Telemedicine:'If you aren't doing anything now, you're way behind'

Any health care provider that's not taking advantange of the many advances in audiovisual tools to connect with patients is woefully behind the curve, experts warn. Here's what some hospitals are up to in both rural communities and urban areas.

Haven't we met before? Don't call it a merger--a spate of new joint operating agreements may spark '90s deja vu, but it's different now, executives say

While a legal ruling in 2000 put a damper on joint operating agreements, hospital officials are again testing the waters. Systems or hospitals in Georgia, Maine, New York and Wisconsin are all looking at some kind of cooperation. "There are a lot more conversations occurring again between organizations, between health systems," says William Petasnick, left. "Some of this is a reflection of times changing again."

A post-1990s assessment of strategic hospital alliances and their marketplace orientations: time to refocus

In past years, many SHAs formed in local urban markets to better compete for managed care contracts. In response to 1990s forces, these SHAs appear to have adapted product, production, and selling orientations to their markets, aimed at large institutional purchasers of health care. However, health care markets have evolved differently than anticipated. SHAs and their hospitals should now adopt the marketing orientation and focus more on patients and enrollees.

[Evaluation of CHILI teleradiology network 4 years after clinical implementation]

The CHILI teleradiology network has more than 60 installations in Germany and the USA. Radiological images and cardiological multiframe series are exchanged in clinical routine. This article investigates in what way and how often the system is used. This is done by means of accounting files that are produced automatically by the system. User functions, transmission protocols, data quantity, frequencies and time of data transmission and teleconferences are evaluated and discussed in this paper. Different application scenarios have been identified and are described and analyzed as well. An important result is, that the system is not merely an emergency system. Instead, it is used in daily routine as a multifunctional, multimodality workstation with advanced features for teleradiology and telecardiology.

[University clinics as centers of radiologic performance alliances in the ambulatory and inpatient sector]

PROBLEM

Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery.

METHODS

The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the "Imaging services--teleradiological center of excellence". Legal, technical and organizational prerequisites were analyzed.

RESULTS

Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad.

CONCLUSION

Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services.

[Teleradiology--blessing or curse? 4 years routine in the North Hessia teleradiology data network]

Several hospitals in northern Hessen, not having their own radiology departments, want to run CT-scanners with the goal of improving medical quality. They requested co-operation from the Radiological Institute in the Hardtwaldklinik I in Bad Zwesten. Therefore a teleradiological network was developed, which enables the exchange of radiological-images and -reports between 19 hospitals today. An elementary requirement for this co-operation is an efficient and functional computer infrastructure and verified co-operation contracts. The conception, structure and development of the program, as well as associated difficulties are presented and discussed from different perspectives in the light of the controversy among experts. The results, experiences and benefits gained in four years, in which the teleradiological network of northern Hessen has been in place, demonstrate the importance and possibilities of teleradiology as an element of telemedicine. Teleradiology/telediagnostics improves the quality of patient care in smaller hospitals located in less-populated areas and present possibilities to optimize and integrate health care structures, taking economic considerations into account.

Collaboration between the Air Force, VA, and a university psychiatry department on an inpatient unit

The David Grant Medical Center at Travis Air Force Base in California is the site of a collaboration between the U.S. Air Force, the Department of Veterans Affairs, and the School of Medicine of the University of California, Davis, which was begun in 1994 to assure optimum use of resources and provide broader educational experiences to residents and students. The three systems have been integrated most fully on an inpatient mental health unit. The authors describe the history and development of the collaboration, focusing on how the model has helped the three organizations address clinical, institutional, and educational needs.

Health care adjusts to the squeeze: networks, outsourcing, and downsizing arrive

The 1990s has become a time when fewer employees are producing more work than ever for increasingly consolidated industries. Here's what that means in the american health care system: hospital networks, sharing laboratory services, contracting for outside services, and restructuring staffs.

Two hospitals join forces to sponsor "A Woman's Comfort Day"

Two Baton Rouge, La., hospitals--usually strong competitors--decided to join forces and collaborate on a special event for the women of the community. "A Woman's Comfort Day," now in its third year, was the successful result. If they're feeling good about themselves, can the Super Bowl be far behind?

Mergers thrive despite wailing about adversity

A push is under way to reform federal and state antitrust laws to permit more collaborative hospital activities. The intent of such reform is to ensure that cost-cutting, quality-enhancing joint projects aren't hampered by federal or state restrictions. But much evidence indicates that hospitals have done just about anything they've wanted in terms of collaboration, and they've done it a lot in the past few years.

Women's, children's groups say reform debate ignores needs

In putting their plans on the table, some health care reformers are forgetting the needs of women and children, advocates for those groups say. Meanwhile, hospitals are collaborating in efforts to fulfill still-unmet health needs.

[Decentralized psychiatry. Evaluation of the first 5 years of psychiatric service based on a general hospital]

In 1977 the state parliament of Berne took the decision to reform the existing psychiatric health care. decentralized, community oriented institutions were to be established with the aim of preventing secondary disabilities due to psychiatric illness, and of enhancing or instigating rehabilitative measures. 4 different psychiatric services based in general hospitals were installed. The present report presents an analysis of statistical data collected during the first 5 years on one of these services. We found a linear increase of admission which appears to be due to several factors: demand, image, manpower, cooperation with other institutions, breadth of the offered service. Furthermore, the distance between the institution and the place of living proved to be an important factor influencing the incidence of psychiatric treatment and the degree of cooperation with other care services--this aspect being consistent with the arguments for a decentralization of care. The degree of consistency in the distribution of diagnoses and the changes of treatment was surprising: an average of 50% of our patients were referred on an out-patient basis, approx. 40% by general hospital wards, 16% remain under the care of the general hospital. Our statistical analysis shows that in an average of 61% of the cases in which a referral to a psychiatric hospital was discussed, this measure could be avoided (although there is a certain degree of subjectivity in this judgement). The psychiatric service does not appear to compete with private practice care: 44% of the patients are referred to general practitioners and practing psychiatrists for after care, while only half as many are referred from private practices.

Emerging contract incentives can add to hospitals' savings

Group purchasing organizations are trying to draw more volume out of their hospital members by offering additional price breaks if purchases meet performance targets, says John Henderson. The purchasing groups see the approach as a way to keep their promise to manufacturers of volume in return for discounts.

Alliances: changing focus for changing times

Alliance networks were supposed to offer members the same buying clout enjoyed by national health care systems and the opportunity to contract with employers as part of a national health care delivery network. But overly optimistic projections about how quickly alliances could reach those goals--and what it would cost to teach them--led to unmanaged growth and disgruntled members. According to our cover story, alliances now are adjusting to changing conditions by adopting strategies to serve the needs of hospitals and systems competing in regional markets.

[Geriatrics in the acute care hospital]

Since 1985, a graded system of medical care has served as a model at the III. Medical Clinic, Antonius hospital, Velbert-Neviges, FRG; Geriatric I (diagnostic, therapeutic, and intensive medicine), Geriatric II (therapy unit), and Geriatric III (day clinic) have not only reflected diagnostic and therapeutic improvements but they have also changed daily hospital operational requirements. Because of the structural adjustment of the hospital geriatric patients receive better care and patient-care costs are reduced.

Group purchasers must take new risks to achieve success

In this article, Henderson shares his perceptions of the group purchasing market and the issues affecting groups and their negotiations with vendors, concentrating on vendors' reactions to changing market forces. He discusses where group purchasing is today and where it is going.

Keeping up with evolution. Choosing strategies as group purchasing gets more complex

The next stage of group purchasing contracts has arrived. Increasing demands of alliances and groups require a more sophisticated response from manufacturers than in the past. Innovative programs, contracts and a thorough knowledge of the group are now required to remain ahead of the competition.