Guide Implementing Telemedicine : Completing Projects On Target On Time On Budget

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This book can help you and your organization prosper with a telemedicine practice, not create a storeroom with expensive, dust covered technology. This book will show you how to excel at leading change in todays complex healthcare environment, an environment that can mean success or failure for those wishing to implement telemedicine.

IMPLEMENTATION OF BUDGET 2019 PROJECTS UNDERWAY

The managers who will be successful in implementing telemedicine today and tomorrow will be the ones who can look at waves of change and see opportunity; who can design a telemedicine vision and strategy for a more positive future for their organizations; and who can implement their designs on target, on time, and on budget by capitalizing on the strengths of their organizations and their bright and dedicated associates.

You dont have to be afraid of change any longer! Dutchs work offers entertaining and simple solutions that will help you move swiftly and efficiently through the growing pains of organizational change, says Ken Blanchard, author of The Secret and The One Minute Manager. Robert Cuyler. When they get patients for surgery from telemedicine, they can collect only concessional charges. It was the success of these two centres that led some states to devise full-fledged telemedicine programmes and network all district hospitals from onwards.

Telemedicine network: district hospitals are linked to 43 super-speciality hospitals The idea evidently is to refine and popularise the technology so that even nursing homes in small towns can hook up with hospitals in cities and use telemedicine independent of the government support. In a first of its kind instance, Mantri Developers has tied up with Apollo to provide the facility at its Mantri Espana, Bangalore. The Apollo Telemedicine Network Foundation has conducted about 36, tele-consultations so far.

Reddy, Chairman, Apollo Hospitals Group. But as Dr Ajit N. Babu, Director of the Centre for Digital Health at Amrita Institute, points out, telemedicine is not an event but a process. Business Today takes a look at whether telemedicine has really impacted the lives of poor people in states—Karnataka, Rajasthan, Kerala, Chattisgarh, and Andhra Pradesh—where almost all district hospitals are employing telemedicine.

The District Hospital in Chamarajanagar, km from Bangalore, stands out as the best example of how a private hospital can test the limits of a government programme. Narayana Hrudayalaya NH has taken over the cardiac care unit at the district hospital. While the Chamarajanagar unit has so far provided telemedicine consultation to about patients, the hospital at Saragur has progressed enough to offer speciality care in a few disciplines such as woman and child health, orthopaedics, pathology, etc. To understand the dynamic and workflow of telehealth among health care professionals and within health care systems, a new theoretical framework for understanding cross-sector care integration needs to be developed.

One way to develop such a framework is to employ an interorganizational approach, such as that used in the eHealth-enhanced Chronic Care Model [ 65 ]. A new framework should address specific approaches for cross-sector care integration, redesign of chronic disease care management, and redesign of multiple care practices through telehealth. In the future, chronic disease management through telehealth technologies needs to be versatile in functionality and to be able to support patients with multiple diseases.

Systems need to provide more options or become more patient-specific and personalized. Guidelines that assist patients in understanding how to use the technology, how the data are analyzed, and how to self-monitor their care need to be developed to help patients obtain a higher degree of self-management. There exists no common conceptualization of business models and cases for telehealth in the literature [ 66 ].

2. Telemedicine Today

However, it is important to break down the business model and business cases into components to understand and then construct sustainable and scalable telehealth initiatives. Sustainable business models must be developed to meet the demands of the many stakeholders in telehealth programs and to create value for a company as well as for the health care sector and patient.

There is limited research on the use of business models and cases in telehealth. However, the identification of innovative telehealth business models is now of interest globally. The question is whether it is possible to develop a general model that can be used across countries and still be sensitive to different legal and operational structures of reimbursement and varied socioeconomic contexts between developed and developing countries. For example, the lack of transportation in developing countries will place a higher emphasis on critical access to basic health care, whereas the value proposition in a developed country would more likely emphasize convenience of location [ 64 ].

The self-tracking technologies are expected to change the role of the consumer in the future because we can expect that the consumer will be able to deal directly with the companies selling medical devices or devices for tracking pulse, sleep, etc. Evaluation of the efficacy of telehealth has been carried out within the traditional research paradigm using randomized controlled trials RCTs. RCTs are considered the highest level of evidence because of their high level of internal validity, but they are both expensive and time-consuming.

With technologies being rapidly developed, the RCT evaluation paradigm may become too cumbersome and time-consuming for stakeholders and managers within the health care system, and policy makers often do not have time to await a scientific assessment of a given technology before they have to decide on budgets for the coming financial year. Alternatively, managers prefer evidence-based decision making and may request information about clinical impact, cost-effectiveness, patient perception, and organizational aspects of telehealth.

This has been demonstrated recently by Kidholm et al [ 67 ] in a study of European health care managers. Globally, there has been discussion about developing a new framework for assessing telehealth technologies at different levels of development. MAST provides a multidisciplinary assessment of telehealth technologies [ 68 ]. The assessment process has three steps. First, the preliminary assessment in which the maturity of the technology and the organization using it must be assessed eg, in the form of a feasibility study.

Second, a multidisciplinary assessment of the outcomes of the telehealth application is conducted within seven domains: 1 health problem and characteristics of the application, 2 safety, 3 clinical effectiveness, 4 patient perspectives, 5 economic aspects, 6 organizational aspects, and 7 sociocultural, ethical, and legal aspects. Finally, the third assessment step is a transferability assessment, in which the transferability of the evidence to the local setting is considered.

Telehealth offers the opportunity to deliver care that is accessible, convenient, and patient-centered, overcoming many of the barriers inherent in traditional health care delivery systems [ 71 ].

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However, widespread implementation will require attention to systems engineering approaches to health care design so that it can address incentives, technical and human requirements, work processes, and payment issues [ 72 ]. To demonstrate and realize added value to health outcomes, telehealth implementation is not simply a feature to be added to existing health care delivery. It must be integrated into innovation at the system level.

Integration involves examining the current flow of care for targeted subpopulations and revising the overall approach to care, integrating telehealth, and changing traditional elements. For example, using telehealth to manage chronic disease might incorporate interprofessional involvement, with nurses, pharmacists, or dietitians coaching the patient through telehealth between visits for primary care. Integration may require challenging adjustments in the current delivery of care.

For example, the number of planned primary care visits may be reduced as telehealth is used to augment care. For telehealth to be fully integrated into global health systems, a number of items that support system transformation will be needed. Given that telehealth often includes patient-generated data, significant changes will be needed to insure accurate, efficient, and timely monitoring of health parameters that are useful for guiding clinical decision making.

Integration and interpretation of these data are essential to optimizing telehealth, yet many EHR systems do not have the capacity to incorporate patient-generated data nor are they not able to make it available in a time-sensitive fashion. Similarly, new competencies will be required for health care professionals in telehealth and systems engineering to improve health [ 72 ].

Finally, telehealth research needs to promote approaches to care that are amenable for adoption in practice. The age-old challenge is to translate research findings into practice to facilitate adoption of new knowledge to telehealth. The challenges are to reinforce the urgency with which evidence is needed to drive policy and provide greater incentive for researchers and practitioners to collaborate. In the United States, the Health Resources and Services Administration works to increase and improve the use of telehealth to meet the needs of underserved people, including those living in rural and remote areas, with low income, uninsured, or those enrolled in Medicaid.

The Affordable Care Act is driving changes in health care delivery that bring greater value and access, particularly to populations who require complex care. As reimbursement moves from fee-for-service to value-based and outcome-driven payment, incentives for providing telehealth should improve. Through the Federal Office of Rural Health Policy and the Office for the Advancement of Telehealth OAT , resources are provided in the United States to support regional telehealth technical assistance centers, a national telehealth policy center, and a national telehealth technology assistance center.

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In addition, OAT provides grants for the creation of evidence-based tele-emergency networks and for demonstration projects to test the use of telehealth networks in improving health care services for medically underserved populations in urban, rural, and frontier areas of the country. In , WHO launched a policy on health technology assessment of medical devices with a focus on this area because new technologies are evolving rapidly [ 74 ]. Finally, Denmark has a national strategy for digitalization of the Danish public sector by Focus is on implementing telehealth at scale, improving personalized telehealth, quality of life for patients and citizens within the health care and social sectors, and to increase the efficiency and effectiveness of workflows within the public sector.

The TTRN advocates more transatlantic telehealth studies to develop synergy in research and gain generalizable results at a more rapid pace. As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that lead to scalable and sustainable telehealth programs.

As an initial effort toward a global research agenda, the members of the TTRN offer a point research agenda that incorporates health care parameters across mediated and traditional modes of care for the benefit of providers, companies, policy makers, and the international research community see Textbox 1. Assessment of personal engagement in own health through the use of telehealth technologies quantified self. Self-determination and motivation with regard to the use of new telehealth technologies.

Health literacy, eHealth literacy, technology literacy, contributions to design features of technology, and interaction with telehealth technologies. Integration of smart home telehealth technologies wellness and health devices and software, Internet of Things. Communication for and between providers and patients telehealth through mobile, wearable, and remote monitoring. Telehealth training and education, including designing communities of knowledge and practice. Cross-sector integration using telehealth technologies Accountable Care Organizations, bundled care, medical homes.

Development of sensor technologies for detection of fluid in the body, sleep patterns, etc. Innovative data analytic approaches for integrating data for precision medicine, including predictive, personalized, and customized analytics. Advances in tracking, data transmission, and storage of telehealth data real-time analytics vs store-and-forward.

Assessing innovative payment and reimbursement systems, especially in the emerging value-based health care environment. Enhancing telehealth data security given advances in mobile, wearable, and cloud-based system configurations. Local, regional, and international regulatory requirements licensing, guidelines, standards. The research goals are designed to facilitate comparative evaluations of telehealth solutions at multiple levels, from individual to system level, using a variety of devices and technologies, and in multiple settings and contexts.

Although this research agenda requires specific refinements to address country and health system variations, it can provide a comprehensive orientation for pursuing global research in personalized telehealth. Conflicts of Interest: Conflicts of Interest: None declared. National Center for Biotechnology Information , U. J Med Internet Res. Published online Mar 1. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Corresponding Author: Birthe Dinesen kd. This article has been cited by other articles in PMC. Abstract As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. Keywords: telehealth, research, individualized medicine, telemonitoring, prevention, mobile phone. Introduction Telecommunication technologies have been used to bring health care expertise to the point of care since the 19th century.

Purpose This paper was prepared by an international team of telehealth providers, clinicians, researchers, and policy analysts assembled through the Transatlantic Telehealth Research Network TTRN. This paper has two aims: To describe the challenges of promoting telehealth implementation and advancing adoption. Telehealth Today: Benefit and Biases In , a meta-analysis of home monitoring studies globally found it to be a cost-effective alternative in 21 of 23 studies, the majority of which focused on chronic disease care [ 15 ].

Telehealth Challenges Health care financing models exist in many industrialized nations. Policy Challenges Within Telehealth Telehealth policies among US states, US federal agencies, and in EU countries are outdated and woefully inadequate to support widespread telehealth adoption and growth. It is hoped that refinements in these state policy initiatives will enable the achievement of the following three goals: Creation of parity for telehealth with other modes of health care delivery; Active promotion of telehealth as a tool to advance stakeholder goals regarding health status, equity of access, greater efficiency in care delivery, and health systems improvements; and Creation of opportunities and flexibility for telehealth to be used in new models of care and systems improvements.

Reimbursement Within the United States and the European Union, reimbursement of telehealth-delivered care and specific reimbursement requirements remain a major challenge. Licensing and Jurisdictional Issues The scaling of telehealth, particularly in the United States, has been limited by professional licensing issues and competition among professionals. Telehealth Approaches for Cross-Sector Care Integration In both the United States and the European Union, hospitals and public health care systems tend to be fragmented between hospitals and municipally based health care services.

Emerging Issues That Influence Telehealth Delivery Providing high-quality, accessible, and cost-effective health care remotely for a socially, economically, and financially diverse population presents challenges, whether within a country or between countries. Matching Patients With Appropriate Technologies As telemedicine and telecommunication have been lauded as a possible solution to the emerging shortage of health care providers, we need to remain cognizant that the use of technology in place of a face-to-face encounter will not be as easy for some patients as others.

Creating New Education Paradigms for Patients Mobile phone and other emerging handheld applied telehealth-based instruments can be used as electronic e -learning tools for patient education, mobile clinical communication, and disease self-management education. Creating New Education Paradigms for Health Care Providers Mobile phones and other emerging handheld devices are powerful and useful professional education tools for health care providers.

ISBN 13: 9781479720514

Forming Communities of Knowledge and Practice Given the significant changes in telehealth and telehealth applications brought about by the rapid emergence of health care organizational change, new software apps, new devices, and new forms of data, it is important for providers to form communities of expertise in applying the most recent scientific advances. New Care and Business Models Tailored to Sustainability and Scalability of Telehealth Initiatives In order to reduce risks and costs when starting up a new telehealth service, it is useful to develop new care and business models to increase the probability of success of the service.

Innovative Research Methodologies Within Telehealth Evaluation of the efficacy of telehealth has been carried out within the traditional research paradigm using randomized controlled trials RCTs. Transfer of Scientific Knowledge: From Research to Implementation and Practice Telehealth offers the opportunity to deliver care that is accessible, convenient, and patient-centered, overcoming many of the barriers inherent in traditional health care delivery systems [ 71 ]. American and European Visions for Personalized Telehealth In the United States, the Health Resources and Services Administration works to increase and improve the use of telehealth to meet the needs of underserved people, including those living in rural and remote areas, with low income, uninsured, or those enrolled in Medicaid.

Personalized Telehealth in the Future: A Global Research Agenda As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that lead to scalable and sustainable telehealth programs. Focus areas for personalized telehealth research. References 1. National telemedicine initiatives: essential to healthcare reform.

Telemed J E Health. J Telemed Telecare. Bartolini E, McNeill N. The Network for Excellence in Health Innovation. Jun 13, []. Care coordination assisted by technology for multiethnic caregivers of persons with dementia: a pilot clinical demonstration project on caregiver burden and depression. Wootton R. Twenty years of telemedicine in chronic disease management--an evidence synthesis. Benjamin RM. Multiple chronic conditions: a public health challenge. Public Health Rep. Anderson N, Edwards K. Building a chain of trust: using policy and practice to enhance trustworthy clinical data discovery and sharing.

Copenhagen: World Health Organization; The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation. Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Boutwell A, Hwu S. Zanaboni P, Wootton R. Adoption of telemedicine: from pilot stage to routine delivery.

Lindeman D. Interview: lessons from a leader in telehealth diffusion: a conversation with Adam Darkins of the Veterans Health Administration. Ageing Int. Rojas SV, Gagnon M. A systematic review of the key indicators for assessing telehomecare cost-effectiveness.


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