: Hospital Administration; Accounting and financial; Procurement; Research and Development; Human Resource Management Primary Activities: Inbound logistics/physician referrals -> Pre-stage patient engagement and categorization -> During-stage in-depth diagnosis and treatment -> Prescription of Medication -> (Outbound logistics) -> Post-stage follow-up A good model figure is required.

Needs for Telestroke State requirement for 24/7 availability of acute stroke services Lack of stroke neurology coverage in spoke hospitals for 24/7, weekend, or night. To save lives and to speed stroke victims’ recovery To make emergency stroke care effective To identify whether the patients could be treated with tPA; Please use the provided table structure for your analysis. This part is a logic continuation of the value chain analysis

Technical and Process Issues MGH’s complex and aging IT infrastructure Heterogeneity of spoke hospitals’ clinical databases and applications Incompatibility among spoke clinical systems Incomplete internal integration at MGH -> re-keying of some patent data that were already maintained in other databases

Components of Telestroke system Hardware: video conferencing equipment, mobile monitor, camera, DICOM (Digital Imaging and communications in Medicine), etc. Software: Browser-based TeleStroke app, with additional decision support, clinical reporting and other functions Data: patient database, data repository of radiology images Procedures: implementation methodology, standards, and procedures of use People: implementation team (Drs. Schwamm, Farrell, full-time software app specialist, two full-time technicians two other employees, and a part-timer), users (hub neurologists, EPs, super users, and others.

TeleStroke Implementation Pilot testing of TeleStroke services for remote consultation at Martha’s Vineyard Hospital Development of implementation methodology and standards for spoke hospitals (MGH) Spoke hospitals (27) purchase video conferencing equipment Treatment room wired for both Internet and ISDN, and some for wireless connections Partners provided advice and training (networking, lighting, video cart placement, uses, etc.) Multi-user support and multiple ports Training of EPs and nurses about using tPA Redesign the system to send CT scans to TeleStroke server first A weekly test of the image transfer system and the videoconferencing system

Cost Analysis (Tangible and Intangible) This is part of the post-implementation analysis Funding from …. Costs for hiring one full-time software development specialist, two full-time technical professionals, three other employees, Shawn Farrell – Executive director, Dr. Schamms (part-time) – medical director, another part-time employee (Figure 11-2, search the Web) Costs for video-conferencing equipment (could be a mobile video conference console for less than $10,000), a mobile monitor, well developed networking system accessing the wired or wireless Internet Cost for training “super users” Cost for training emergency physicians and nurses Any others?

Benefit Analysis (Tangible and Intangible) This is part of the post-implementation analysis $10,000 for a “book” of ten pre-paid TeleStroke consultations Option of additional blocks of five pre-paid TeleStroke consultations Additional fees for tech support and training Efficiency of using TeleStroke services were gained over time Page 4, “As of 2011, ……” convenience, efficiency, mobility, effectiveness, etc... An overall question to ask - How does TeleStroke service improve the value chain operations in a spoke hospital?

Implications of the TeleStroke Implementation Please choose a perspective For healthcare institutions For MIS field For MIS education

Recommendations for A Better Solution Please choose a perspective Pick a most obvious weakness to analyze Make one recommendation with expected results

Please use APA style for all the citations in the text and the reference list at the end.