Adopting New Technology Into Society: Going From an Idea to an Institution Michael J. Ackerman, Ph.D. Assistant Director High Performance Computing and Communications National Library of Medicine

Telemedicine Using telecommunications and computers to provide information to support medical decision making Medical Records Literature search Decision support Consultation and Conferencing

TELEMedicine:

Telemedicine and Telecommunications: Options for the New Century March 13-14, 2001 Natcher Conference Center

Beth Israel Deaconess Medical Center, Boston, MA Baby CareLink

Video house calls for patients with special needs National Laboratory for the Study of Rural Telemedicine, University of Iowa, Iowa City, IA

University of Alaska at Anchorage, Anchorage, AK

Lessons Learned: Patient’s view Acceptable to patient Satisfied with encounters, perception of better quality of healthcare encounter More personal responsibility for healthcare Ploy by HMO to prevent referral to specialist

Lessons Learned: Payor’s view Unanticipated social and economic barriers Cost “savings” is based on method of cost accounting Lack of equipment and communications standards Patient demand, as a market force, will drive adoption of telemedicine No business plan to support telemedicine after grant is completed Healthcare system must adapt in order to benefit from the immediacy and quick turn-around afforded by telemedicine

Telemedicine and Home Healthcare September , 2003 Ft. Lauderdale, FL

Types of telehome health care Three types of modalities –data only –video/audio only –video/audio and data

Current findings: Patient’s / Client’s view Acceptable to patient –Study after study demonstrates positive perceptions Satisfied with system –Perception of better quality and more caring –Feeling of greater independence and confidence Feeling of more personal responsibility for healthcare

Current findings: Provider’s view Nurses’ responses - cautious enthusiasm: –Significant learning curve among nurses –Comfort and ease with technology will come with time (Dansky and Bowles, 2002) Providers may actually be the most significant barrier to diffusion of telehome health Providers tend to be predisposed to avoid the use of telehome health equipment (Whitten, Doolittle, Mackert & Rush, in press)

Current findings: Payor’s view Cost “savings” –based on how cost accounting is applied –must be realized within reporting period Problems with interoperability of equipment Last mile problems - POTS is the common denominator –most equipment designed for 33 kbit channel Patient and family demand, as a market force, will drive adoption of home telehealth Healthcare system must better integrate telehealth model into the care model

Telemedicine People: Patients Providers Payers

“Well, says it’s just a virus, but I came to you for a second opinion.”

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