CHAPTER 16. MEASURES OF SUCCESS

Ultimately, AMD's goal is to help all of its customers operate successful telemedicine programs. How that success is defined, however, is largely determined by you, based on the objectives to be achieved. Prior to implementing your program, AMD recommends that you establish measures of success in an effort to help determine whether program objectives have been achieved.

The advantages of documented success are many. First, the measures of success will help determine whether you have achieved your original objectives. If those objectives are achieved and success is documented, you can effectively communicate that success to leaders in the organization. This helps develop advocates for telemedicine within the organization and fosters its acceptance within the mainstream of everyday medicine.

Ongoing measurement of success also has the benefit of continually improving your program. Continual review of the program requires that managers think critically about program operation, assess operational changes, identify new telemedicine applications, and incorporate new technologies which enhance program performance. Continual assessment of program performance may help the program achieve defined objectives. Measurement of success can be incorporated into your organization's process for continuous quality improvement.

Finally, assessment of satisfaction of objectives helps to determine whether original objectives were realistic or whether your organization could realize all of the benefits of telemedicine. After your program commences operation, it may be necessary to revise original objectives.

The following are suggested measures of success depending upon the types of program objectives described in Program Objectives.

Access Model - The Access Model is intended to improve access to health care services using telemedicine as a cost effective alternative. The following are suggested steps which can be undertaken to measure success:

• Identify the populations intended to benefit from each telemedicine application, including specific medical conditions;
• Document the suspected incidence of the targeted medical condition prior to introduction of telemedicine;
• Document the treatment history and pattern prior to introduction of telemedicine;
• Measure the number of consults or services rendered to each targeted population;
• Longitudinally measure the changing service utilization; and
• Assess the effect on outcomes.

Using the State of Alaska example in Chapter 2, the initial objective of the program was to use otoscopy to diagnose ear infections with the goal of avoiding compromised hearing relating to repeated and undiagnosed ear infections, while at the same time reducing inappropriate antibiotic administration. In this telemedicine application, one can measure the number of images forwarded for consultation, the percentage of cases resulting in diagnosis of ear infection, the number of antibiotic prescriptions on average per year per patient, and the percentage of population presenting with compromised hearing. The two desired outcomes, reduced incidence of compromised hearing and reduced antibiotic administration must be measured longitudinally, and programs should be put in place to periodically access effectiveness of medical outcomes.

Parties implementing a telemedicine program to improve access must be committed to a long-term plan to operate the program and to assess success.

The Competition Model - The development of Measures of Success in the Competition Model is a much easier task. An institution can monitor its consults outside of the primary service area and compare the growth and number of referrals and revenue over time from markets where the program sponsor has established a telemedicine relationship. Progressive institutions may structure bonuses or incentive programs for physicians who participate in the development of telemedicine programs recognizing that the early years of the program may involve a significant investment of their time when program revenue is lowest. That investment, however, often leads to long-term program success.

The Cost Saving Model - In the Cost Saving Model, health care services are delivered using existing infrastructure. The goal of telemedicine is to reduce the cost of delivery of health care services. Often times, the most difficult task in measuring success in a Cost Saving Model involves obtaining access to information to document all cost savings resulting from implementation of a telemedicine program. In certain instances, cost savings may benefit multiple parties, such as an employer, patient or insurer, and those parties may be in possession of information relevant to the cost-savings analysis.

The following are suggested steps which can be taken to measure success:

• Document the present method of care delivery and its cost;
• Monitor the costs of delivery of care using telemedicine;
• Assess all savings achieved by each party after introduction of the telemedicine program; and
• Document savings to affected parties.

A potential illustration of the Cost Saving Model occurs in home care. For certain diagnoses (e.g. congestive heart failure, chronic obstructive pulmonary disease, and diabetes), home based monitoring may be instituted to help manage chronic illness. A desired outcome may be a reduction in utilization of emergency or inpatient medical services, a benefit well perceived by insurers. Measuring success in this circumstance may require that an insurer participate first in the documentation of the method of care delivery and its cost (including hospital, physician and other costs and the utilization rates such as hospital days per year) for individuals with targeted chronic illness. In addition, a search of the literature could be conducted to determine the experience of others in similar programs to establish expectations. After the program has been operational, the insurer would also participate in the documentation of cost after introduction of the telemedicine program, often at annual intervals. Again, measuring success often requires the commitment of the program sponsor and affected parties for several years to determine the likely cost savings of the program.