Here is the original question posed on a number of LinkedIn groups, followed by a selection of responses. Should Telemedicine/Telehealth have its own department or be integrated into individual clinical departments? What Pros and Cons do you see? Al Kyle – Founder and President at StatVideo The answer to this question may depend on the situation. Tele-cardiology- more specifically tele-echocardiography, is often independent from the other telemedicine departments. There are dozens of tele-echo networks for pediatric echo that are run in hospitals with no telmedicine center. Many of these tele-echo networks have operated for 10+ years, with multiple subscribers. The infrastructure required to support the other telemedicine applications may be different from the technology needed to perform a real-time echo consult. In these cases, it may be more cost effective to be integrated into the clinical department. John Kornak – Director of Telehealth at University of Maine Medical Center While the Office of Telehealth is a separate department here at University of Maryland Medical Center, we do not report under the Information Technology side of the house. This is very important since IT tends not to want to deal with this type of technology nor has the resources to support such technology. I would agree with Mr. Kyle that it would all depend on the "use case" but I believe that a Telehealth Dept should be established and the clinical department tied into the Telehealth via a Telehealth Steering Committee so that ideas and projects can be suggested, approved, funded, and placed into production while also using a standards approach to hardware, software, and a support model. Laura Lappe – Associate Director of Telemedicine at Texas Tech University Health Sciences Center Here at Texas Tech University Health Sciences Center, we operate a separate services office from clinical departments. We actually function under a Rural Health Institute along with other such focused projects like AHEC, Health IT Resource, community-based research, etc. I actually like the idea of a steering committee, John. It's something we have talked about here. Otherwise, we work closely with clinical department administrators and many times directly with the providers to coordinate care. I suppose the big difference between what we do versus integration would be having staff available to function as an telehealth outreach coordinator who can keep abreast of the technology part as well. Dr. David C. Chilvers – Technology business creator As you are aware one of the main obstacles to the progress in the provision of new products and services is conflict of interest in terms of what is truly best for the patient versus what is best for the healthcare provider. While clinical input is clearly needed it is important that the objective of any new service is defined independently taking into consideration both the patient’s interest and the business case. I do not believe that you can generalise but each situation has to be considered in relation to the motivation of the people involved and optimised accordingly to meet the objectives. Frank Ruge – VP Vertical Markets EMEA at Vidyo It is a tool which clinicians need to adopt as a part of their toolbox. Therefore it has to be an integral part of the department's workflow. Peter Haigh, FHIMSS – Principal at Tele-Mobile Healthcare Solutions I think the answer is both. "Tele....." and "Mobile............" solutions have application in many departments and functions within healthcare, for patients as well as providers. Solutions of this type will be most valuable if they are integrated into "traditional" processes and practices. At the same time in order for potential applications to be identified it is important that they have an internal "Champion". Most likely this Champion function should be within the IT and Telecom organization, where they can make sure that the organization has awareness of the latest developments in Tele-Mobile technology. Tori Wade – Doctor at the University of Adelaide The answer is "it depends". Considering firstly the clinical activity and workflow, my research on the uptake and sustainability of telemedicine services indicates that there are a small number of distinct niches within which telemedicine can operate on an ongoing basis. The first is where telemedicine is a fixed activity within a larger service, so for example where telemedicine assessments are available every Thursday afternoon, or multi-D video case conference is Wednesday 8am. Another niche is where there are enough referrals to justify dedicated administration or coordination. So, for example, a telepsychiatry service to rural areas might have enough work coming in to justify employing one or more support staff, having their own rooms and so on, in which case it has become a separate organizational unit. I think this is a necessary phase because if one tries to spread telemedicine too thinly at the beginning there is not a critical mass of expertise and the activity often fizzles out, leading to the well known problem of lack of sustainability of the service. However once it has grown further, then one can move to the third option, where telemedicine has become a ubiquitous part of healthcare delivery at all levels: most organizations are not there yet. Now considering the technical aspects of providing a telehealth service, I would argue that it is important to have a separate technical unit that actually understands the requirements of telemedicine and how these are different to the general IT support services. Most IT support, for example, has no idea of what is needed for good quality and reliable video communication. Mathias Rauchhaus, MD, PhD – Founder at Consulting Firm In my opinion, first you need to specify what you mean by saying "telemedicine". Most of our recurrent misunderstandings are based on the fact that almost all people understand something different if saying telemedicine. Is it tele diagnostic, tele monitoring, tele therapy, video conferencing or something else? If one defines what specifically is meant one can start thinking where the best place is to operate a telemedicine center. So, the answer lies in the specific problem you want to address with telemedicine. Nancy E. Brown Connolly – Senior Program Director at Project HOPE This question does not have one answer. Both are acceptable and serve the patient and health system in different situations. Ultimately integration as a tool will best serve stakeholders. Remember we are the stakeholders as patients and professionals. Meeting critical factors is key and one of those is the availability of the technical support. Anna Caroline Braga - Physiotherapist I think that depends about what range of services your department will offer. I use telemedicine in my current practice for remote monitoring my ventilated patients. We have a partnership with company that provide respiratory equipment, and other partnership with a company responsible by smartphone which we use. This way it is possible to follow these patients without needing a specific location in my hospital, except my office. Final Thoughts The top reasons to have a separate telemedicine department that serves multiple clinical areas are:
If your program is new or covering just one clinical area, I’d say it is better to start out as an integrated extension of a specific clinical department. Once you get the integrated program operating smoothly, then you can look at expanding out to other clinical areas and at the same time extracting certain roles into a general telemedicine department. To put it another way, once you've proven out the telehealth concept in one clinical area, you are in a better position to systematize your learnings into a separate operation. And unless you had grant money to begin with, you may find it easier to get administration to fund a separate department once they see the potential benefits that telehealth can bring to the overall facility. The separate department should have roles like telehealth director, telehealth coordinator, and technical support. It should probably have a part- or full-time medical director as well. As the operation grows, this team could expand in various functions like training and marketing. Ultimately, as telehealth, telemedicine, and mHealth become mainstream within the workflow of different clinical departments, it will only make sense to ensure that this department serves as a consolidated support team for the hospital, much like IT is today.
It's your turn. What's your opinion on having a separate department for telehealth / mHealth / telemedicine? Please share your comments below.
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