Patient referral by telemedicine: effectiveness and cost analysis of an intranet system

Abstract

The clinical effectiveness and costs of telemedicine in improving the referral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medicine outpatient clinics of two Finnish district hospitals were compared--Peijas Hospital (PH) with telemedicine and Hyvinkää Hospital (HH) without it. The three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/1000) from primary-care centres was twice that to HH (3.8/1000). Thirty-seven per cent of referrals to PH included requests from general practitioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patients receiving a teleconsultation ended up in the outpatient department of PH within one year. These visits were mainly due to progression of chronic disease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic visit in internal medicine (EU211) were seven times greater per patient than for an e-mail consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU7876 in favour of the teleconsultation process. General practitioners sought an outpatient visit for 130 of their patients, and advice only for another 77. On-line advice was nonetheless given in 108 cases, and only 88 patient visits were arranged. Eleven referrals were declined. The cost difference between giving on-line medical advice for the 108 cases and a visit to the outpatient clinic for the other 88 was less costly (by EU4140) than investigating the 124 patients whose original clinic referrals to the PH were not declined. Productivity in the hospital increased over threefold by using e-mail consultations instead of traditional outpatient visits. The wide interactive use of the intranet referral system between secondary and primary care improved clinical effectiveness, lowered direct costs, increased productivity and was cost-effective.

Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit–Cost Analysis

“…Whitten and colleagues 6 review over 600 articles addressing the costs and effectiveness of telemedicine and find that fewer than 4% contain a legitimate economic evaluation and that the vast majority of those carry out a simple cost analysis without linking costs to program outcomes. For examples of the application of cost analysis to telemedicine, see Stensland and colleagues, 7 Bergmo, 8 Harno and colleagues, 9 McCue and colleagues, 10 and Persaud and colleagues. 11 When both costs and outcomes of telemedicine are considered, CEA is the most common, although not widely used, type of full economic evaluation.…”

Policy Innovation is Needed to Match Health Care Delivery Reform: The Story of the Champlain BASE eConsult Service

“…However, the Champlain BASE eConsult service is the only multispecialty asynchronous service of its kind currently operating in Canada. Worldwide, there are four other multi-specialty asynchronous services reported in the literature, which are located in the following institutions: San Francisco General Hospital (Kim-Hwang et al 2010), the Mayo clinic in Minnesota (North and Tulledge-Scheitel 2014), The Kaiser Permanente Hospital in Colorado (Palen et al 2012), and the Peijas hospital in Finland (Harno et al 2000). Similar to our findings, early results also suggest that these services improve access to specialist care, reduce wait times, and improve communication between PCPs and specialists (Straus et al 2011;Callahan et al 2005;Wootton, Menzies, Ferguson 2009).…”

Telemedicine and home care: controversies and opportunities

“…In this case, advice to doctors is provided by a panel of consultants who are not on site and answer via a teleconsultation. This scheme is likely to be cost-effective [7,8].…”