1. Telemedicine: Re-envisioning The Telephone Consultation
Julie J. McGowan, Ph.D., FACMI
IU School of Medicine
Regenstrief Instutute

2. Coming to You through the Miracle of Modern Technology – The Telephone

3. The Consultation In Person Letter Express Delivery Telegraph Telephone
Telehealth
In Person, Virtually

4. TELEMEDICINE DEFINED communications technologies to provide
“...the use of electronic information and
communications technologies to provide
and support health care when distance
separates the participants...”
from: Institute of Medicine: Telemedicine: A Guide
to Assessing Telecommunications in Health Care

5. What is Telehealth? Video Conferencing Distance Learning Telemedicine
Asynchronous – Provider to Provider
Synchronous – Provider to Patient & Provider
Synchronous – Provider to Patient

6. Early History of Telemedicine 1950s and 1960s
Nebraska Psychiatric Institute - UN & state mental hospital & Interact System - Dartmouth and UVM Medical Schools [Microwave]
STARPAHC [Space Technology Applied to Rural Papago Advanced Health Care - Papago Indian Reservation & Public Health Hospital in Arizona
Alaska Satellite Biomedical Demonstration Project used NASA technology to link 26 sites across Alaska.

7. WHY PROGRESS TO TELEMEDICNE

8. The Rationale Just-in-time Care Improved Quality Enhanced Efficiency
Better Professional Communication
Patient Satisfaction
Enlarged Catchment Area
Cost Savings?

9. Culture – Medical & Re-engineering practice Crossing referral lines
Comfort with and understanding of Technology as a Tool
There are no problems….
just insurmountable opportunities

10. “REPORT CARD” OF TELEMEDICNE EFFECTIVENESS
Define Desired Outcomes
Quality Improvement
Reduced Costs
Provider Satisfaction
Patient Satisfaction
Develop Evaluation to Assess Desired Outcomes

11. The Report Card Continued
Disseminate Findings
Select appropriate recipients
Combine findings with marketing strategy
Be Willing to Modify Program as Necessary
Re-Evaluate Frequently

12. EVALUATING TELEMEDICINE

13. Need for Evaluation Administrative Justification Sociological
Consulting and Referring Providers
Patients
Political
Patient Safety
Competitive Health Care Marketplace

14. Types of Evaluation Technology Provider and Patient Satisfaction
Economic Issues
Quality Improvement

15. Technology Image vs. Use Store and Forward Human Interaction
Patient / Provider Consultation
Psychiatry; Orthopedics
Image Quality
Color Reliability
Movement Artifacts

16. Technology Reliability of Technology Connections Peripheral Equipment
Ease and Reliability of Contact
Interface Standards
Peripheral Equipment
Quality – Digital vs. Digitized
Transmission Protocols

17. Provider Satisfaction
Comfort level with technology
Comfort level with process
Comfort level with patient communication
Comfort level with provider interaction
Unanticipated Benefits
Unanticipated Problems

18. Patient Satisfaction Patients Follow Images The Value Equation
Home is Where…
Comfort issues
Environmental issues
Economic issues

19. Economic Analysis of Telemedicine

20. 4 Ways to Look at $$$ Managed Care Environment Multi-Payer Environment
Alternative Savings [Training, Patients]
Cost-Plus in Captive Patient Populations

21. Crossing the Quality Chasm
Application of standard quality measures to health care using a new tool
Consider:
QOL
Unintended Consequences
Unintended Confounders
Grand Canyon of Research Opportunities

22. For More Information http://www.va.gov/occ/THinVA.asp

23. ??? QUESTIONS ???