The report “Strategic Choice in Developing Telemedicine Observations from Three Organizations” was developed by the RUPRI Center for Rural Health Policy Analysis (RUPI) at the University of Iowa http://www.public-health.uiowa.edu/rupi with support by the Federal Office of Rural Health Policy within HHS.
The report authored by Thomas Vaughn PhD, Fred Ullrich, BA, Muska Nataliansyah, MPH, and Keith J. Mueller, PhD, explores organizational motivations for incorporating telemedicine into patient care services at three organizations.
The organizations include Kaiser Permanente Southern California (Kaiser) https://thrive.kaiserpernamente.org Mayo Clinic “Center for Connected Care” (Mayo) https://www.mayoclinic.org , and the University of Mississippi Medical Center (UMMC) https://www.umc.edu.
To begin the study, the authors first researched Kaiser. Today there are seven California regions within the Kaiser Permanente System. The Southern California region has recently experienced significant membership growth with most of the membership increase occurring in areas that are distant from the core facilities.
Kaiser’s been piloting telemedicine services since 2010 with the focus on behavioral health, telestroke, and dermatology services without a clear strategy for growth. Telemedicine is offered in geographic areas where it can be difficult to recruit specialist physicians.
Kaiser is now identifying current telemedicine services to determine where there is high demand and high value in certain geographic service areas. Kaiser plans to implement the service broadly across the entire region and is looking closely to determine how to make telemedicine services more efficient.
Mayo provides telemedicine through their Center for Connected Care (The Center). The purpose of the Center is to provide specialty services in areas that are some distance from Mayo’s larger hospitals. The Center serves patients throughout the Mayo Network, which now serves roughly 72 communities in Wisconsin, Minnesota, and Iowa plus 34 affiliates. The report concentrates on the Minnesota Medical Center in Rochester and hub sites in Wisconsin.
UMMC services 218 telemedicine sites across the state in 64 of Mississippi’s 82 counties, excluding services in patients’ homes. Telemedicine services are provided to hospitals, clinics, Rural Health Clinics, mental health clinics, FQHCs, state prisons, colleges and universities, corporations, and patients’ homes.
The main services discussed in the report are tele-ED, telepsychiatry, and teledermatology, teleneonatology, corporate urgent care, and chronic care management in the home. UMMC offers tele-ICU only within their own main campus and at one of two satellite hospitals.
Five primary themes emerged from the project via literature searches and interviews with individuals at the three organizations:
- Organizations have established telemedicine to provide specific specialty services in geographic areas where it is hard to recruit physicians
- New services and services to new communities focus on needs identified by local providers to keep patients in their home communities rather than on revenue generation. Only one of the three organizations, UMMC stated that their telemedicine program was profitable
- All three organizations now see telemedicine as a mechanism to retain and build market share by retaining patients in the host organization’s system of care and to expand referrals from providers in these communities. All three organizations are interested in home monitoring for patients with chronic conditions
- All three organizations note that the development and growth of telehealth services has introduced new technical and staffing challenges
- All three organizations are considering the future of their telehealth services, including service expansion in both scope and geography
All three organizations want to provide home monitoring services but question the regulations needed for offering services across state lines. Should there be different regulations for integrated delivery systems or ACOs that operate across state lines versus independent providers? Also, who should set the standards for quality?
Organizations want to know, what are the financial obligations of the Federal and State government and the insurers? How should the funding be made available? What is the criteria for receiving funding? Finally, what licensing or accrediting regulations need to be put in place?
Go to http://rupi.publichealth.uiowa.edu/publications/policypapers/Telehealth%20Strategic%20Choice.pdf to view the document.