Economic evaluation of interactive teledermatology compared with conventional care.

Teledermatology offers a means of providing specialist care to underserved patients. The objectives of this study were to compare the costs of interactive teledermatology with conventional care, and to evaluate from a healthcare provider perspective whether interactive teledermatology is economically viable in the northeastern region of the United States. We studied the interactive teledermatology practice at Nantucket Cottage Hospital on Nantucket Island and the ambulatory clinics at the Massachusetts General Hospital in Boston, Massachusetts. The cost-minimization analysis compared the costs of an interactive teledermatology practice with that of a face-to-face dermatology clinic. One-way sensitivity analyses examined the effect of varying the costs of technology, physician compensation, or clinic space on the overall cost of interactive teledermatology. We also assessed the economic viability of the interactive teledermatology practice by comparing the operating costs with reimbursements. The total hourly operating costs for the interactive teledermatology practice on Nantucket Island and the face-to-face clinic in Boston were $274 and $346, respectively. Three separate one-way sensitivity analyses showed that, for the cost of the teledermatology practice to equal that of the conventional clinic, the cost of teledermatology technology could increase by 9.3-fold, dermatologists working at the teledermatology practice could be compensated up to $197 an hour, or the cost of teledermatology clinic space could reach $57 an hour. Our analysis also showed that the hourly reimbursement for the teledermatology practice was $487, which exceeded its hourly operating cost of $274. The cost of operating an interactive teledermatology practice in a remote region may be less than that of a conventional clinic in a nearby urban center in the northeastern area of the United States. From a healthcare provider perspective, interactive teledermatology can be an economically viable means of providing dermatological care to remote regions.

Global health care - bridging the gap.

The World Health Assembly has acknowledged that telehealth could play an important role in providing access to health care for populations at risk worldwide. The Cambodia Teleconsultation Programme or Village Leap Programme connects those in need of health care, with those willing to share their medical expertise. Telemedicine clinics are run every other week at one of two villages in northern Cambodia. The nurse is responsible for gathering medical information and transmitting it by email to physicians in the USA, and to the Sihanouk Hospital of Hope in Phnom Phen. Poorer countries do not and are not likely to have national telemedicine programmes in the near future. But as the experience in Cambodia shows, grass-root telemedicine programmes can make a difference. The need is great and we can no longer wait for governments to lead. Thoughtfully implemented telemedicine programmes providing medical education, health care and screening may change the health of the world.

Telemedicine in the future.

Telemedicine can provide a compelling alternative to conventional acute, chronic and preventive care, and can improve clinical outcomes. In the industrialized world, it is likely that telemedicine will continue to move healthcare delivery from the hospital or clinic into the home. In the developing world or in regions with limited infrastructure, telemedicine will mainly be used in applications that link providers based at health centres, referral hospitals and tertiary centres. The future of telemedicine will depend on: (1) human factors, (2) economics and (3) technology. Behaviours related to technology affect change at the individual, organizational and societal level. Personnel shortages and decreasing third-party reimbursement are significant drivers of technology-enabled health care in the industrialized world, particularly in the areas of home care and self-care. We can safely assume that developments in mobile communications, sensor devices and nanotechnology will alter the way that health care is delivered in the future. The growth and integration of information and communication technologies into health-care delivery holds great potential for patients, providers and payers in health systems of the future. Perhaps the most difficult question to answer, however, is 'When will telemedicine become part of the standard of care?'

Clinical outcomes associated with telemedicine/telehealth.

This paper is a comprehensive review and synthesis of the literature concerning clinical outcomes associated with various telemedicine applications. It starts out with a brief description of the findings reported by similar literature reviews already published. Subsequently, it proposes a conceptual model for assessing clinical outcomes based on Donabedian's formulation of the Medical Care Process. Accordingly, research findings are reported in terms of the relevant components of the medical care process, namely, diagnosis, clinical management, and clinical outcomes. Specific findings are organized according to the designated clinical and diagnostic application. This is followed by a general report of studies dealing with patient satisfaction.