Connected Health: A New Framework for Evaluation of Communication Technology Use in Care Improvement Strategies for Type 2 Diabetes
Mathur A, Kvedar JC, Watson AJ. Connected health: a new framework for evaluation of communication technology use in care improvement strategies for type 2 diabetes. Curr Diabetes Rev. 2007 Nov;3(4):229-34. PubMed PMID: 18220678.Read More...
Current methods of analyzing the use of communication technologies in diabetes care improvement programs are limited by a poor understanding of the impact of technology on the delivery of care. We applied a standardized methodology using a functional framework to analyze 14 diabetes care improvement programs that used communications technology. Controlled trials and observational studies were selected after searching 5 electronic databases to identify care improvement programs for type 2 diabetes that used communications technology in the past 10 years with greater than 10 subjects. A 3-stage framework was used to analyze intervention elements: 1) functional components, 2) structural components, and 3) level of automation in program design. Using this methodology we found marked variability in operational design of programs and poor rationalization of choice of outcome metrics with program components. Although 11 of 14 studies showed significant declines in HbA1c, our analysis indicated that the causal pathways remain unclear. Recent systematic reviews have highlighted the difficulties in evaluating communication technology use in diabetes. The functional framework presented in this review provides a systems approach to the problem and represents a standardized methodology for analyzing communications technology use in diabetes care.
Third Annual Connected Health Symposium
Myint-U K, Ternullo JL, Kvedar JC. Third Annual Connected Health Symposium. J Telemed Telecare. 2007;13(4):214-6. PubMed PMID: 17565781.Read More...
Economic Evaluation of Interactive Teledermatology Compared with Conventional Care
Armstrong AW, Dorer DJ, Lugn NE, Kvedar JC. Economic evaluation of interactive teledermatology compared with conventional care. Telemed J E Health. 2007 Apr;13(2):91-9. PubMed PMID: 17489695.Read More...
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.
Watson AJ, Bergman H, Kvedar JC. Teledermatology. eMedicine 27 February 2007.Read More...
The use of communications technology to facilitate the provision of health care for persons with skin disease is an area of increasing interest and activity. Following the first article on this topic in 1995, more than 180 publications have reported on active research projects from across the globe (PubMed search "teledermatology"). In 2005, a survey by the American Telemedicine Association reported 62 active teledermatology programs in 37 different US states.
Despite this level of interest and activity, questions remain regarding how best to use the available technology and overcome the current adoption challenges, thus allowing teledermatology to become an integral element of mainstream care delivery.
The following sections address why telemedicine is a valuable resource for dermatology, the current extent of its practice, the challenges in validating teledermatology as an effective adjunct to conventional care, and the factors limiting widespread adoption.