Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a Health Economic Modeling Study.

OBJECTIVE: Depressive disorders are important causes of disease burden and are associated with substantial economic costs. Therefore, it is important to design a health care system that can effectively manage depression at sustainable costs. This paper computes the benefit-to-costs ratio of the current Dutch health care system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. METHODS: A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compares a base-case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome is the benefit-to-cost ratio, also known as return-on-investment (ROI). RESULTS: In terms of ROI, a health care system with preventive telemedicine for depressive disorders offers better value for money than a health care system without internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base-case scenario to €1.76 ($2.09) in the alternative scenario where preventive telemedicine is offered. In a scenario where the costs of offering preventive telemedicine are balanced by cutting back on the expenditure for curative interventions, ROI increases to €1.77 ($2.10), while keeping the health care budget constant. CONCLUSION: In order for a health care system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement

A telemedicine distributed system for cooperative medical diagnosis

Procceedings of: Eighteenth Annual Symposium on Computer Aplications in Medical Care, november 5-9, 1994, Washington, USA. Edited by Judy G. OzboltTelemedicine is changing the classicalform of health care delivery, dramatically increasing the number of new applications in which some type of distributed synchronous cooperation between health care professionals is required. This paper presents the design and development ofa telemedicine distributed system for cooperative medical diagnosis based on two new approaches: 1) a distributed layered architecture specially designed to add synchronous computer supported cooperative workfeatures either to new or existing medical applications; 2) the definition of a methodological procedure to design graphical user interfaces for telemedicine cooperative working scenarios. The cooperative work is supported by a collaborative toolkit that provides telepointing, window sharing, coordination and synchronization. Finally, we have implemented and installed the telemedicine system in clinical practice between two hospitals, providing teleconferencing facilities for cooperative decision support in haemodynamics studies. This specific implementation and a preliminary evaluation were accomplished under the Research Project FEST "Framework for European Services in Telemedicine" funded by the EU AIM Programme.This work is supported in part by EU - AIM FEST project no. A-201 1, and by grants CICYT TEMA TIC 92-1288-PB and TELEMEDICINA TIC 93-1279-E.Publicad

A telemedicine health care delivery system

The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described

Negotiating professional knowledge and responsibility in cross-sectoral Telemedicine

In ongoing efforts of rationalization and retrenchment in the Danish health care sector, tasks are increasingly moved from costly specialized hospital departments to the primary health care sec- tor, where less specialized personnel take on these tasks. Telemedicine plays an important role in facilitating local access to specialized competences at central hospitals through ICT systems and establishes new virtual spaces for cross-sectoral cooperation between hospital and municipal health care workers. In an explorative ethnographic study, comprising interviews and participant observation, of telemedicine-based interaction between community nurses and specialized hospi- tal nurses, we show how the ‘tele-ulcer’ system becomes a site for professional development for community nurses, although a hierarchization of professional knowledge also takes place. Further- more, extensive articulation work is necessary to make the tele-ulcer system work.We illuminate how contradictory divisions of responsibility may result from the design of the sociotechnical sys- tem, leaving professionals to deal with risks and insecurity

Modeling Telemedicine Systems to Effectively Allocate Administrative and Medical Resources

David Ben-AriehTelemedicine stands as one of the most promising innovations in healthcare. By delivering healthcare through electronic means, doctors can greatly expand the number and geographic diversity of patients they serve. While most telemedicine today focuses on more traditional health care applications, telemental health aims to apply telemedicine principles to mental health services. Telemental systems offer convenient and efficient ways for healthcare providers to provide psychological and psychiatric service to patients in far-flung geographic areas. Unfortunately, these systems can suffer from serious congestion if not well put-together. Maximizing the valuable time of doctors while ensuring short waits for patients should be a primary goal of telemedicine system design. Telemental health systems come in several varieties such as synchronous, asynchronous, and group telemental health. Each variety offers different system properties and flow behavior. This paper presents models for synchronous, asynchronous, and group telemental health systems using a discrete-event simulation and examines their properties using that tool. It compares their relative performance in this way. The analysis determines effective system capacity and demonstrates the effect of expanding the number of doctors and patients in the system. Moreover, the results can serve as a tool for healthcare providers seeking to establish telemental health systems. The models revealed that, given a single specialist, nurse, set of audiovisual equipment, and administrative team, group telemedicine offered the highest capacity of roughly 300 patients at a time. Asynchronous individual systems followed with a capacity of 30, and synchronous individual systems trailed with a capacity of 25. As capacity decreases, however, the configuration’s ability to provide patients with one-on-one care rises. The proper selection depends on the needs of the patient and the demands on the provider. The analysis also extends to some modifications of the original models that remove assumptions made in describing group telemedicine, probe the impact of variance reduction, and examine the maximum number of specialists a single administrative team can handle

Open IOT-based telemedicine hub and infrastructure

In this paper, a unique healthcare solution is described that supports the even more effective operation of the hospital information systems. The main question is whether the emerging opportunities of the Internet of things devices can also be exploited in the industrial hospital information system landscape. This demonstrated research describes the most feasible way to integrate the Internet of things capability into hospital information production systems. The initial goal was the design and implementation of a single, unified telemedicine hub offering community-based solution for integrated medical systems. This solution allows the intercepted information to be collected and interpreted at community level. The designed and implemented system acts as a transmitter between the physician and patient. The software solution operates with sensor-based information collected from the individual. Emerging Internet of things devices and solutions open new horizons for today’s health care systems. The presented and detailed system provides the ability to real-time health-monitoring and in-depth health analyzing through open application programming interfaces. The telemedicine hub system makes it easier to integrate the Internet of things capability into the operating health care systems

Intelligent Remote Monitoring and Management system for Type1 Diabetes

The work presented in this thesis focuses on developing a telemedicine system for better management of type1 diabetes in children and teenagers. The research and development of the system is motivated by the inadequate communication in the current system of management of the disease, which results in non-compliance of patients following the regimen. This non-compliance generally results in uncontrolled blood glucose levels, which can result in hypoglycaemia, hyperglycaemia and later life health complications. This further results in an increase in health care costs. In this context, the thesis presents a novel end-to-end, low cost telemedicine system, WithCare+, developed in close collaboration between the University of Sheffield (Electronics & Electrical Engineering) and Sheffield Children’s Hospital. The system was developed to address the challenges of implementing modern telemedicine in type 1 diabetic care with particular relevance to National Health Service children’s clinics in the United Kingdom, by adopting a holistic care driven approach (involving all stakeholders) based on specific key enabler technologies such as low cost and reconfigurable design. However, one of the major issues with current telemedicine system is non-compliance of the patients due to invasive procedure of the glucose measurement which could be clearly addressed by non-invasive method of glucose measurement. Hence, the thesis also makes a contribution towards non-invasive glucose measurement using Near Infrared spectroscopy in terms of addressing the calibration challenge; two methods are proposed to improve the calibration of the Near Infrared instrument. The first method combines locally weighted regression and partial least square regression and the second method combines digital band pass filtering with support vector regression. The efficacy of the proposed methods is validated in experiments carried out in a non-controlled environment and the results obtained demonstrate that the proposed methods improved the performance of the calibration model in comparison to traditional calibration techniques such as Principal Component Regression and Partial Least Squares regression

Characteristics of U.S. acute care hospitals that have implemented telemedicine critical care

OBJECTIVES: Telemedicine critical care is associated with improved efficiency, quality, and cost-effectiveness. As of 2010, fewer than 5% of U.S. hospitals had telemedicine critical care, and fewer than 10% of ICU beds were covered. We evaluated recent telemedicine critical care implementation and bed coverage rates in the United States and compared characteristics of hospitals with and without telemedicine critical care. DESIGN: Cross-sectional study of 2018 American Hospital Association Annual Survey Database. SETTING: U.S. hospitals. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We obtained data regarding telemedicine critical care implementation, ICU capability (defined as ≥ 1 ICU bed), other hospital characteristics, and the Herfindahl-Hirschman Index, a measure of ICU market competition based on hospital referral regions. Among 4,396 hospitals (response rate 71%), 788 (17.9%) had telemedicine critical care, providing potential coverage to 27,624 (28% of total) ICU beds. Among 306 hospital referral regions, 197 (64%) had a respondent hospital with telemedicine critical care. Telemedicine critical care implementation was associated with being a nonprofit (odds ratio, 7.75; 95% CI, 5.18-11.58) or public (odds ratio, 4.16 [2.57-6.73]) compared with for-profit hospital; membership in a health system (odds ratio, 3.83 [2.89-5.08]; stroke telemedicine presence (odds ratio, 6.87 [5.35-8.81]); ICU capability (odds ratio, 1.68 [1.25-2.26]); and more competitive ICU markets (odds ratio per 1,000-point decrease in Herfindahl-Hirschman Index 1.11 [1.01-1.22]). Notably, rural critical access hospitals had lower odds of telemedicine critical care implementation (odds ratio, 0.49 [0.34-0.70]). Teaching status, geographic region, and rurality were not associated with telemedicine critical care implementation. CONCLUSIONS: About one fifth of respondent hospitals had telemedicine critical care by 2018, providing potential coverage of nearly one third of reported ICU beds. This represents a substantial increase in telemedicine critical care implementation over the last decade. Future expansion to include more rural hospitals that could benefit most may be aided by addressing hospital financial and market barriers to telemedicine critical care implementation

Impact of Telemedicine on Mortality, Length of Stay, and Cost among Patients in Progressive Care Units: Experience from a Large Healthcare System

Utilizing a retrospective observational study design, this study aimed to determine whether telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients. Adult patients admitted to progressive care unit (PCU) as their primary admission in a large health care system between December 2011 and August 2016 (n = 16091). During the study period, PCU patients with telemedicine intervention (TPCU, n = 8091) and nontelemedicine (NTPCU, n = 8000) were compared concurrently. Primary outcome was PCU and hospital mortality. Secondary outcomes were hospital length of stay, PCU length of stay, and mean direct costs. The mean age NTPCU and TPCU patients were 63.4 years (95%CI, 62.9-63.8 yr) and 71.1 years (95% CI, 70.7-71.74 yr), respectively. All Patient Refined-Diagnosis Related Group Disease Severity (