telmed_eval.html

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<p align="CENTER"><B>Telemedicine Evaluation</B> </p>
<p align="CENTER">Victoria Garshnek, Ph.D., Project Manager, PRPO
<p>&nbsp; </p>
<UL>
  <LI><A HREF="#background">Background</A> </LI>
  <LI><A HREF="#organization">Organization</A> </LI>
  <LI><A HREF="#mission">Mission Statement</A> </LI>
  <LI><A HREF="#goals">Goals and Objectives</A> </LI>
  <LI><A HREF="#current">Current Status</A> </LI>
  <LI><A HREF="#strategic">Strategic Direction</A> </LI>
  <LI><A HREF="#business">Business Associations</A> </LI>
  <LI><A HREF="#security">Project Security</A> </LI>
  <LI><A HREF="#summary">Summary</A></LI>
</UL>

<hr>
<blockquote>

<p align="CENTER">&nbsp;</p>
<a name="background">
<p>1. <b>Background</b> -- Since the 1960s, there have been numerous attempts
  to advance telecommunications technology to augment health care delivery. Yet,
  despite the simplicity and apparent logic of the concept and three decades of
  experience, we are unable to show that telemedicine improves access, reduces
  cost, or affects the quality of health care. There are few well- designed studies
  and generalizing the findings to the military health care system and patient
  populations may not be valid. Consequently, there is clearly a need for well
  designed research in this area. The current evaluation research program consists
  of four projects that address the following domains: Clinical Outcomes; Patient/Provider
  Satisfaction; Organizational Impact; and Cost/Effectiveness. The protocol employs
  a randomized design to compare patient and process outcomes of two methods of
  consultation (telemedicine and usual care). The sample population for this study
  is active duty and retired military and their dependents requiring consultation
  from a primary care (Hickam) to a tertiary care (Tripler) facility and their
  health care providers. The study uses store and forward technology in a Web-based
  paradigm.
<p>&nbsp;
<p>&nbsp;
<a name="organization">
<p>2. <b>Organization Management:</b><br>
<blockquote>
  <p>L. Harrison Hassell, COL, MC, USA* -- Principal Project Director <br>
    Victoria Garshnek, Ph.D.** -- Project Manager <br>
    Investigators:<br>
    Clinical Outcomes<br>
    L. Harrison Hassell, COL, MC, USA* (PI); Victoria Garshnek, Ph.D.** (Co-I);
    George Underwood, M.D.** (Co-I), Mark Nadeau, LTC, MC, USAF***(Co-I), Theresa
    V. Jones** (Consult Manager)<br>
    Patient/Provider Satisfaction<br>
    Sharon DeRuvo, LTC, AN, USA+ (PI); Elizabeth Hill, LTC, AN, USA** (Co-I)<br>
    Organizational Impact<br>
    Robert Doktor, Ph.D.++ (PI); David C. Bangert, Ph.D. ++ (Consultant)<br>
    Cost/Effectiveness: Eric L. Mais, Ph.D. ++ (PI) </p>
</blockquote>
<p>*AMEDD Center and School, Fort Sam Houston, TX<br>
  **Tripler Regional Medical Center, HI<br>
  ***Hickam Air Force Base, HI<br>
  +Landstuhl Regional Medical Center, Germany<br>
  ++University of Hawaii, College of Business Administration, HI
<p>&nbsp;
<p>&nbsp;
<a name="mission">
<p>3. <b>Mission Statement</b> -- Before telemedicine consultations are used as
  a substitute for usual care in which the patient and consultant meet in a clinical
  encounter, we must demonstrate through objective and measurable outcomes the
  equivalency of both methods of consultation in providing health care.
<p>&nbsp;
<a name="goals">
<p>4. <b>Goals and Objectives</b><br>
<p>A. Objectives -- The objective of the overall project is to provide a scientific
  evaluation of outcomes resulting from insertion of telemedicine into a primary
  care clinic that routinely refers patients to a tertiary medical care center.
  Objectives of the four individual research domains are: 1) to investigate if
  telemedicine consultation between medical treatment facilities: (a) impacts
  the clinical outcome of patients compared to usual care; (b) affects patient
  and provider satisfaction compared to usual care and (c) reduces cost in relation
  to benefits compared to usual care; 2) to evaluate the human impact on providers
  of performing consultations using advanced telecommunications technology; and
  3) to investigate the organizational changes that occur when telemedicine is
  implemented in a medical treatment facility.<br>
<p>B. Goals -- The major goal of the AKAMAI evaluation effort is to provide health
  care policy-makers with scientific information to assist them in the decision
  to augment DoD medical treatment facilities in the Pacific Basin with telemedicine
  technology.
<p>&nbsp;
<a name="current">
<p>5. <b>Current Status</b><br>
<p>A. Primary Accomplishments<br>
<p>Project #1: Clinical Outcomes: Significant progress has been made in establishing
  an infrastructure for transmission of consult data. A Web-based paradigm will
  be used. The Medical Information Data Archiving System (MIDAS) has been developed
  for 12 specialty areas. Training and tools (MedQuest) have been provided to
  enable modification/update of screens and creation of new ones. Specialists
  from Dermatology and Orthopedics have reviewed screens in their areas. A &quot;patient
  trajectory analysis&quot; has been explored as the major analysis tool. Once
  the infrastructure is operational, an Experiment Verification Test (EVT) will
  test procedures, systems, and coordination. After refinement, data collection/analysis
  will commence. <br>
<p>Project #2: Patient/Provider Satisfaction: Once the systems for telemedicine
  consultation are operational for at least 2 to 3 months, focus groups evaluating
  patient and provider satisfaction will be conducted. Arrangements are currently
  underway to conduct the preliminary focus groups.<br>
<p>Project #3: Organizational Impact: An inventory has been identified which measures
  cognitive perceptions of the caregivers job characteristics. The medical decision
  making process has been identified as the variable to be measured and qualitative
  research methodology of ethnography has been adopted as the operative tool.
  An inventory assessing organizational learning has been chosen as the measuring
  instrument. Currently, the team is finalizing evaluation instruments and preparing
  procedures to test these instruments during the EVT phase.<br>
<p>Project #4: Cost-Effectiveness: Currently, refinement of an initial cost/benefit
  model is underway based on a high-level process flow diagram for the telemedicine
  consults. The cost/benefit model will continue refinement through the EVT phase.
  Procedures for the EVT are currently being written.
<p>&nbsp;
<a name="strategic">
<p>6. <b>Strategic Direction</b> -- This project will pilot evaluation methodology
  in Dermatology and Orthopedics. Successful completion will enable additional
  specialties to be brought on-line and thus expand the scope, value, and application
  of the basic study methodology.
<p>&nbsp;
<a name="business">
<p>7.<b> Business Associations</b><br>
  A. Corporate Partnerships -- ISS - Project Manager (Dr. Victoria Garshnek),
  Consult<br>
  Manager (Theresa V. Jones); Picker Institute (consultant services).<br>
  B. Government/University Partnerships -- University of Hawaii (Dr. Robert Doktor,
  Dr. David Bangert, Dr. Eric Mais, one UH graduate student).
<p>&nbsp;
<a name="security">
<p>8. <b>Project Security </b>--N/A
<p>&nbsp;
<a name="summary">
<p>9. <b>Summary</b> -- Significant strides in infrastructure development have
  been made and will enable a high-fidelity EVT to take place in December 97/January
  98. Currently, the project team is preparing procedures and instruments for
  the EVT. Resulting refinement will enable the trials (data collection) and analysis
  to take place mid-1998. Final data analysis and reporting will take place September
  through December, 1998.
<p>
</blockquote>
</body>
</html>
	<html>
	<head>
	<title>Untitled Document</title>
	<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"></head>

	<body bgcolor="#FFFFFF">
	<p align="CENTER"><B>Telemedicine Evaluation</B> </p>
	<p align="CENTER">Victoria Garshnek, Ph.D., Project Manager, PRPO
	<p>  </p>
	<UL>
	<LI><A HREF="#background">Background</A> </LI>
	<LI><A HREF="#organization">Organization</A> </LI>
	<LI><A HREF="#mission">Mission Statement</A> </LI>
	<LI><A HREF="#goals">Goals and Objectives</A> </LI>
	<LI><A HREF="#current">Current Status</A> </LI>
	<LI><A HREF="#strategic">Strategic Direction</A> </LI>
	<LI><A HREF="#business">Business Associations</A> </LI>
	<LI><A HREF="#security">Project Security</A> </LI>
	<LI><A HREF="#summary">Summary</A></LI>
	</UL>

	<hr>
	<blockquote>

	<p align="CENTER"> </p>
	<a name="background">
	<p>1. <b>Background</b> -- Since the 1960s, there have been numerous attempts
	to advance telecommunications technology to augment health care delivery. Yet,
	despite the simplicity and apparent logic of the concept and three decades of
	experience, we are unable to show that telemedicine improves access, reduces
	cost, or affects the quality of health care. There are few well- designed studies
	and generalizing the findings to the military health care system and patient
	populations may not be valid. Consequently, there is clearly a need for well
	designed research in this area. The current evaluation research program consists
	of four projects that address the following domains: Clinical Outcomes; Patient/Provider
	Satisfaction; Organizational Impact; and Cost/Effectiveness. The protocol employs
	a randomized design to compare patient and process outcomes of two methods of
	consultation (telemedicine and usual care). The sample population for this study
	is active duty and retired military and their dependents requiring consultation
	from a primary care (Hickam) to a tertiary care (Tripler) facility and their
	health care providers. The study uses store and forward technology in a Web-based
	paradigm.
	<p>
	<p>
	<a name="organization">
	<p>2. <b>Organization Management:</b><br>
	<blockquote>
	<p>L. Harrison Hassell, COL, MC, USA* -- Principal Project Director <br>
	Victoria Garshnek, Ph.D.** -- Project Manager <br>
	Investigators:<br>
	Clinical Outcomes<br>
	L. Harrison Hassell, COL, MC, USA* (PI); Victoria Garshnek, Ph.D.** (Co-I);
	George Underwood, M.D. (Co-I), Mark Nadeau, LTC, MC, USAF*(Co-I), Theresa
	V. Jones** (Consult Manager)<br>
	Patient/Provider Satisfaction<br>
	Sharon DeRuvo, LTC, AN, USA+ (PI); Elizabeth Hill, LTC, AN, USA** (Co-I)<br>
	Organizational Impact<br>
	Robert Doktor, Ph.D.++ (PI); David C. Bangert, Ph.D. ++ (Consultant)<br>
	Cost/Effectiveness: Eric L. Mais, Ph.D. ++ (PI) </p>
	</blockquote>
	<p>*AMEDD Center and School, Fort Sam Houston, TX<br>
	**Tripler Regional Medical Center, HI<br>
	***Hickam Air Force Base, HI<br>
	+Landstuhl Regional Medical Center, Germany<br>
	++University of Hawaii, College of Business Administration, HI
	<p>
	<p>
	<a name="mission">
	<p>3. <b>Mission Statement</b> -- Before telemedicine consultations are used as
	a substitute for usual care in which the patient and consultant meet in a clinical
	encounter, we must demonstrate through objective and measurable outcomes the
	equivalency of both methods of consultation in providing health care.
	<p>
	<a name="goals">
	<p>4. <b>Goals and Objectives</b><br>
	<p>A. Objectives -- The objective of the overall project is to provide a scientific
	evaluation of outcomes resulting from insertion of telemedicine into a primary
	care clinic that routinely refers patients to a tertiary medical care center.
	Objectives of the four individual research domains are: 1) to investigate if
	telemedicine consultation between medical treatment facilities: (a) impacts
	the clinical outcome of patients compared to usual care; (b) affects patient
	and provider satisfaction compared to usual care and (c) reduces cost in relation
	to benefits compared to usual care; 2) to evaluate the human impact on providers
	of performing consultations using advanced telecommunications technology; and
	3) to investigate the organizational changes that occur when telemedicine is
	implemented in a medical treatment facility.<br>
	<p>B. Goals -- The major goal of the AKAMAI evaluation effort is to provide health
	care policy-makers with scientific information to assist them in the decision
	to augment DoD medical treatment facilities in the Pacific Basin with telemedicine
	technology.
	<p>
	<a name="current">
	<p>5. <b>Current Status</b><br>
	<p>A. Primary Accomplishments<br>
	<p>Project #1: Clinical Outcomes: Significant progress has been made in establishing
	an infrastructure for transmission of consult data. A Web-based paradigm will
	be used. The Medical Information Data Archiving System (MIDAS) has been developed
	for 12 specialty areas. Training and tools (MedQuest) have been provided to
	enable modification/update of screens and creation of new ones. Specialists
	from Dermatology and Orthopedics have reviewed screens in their areas. A "patient
	trajectory analysis" has been explored as the major analysis tool. Once
	the infrastructure is operational, an Experiment Verification Test (EVT) will
	test procedures, systems, and coordination. After refinement, data collection/analysis
	will commence. <br>
	<p>Project #2: Patient/Provider Satisfaction: Once the systems for telemedicine
	consultation are operational for at least 2 to 3 months, focus groups evaluating
	patient and provider satisfaction will be conducted. Arrangements are currently
	underway to conduct the preliminary focus groups.<br>
	<p>Project #3: Organizational Impact: An inventory has been identified which measures
	cognitive perceptions of the caregivers job characteristics. The medical decision
	making process has been identified as the variable to be measured and qualitative
	research methodology of ethnography has been adopted as the operative tool.
	An inventory assessing organizational learning has been chosen as the measuring
	instrument. Currently, the team is finalizing evaluation instruments and preparing
	procedures to test these instruments during the EVT phase.<br>
	<p>Project #4: Cost-Effectiveness: Currently, refinement of an initial cost/benefit
	model is underway based on a high-level process flow diagram for the telemedicine
	consults. The cost/benefit model will continue refinement through the EVT phase.
	Procedures for the EVT are currently being written.
	<p>
	<a name="strategic">
	<p>6. <b>Strategic Direction</b> -- This project will pilot evaluation methodology
	in Dermatology and Orthopedics. Successful completion will enable additional
	specialties to be brought on-line and thus expand the scope, value, and application
	of the basic study methodology.
	<p>
	<a name="business">
	<p>7.<b> Business Associations</b><br>
	A. Corporate Partnerships -- ISS - Project Manager (Dr. Victoria Garshnek),
	Consult<br>
	Manager (Theresa V. Jones); Picker Institute (consultant services).<br>
	B. Government/University Partnerships -- University of Hawaii (Dr. Robert Doktor,
	Dr. David Bangert, Dr. Eric Mais, one UH graduate student).
	<p>
	<a name="security">
	<p>8. <b>Project Security </b>--N/A
	<p>
	<a name="summary">
	<p>9. <b>Summary</b> -- Significant strides in infrastructure development have
	been made and will enable a high-fidelity EVT to take place in December 97/January
	98. Currently, the project team is preparing procedures and instruments for
	the EVT. Resulting refinement will enable the trials (data collection) and analysis
	to take place mid-1998. Final data analysis and reporting will take place September
	through December, 1998.
	<p>
	</blockquote>
	</body>
	</html>