Is there a contradiction between telemedicine and business?

Is there a contradiction between telemedicine and business? The driving forces in the telemedicine market are: competition within the health-care industry, newly developed cheap information technology (especially the Internet) and 21st-century health-care consumers, with their expectations of free choice and a high level of health-care. The market has four segments (citizens, patients, professionals and employees) and the boundaries between these segments are blurred. The telemedicine market is obviously growing, but it is still unstructured, fractured and disorganized. The telemedicine market needs a meeting place where the status of telemedicine and telecare can be reviewed. This would be a place in which to explore new ways to improve the efficiency of health-care services and a forum in which to draw a roadmap for future developments. One such place is the International Trade Event and Conference for eHealth, Telemedicine and Health ICT, Med-e-Tel. At the 2004 event, there were 32 exhibitors from 23 countries and over 400 industry and medical participants. A survey of participants showed that the event was judged to be a success. There is no conflict between telemedicine and business. On the contrary, telemedicine is a promising area of business development.     

From flying doctor to virtual doctor: an economic perspective on Australia's telemedicine experience

Current funding mechanisms can impede the efficient use and integration of telemedicine services. Telemedicine has developed in Australia against a background of complex funding arrangements and interwoven health-care responsibilities. These impediments are not unique to telemedicine but are accentuated by its ability to cover different locations, clinical areas and purposes. There is also a link between economic evaluation and funding mechanisms for telemedicine. While economic evaluations provide important information for the efficient allocation of resources, the funding environment in which telemedicine is established is also crucial in ensuring that services are efficient. Given these complexities, should telemedicine be funded? We conclude that this will depend on: the objectives and priorities of the health system; the efficiency of telemedicine relative to that of other forms of health-care delivery; and the funding environment. In terms of resource allocation processes, the optimum scenario is likely to be where the decision to invest in telemedicine services is made taking local needs into account, but where considerations such as market structure and network compatibility are examined on a broader scale and balanced against the principles of efficiency and equity.     

Health delivery system changes required when integrating telemedicine into existing treatment flows of information and patients

Business model and financial recovery issues dominate discussions about using telemedicine to improve chronic disease management. The technical issues are numerous, daunting and complex, but many can be addressed using the resources and infrastructure available in large, well-integrated clinical information systems. The cost-benefit balance will change when it becomes possible to use devices that are owned by patients for everyday use, rather than installing special-purpose devices for telemedicine. Technology and communications capabilities are driven mainly by market factors other than uses for health care. Provider-side telemedicine capabilities, specifically for upload, storage and display of home medical data, will improve as technology develops. How health-care providers will process the larger amount of data made available by telemedicine is a clinical issue, but it is likely that software will emerge to assist in this task. The alignment of financial incentives for health-care providers is a decisive factor in understanding why telemedicine has had substantial deployment within the US Veterans Hospital Administration system, and to some extent within prison health systems and the Kaiser Permanente Health Plan, but much less widely in other settings.     

Legal issues relating to telemedicine in Canada's publicly funded health-care system

The advent of telemedicine poses new legal challenges for Canada's health-care system. Although telemedicine increases access, it does not fit easily into Canada's traditional one-tier approach to health-care. Cross-border telemedicine services may inadvertently contribute to a two-tier system. The current legal system will have to be adapted to accommodate changes instigated by cross-border telemedicine.     

Contracting for services and limits to managed competition

The introduction of market forces into the NHS has led to an operational divorce between health care providers and those who need health-care. Central to this change has been the widespread use of contracts. As a management problem, contract negotiation must incorporate consideration of full cost recovery to establish prices for hospital services sold and to ensure that available information is employed in assessing external services purchased. Ignoring the important issue of information availability in identifying relevant costs, it is the difficulty in specifying the cost of an episode of treatment, for example, that has led to contracts being negotiated in block form. Argues that this may be the only contract that can be effectively established. An important consequence of this is that the complexity of hospital services and requirements will work against a wider implementation of piecemeal managed competition and will form a natural barrier to market forces in the NHS.     

Defining the needs of a telemedicine service

While telemedicine programme objectives, technologies and even philosophies will differ, certain common factors that enhance programme success can be identified. For example, a programme design which is driven by technological imperatives is likely to fail. It must also be recognized that telemedicine programmes cannot force remote sites to use their services. Thus developers must assess the needs for the proposed telemedicine service from a clinical, economic and technical perspective. From a clinical perspective, it is important to remember that certain clinical services can be provided via telemedicine while others cannot. Programme developers must recognize the significant role of the remote team in sustaining services; the on-site presenter is essential for the successful practice of telemedicine. Evaluating a telemedicine programme should be viewed as an integral step in its design and implementation. One site may define effectiveness in terms of access to services while another may measure success by cost savings. The success of future telemedicine programmes will be strongly related to their ability to recognize that they should be used to enhance current health-care delivery rather than to replace it.     

Benefits and drawbacks of telemedicine

Telemedicine is a vast subject, but as yet there are limited data on the clinical effectiveness and cost-effectiveness of most telemedicine applications. As a result, objective information about the benefits and drawbacks of telemedicine is limited. This review is therefore based mainly on preliminary results, opinions and predictions. Many potential benefits of telemedicine can be envisaged, including: improved access to information; provision of care not previously deliverable; improved access to services and increasing care delivery; improved professional education; quality control of screening programmes; and reduced health-care costs. Although telemedicine clearly has a wide range of potential benefits, it also has some disadvantages. The main ones that can be envisaged are: a breakdown in the relationship between health professional and patient; a breakdown in the relationship between health professionals; issues concerning the quality of health information; and organizational and bureaucratic difficulties. On balance, the benefits of telemedicine are substantial, assuming that more research will reduce or eliminate the obvious drawbacks.     

Evaluation of a telemedicine demonstration project in the Magdalene Islands

The Magdalene Islands are an archipelago located in the middle of the Gulf of St Lawrence, more than 1000 km away from supra-regional medical referral centres. We have implemented and evaluated a telemedicine network for the local hospital on the Magdalene Islands. During a 13-month study period, 118 transmissions were made. Orthopaedics and radiology were the medical specialties that used telemedicine most frequently. Store-and-forward imaging was the technique used most often because of the large number of transmissions in orthopaedics and radiology. Various medical specialties and psychosocial services used videoconferencing, while realtime imaging (ultrasound) was used in gynaecology and obstetrics. A combination of videoconferencing and imaging was used for otolaryngology. A total of 101 individual patients benefited from a teleconsultation during the study period. Eight emergency transfers were avoided and 15 patients who would have required elective transfer were managed locally by telemedicine. For health-care providers, telemedicine seemed to be an acceptable way of delivering specialized services. Nevertheless, demonstration projects in telemedicine are quite different to 'real life' telemedicine utilization. Deployment of telemedicine in the health-care system as a whole will require a more structured approach.     

Quality assessment and cataloguing of telemedicine applications

We created a Web catalogue of approved telemedicine systems that authoritative Italian research bodies had made available for more general use. The evaluation process was divided into two stages: (1) classification of the telemedicine systems and rough preliminary evaluation; (2) assessment of the telemedicine products and services. The scoring method was applied to four well-known telemedicine systems that had been tested in health-care settings: an echocardiology teleconsulting and analysis system; a ward nursing management system; a virtual cooperative system for the management of oncology patients and a telepathology system based on remotely controlled microscopy. After technical revision during the standardization/qualification process, the applications were transferred successfully to eight new health-care facilities. The methodology achieved the main goal of providing effective tools, such as a set of quality control procedures for telemedicine and telehealth projects and a Web catalogue of telemedicine applications with a standardized level of quality, available to all interested parties.     

基于超高清晰度远程医学系统的建设

目的：为了使有限的医疗资源得到充分利用,需要建设远程医学系统。方法：系统将医院分为服务指导中心、一般医院结点、标准医院节点,3种模式分别拥有不同的医疗资源。结果：通过对医疗资料的采集、压缩、传输、处理、管理、存储,加上异地医疗人员的协同,使患者在本地医院就可以得到远程医疗专家的良好服务,共享病史资料和昂贵的医疗设备,降低医疗成本．提高诊治质量。结论：超高清晰度远程医疗系统对提高医疗领域的人才培养、中小城市的医疗技术水平、医院设备的利用效率都有一定的帮助。     

A proposed model for telemedicine to supplement the physician workforce in the USA

Maldistribution of physicians is the norm in much of the USA. This paper explores the effect that the integration of telemedicine into the health system could have on physician workforce requirements in the USA. The analysis is based on preliminary evidence suggesting that telemedicine is an effective and efficient means of delivering a broad spectrum of health services to medically under-served rural and inner-city communities. While the emphasis here is on interactive, video-based telemedicine services, other telemedicine modalities, such as store-and-forward techniques and remote monitoring, are likely to have a parallel effect. As these new technologies become a normal part of health care, they will reshape the medical workforce and exert a profound influence on physician workforce requirements in the USA. This paper presents a potential model for this reshaped workforce that emphasizes an expanded role for mid-level health-care providers.     

Telemedicine in Armenia

Telemedicine in Armenia began with the US Telemedicine Space Bridge programme, which was introduced following the disastrous earthquake in 1988. More recently educational programmes have been established between the School of Medicine at Boston University and the Emergency Hospital in Yerevan. There are also telemedicine activities involving the Internet, for example at the Diagnostica Medical Centre in Yerevan. The future integration of telemedicine and telehealth services within the health services in Armenia will produce significant benefits. Current telemedicine activities in Armenia represent models for collaborative projects in other former Soviet republics with the aim of providing greater access to health-care at higher quality and lower cost.     

The evolution of a successful telemedicine mental health service

Development of telemedicine mental health services in Alberta evolved via a pilot project, the delivery of routine services to a small group of centres and subsequent expansion to a province-wide programme. Success of the service was linked to support for telehealth by the provincial government and consultation between the Alberta Mental Health Board (AMHB) and local stakeholders. Assessments by the AMHB have shown that telepsychiatry is acceptable and sustainable at a realistic cost. However, there are few measures of clinical effectiveness available and none of cost-effectiveness. A detailed economic evaluation of the telemedicine mental health network would now be a major task. The expansion of telemedicine mental health services has increased the expectations of health-care decision makers. In addition, the complexity of the network has increased and new initiatives, such as the use of telepsychology, have been introduced. Management of this successful telehealth programme continues to be time consuming and challenging.     

The evolution of a successful telemedicine mental health service

Development of telemedicine mental health services in Alberta evolved via a pilot project, the delivery of routine services to a small group of centres and subsequent expansion to a province-wide programme. Success of the service was linked to support for telehealth by the provincial government and consultation between the Alberta Mental Health Board (AMHB) and local stakeholders. Assessments by the AMHB have shown that telepsychiatry is acceptable and sustainable at a realistic cost. However, there are few measures of clinical effectiveness available and none of cost-effectiveness. A detailed economic evaluation of the telemedicine mental health network would now be a major task. The expansion of telemedicine mental health services has increased the expectations of health-care decision makers. In addition, the complexity of the network has increased and new initiatives, such as the use of telepsychology, have been introduced. Management of this successful telehealth programme continues to be time consuming and challenging.     

The need for cost-effectiveness studies in telemedicine

Telemedicine has the potential substantially to improve the delivery of health care. However, cost-effectiveness studies are needed to help define the appropriate scope and application of telemedicine in different settings. Reports on the evaluation of telemedicine are dominated by technical and feasibility studies. Such studies may be very helpful for initial decision making. However, any cost information at this level tends to be very preliminary and often concerned with making a case to proceed further. Decision makers will wish for further information as the telemedicine application is introduced, to consider its effectiveness - its performance under routine conditions. Without information on the costs and effectiveness of telemedicine services, decision makers run the risk of supporting telemedicine systems that are not responsive to health-care needs or which do not provide cost-effective services. The most immediate needs seem to be improvements in the conduct and reporting of studies, and additional information on the performance of telemedicine in routine practice. Investigators need to provide transparent accounts of their studies, describing in detail the approaches taken, sources of data and assumptions made, and indicating the reliability of their results. Decisions may have to be made on the basis of limited studies, but sufficient detail must be made available to decision makers.     

The potential of telemedicine: barriers, incentives and possibilities in the implementation phase

Between 1998 and 1999, the Swedish Institute for Health Services Development (Spri) evaluated three applications in which specialist competence was being accessed via telemedicine. The results indicated that these kinds of application can be cost-effective in an organization well adapted to new technology and that telemedicine can improve continuity of care for patients. However, the new technology was seldom supported by the old organization and better education and technical support are needed. In a study called 'Incentives and Implementation', the Federation of Swedish County Councils interviewed people in Swedish health-care with a lot of experience of telemedicine. The interviewees agreed that telemedicine was likely to affect the whole structure of health-care. Peripheral competence was expected to increase and referral patterns to change, as well as the functions of the personnel and the hospitals. New working conditions and methods of work were expected to be made possible by telemedicine and health-care was expected to become more process oriented, partly because patients are likely to be more demanding and better informed. To be able to utilize this potential, health-care managers will have to show more interest in and commitment to telemedicine. Old organizational patterns must be called into question and be developed along with information technology and telemedicine. It is also important to give priority to training in telemedicine for physicians and nurses.     

医疗设备售后服务区域性标准探讨

目的:提高医疗设备售后服务质量,进一步增强售后服务意识。方法:根据区域资源,通过制定和规范售后服务区域性标准。结果:综合分析了上海标准采购合同中相关内容的要点,对区域性维护保养工作提出了建议。结论:形成了从制定标准、组织检查、反馈意见、发布表彰这一个区域性售后服务循环模式,对售后服务的整个服务市场进行规范。     

贫困地区医务人员远程医疗使用意愿及影响因素调查——以重庆市城口县为例

目的 了解重庆市城口县医务人员对远程医疗的使用意愿及影响因素,为贫困地区远程医疗服务工作的开展及远程医疗协作网络建设提供决策参考。方法 采用多阶段分层抽样,在已开展远程医疗服务的重庆市城口县医疗机构中抽取153名医务人员进行问卷调查。结果 该县有75.8%的医生认为了解远程医疗,使用意愿为71.2%,使用率为47.1%。单因素分析结果显示不同年龄、文化程度、职称、是否使用过远程医疗、对远程医疗了解情况、使用远程医疗方便程度、远程医疗对诊疗工作帮助程度、远程医疗对临床技能提升程度、降低患者医疗费用程度的使用意愿不同,差异具有统计学意义（P<0.05）;多因素logistic回归分析结果显示年龄、文化程度、使用远程医疗服务方便程度、远程医疗对诊疗工作帮助程度、降低患者医疗费用程度是医生远程医疗使用意愿的影响因素。结论 重庆市城口县医生远程医疗使用意愿有待提高,应加强远程医疗服务机制体制建设,提高医生远程医疗使用意愿。     

School-based telemedicine: teachers', nurses' and administrators' perceptions

In 1997, a telemedicine project began in Kansas which brought health-care directly into elementary schools using interactive video-links. The project initially involved four schools, but was expanded to cover 10 schools, including two middle and one high school. We examined the organizational issues related to telemedicine links to schools. Specific attention was paid to the perceptions of the nurses, teachers and key administrators. The research involved analysing archive data and interviewing participants in the project from the schools and the medical centre. The results showed the difficulties in delivering health-care, especially by telemedicine, to under-served urban children. However, the data also revealed that these can be overcome. Once they had experienced it at first hand, almost all concerned began to see telemedicine as an effective and important asset to the delivery of health-care.     

军队医院拓展医疗市场的实践

本文从分析目前医疗市场入手,即目前医疗服务及其信息、医疗市场的垄断和医疗保健制度的特点和变化。在新的医疗形势下,更新医院经营理念、服务理念和市场观念,拓展部队医院医疗市场、使医院可持续发展,提出思考。