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Telemedicine

The Value Challenge

Gignon, Maxime M.D., Ph.D.

Plastic and Reconstructive Surgery: February 2016 - Volume 137 - Issue 2 - p 496e–497e
doi: 10.1097/PRS.0000000000002117
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Quality and Safety in Healthcare Unit, Public Health Department, Amiens Medical Center, Amiens, France, Health Simulation Training Center (SimUSanté), Amiens, France, University Paris 13, Sorbonne Paris Cité, Educations and Health Practices Research Team, Bobigny, France

Correspondence to Dr. Gignon, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens Cedex 1, France, gignon.maxime@chu-amiens.fr

Chronic wounds represent a major burden for patients, families, caregivers, and healthcare organizations. Wound care is a complex and time-consuming process. Patients have many appointments to perform specialized regular assessment and frequent home visits. Telemedicine could be helpful to limit transportation.

Telemedicine is defined as the practice of healthcare using interactive audio, visual, and/or data communications.1 Most of the literature focuses on image technology and feasibility.1–3 Telemedicine is an encouraging way to access to a specialized team and to provide recommendations to visiting nurses, and it may reduce costs. However, controlled clinical trials are still needed to study cost-effectiveness, value, and satisfaction among professionals and patients.2 These dimensions are important to a successful implementation while still maintaining high-value care.

Telemedicine often introduces organizational changes and may have a negative impact on quality of care.4 Providers have to think how to integrate telemedicine in a high-value process to meet users’ needs, preferences, and values.

The needs of professionals must be identified. All professionals have to be trained to use the telemedicine solution. An active education by simulation could be a way to train professionals and test the telemedicine solution in the clinical context. Visiting nurses must also update their skills in wound care. A shortage of trained staff could be a factor if implementation fails.3 Communication allowed by telemedicine between visiting nurses and the outpatient clinical staff could be an educationally invigorating process. It could be a source of improvement and potentially beneficial patient-related outcome.3

Professionals should identify the target population: clinical criteria, primary care professionals available, insurance coverage, health literacy, and so on. Patients should have the choice between a full telemedicine, full in-setting, or mixed follow-up. In order to choose, patients have to be informed. Indeed, patients might need interactions with the physician, and telemedicine could be frustrating and a cause of dissatisfaction.3

Two major, broad telemedicine models exist. The store-and-forward model consists of storing clinical information for review by off-site personnel at a later time. The synchronous model, characterized by real-time relay and review of clinical information between visiting nurses and patients and the off-site personnel.2 This choice will influence the process of care, feasibility, and relations between patients, primary care physicians, and specialized professionals. Although the synchronous model enables direct interaction, it could difficult to use by busy clinicians who need to schedule appointments with patients and visiting nurses. The store-and-forward model is more acceptable and feasible, but could limit communication.2

Diseases associated with chronic wound are linked with frequent unhealthy behaviors.2,4 Preventive care must be included and the telemedicine process has to enable patient education, empowerment, and self-management.

The implementation of telemedicine may introduce organizational changes and have a negative impact on quality of care. The challenge is to create high-value care processes that include a well-designed telemedicine solution. We suggest adopting a “living laboratory” approach, bringing together patients, interdisciplinary healthcare professionals, and telemedicine experts, to develop, deploy, and test, in actual living environments, new technologies and strategies for the design of healthcare value processes, including telemedicine.5 It could be an interesting way to co-produce better e-health services.

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ACKNOWLEDGMENTS

The author would like to acknowledge the Telemedicine Center of Picardy (GCS E-Santé Picardie), the plastic surgery and wound clinic teams at Dartmouth Hitchcock Medical Center, and the Dartmouth Institute for Health Policy and Clinical Practice for their help in his thought on this topic.

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DISCLOSURE

The author has no financial interest to declare in the content of this article.

Maxime Gignon, M.D., Ph.D.

Quality and Safety in Healthcare Unit

Public Health Department

Amiens Medical Center

Amiens, France

Health Simulation Training Center (SimUSanté)

Amiens, France

University Paris 13

Sorbonne Paris Cité

Educations and Health Practices Research Team

Bobigny, France

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REFERENCES

1. Bowling FL, Paterson J, Ndip A. Applying 21st century imaging technology to wound healing: An Avant-Gardist approach. J Diabetes Sci Technol. 2013;7:1190–1194
2. Chanussot-Deprez C, Contreras-Ruiz J. Telemedicine in wound care: A review. Adv Skin Wound Care. 2013;26:78–82
3. Rasmussen BS, Jensen LK, Froekjaer J, Kidholm K, Kensing F, Yderstraede KB. A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients. Int J Med Inform. 2015;29 PII: S1386-5056(15)30001-0. DOI: 10.1016/j.ijmedinf.2015.05.012.
4. Aas IH. The future of telemedicine: Take the organizational challenge! J Telemed Telecare. 2007;13:379–381
5. Haux R. Medical informatics: Past, present, future. Int J Med Inform. 2010;79:599–610
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