John Bennett, member of the Administrators in Academic Psychiatry (AAP) and working at the Michigan University, on several occasions has reported on the development of telepsychiatry as an application of telemedicine. In the AAP Magazine Grapevine, he clarifies his viewpoints on what role technology can play with relationship to telepsychiatry as to reduce costs in patient treatment while at the same time adding value to the psychiatric health care. Bennett suggests we should have a look at the commercial business experiences of the eighties where downsizing had to be reconciled with process re-engineering in order to stay alive and competitive.
Telepsychiatry is facing a dilemma. Telemedicine equipment such as high grade video cameras and monitors, digitisation and compression of analogue audio/video signals, simultaneous transmission of data, on the one hand and transmission charges on the other are extremely expensive. The reduction of federal funding has an immediate repercussion on the implementation and sustainability of telepsychiatry which is hardly self supporting. Yet, factors like distribution of expertise, ready access to psychiatry resources, improved follow-up and maintenance, ease of consultation might constitute important savings.
Question is how to integrate and finance advanced technology in a way that telepsychiatry meets the expectations of all patients and is able to reduce the level of acuity while costs are simultaneously being lowered. Therefore, it is absolutely necessary to understand the relationship between technology, management and business strategy, as Bennett stresses. Health care is becoming more and more commercialised, offering services at competitive prices while governments stand by and watch. Customer demands gradually rule the marketplace. Technology alone however does not transform common tasks into more efficient processes as commercial business experiences in the eighties have showed.
The focus shifted from vertically organised management structures to horizontally embedded quality control circles where communication and downsizing formed the new magic words. Still competitive results were insufficient so the next move implicated re-engineering of manufacturing procedures into horizontal, end-to-end processes adding value to the customer. This kind of business process re-engineering (BPR) includes technologies which mutually link and network so that production and service match the market needs on an individualised basis.
According to Bennett, psychiatry should follow the same BPR path and learn from the mistakes commercial business has made. Simple rationing of care is no long term solution. It will demoralise health care workers and alienate customers without ever responding to market needs. Business and care processes should urgently be re-engineered with focus on patient added value and that's where technology comes in. This means no less than a copernican revolution in the health care business where job security as well as hierarchical structures will be at stake.
The type of technology needed in health care depends on the level of process evolution. First, mission critical data needs to be computerised and stored in digital form. Next, technologies have to link tasks into common communication frameworks providing feedback on quality issues. Finally, full integration of data and processes from horizontal end-to-end point should guarantee value added service to the customer as well as significant cost savings to the organisation. A long and winding road to travel but worth the while as patients in the future can rely on lean, cost-effective, integrated and regionalised health care delivery systems. Read the full story on BRP in telepsychiatry in the Grapevine excerpts at the AAP web site.