Telemedicine Beginnings

By the end of 1993, MCG’s Telemedicine Program had expanded to seven sites, listed below in order of operational date:

In March 1992, then Governor Miller signed into law Senate Bill 144, The Distance Learning and Telemedicine Act of 1992, which mandated a statewide telecommunications network be established to support both a statewide distance learning program and a statewide telemedicine program.  A Governing Board was established, and various committees and task forces developed to implement the charges of SB 144.  (More information about distance learning in Georgia.)

In late 1993, the Governing Board asked the Board of Regents to develop and manage the telemedicine program charge of SB 144.  The Board of Regents, through the President of the Medical College of Georgia (MCG), assigned this responsibility to the Telemedicine Center at MCG.

A partial list of stated goals for the state’s telemedicine program in SB 144 follows:

• Improve access to medical care for geographically or socioeconomically isolated patients

• Enhance the quality, continuity and affordability of medical care

• Avoid unnecessary patient travel to secondary or tertiary care centers

• Help secure the financial stability of rural hospitals and allow patients to obtain medical consultation in their own community. 
  (More about health care in rural Georgia.) 

• Maintain the patient’s current provider-to-patient relationship

• Enhance continuing medical education and support for rural-based providers and remove the obstacle of professional isolation

• Secure the integrity of the health care system in under-served areas by providing support for the socioeconomic fabric of the community

• Effectively utilize the State’s medical resources by creating an integrated statewide network of primary, secondary and tertiary care for Georgia’s citizens

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Funding

From 1994 until June 2000, approximately $10 million was awarded by the Governing Board for telemedicine operations.  Additionally, MCG, who had the management responsibility as an unfunded mandate, contributed almost $6 million of its own funds toward program development, and spent an additional $3 million for management operations.  Each participating site had fiduciary responsibilities as well, averaging about $24,000 annually in addition to their Telemedicine Coordinator’s salary.

The Governing Board’s $10 million were allocated for the following:

• Equipment and site-specific cabinetry

• Installation of T-1 and three business lines

• Two-year subsidy for line and maintenance costs

• Conversion of four existing sites from the MCG Telemedicine Program

• Microscopes

• Development and implementation of a Clinical Training Program

• Development of a Patient Data Management System

• Redeployment funds

MCG’s $6 million was allocated for the following:

• Conversion of three existing sites from the MCG Telemedicine Program

• Funding for seven new sites

• Funding for the telecommunications and equipment maintenance recurring costs for some sites in fiscal years 1994, 1995, 1997, 1998, 1999, 2000; all sites in fiscal year 1996.

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Management

Important Update about GSTP Management in 2001.

§      A partial listing of the GSTP management functions of the MCG Telemedicine Center follows:

The MCG Telemedicine Center Director and Director of Operations were members of the Governing Board’s Telemedicine Task Force, along with members from other health care organizations and facilities.

Unique GSTP Features Implemented by the Telemedicine Center During its Management Years:

Coordinators- Single Point of Contact

Each telemedicine site in the GSTP designates a primary telemedicine coordinator, also known as the SPOC, or single point of contact. The SPOC system was implemented to simplify the communications process and make it as efficient as possible. A telemedicine site's SPOC serves as a primary contact and a facilitator between the patient and the provider and the telemedicine program.

Education and Training Programs

All GSTP telemedicine sites complete a training program that covers all aspects of the program, including: setting up the local program, using the equipment, using the PDMS, and the site's responsibilities.  The training program is administered by the MCG Telemedicine Center.  The Telemedicine Center furnishes training manuals to be used for reference following training.  In addition, the Telemedicine Center offered follow-up, or "refresher" training, for sites that requested it.

Equipment and Network Validation

Quality control and maintenance are important when using any type of equipment in the medical arena.  Once a site's equipment is installed using the Telemedicine Center's "Gold Standard" specifications, the validation process begins.  First, an on-site validation form/process is completed and submitted to the Telemedicine Center's Technical Director for review.  The second step consists of a connection between the new site and the Center's lab site.  A thorough check of the network and all the system's components is conducted.  Any component that does not "pass" has to be brought up to standard before a site can be considered validated.  To ensure the ongoing reliability of the system, a maintenance vendor responds to trouble calls on a 24 x 7 basis and provides quarterly preventive maintenance visits to all sites.

Local Program Development

Participating GSTP sites are responsible for the development of their local programs.  The ideal GSTP site is an innovative leader in the community, a large employer, concerned about the health of its citizens, concerned about its own financial viability and searching for ways to maximize efficiencies while maintaining or reducing costs.  Local sites are responsible for clinician recruiting, the commitment of the site's administration, board approval, integration with the existing structure, maintaining knowledge and continuing GSTP training.  

Clinicians in the local community should be provided information about:

• Reimbursement
• Research
• The Patient Data Management System (PDMS)
• Procedures for requesting a consultation
• Percentage of patients retained in local communities because of telemedicine
• Ability to facilitate transfers via telemedicine
• Continuity of care because of telemedicine
• Provider networks possible because of telemedicine
• Lessening of professional isolation due to telemedicine
• Providers using telemedicine are eligible for Category 1 CME, CE and GNA credits.
• Other educational opportunities are available via telemedicine

Newsletter

Patient Data Management System

The Medical College of Georgia Telemedicine Center contracted with the Biomedical Interactive Technology Center at the Georgia Institute of Technology to create a data management software program for the GSTP. The Patient Data Management System (PDMS) simplifies and organizes the collection of all consult-related information, tracking administrative details, such as the time of the consult, the patient and providers' names and the names of the sites involved. Patient images and heart and lung sounds associated with telemedicine consultations can be captured and added to the patient's electronic record.

Reimbursement

Reimbursement History
Reimbursement Today

Room Configuration

Each telemedicine room is custom designed for a site's clinical and educational needs, while incorporating standard configuration guidelines. Upon conclusion of a visit to the prospective telemedicine site, the Site Survey Team identifies modifications required prior to installation of the telecommunications lines, equipment, and cabinetry. The MCG Telemedicine Center compiles this information and develops both a detailed room configuration drawing and an actions list outlining the facility's responsibilities for room preparations to include, but not limited to, conduit and telecommunications company installation requirements, wall color, window and floor coverings, lighting specifications, as well as any necessary structural modifications.

Site Visits

A site survey team consisting of a representative from the MCG Telemedicine Center, a BellSouth BIC Engineer, and a local telecommunications company representative meets with a site's Administrator, Medical and/or Nursing Directors, Education Directors, identified Telemedicine Coordinator(s), Plant Engineer or Electrician, and the Chief Financial Officer during a site visit. The purpose of the site visit is to gather the necessary information to begin preparations for the installation of a GSTP telemedicine system. Information that will be gathered about the telemedicine room selected includes the heating and cooling system, room dimensions, adjacent rooms and hallways, clinical support needs, telecommunications needs, lighting, as well as electrical requirements necessary for determining an appropriate Room Configuration and Actions List.