IMPLEMENTING A TELEMEDICINE SOLUTION, Major themes: system acquisition; use of emerging technologies Background Information Grand Hospital is
located in a somewhat rural area of a Midwestern state. It is a 209-bed, community, not-for-proï¬t 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 Moodyâs, Standard & Poorâs, and Fitch Ratings. Operating in a remarkably
competitive market (there are roughly 100 hospitals within seventy-ï¬ve minutes driving time of Grand), the organization is one of the few in the
regionâproprietary or not-for-proï¬tâthat have 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 areaâs 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
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physicians, both 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) ï§ Patient registration and revenue management ï§ Electronic medical records with computerized physician order entry ï§ Imaging via a
PACS ï§ Laboratory management ï§ 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 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 physician
specialists by the regionâs major health insurer, this region constitutes a âphysician unfriendlyâ 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 information technology solutions. The ï¬ndings and conclusions of a medical staff development plan,
which has been endorsed and accepted by Grandâs medical executive committee and board of trustees, have indicated that because of needs and
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circumstances speciï¬c to the institution, the ï¬rst areas of medical practice on which Grand should focus in approaching this challenge are radiology,
behavioral health crisis intervention services, and intensives physician services. In the area of radiology, Grand needs qualiï¬ed and appropriately
credentialed radiologists available to interpret studies 24 hours per day, 7 days per week. Similarly, it needs qualiï¬ed and appropriately credentialed
psychiatrists available on a 24/7 basis to assess whether behavioral health patients who present in the hospitalâs emergency room are a danger to
themselves or to others, as deï¬ned by state statute, and whether these patients should be released or committed against their will for further
assessment on an inpatient basis. Finally, inasmuch as Grand is a community hospital that relies on its voluntary medical staff 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 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 organizationâs
need for enhanced physician coverage in radiology, behavioral health, and critical care medicine. Discussion Questions 1. What are the ways in which
Grandâs 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 ï¬rst steps you would take? Whom would you involve in the planning process? Defend your response. ⢠A
minimally acceptable response length for each question is 350 words
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