CHAPTER 3. MANAGEMENT

A successful telemedicine program requires management dedicated to successful implementation and operation of the program, with clear accountability for its operation. Generally, management is required at a number of levels to assure effective operation of the program.

The Program Director. A telemedicine program will benefit from the efforts of an administrative representative (referred to as the "Program Director"), who is responsible for the overall operation of the program. The Program Director is responsible for planning the program and managing all of the resources required for its operation. The Program Director must assure the continued availability of resources to support the ongoing operation of the program, a delicate task when there is intense competition for limited resources. A dedicated Program Director can significantly advance the standing of the telemedicine program within a health care organization by carefully planning the program, overseeing its implementation, and trumpeting its success. Maintaining the enthusiasm and participation of consulting professionals is critical.

A Program Director should continually evaluate the operation of the program, establish quarterly goals to be achieved in the operation of the program, and regularly (and critically) assess the attainment of those goals. Finally, the successes of the program must be communicated effectively to organizational leaders. Everyone loves to be associated with a successful program, and telemedicine results in many patient success stories, which present an organization with favorable public relations opportunities.

The Clinical Director. Clinical support of a telemedicine program is also crucial. A Clinical Director should establish a physician liaison in each department or medical specialty which participates in the telemedicine program. The Clinical Director must have the standing in the organization to secure the commitment of multiple departments or divisions to participate, must marshal professional resources in affected departments, must assure that physicians and staff have appropriate training in the use of telemedicine technologies, and must mainstream the program into every day clinical life to avoid disruption to the existing clinical practice. Even the most successful programs will represent only a small portion of physician incomes in the immediate future. Nothing will advance a program more than effective clinical leaders who embrace telemedicine technologies in the conduct of every day practice.

Originating Site Manager. Designation of a manager responsible for the operation of each Originating Site is also important. AMD terms this person the "Originating Site Manager". This does not necessarily require a person dedicated solely to telemedicine functions, but does identify the person responsible for operations at the Originating Site. The Originating Site Manager is the liaison to direct patient care and must assure that all operations at the Originating Site are conducted smoothly and efficiently. The manager at the Originating Site must assure that all personnel are adequately trained in the use of telemedicine devices to capture diagnostic quality images, data and sound, that operations and documentation comply with the requirements for reimbursement by governmental entities and insurers, and that all personnel at the Originating Site establish realistic expectations among the patients who use the site.

The Multi-Disciplinary Team. Finally, because telemedicine involves a multi-technology solution the management team must often draw upon a collection of resources, including telecommunications, information technology and finance professionals, to successfully implement and operate a telemedicine program. Issues such as finance, billing and reimbursement, integration of telemedicine software for interoperable platform operations, network computing, integration of medical information into electronic medical records, data security, regulatory compliance, and the selection of "live" or "store and forward" applications, and the concomitant effect on selection of video-conferencing platforms and telecommunications options, all commonly arise in the planning of a successful telemedicine program. A Program Director must assess the in-house availability of resources and secure such resources on an outsourced basis when appropriate. When reviewing the use of in-house resources, the Program Director should assess the technical expertise and the time available to devote to the telemedicine program.

Ultimately, a well functioning and coordinated management team is critical to a successful telemedicine program. The management team must be prepared to address all clinical and administrative matters affecting the operation of a successful telemedicine program, to assemble the resources necessary for continued program operation, and to effectively communicate the story of success.