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Page of 2 Zoom CASE 4: IMPLEMENTING A TELEMEDICINE SOLUTION Grand Hospital is located in a somewhat rural area of a Midwestern state. It is a 209- bed, community, not-for-profit entity offering a broad range of inpatient and outpatient services. Employing approximately 1,600 individuals (1,250 full-time equivalent personnel) and having a medical staff of more than 225 practitioners, Grand has an annual operating budget that exceeds $130 million, possesses net assets of more than $150 million, and is one of only a small number of organizations in this market with an A credit rating from Moody’s, Standard & Poor’s, and Fitch Ratings. Operating in a remarkably competitive market (there are roughly one hundred hospitals within seventy-five minutes’ driving time of Grand), the organization is one of the few in the region—proprietary or not- for-profit—that has consistently realized positive operating margins. Grand attends on an annual basis to the health care needs of more than 11,000 inpatients and 160,000 outpatients, addressing more than 36 percent of its primary service area’s consumption of hospital services. In expansion mode and currently in the midst of $57 million in construction and renovation projects, the hospital is struggling to recruit physicians to meet the health care needs of the expanding population of the service area and to succeed retiring physicians. Grand has been an early adopter of health care information systems and currently employs a proprietary health care information system that provides (among other components) these services: • Patient registration and revenue management • EHRs with computerized physician order entry • Imaging via a PACS • Laboratory management • Pharmacy management Information Systems Challenge Since 1995, Grand Hospital has transitioned from being an institution that consistently received many more inquiries than could be accommodated concerning physician practice opportunities to a hospital at which the average age of the medical staff members has increased by eight years. There is a widespread perception among physicians that because of such factors as high malpractice insurance costs, an absence of substantive tort reform, and the comparatively unfavorable rates of reimbursement being paid to physician specialists by the region’s major health insurer, this region constitutes a “physician- unfriendly” venue in which to establish a practice. Consequently, a need exists for Grand to investigate and evaluate creative approaches to enhancing its physician coverage for certain specialty services. These potential approaches include the effective implementation of IT solutions. The findings and conclusions of a medical staff development plan, which has been endorsed and accepted by Grand’s medical executive committee and board of trustees, have indicated that because of needs and circumstances specific to the institution, the first areas of medical practice on which Grand should focus in approaching this challenge are radiology, behavioral health crisis intervention services, and intensivist physician services. In the area of radiology, Grand needs qualified and appropriately credentialed radiologists available to interpret studies twenty-four hours per day, seven days per week. Similarly, it needs qualified and appropriately credentialed psychiatrists available on a 24/7 basis to assess whether behavioral health patients who present in the hospital’s emergency room are a danger to themselves or to others, as defined by state statute, and whether these patients should be released or committed against their will for further assessment on an inpatient basis. Finally, in as much as Grand is a community hospital that relies on its voluntary medical staff members to attend to the needs of patients admitted by staff members such as some ED personnel, it also needs to have intensivist physicians available around the clock to assist in assessing and treating patients during times when members of the voluntary attending staff members are not present within or immediately available to the intensive care unit. The leadership at Grand Hospital is investigating the potential application of telemedicine technologies to address the organization’s need for enhanced physician coverage in radiology, behavioral health, and critical care medicine. Discussion Questions 1. What are the ways in which Grand’s early adoption of other health care information system technologies might affect its adoption of telemedicine solutions? 2. What do you see as the most likely barriers to the success of telemedicine in the areas of radiology, behavioral health, and intensive care? Which of these areas do you think would be the easiest to transition into telemedicine? Which would be the hardest? Why? 3. If you were charged by Grand to bring telemedicine to the facility within eighteen months, what are the first steps you would take? Whom would you involve in the planning process? Defend your response

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