Benefits of telemedicine

"Telemedicine can both provide socio-economic gains and offer qualitative benefits in the public health service," conclude researchers from the social science research institute NORUT and the Norwegian Centre for Telemedicine in a study from 2006: Gevinster av norsk telemedisin (Benefits from telemedicine in Norway).

Proven benefits

Fewer hospital admissions, time savings for health staff, and reduced travel expenses were among the benefits the researchers found in this study. Benefits from the introduction of electronic patient records (EPR) and messaging may include less duplication of effort and fewer errors. Resources are released; routines become simpler; communication is faster.

According to the NST researchers Elin Johnsen and Elin Breivik, the results presented in the report are based only on documented studies.

"This does not however exclude other potential benefits from the use of telemedicine and eHealth. It is just that these have not been documented yet."

"We have reviewed the documentation available, both on services in routine operation and on time-limited projects, and present the results of the review in our report," explains project manager Elin Johnsen at the NST.

Economic assessment

The main objective of economic assessments is to find out whether new ways of providing health services can make limited health resources more accessible to the population, improving the public health service offering. Economic assessment is performed by comparing and analysing at least two different ways of delivering a health service (for example, a traditional meeting between doctor and patient at the hospital – and a meeting in which the doctor and patient are at a distance from each other and communicate by using telemedicine equipment).

The assessment involves identifying and considering values, then comparing the consequences of different ways of providing the health service and measuring costs and outcomes. This type of information can help health authorities to set priorities in a sector with limited resources.

Most economic assessments performed so far have compared the costs of using telemedicine with the costs of conventional forms of health service delivery. The benefits have been limited to savings on travel expenses. Travel expenses will vary depending on the distance to the medical centre and the hospital. The result is that research on the economics of telemedicine use is greatly influenced by the situation. It is difficult to generalize the results and compare them from one situation to another.

Economic analyses of several telemedicine services in northern Norway have been carried out. Some services result in demonstrable economic benefits, while others do not. A teleradiology service, an ear, nose and throat service (Bergo, 1997) and a dermatological service (Bergo, 2000) provided economic benefits.

Teleradiology

A teleradiology service between a general practitioners' practice at Otta and Innlandet Hospital Trust in Lillehammer [about 115 km (70 miles) away] was found to result in economic benefits because the patient volume and travel expenses were high, while the investment costs for the service were low (Johansen et al, 2004). For another teleradiology service analysed in a scenario study, the conclusion was the opposite (Halvorsen, et al, 1997). This study found that the service was not economically profitable due to high investment costs.

Teledialysis

Use of teledialysis at a local dialysis unit has also been assessed (Rumpsfeld et al, 2005). This service was expensive and not economically profitable compared with the alternative method, a nephrologist travelling from the University Hospital to the local hospital. However, teledialysis still offered great advantages for patients. They avoided having to travel to the University Hospital for follow-up, and the dialogue between patient and specialist improved.

Sound and still images

Affordable telemedicine services using still images and sound transmitted electronically can be economically profitable for medical centres in rural areas (Bergmo et al, 2004). This is however dependent on the volume of patients and the travel distance to the specialist health service. Where heart disorders in children are suspected because of abnormal heart sounds, recordings of the sounds can be transmitted electronically to a specialist for evaluation.

However, this is such a rare condition in children that the volume of the service is not enough to make it economically profitable. In contrast, the use of still images for dermatological consultations can be economically profitable in rural areas if the volume of patients is high and it is possible to save travel expenses (Bergmo et al, 2000).

Referrals and discharge letters

Referrals and discharge letters can be sent electronically. A study of electronic messaging shows that to derive economic benefits, the public health service must take advantage of the potential that this functionality offers. The greater the number of messages sent electronically, the greater the economic benefits (Aanesen et al, 2006).

Volume of patients most critical

Whether telemedicine services are economically profitable depends on various situation-specific factors. The most important, however, is the volume of patients. Other factors such as investment costs and other expenses associated with the service, as well as the distance between the local medical centre and the specialist health service (hospital), will also influence the outcome. Decisions about whether to implement telemedicine on the basis of economic arguments must be made from a local perspective.

There are many external factors involved in realizing the benefits of telemedicine use. The services may result in gains for one organization or one municipality, while the same services do not result in the same gains in another organization or municipality. This may be related to geographical factors, population figures, or other aspects. These are factors that are difficult to control, and can thus have different effects.

A selection of economic analyses of telemedicine services conducted in Norway:

• Johnsen E, Breivik E. Myrvang R, Olsen F. Benefits from telemedicine in Norway.
• Norum J, Bruland ØS, Spanne O, Bergmo T, Green T, Olsen DR, Olsen JH, Sjaaeng EE, Burkow TM. Telemedicine in radiotherapy: a study exploring remote treatment planning, supervision and economics. Journal of Telemedicine and Telecare, 125: p. 245-250, 2005
• Rumpsfeld M, Arild E, Norum J, Breivik E. Telemedicine in haemodialysis: a university department and two remote satellites linked together as one common workplace. Journal of Telemedicine and Telecare, (11): p. 250-255, 2005
• Bjørvig S, Johansen M,  Fossen K: An economic analysis of screening for diabetic retinopathy. Journal of Telemedicine and Telecare, (8): p. 32-35, 2002
• Bergmo T: A cost-minimization analysis of a realtime teledermatology service in northern Norway. Journal of Telemedicine and Telecare, (6): p. 273-277, 2000
• Bergmo TS. An economic analysis of teleconsultation in otorhinolaryngology, Journal of Telemedicine and Telecare. 1997;3(4):194-9
• Bergmo TS. An economic analysis of teleradiology versus a visiting radiologist service. Journal of Telemedicine and Telecare. 1996;2(3):136-42

Contacts

If you have questions about benefits or economic analyses related to the introduction of telemedicine, you can contact our special advisers, Trine Bergmo, mobile telephone (+47) 480 03 565 and email trine.bergmo@telemed.no or Elin Breivik, mobile telephone (+47) 481 54 808 direct and email Elin.Breivik@telemed.no.

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