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Administrative Lessons

Expect to expend considerable effort in training and convincing practitioners to try telemedicine
We all spend considerably more time than we initially anticipated training practitioners and convincing them to try telemedicine. Among the techniques used to encourage practitioners to try telemedicine were holding open houses where practitioners could play with the equipment; encouraging practitioners to use the equipment during continuing education sessions, when there is less pressure to be an expert; and having physician advocates who are interested in telemedicine "sell" it to their colleagues. Despite these efforts you still may not be successful.

Utilization is as likely to be initiated by specialists as by rural Practitioners
Significant jumps in utilization can occurr when a specialty practitioner adopts the technology and uses it to provide consults to patients at remote sites. Our hematologist had it available but it was in an inconvenient location. With considerable effort we arranged for him to see one of our patients for counselling over our system and now he wants to spread it for patients regionally. The lesson is, don't wait for rural practitioners to schedule patients for telemedicine consults. Encourage specialists to schedule telemedicine consults for patients who otherwise would have to travel significant distances for brief follow-up visits.

Look for non-conventional clinical applications
Utilization can come from non-conventional consults like podiatry, speech therapy, or nutrition counseling. Telemedicine is not just for traditional specialty consults involving specialty physicians, such as cardiology or orthopedics.

Conduct a thorough needs assessment and regularly scheduled telemedicine clinics
We are working with Blue Cross to determine which specialty areas to target for telemedicine usage. One technique is to by find out which specialty areas had the most missed appointments by rural patients. In response we can set up regularly scheduled clinics in those specialty areas. Regularly scheduled clinics also make providing telemedicine consults more predictable for the specialists.

Confidentiality and privacy may be bigger concerns in theory than in Practice
By following fairly standard health care protocols to assure patient confidentiality and privacy, we have not had experienced significant problems or concerns about confidentiality or privacy.

Data transmission costs are high and need to be factored into long-term plans for sustaining a telemedicine network. However, implementation of the Telecommunications Act of 1996 should result in lower transmission costs for rural telemedicine networks.