How We Can Reap the Full Benefit of Teleconsultations: Economic Evaluation Combined With a Performance Evaluation Through a Discrete-Event Simulation

Abstract

Background In recent years, the rapid development of information and communications technology enabled by innovations in videoconferencing solutions and the emergence of connected medical devices has contributed to expanding the scope of application and expediting the development of telemedicine. Objective This study evaluates the use of teleconsultations (TCs) for specialist consultations at hospitals in terms of costs, resource consumption, and patient travel time. The key feature of our evaluation framework is the combination of an economic evaluation through a cost analysis and a performance evaluation through a discrete-event simulation (DES) approach. Methods Three data sets were used to obtain detailed information on the characteristics of patients, characteristics of patients’ residential locations, and usage of telehealth stations. A total of 532 patients who received at least one TC and 18,559 patients who received solely physical consultations (CSs) were included in the initial sample. The TC patients were recruited during a 7-month period (ie, 2020 data) versus 19 months for the CS patients (ie, 2019 and 2020 data). A propensity score matching procedure was applied in the economic evaluation. To identify the best scenarios for reaping the full benefits of TCs, various scenarios depicting different population types and deployment strategies were explored in the DES model. Associated break-even levels were calculated. Results The results of the cost evaluation reveal a higher cost for the TC group, mainly induced by higher volumes of (tele)consultations per patient and the substantial initial investment required for TC equipment. On average, the total cost per patient over 298 days of follow-up was €356.37 (US $392) per TC patient and €305.18 (US $336) per CS patient. However, the incremental cost of TCs was not statistically significant: €356.37 – €305.18 = €51.19 or US $392 – US $336 = US $56 (95% CI –35.99 to 114.25; P=.18). Sensitivity analysis suggested heterogeneous economic profitability levels within subpopulations and based on the intensity of use of TC solutions. In fact, the DES model results show that TCs could be a cost-saving strategy in some cases, depending on population characteristics, the amortization speed of telehealth equipment, and the locations of telehealth stations. Conclusions The use of TCs has the potential to lead to a major organizational change in the health care system in the near future. Nevertheless, TC performance is strongly related to the context and deployment strategy involved.

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

“…Many of the surveyed papers studied HOFs using specific technologies including mental health consultation [20,21], online consultations [22,32], clinical decision support systems (CDSS) [23], electronic medication management systems [24], video consultation [25][26], aged care systems [27] and telemedicine [36]. The context of use for these systems included hospitals [23,[28][29][30][31][32][33][34], residential aged care homes [27], and community health facilities [35]. Eleven papers were review papers and described a range of technology, users, and processes [20-22, 26-27, 31, 37-41].…”

“…Some papers presented innovative approaches for understanding and helping understand micro level system behaviours. Hueget et al [32] studied economic viability of a teleconsultation system and showed that attention must be paid to characteristics of the system's users, as it influences system performance and outcomes such as cost-efficiency. Their approach used a novel discrete simulation system to better understand user scenarios and how different system configurations impact economic outcomes of the system [32].…”

“…Hueget et al [32] studied economic viability of a teleconsultation system and showed that attention must be paid to characteristics of the system's users, as it influences system performance and outcomes such as cost-efficiency. Their approach used a novel discrete simulation system to better understand user scenarios and how different system configurations impact economic outcomes of the system [32]. Cifra et al [34] developed a semiautomated electronic feedback system that delivered timely and relevant pediatric intensive care unit (PICU) patient outcome feedback to referring ED physicians.…”

“…As expected, our review saw a range of studies focusing on different technologies and across different system levels. Many of the surveyed papers studied HOFs using specific technologies including mental health consultation [20,21], online consultations [22,32], clinical decision support systems (CDSS) [23], electronic medication management systems [24], video consultation [25][26], aged care systems [27] and telemedicine [36]. The context of use for these systems included hospitals [23,[28][29][30][31][32][33][34], residential aged care homes [27], and community health facilities [35].…”

“…Day Operations -The need to support innovation was emphasized in some papers (e.g., [25,32]) but it was pointed out that innovation is a different process from day-to-day care delivery tasks [59]. System design to support day-to-day care delivery is more purposeful while innovation is more exploratory and may have different goals and outcomes.…”