SD18 - Telemedicine Study


Executive Summary:
Telemedicine has been defined as "...the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care" (American Telemedicine Association). This is purposely an open-ended definition because telemedicine is such a rapidly expanding and changing field that to define it by the technology (e.g. full-motion-video) or by what is transmitted (e.g., x-rays) or by who is going to use the information (e.g., physicians, lab technicians, pharmacists) would blind us to substantive changes in the rapidly changing communications system which is transforming healthcare. With current developments in bio-sensing devices and in wireless transmission systems, a patient can be networked to a computer system that will provide a new level of access to health care and a personal "early warning system." This alone could transform what is meant by home health care. Is this telemedicine? To exclude it would be to impoverish our understanding of where the healthcare system is headed and distort our understanding of healthcare in the present information age.

The Virginia Department of Health, as both a provider of health care services and as a regulatory agency for health facilities is deeply involved in this telecommunications revolution. We are reviewing our responsibilities and expanding our horizons through our three "hands-on" telemedicine sites described in this document. We have learned much but continue to explore what this revolution will mean to the Commonwealth's public health sector. We do already know, however, that it is Virginia's isolated rural areas where the public health's telemedicine role will be the greatest and our technical investments will be concentrated. Telemedicine holds the promise of providing a more equitable distribution of health care expertise throughout the Commonwealth's rural medically underserved areas.

The Department is confident that, although in its infancy, the present state of telemedicine in the Commonwealth is basically sound. The three medical schools should be commended for their coordinated efforts. The Joint Commission on Health Care has, in addition, provided the appropriate analytical framework for telemedicine in the Commonwealth through its HJR 455 (1995) and HJR 210 (1998) reports. The Department takes this opportunity, in response to Senate Bill 1214 (1999) and Item 333 #6c of the Budget, to further these earlier groundbreaking medical school efforts and Joint Commission studies.

Two approaches to the research need to be stressed. The VDH study will be a prospective study, in that the Department will be initiating a broad implementation of evaluative criteria that will be needed to adequately evaluate telemedicine in the future. Many of the data elements that will be required are not presently collected. It is very difficult, for instance to determine the cost-effectiveness and medical efficacy of health services provided through telemedicine, if detailed encounter and outcome data are not collected. The intent is to introduce a common set of evaluative measures that will facilitate annual reporting on the status of telemedicine initiatives and their efficacy and cost-effectiveness. Comparison of outcomes based on like criteria will be important in developing policy for this technology.

It is worth noting that VDH took this particular approach to the study by combining the language and the intentions of both Senate Bill 1214 and Item 333 #6c of the 1999 Budget. SB 1214 requires a study very broad in scope in a very short time frame and encompassing all agencies of the Commonwealth that are using telemedicine. The budget language requires a study of just the VDH telemedicine sites in Lancaster and Lee counties and the City of Danville, with a final report due in October of 2001. As these sites are not yet operational, the decision was made to study these sites as well as all other sites operated by Virginia agencies in a prospective study that is expected to continue for at least two years. This approach will allow VDH to apply the same study design to all the telemedicine sites and will permit uniform data collection on all the sites. VDH staff met with staff of the Joint Commission on Health Care and the Senate Finance Committee to enlist their approval of the proposed study design in advance of beginning the study.

The mission of the Virginia Department of Health is to "...achieve and maintain the optimum personal and community health..." within the Commonwealth. Telemedicine is shaping, defining and renewing our commitment to ensuring access to quality health care for all Virginians so that our mission can be fulfilled.