Hosted by Department of Management Services, August 28, 1998, Tallahassee, FL
Computers, people, information on the Network - but work processes have not changed very much.
Telehealth - improve the general health of population through information technology.
Local/Remote/Asynch/Sync Matrix
Objectives for Telemed
Nemours specialists are spending more time interpreting information brought in by parents and less time working directly with the patient.
Cost is not the same as "charges" or "collections." Must include subsidies!
Georgia system did not include free telephone network.
Benefits for whom?
Telemed may shift benefits: specialist -> primary care MD,
Barriers to telemed are not technical but organizational - must align incentives.
Minnesota Study - Video in the home added 5.3 "visits" and decreased home health and MD visits by 25-33%. Hospitalization was reduced by 50%. Overall cost decreased by about 33%.
Conclusions
Liability and privacy issues are not true barriers to telemed.
Telemed will strongly impact privacy - survelence of compliance (ie, denial of payment for a diabetic who's blood sugar remains high). This will engender a big public policy debate.
80-90% of medical problems are handled at home. Increased self care ($3 book) decreased cost by $4 per every $ spent.
CMS has invested in home teleconf systems for family support and case management.
Child Protective Services will use store-and-forward for training, supervision, and consultation. (AbuseNet) Works over the Internet with encryption.
Will use "live" teleconf for training and direct assessments of alleged abuse. May include remote monitoring of field workers.
Hope to decrease false positive rate for abuse determinations.
[Debra Sutherland - USF Informatics person]
Must have a good business
"Thompson's Law" Every 6 months a product will be introduced that renders a previous decision you have made absurd.
Leasing is essentially a purchase with a different payment schedule.
Store-and-forward is adequate for much of what needs to be done.
There is no substitute for good people.
Telemed is about outreach and preventing hospitalization.
85% of all telemed encounters are store-and-forward. Keep live telemed to a minimum.
New emphasis on hands-on clinical case management via home health monitoring.
Avoid transfer from small hospitals (stem revenue leak). This is a make or break issue for some.
Add skill enhancement and professional development.
Keep patients at home instead of the hospital, early discharge.
Preserve market share of tertiary centers.
Focus on high acuity cases.
Prevent 15% to 20% of referrals through better communication with specialists.
Decrease use of ER and hospitalization through case management/home monitoring.
Medicaid has a central role in the development and payment for telemed.
Use front-end encounter fee and back-end risk sharing based on cost history for diagnostic catagory.
Ernie Schoolfield (BellSouth)
Must notify long distance carrier that you are using ISDN for teleconf or you may be unable to send video (due to analog lines).
COIN - Community of Interest Network - Issues are organizational, not technical.
Universal Access Monies available for rural, not of profit entities.
Services available:
Talk to vendors about your application NOT specific technologies (eg ISDN, ATM, etc.).
ATM is NOT the solution in every case (ie at times it has up to 20% overhead).
Where is the state headed:
1-888-4SUNCOM (478-6266)
Over 50 locations for walk-up teleconf services.
Video teleconf equipment on state contract.
Turnkey telemedicine units available under "SNAPS" program.