Economic Environment and Applications of Telemedicine

Telemedicine is broadly defined as the transmission of electronic medical data across a distance among hospitals, clinicians, and/or patients. This definition is deliberately unlimited to what kind of information is transmitted, how the information is transmitted, or how the information is used once received (HCAB, 2003). Telemedicine has the potential of making a greater positive effect on the future of healthcare and medicine than any other modality. Fueled by advances in multiple technologies such as digital communications, full-motion/compressed video, and telecommunications, providers see an unprecedented opportunity to provide access to high-quality care, independent of distance or location

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

Since the 1990s, the Veterans Health Administration (VHA) has used information and communications technologies to provide high-quality, coordinated, and comprehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans' homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA's success -- like the organization's leadership, culture, and existing information technology infrastructure -- as well as opportunities and challenges

Evidence-Based Toolkit to Evaluate Telemedicine Delivery of Palliative Care

Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest hospice and palliative care organization identified the need to expand palliative care services to a rural healthcare setting through telemedicine. However, the organization was lacking an evaluation plan for outpatient telemedicine delivery of palliative care. This quality improvement project focused on collaboration with a Midwest hospice and palliative care to develop an evidence-based toolkit to evaluate outpatient telemedicine delivery of palliative care. The Donabedian model and The Plan Do Study Act (PDSA) Cycle were used to guide toolkit development for evaluation and implementation of telemedicine delivery. The evidence-based toolkit includes telemedicine equipment and staffing needs, a formalized care flow process, referral recommendations, patient and organizational data collection, a cost-savings analysis, and a sustainability plan. To ensure standardized care is delivered, the evidence-based toolkit can be adapted to varied populations in different settings to expand palliative care services. The overall focus of the project and sustained goal was to address the quadruple aim of healthcare: to improve patient outcomes and experiences, reduce costs of care, and increase staff satisfaction (Bodenheimer & Sinsky, 2014)

Modeling And Optimization Of Non-Profit Hospital Call Centers With Service Blending

This dissertation focuses on the operations problems in non-profit hospital call centers with inbound and outbound calls service blending. First, the routing policy for inbound and outbound calls is considered. The objective is to improve the system utilization under constraints of service quality and operators\u27 quantity. A collection of practical staffing assignment methods, separating and mixing staffing policy are evaluated. Erlang C queuing model is used to decide the minimum number of operators required by inbound calls. Theoretical analysis and numerical experiments illustrate that through dynamically assigning the inbound and outbound calls to operators under optimal threshold policy, mixing staffing policy is efficient to balance the system utilization and service quality. Numerical experiments based on real-life data demonstrate how this method can be applied in practice. Second, we study the staffing shift planning problem based on the inbound and outbound calls routing policies. A mathematical programming model is developed, based on a hospital call center with one kind of inbound calls and multiple kinds of outbound calls. The objective is to minimize the staffing numbers, by deciding the shift setting and workload allocation. The inbound calls service level and staffing utilization are taken into consideration in the constraints. Numerical experiments based on actual operational data are included. Results show that the model is effective to optimize the shift planning and hence reduce the call centers\u27 cost. Third, we model the staffing shift planning problem for a hospital call center with two kinds of service lines. Each kind of service is delivered through both inbound calls and outbound calls. The inbound calls can be transferred between these two service lines. A mathematical programming model is developed. The objective is to minimize the staffing cost, by deciding the shift setting and workload allocation. The inbound calls service level and staffing utilization are taken into consideration in the constraints. Numerical experiments are carried out based on actual operational data. Results show that the model is effective to reduce the call centers\u27 labor cost

Telehealth Adoption: Three case studies at the organisational level

We present the results of an inductive analysis using interview data to establish core themes in organisational level adoption of telehealth. The source of the interview data was a large study to evaluate how telehealth can promote long term health and independence and improve quality of life for people suffering from chronic health conditions. The study took place over three different pilot sites and 41 interviews were conducted with healthcare professionals who collectively had responsibility for over 5000 patients. We explore the data from the perspective of the organisation, focusing on the unique features of each pilot site and seeking evidence for themes of adoption success at the organisational level, particularly via organisational identity. We explore the data via a set of propositions based on organisational theory and technology adoption. The major finding of this work is that experience in telecare was found to detract from telehealth adoption success