There are a number of different costs associated with the development and operation of telemedicine services. A model is proposed in order to assist in strengthening the evidence base for telemedicine. It includes the following components: project establishment costs; equipment costs; maintenance costs; communication costs; staffing costs. All need to be considered in arriving at an annual cost figure for operating a telemedicine service. The inclusion of all these costs, prepared in the standard manner outlined in the model, will ensure that a realistic cost figure is available when evaluating the cost-effectiveness of a telemedicine service.
Papers presented at the three Successes and Failures in Telehealth conferences have made a helpful contribution to what is known about the practicalities of implementing and using telehealth. Ten of the 89 papers covered general concepts, 40 described primary studies and 26 discussed telehealth programmes or networks. Common themes that emerged on determinants of success and failure included the reliability of equipment, the reliability of vendors, political and budgetary issues,the perceived need for telehealth, the involvement of stakeholders, health professionals' opinions, the stability of management structures, the turnover of personnel and cooperation between organizations. Limitations in some papers included an absence of data, weak study designs, short-term perspectives and lack of information on health outcomes. Despite these limitations, the papers have made a valuable contribution to our knowledge of what has worked and what has failed in the field of telehealth.
In 2001 a radiology information system/picture archiving and communication system (RIS/PACS) was installed at the Princess Alexandra Hospital (PAH) in Brisbane, with electronic image transfer links to other major hospitals in Queensland. An assessment study is being performed of the effect of the ready availability of radiology results on clinicians, clinical decision making and the time taken to treat patients. A series of structured interviews with senior clinicians at the PAH began in July 2002. Administrative data are being collected from the PAH computer system. Preliminary results from the first six months of the study suggest that the introduction of the RIS/PACS at the PAH has been well received by senior clinicians and has been helpful in clinical decision making. Patient management has been improved and the time taken to arrive at clinical decisions has been reduced, particularly in neurosurgery. The RIS/PACS has significantly improved access to imaging resources for teaching, owing to the ability to retrieve reference images and to project high-quality images during teaching sessions. However, the introduction of the RIS/PACS has not reduced patient length of stay.
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