Telemedicine Cost and Clinical Efficiency Issues –

Experience from a Pilot Project Between the

Rikshospitalet- Radiumhospitalet HF (RR) Oslo, Norway and

Methodist Rural Public Care Center (MPCH) Mursan India

Vinod Mishra, PhDRikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway

TTeC2006 conference 2006 Tromsø

Overview• Brief Norway and India equity and diversity• Goal telemedicine / telediagnostic project• Experience

– Patient– Clinical efficiency– Cost efficiency

• Barriers• Conclusion

• Population 4,604,800• Life expectancy

Male 76 yearFemale 82 year

• GDP per capita 32 224 USD• Unemployment rate 4.4%• Health expenditures

Health & social services

30 billion USD, 10.4 % of GNP

• Hospitals expenses11 billion USD 1 USD = 6.50 NOK

• Population 1. 025 billion• Life expectancy

Male 63.9 yearFemale 65

year• GDP per capita 3 400 USD• Unemployment rate 9.9 % est• Health expenditures

Health & social services

5.3 % of total budget, 0.9 % of GNP

• 60 millions mobiles telephone in 2005 (increasing 100% each year)

• 12 millions new TV each year• 1.6 million new cars each year

Telemedicine

Telemedicine

Major Diagnosis Specialties Pictures

Obstetric and Gynaecology

28%

HIV/Aids Herpes 3 Psoriasis post delivery 4 Pregnancy Malaria, Thyroid 2 New born baby with breast problems 3 Congenital abnormalities 3 Premature delivery with PV leakage 3 Dermatology 64% Eczema 2 Skin rashes 4 Fungal infection 2 Fungal infection 2 Superficial infections 4 Fungal infection 2 Unknown severe skin rashes 14

Chronic dermatitis 2 Fungal infection

3

Fungal infection 2 Fungal infection 4 Neonatal cardiology 3% Congenital heart problems 2

Respiratory diseases 2% Respiratory problems 1 Ophthalmology 3% Neonatal rectalageni 2

Main goals Web based Telemedicine project MURSAN

• Provide expert opinion for under privileged patients• Facilitate medical consultation• Educational activities• Introduction of two-ways, interactive telecommunication

between university hospital and primary health center

Web based Telemedicine project - MURSAN• Image management and secure storage system• Future plan for real time tele-communication and education

sessions• Web based system an economic mode of providing expert

services to the primary center at remote site in India• Better management of patients since this system allows fast

diagnosis, fast opinion and inter-consultation among specialist located not only at our hospital but around the world.

Web based Telemedicine project – MURSAN Patients• Better access to care • Access to a multidisciplinary network of skills and

competences• More relevant indication of patients- reduce transfers

between primary- secondary and tertiary care• Societal benefits improved cost-effectiveness of treatment

Web based Telemedicine project – MURSAN Clinical efficiency• Keep more patients to local providers • Major assets in favor of a network-organized professional

practice • Professionals feel less lonely they are fellow worker• Ongoing learning and daily practice are interrelated• Effects on patient management- changes in clinicians

decisions making

Web based Telemedicine project – MURSAN Cost efficiency• Cost effective (direct cost, direct non medical cost and

indirect cost, opportunity cost)– Cost of consultation a major issue– Patient non-emergent transport expenses– Standard hospitalization cost– Standard ancillary cost

• Cost of specialists can be shared by low incidence users• Time reduction in work flow• Automatic and intelligent solution• Cost effective only if a certain threshold is achieved

Web based Telemedicine project – MURSANbarriers• No institutional strategic plan for telemedicine• The technology is not as affordable as we think it is• The technology is not so easy to employ as we would like to

believe• The technology is not as universally useful as we want• The infrastructure is not as ubiquitous as it needs to be• Clinicians are reluctant to use

Conclusion• Web based telemedicine- telediagnostic is a win win situation

for partners• Systems can be used as a tool for distance learning program

between tertiary Sand primary level • Web based telemedicine- telediagnostic is JUST A TOOL• Experience shows that one must have

– focus on clinical efficiency – focus on cost efficiency– use of cost-benefit analysis

Telemedicine

Thank you for attention

Vinod MishraSpecial advisorRikshospitalet- Radiumhospitalet University HospitalOslo NorwayTl. + 47 23 07 11 76Fax + 47 23 07 11 78Email: vinod.mishra@rikshospitalet.nowww.rikshospitalet.no