Important considerations in managing patients with advanced PD are addressed in this interactive, case-based program. Other than motor symptoms, what specific issues should be the focus of treatment? Read more at the Parkinson’s Disease Resource Center.
In order to make sure that the incentives for providing and requesting teleconsultations for both expert providers, small groups, large organizations, hospitals, clinics and individuals are aligned and in support of the deployment issues, here are some thoughts..
Responsibility for costs and outcomes
Expertise Provider (specialist, et al)
Buy the PC/laptops, remote camera and any software needed on them, put your logo on them, and have them setup (I can help you do this, it is easy) exactly the way it wil
help you get the work done. The receiving institution, if they already HAVE this obviously wont need you to provide it, but assume that they DONT and modify cost of service if you also are providing the tools
Contract with whatever technicians/care managers, etc who MIGHT be needed in remote site IF the remote site does not already provide the same, or able to certify their competence
Pay for the “find me” communication services that makes it easy to “find, schedule and get hold of the right expert”–this stuff will amount to less than $100 a month for the entire group and probably many more, so no one should balk at that given the payoff
Determine the rates you will be charging for readings, and consultations and whether there is a direct pay component (i strongly urge this) or just relying on traditional insurance reimbursement (i am not terribly interested in this latter model, it retains all the same antiquated dependence on non-functioning industry)
What this does is defines the business model that puts the expert provider in command of whatever they need to enable other people to access their expertise virtually. But the expert and/or group has to really, really want to move to this type of model and see its potential broadly. Because if that is the case, it is not going to let any aspect of the project with any one hospital be dragged down by someone else’s challenges around technology, etc. The expert provider DEFINES the business
Hospital or other organization “requesting expertise”
Open Internet connections so that standard, inexpensive tools used by remote expert can be leverage with NO dependence on local IT resources
Imaging and other expensive capital devices, local physical plant resources, etc
Set aside of operational dollars, supported by foundations where feasible, but not required—so that there is a fund to DIRECTLY pay any provider of expert telehealth and not have these projects
depend on external reimbursement in order to get launched
Appropriate nurse/care manager support person to help initiate the request for consultation
Internal compensation or support for those (ER docs, OB docs, etc) who we WANT to be requesting remote expertise, making it easy as possible for them to do so, in terms of time, people, communication, etc
This is an interesting white paper I found as part of the American telemedicine site. It reviews the state of Tele-ICU medicine, opportunities and barriers
We are all trying to best understand how to establish a truly pragmatic approach to broader tele-stroke, tele-neurology. I know people have been looking at InTouch, Reach, PolyCom, and different variations, but I was more interested in having us establish a set of specifications of what the “technology” needs to enable, and where the “resources” should both come from and enable, as well as optimal methods of notification and communication. The more I work with others on issues of interfacility transfer for complex neuro, stroke, neurosurgery in particular, the more obvious it is that some broader, collaborative regional approach to tele-consultative neuroscience support, including stroke, critical care neuro, neuroradiology, neurosurgery, interventional expertise, etc is needed. Whenever I can see the inevitable I feel a need to begin working toward that, not the things in between which just wont ever quite get there!. Here are some thoughts
Whatever physical devices and network setups are used for teleconsultation, a few criteria are key
It must be simple to deploy without excess dependence on local/hospital/office IT resources, technical support or even capital expense
It must enable simple bidirectional audio/video when desired, but at least bidirectional “switch back and forth” to alternate between expert and recipient
It must have some pragmatic mobility until such time as every single bed has the same capability in every room and location
It must enable a multitude of experts, in different places at different times, to easily connect into it via the web, without any special hardware or complex software installed on the experts workstation, mobile, laptop, etc (this is where I struggle with the InTouch approach, to be honest)
MOST of the money for this should be allocated for compensation of the person providing expertise and even the busy clinician taking the time to request decision support, NOT into the technology itself, given that the fundamentals of telecommunications are more ubiquitously available
It should make the documentation of events, recording of them, etc much easier without introduction of new complex data systems or duplication of work
I know many have been working on proposals to states and regions, etc. and there are many telemedicine associations, grants, etc But it seems to me that the most important thing is for a group of neurologists and other neuroscience experts who are likely to be engaged in the provision of virtual care to map out the essential elements of capability, deployability, operational support, costs, compensation, etc BEFORE looking at specific technologies and systems. because technologies evolve quite rapidly nowadays, and most of this is overlapping with developments in the generic telecom industry
I think this is where we are heading in maryland and elsewhere, in order to more readily provide distributed decision support to ER< ICU, hospitalists, that creates a broader “virtual critical care” environment less dependent on a small number of physical neuro icu beds in a few large hospitals.
