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

2. Case Hospital Structure
Partners HealthCare
MGH
BWH +

3. 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.

4. 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.

5. 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

6. 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

7. 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.

8. 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

9. 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?

10. 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?

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

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

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