Transcript Web based Telemedicine project

Telemedicine Cost and Clinical Efficiency
Issues –
Experience from a Pilot Project
Between the
Rikshospitalet- Radiumhospitalet HF (RR) Oslo, Norway
and
Methodist Rural Public Care Center (MPCH) Mursan India
Vinod Mishra, PhD
Rikshospitalet-Radiumhospitalet University Hospital,
Oslo, Norway
TTeC2006 conference 2006 Tromsø
Overview
• Brief Norway and India equity and diversity
• Goal telemedicine / telediagnostic project
• Experience
– Patient
– Clinical efficiency
– Cost efficiency
• Barriers
• Conclusion
• Population
• Life expectancy
year
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4,604,800
Male 76
Female 82 year
GDP per capita 32 224 USD
Unemployment rate 4.4%
Health expenditures
Health & social services
30 billion USD,
10.4 % of GNP
Hospitals expenses11 billion USD
1 USD = 6.50 NOK
• Population
• Life expectancy
63.9 year
1. 025 billion
Male
Female 65 year
• GDP per capita 3 400 USD
• Unemployment rate 9.9 % est
• Health expenditures
Health & social services
5.3 % of total budget,
0.9 % of GNP
• 60 millions mobiles telephone in 2005 (increasing
100% each year)
• 12 millions new TV each year
• 1.6 million new cars each year
Telemedicine
Telemedicine
Major Diagnosis
Specialties
Obstetric and
Gynaecology
HIV/Aids Herpes
Psoriasis post delivery
Pregnancy Malaria, Thyroid
New born baby with breast problems
Congenital abnormalities
Premature delivery with PV leakage
Pictures
28%
3
4
2
3
3
3
64%
Dermatology
Eczema
Skin rashes
Fungal infection
Fungal infection
Superficial infections
Fungal infection
Unknown severe skin rashes
2
4
2
2
4
2
14
Chronic dermatitis
Fungal infection
2
3
Fungal infection
Fungal infection
2
4
3%
Neonatal cardiology
Congenital heart problems
2
2%
Respiratory diseases
Respiratory problems
1
3%
Ophthalmology
Neonatal rectalageni
2
Main goals Web based Telemedicine project
MURSAN
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Provide expert opinion for under privileged patients
Facilitate medical consultation
Educational activities
Introduction of two-ways, interactive telecommunication
between university hospital and primary health center
Web based Telemedicine project - MURSAN
• Image management and secure storage system
• Future plan for real time tele-communication and education
sessions
• Web based system an economic mode of providing expert
services to the primary center at remote site in India
• Better management of patients since this system allows fast
diagnosis, fast opinion and inter-consultation among
specialist located not only at our hospital but around the
world.
Web based Telemedicine project – MURSAN
Patients
• Better access to care
• Access to a multidisciplinary network of skills and
competences
• More relevant indication of patients- reduce transfers
between primary- secondary and tertiary care
• Societal benefits improved cost-effectiveness of treatment
Web based Telemedicine project – MURSAN
Clinical efficiency
• Keep more patients to local providers
• Major assets in favor of a network-organized professional
practice
• Professionals feel less lonely they are fellow worker
• Ongoing learning and daily practice are interrelated
• Effects on patient management- changes in clinicians
decisions making
Web based Telemedicine project – MURSAN
Cost efficiency
• Cost effective (direct cost, direct non medical cost and
indirect cost, opportunity cost)
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Cost of consultation a major issue
Patient non-emergent transport expenses
Standard hospitalization cost
Standard ancillary cost
Cost of specialists can be shared by low incidence users
Time reduction in work flow
Automatic and intelligent solution
Cost effective only if a certain threshold is achieved
Web based Telemedicine project – MURSAN
barriers
• No institutional strategic plan for telemedicine
• The technology is not as affordable as we think it is
• The technology is not so easy to employ as we would like to
believe
• The technology is not as universally useful as we want
• The infrastructure is not as ubiquitous as it needs to be
• Clinicians are reluctant to use
Conclusion
• Web based telemedicine- telediagnostic is a win win situation
for partners
• Systems can be used as a tool for distance learning program
between tertiary Sand primary level
• Web based telemedicine- telediagnostic is JUST A TOOL
• Experience shows that one must have
– focus on clinical efficiency
– focus on cost efficiency
– use of cost-benefit analysis
Telemedicine
Thank you for attention
Vinod Mishra
Special advisor
Rikshospitalet- Radiumhospitalet University Hospital
Oslo Norway
Tl. + 47 23 07 11 76
Fax + 47 23 07 11 78
Email: [email protected]
www.rikshospitalet.no