Return on Investment Analysis of Health Experts onLine at Portsmouth: A 2-Year Review of the Navy's Newest Teleconsultation System

Lin, Andrew H; Welstead, Bethany L.; Morey, Brittany L.; Mahnke, C. Becket; Cole, Jacob; Johnston, Michael

doi:10.7205/milmed-d-16-00259

Cited by 12 publications

(7 citation statements)

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“…Although we identified two studies reporting a process similar to eConsult in Finland in the early 1990s, the contemporary eConsult design was implemented in the early 2000s and was further developed in the 2010s in large-scale programme in Ontario and the USA. In addition, we identified three non-civilian eConsult programmes in the USA that provide access to specialist care for military personnel and their families 47 69–72…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

et al. 2019

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IntroductionElectronic consultation (eConsult)—provider-to-provider electronic asynchronous exchanges of patient health information at a distance—is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services.MethodsWe applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied.ResultsAmong the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult.ConclusionThere are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.

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Section: Resultsmentioning

confidence: 99%

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

et al. 2019

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“…It was well-integrated in the overseas military medical environment prior to restrictions being placed on travel due to a global pandemic, and is a model that could be applied to healthcare service in civilian settings as well. This low-bandwidth, secure system demonstrated increased access to care in a method that was both time-efficient and costsaving over the course of the 2 decades it has been used, and in various global settings [1,5,6,8].…”

Section: Discussionmentioning

confidence: 99%

“…A two-year review of HELP's return on investment (ROI) showed considerable savings (both tangible and intangible) to the Military Healthcare System for relatively minimal cost by decreasing the medical provider's reliance on medical evacuation, most often from a ship, in questionable cases utilizing a low bandwidth, asynchronous, and internet accessible teleconsultation system [6]. This review looked at the first two years of this relatively new platform, but with only 559 cases they were able to use a physician review panel with three independent reviewers to assess each case.…”

Section: A Scalable Platform: Growth Of Path Beyond the Pacificmentioning

confidence: 99%

Asynchronous Teleconsultations: The US Military Experience in the Pacific

Mbuthia

Miller

2021

Studies in Health Technology and Informatics

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Tripler Army Medical Center (TAMC), located in Honolulu, Hawaii, serves as the US military’s tertiary medical referral center for the Western Pacific. Over 20 years ago, the TAMC Department of Pediatrics developed an asynchronous provider-to-provider teleconsultation pilot program, eventually named the Pacific Asynchronous TeleHealth (PATH) system. A secure teleconsultation platform for pediatric sub-specialty provider-to-provider advice, the platform grew based on the needs of users, eventually expanding to serve all age-groups, with over 60 different specialties based at TAMC providing teleconsultation. Eventually, the success of PATH drove further expansion to serve military clinicians located in other overseas locations beyond the Asia-Pacific. This cost-effective model can be applied to civilian healthcare settings, particularly where geographic distance or limited connectivity are challenges to delivery of synchronous telehealth or in-person specialty care.

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“…The positive return on investment and cost savings from prevented aeromedical evacuation has previously been reported in military telemedicine. 14 The mobile eye care app prevented the need for aeromedical evacuation in 4 consults (14%; 95% CI, 0.7%-28%) and downgraded the category of precedence from urgent or priority to routine in 4 consults (14%; 95% CI, 0.7%-28%).…”

Section: Discussionmentioning

confidence: 99%

Military Teleophthalmology in Afghanistan Using Mobile Phone Application

et al. 2020

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The coronavirus disease 2019 pandemic has highlighted the need to expand telemedicine solutions.OBJECTIVE To beta test a secure teleophthalmology mobile app at military treatment facilities in Afghanistan. DESIGN, SETTING, AND PARTICIPANTSThis prospective case series included 16 military treatment facilities at diverse roles of care including forward operating bases in Afghanistan and 1 location outside of Afghanistan. Thirty point-of-care medics and medical professionals were included from September to November 2019.INTERVENTIONS Users placed teleophthalmology consults on their mobile phone using the mobile eye care app, and an expeditionary ophthalmologist stationed at a military hospital in Afghanistan responded. Users graded the mobile app using a rating scale from 1 to 5, with 1 being very dissatisfied and 5 being very satisfied. MAIN OUTCOMES AND MEASURESMean initial response time, agreement between the teleophthalmology diagnosis and final diagnosis, treatment and management following recommendations outlined in the Joint Trauma System clinical practice guidelines, prevention of the need for aeromedical evacuation, user satisfaction, and security and the Health Insurance Portability and Accountability Act compliance of consult.RESULTS There were 28 consults placed over 6 weeks by 18 different users that were received by the expeditionary ophthalmologist. The mean (SD) patient age was 30.3 (9.8) years. Most patients were male (26 [93%]) and active duty US military (22 [78%]). The mean initial response time was 3 minutes 58 seconds (95% CI, 2 minutes 30 seconds to 5 minutes 26 seconds). There was agreement between the teleophthalmology diagnosis and final diagnosis in 24 consults (86%; 95% CI, 72%-100%). The treatment and management followed recommendations outlined in the Joint Trauma System Clinical Practice Guidelines for Eye Trauma: Initial Care in 28 consults (100%). Teleophthalmology consultation prevented the need for aeromedical evacuation in 4 consults (14%; 95% CI, 0.7%-28%). The patient returned to duty in 15 consults (54%; 95% CI, 34%-73%). Median overall satisfaction was 5 (minimum, 3; maximum, 5). All 28 consults (100%) were secure and compliant with the Health Insurance Portability and Accountability Act. CONCLUSIONS AND RELEVANCEWhile only a limited number of consults were evaluated, this study suggests that teleophthalmology mobile phone apps may improve and extend ophthalmic care in combat zones.

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Return on Investment Analysis of Health Experts onLine at Portsmouth: A 2-Year Review of the Navy's Newest Teleconsultation System

Cited by 12 publications

References 0 publications

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

Asynchronous Teleconsultations: The US Military Experience in the Pacific

Military Teleophthalmology in Afghanistan Using Mobile Phone Application

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