Congressional Office of Technology Assessment OTA

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• Congressional Office of Technology Assessment
  (OTA)
• assessment of role of information technologies in
  health care delivery (telemedicine)

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TELEMEDICINE

• I. History Telemedicine (Informatics)
• II. Survey Current Activities
• III. Why TelemedicineI V.
• IV. Obstacles to Telemedicine
• V. Resources

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Informatics in Telehealth

• Congress Office of Technology Assessment
• Bringing Health Care Online The Role of
  Information Technologies
• http//www.access.gpo.gov

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Have seen 3 Generations

• 1924 Concept published (Television 1929)
• 1950s Two-way interactive video (psych, rad)
• 1960s Up Down (Fed funding)
• 1990s Third Rise of Telemedicine

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Lessons Learned

• Primitive, non medical technology
• lack of design for applications
• lack of user friendliness
• No evaluations
• Lack of business sustainability

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Accessibility is Essential to Success
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Reorganization A New Entity Redirect
Resources
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• Faculty Assistance

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PERSONNEL

• Adequate staffing
• Trained (not video/computer/telephone)

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• Technology
• Reliable
• Accessible
• Easy to Use

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STANDARDSInteroperabilityIntegra
tion Future Technology
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EVALUATION

• Cost
• Patient referral patterns
• Outcomes
• Provider satisfaction
• Patient satisfaction

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II. SURVEY CURRENT ACTIVITIES
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UTHSCSA
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INTERFACED TO UTHSCSA

• 30 Distant Sites

DOD/VA
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One-on-One
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Peripherals
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Pediatric Hematology/Oncology
Dr. J. Kane
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Pediatric Echocardiology
Dr. J. Rogers
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Teleradiology(TDH)
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Tele-Ophthamology
Dr. Hobson
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Fundus Photography
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TDH Medical Van / Harlingen
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Complete Working Laboratory
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Retinal exam/ Dental exam areasRadiology area
behind cameraTelecomms on front wall
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Dial In/Out
(Interfacing with Surgical Suites)
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Virtual Reality (Simulations)Direct from Santa
Rosa
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Teledentistry/Pathology (Financed by Private
Dentist)
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Store-and-ForwardUT Systems (Bauer)Dept
Agriculture (Benavides)
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Home Health
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Demand

• Patients - access to quality care
• Health professionals - access to expert
  consultants/CE
• Patients professionals - digital library, WWW
  resources

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• Expands access to care
• Enhances provider education
• Improves quality of care
• Lowers cost of care
• Permits rural hospitals to stay in business

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Office of Rural Health Policy

• Of 2472 rural hospitals surveyed, 30 were using
  telemedicine
• In 1997, number of telemedicine programs
  increased by 66
• Most programs are not telemedicine solely, but
  incorporate education, administration, public
  health, training

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V OBSTACLES / LEGAL
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Reimbursement

• ECU (60 14)
• MCG (22 - 150)

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OBSTACLES ??

• Initial cost
• Interstate licensure
• Accreditation
• New economics with change in pt referral
• Institutional inertia

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Legal

• UTHSCSA Medical liability insurance includes
  telemedicine (only in USA)
• National - liability telemedicine case never gone
  to court have settled outside courts -- message
  keep good records and no problem

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VII. RESOURCES
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Telehealth Associations

• American Telemedicine Association
• Health Information and Management Systems Society
  (HIMSS)
• American Medical Informatics Association

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References

• Telemedicine Sourcebook 1998
• FG Healthcare Information Center
• A Telemedicine Primer
• Jim Reid, Innovative Medical Communications
• 1998 Compendium of Telemedicine Laws
• Legamed Inc.
• Telemedicine A Guide to Assessing
  Telecommunications in Health Care
• Institute of Medicine

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• Medical Outcomes Guidelines
• Faulkner Gray, 1998
• Guide to Health Care Resources Internet
• Faulkner Gray, 1998

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Journals

• Telemedicine Jn
• Government Video
• Teleconferencing
• Telemedicine Today
• Telemedicine and Telehealth Networks

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IX. FUTURE
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Accessibility
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• Multimedia server for patient record
• Desk top
• Office
• Patient home / hospital

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FUTURE ATM to Healthcare
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• Minimally invasive robotic surgery
• Robotic surgery at distance
• 3-D Imaging
• Fully digital hospitals
• Electronic house calls to homes/monitors
• Patient involvement in own health care
• Public health education via Web, etc.