telemedicine project analysis

8/6/2019 Telemedicine Project Analysis

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TELEMEDICINETELEMEDICINE

DIGITAL MULTIMEDIADIGITAL MULTIMEDIA

ARCHIVINGARCHIVING

andandELECTRONIC PATIENTELECTRONIC PATIENT

RECORDRECORD


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Application of telecommunicationApplication of telecommunication

technology to the practice of medicinetechnology to the practice of medicine

Commonly used to define interactiveCommonly used to define interactive

medical multimediamedical multimedia

Better manage patients by having moreBetter manage patients by having more

complete informationcomplete information

Dynamic imaging with full motionDynamic imaging with full motionvideo/audiovideo/audio

( interactive = real( interactive = real--time )time )

( store and forward = video E( store and forward = video E--mail )mail )


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HISTORY

Initial developments in late 1950s:Initial developments in late 1950s:

Dr. Cecil Wittson in Omaha, NebraskaDr. Cecil Wittson in Omaha, Nebraskadeveloped an extensive telepsychiatrydeveloped an extensive telepsychiatry

programprogram

Dr. Albert Jutras in Montreal, QuebecDr. Albert Jutras in Montreal, Quebec

developed an interdeveloped an inter--facility teleradiologyfacility teleradiologyprogramprogram


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HISTORY

Subsequent programs in NorthSubsequent programs in North

America established with federalAmerica established with federalgrants and most utilized satellitegrants and most utilized satellite

uplinksuplinks

By the late 1970s, none could sustainBy the late 1970s, none could sustain

themselvesthemselves


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HISTORY

Reawakening of interest in the lateReawakening of interest in the late

1980s:1980s: decreased cost of landdecreased cost of land--basedbased

telecommunicationstelecommunications

CODECsCODECs

improved inexpensive computersimproved inexpensive computers


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HISTORY

19891989 -- 3 interactive3 interactive--video telemedicinevideo telemedicine

programsprograms19931993 -- 10 interactive10 interactive--video programvideo program

19941994 -- 20 programs20 programs

19951995 -- almost 40 programs in variousalmost 40 programs in variousstages of discussion/implementationstages of discussion/implementation


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EUROPEAN COMMUNITY

PROJECTS

AIMAIM / /EuriPACSEuriPACS

SMZOSMZO -- 400400 --bed geriatric hospital, 1000bed geriatric hospital, 1000--bed acute care hospital, geriatric center, andbed acute care hospital, geriatric center, and

a nursing collegea nursing college

COVIRACOVIRA -- integration of CT, MRI/MRA,integration of CT, MRI/MRA,

DSA, PET, and other modalitiesDSA, PET, and other modalitiesFESTFEST -- telemedicine integrationtelemedicine integration

frameworkframework


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EUROPEAN COMMUNITY

PROJECTS

GEHRGEHR -- define requirements for a standarddefine requirements for a standard

health record architecturehealth record architecture

MILORDMILORD-- integrated departmentalintegrated departmental

environment using objectenvironment using object--oriented model tooriented model to

implement a true multimedia environmentimplement a true multimedia environment

SAMMIESAMMIE-- software for an integratedsoftware for an integratedmedical workstationmedical workstation


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EUROPEAN COMMUNITY

PROJECTS

SEISMEDSEISMED -- guidance on security matters nguidance on security matters n

CEC DGXIII/F publication (ITSSEC)CEC DGXIII/F publication (ITSSEC)

DIOGENEIIDIOGENEII-- distributed HIS integrateddistributed HIS integrated

with PACS and RISwith PACS and RIS

RACE/TELEMEDRACE/TELEMED -- working groupworking group

IMPHONEIMPHONE-- investigation of hospitalinvestigation of hospitalcommunication needs and functionalitycommunication needs and functionality

needs in workstationneeds in workstation


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PROJECTSWITHIN THE

UNITED STATESTEXAS TELEMEDICAL PROJECTTEXAS TELEMEDICAL PROJECT

MAYO CLI

NI

CMAYO CLI

NI

CKANSAS / OKLAHOMA / IOWAKANSAS / OKLAHOMA / IOWA

MCGMCG

MilitaryMilitary

Over 20 interactive video project inOver 20 interactive video project in

telemedicinetelemedicine


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MAJORPROBLEMS FACINGMAJORPROBLEMS FACING


1) Mistrust and miscommunication1) Mistrust and miscommunication

2) Lack of consistent reliable managerial2) Lack of consistent reliable managerial

planplan

3) Lack of standards3) Lack of standards

4) Legal / confidentially issues4) Legal / confidentially issues


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MAJORPROBLEMS FACING

TELEMEDICINE (cont.)

5) Reliance on vendor claims

6) Poorly selected or overpriced

equipment

7) Continued reliance on federaland state grants


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MAJOROPPORTUNITIESWITH

TELEMEDICINEClinical Consultations to provide access toClinical Consultations to provide access to

cost effective Health Carecost effective Health Care

Medical Education in a real timeMedical Education in a real time

environmentenvironment

AdministrationAdministration

Financial with ability to drive down costsFinancial with ability to drive down costs


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DIGITAL ARCHIVINGDIGITAL ARCHIVING

ELECTRONIC PATIENTELECTRONIC PATIENT

RECORDRECORD


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ECH

TCHC

icesTCHC utreachClinics

Hospitals Serviced

Savannah


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Primary Impetus is to improve patient carePrimary Impetus is to improve patient care

Early intervention = early diagnosis =Early intervention = early diagnosis =shorter hospital stayshorter hospital stay

Improve utilization of resources:Improve utilization of resources:

Physician / technicianPhysician / technician

always accessible studies within thealways accessible studies within thesystem which by definition aresystem which by definition are

diagnostic qualitydiagnostic quality


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Initial thrust to transmit

ECHOCARDIOGRAMS in a real-time

interactive environment

Open platform / scaleable

DICOM / HL-7 compatible

Digital solution (becomes a link in a totalelectronic patient record)

Off-the-shelf solution


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Cost savings

Neonatal transport savings466 Neonatal transports via Angel

25% Approximate Cardiology referrals

$2,500 Average cost / transport

$292,000 Savings in Transport costs (ideal)$150-200kIncreased revenue to referral

hospital


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Cost savings

Physician Time

140 Average number of Remote

echocardiograms / month 1995

70 Echocardiograms which could be

performed with a telemedicine

application

2.33 Average number of

telemedicine episodes / day


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Cost savings (cont.)

4.0 Hours of underutilized physician

time / day

150k Average Cardiologist salary

30% Benefits for physician

$ 95 Value / hour physician time

$ 380 Savings / day physician time

$138,700 Cost savings / year in physician

time


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COMMUNICATIONCOMMUNICATION

HOSPITAL NETWORK DESIGNHOSPITAL NETWORK DESIGN EthernetEthernet 10 Mbits / sec10 Mbits / sec

FDDIFDDI 100 Mbits / sec100 Mbits / sec


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TELECOMMUNICATIONTELECOMMUNICATION FIBEROPTIC CABLEFIBEROPTIC CABLE

TT--3 / T3 / T--11

ATM / SONETATM / SONET

ISDNISDN


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TELECOMMUNICATIONTELECOMMUNICATION 64 K / 56 K64 K / 56 K

Twisted pairsTwisted pairs

CellularCellular Satellite ( SWAN )Satellite ( SWAN )


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WORKSTATION DESIGNWORKSTATION DESIGN

Essential part ofEssential part ofIMACS/PACSIMACS/PACS User friendlyUser friendly

Well developed management toolsWell developed management tools

High performance with sustainedHigh performance with sustainedthroughthrough--put and speedput and speed


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STORAGE MEDIASTORAGE MEDIA

Magnetic DiskMagnetic DiskJukeboxJukebox

Capacities in excess of 28 TbytesCapacities in excess of 28 Tbytes

Magnetic TapeMagnetic Tape


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STORAGE MEDIASTORAGE MEDIA

Optical DiskOptical Disk WORMWORM

MOMO

Optical TapeOptical Tape CDCD--ROMROM


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STORAGE AND

COMMUNICATIONSTANDARDS

1983 ACR1983 ACR--NEMA Digital Imaging And NEMA DigitalImaging And

Communications Standards CommitteeCommunications Standards Committee 1985 Standard 1.01985 Standard 1.0

1988 Standard 2.01988 Standard 2.0

1993 DICOM 3.0 ( ANSI )1993 DICOM 3.0 ( ANSI )


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SPECIFIC ISSUESTO

CARDIOLOGY

File formatFile format

Demographic dataDemographic data Administrative informationAdministrative information

Video imageVideo image

concurrent calibration information forconcurrent calibration information for

measurementmeasurement

raw dataraw data


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SPECIFIC ISSUESTO

CARDIOLOGY

Identify the endusersIdentify the endusers

general hospital communitygeneral hospital community rapid access to data via networkrapid access to data via network

easy integration with all areas/easy integration with all areas/

modalitiesmodalities

Clinical echocardiographerClinical echocardiographer

rapid access to current and all priorrapid access to current and all prior

studiesstudies


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STANDARDIZATION

Size of screen to archiveSize of screen to archive

512 x 512512 x 512 256 x 256256 x 256

further windowing to best utilizefurther windowing to best utilize

archive mediaarchive media


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STANDARDIZATION

CompressionCompression

manageable levels of compressionmanageable levels of compression Gold Standard is videotapeGold Standard is videotape

ratio 24:1ratio 24:1

a lack of clinically validated studiesa lack of clinically validated studies

existexist JPEG, MPEG, Wavelets, and othersJPEG, MPEG, Wavelets, and others


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TECHNOLOGY CAVEATSTECHNOLOGY CAVEATS

Adaptability to changeAdaptability to change

Open architectureOpen architectureScaleabilityScaleability

Ease of operationEase of operation

Minimal maintenance requirementsMinimal maintenance requirementsTechnologicalTechnological

compatibility/upgradeabilitycompatibility/upgradeability


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ApplicationsApplications-- matching technologymatching technology

with specific demands of specialtywith specific demands of specialty

(consumer driven)(consumer driven)ResearchResearch-- specifically in areas ofspecifically in areas of

standardizationstandardization

Standardsofcare/outcome analysisStandardsofcare/outcome analysis--evaluation of added value toevaluation of added value to

communitycommunity


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ReimbursementReimbursement

ImplementationImplementationConfidentialityConfidentiality-- software/hardwaresoftware/hardware

protocolsprotocols

Value/EconomicsValue/Economics-- identify as a valueidentify as a valueadded serviceadded service


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Educational valueEducational value- on-going

educational value/CME/interactiveeducational value/CME/interactive

surgical teachingsurgical teaching

CommunicationcostsCommunicationcosts-- flexibility offlexibility of

technology/new technologiestechnology/new technologies

Motivation for providers/patientsMotivation for providers/patients


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MEDICAL EDUCATIONMEDICAL EDUCATION

RESEARCHRESEARCH

VIRTUAL HOSPITALVIRTUAL HOSPITAL

VIRTUAL RESEARCH CONSORTIUMVIRTUAL RESEARCH CONSORTIUM

CLINICAL TRIALSCLINICAL TRIALSMAGNETMAGNET


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telemedicine project analysis

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