Dissertation Abstract

Cost Effectiveness in Telemedicine: Conventional Versus Digital Delivery of Radiologic Images

Medical informatics deals with the acquisition, compilation, organization, storage, and appropriate distribution of clinical and other health data. The field also seeks to streamline the process of conversion from data to information to knowledge, making the knowledge worker more efficient. Research and development activities in clinical informatics are leading to better management, dissemination, and use of medical knowledge. Quantifying this better use of medical knowledge, especially from an economic point of view, is a challenge. With the current political and economic climate of healthcare, all new information systems require proof of cost effectiveness. This research studies the cost effectiveness of the telemanagement of medical images produced for the Section of Neuroradiology, Department of Radiology, at the University of California at San Francisco (UCSF). UCSF is at the forefront of digital image management in the United States. The Department of Radiology's project relies upon hospital information systems (HIS), radiology information systems (RIS), picture archiving and communications systems (PACS), and teleradiology, to telemanage neuro-images. The system under study links UCSF to the Mount Zion Medical Center, an affiliated community hospital, and delivers telemanagement through two forms of digital delivery, T1 lines (1.544 Mbits/sec) and Asynchronous Transfer Mode or ATM-OC3 lines (155 Mbits/sec). This study addresses the problem of developing a reliable cost analysis model for PACS and for the use of telemanagement in neuroradiology. This study uses and defines criteria for inclusion in a CEA for PACS and produces a replicable assessment of cost effectiveness for PACS in neuroradiology using both conventional and activity based accounting models. Telemanagement for neuroradiology, between a teaching hospital and an affiliated community hospital, was found to be cost effective utilizing T1 delivery, in both standard cost modeling and activity based modeling. ATM delivery, while not cost effective at this time using standard cost modeling, was found to be less costly than film, based systems using activity based modeling. This study recommends inclusion of activity accounting to justify real time radiology and to provide additional evidence that PACS can be cost effective.

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