Shea Steven
Department of Medicine, Columbia University, New York, USA.
J Telemed Telecare. 2006;12 Suppl 2:S85-90. doi: 10.1258/135763306778393126.
Business model and financial recovery issues dominate discussions about using telemedicine to improve chronic disease management. The technical issues are numerous, daunting and complex, but many can be addressed using the resources and infrastructure available in large, well-integrated clinical information systems. The cost-benefit balance will change when it becomes possible to use devices that are owned by patients for everyday use, rather than installing special-purpose devices for telemedicine. Technology and communications capabilities are driven mainly by market factors other than uses for health care. Provider-side telemedicine capabilities, specifically for upload, storage and display of home medical data, will improve as technology develops. How health-care providers will process the larger amount of data made available by telemedicine is a clinical issue, but it is likely that software will emerge to assist in this task. The alignment of financial incentives for health-care providers is a decisive factor in understanding why telemedicine has had substantial deployment within the US Veterans Hospital Administration system, and to some extent within prison health systems and the Kaiser Permanente Health Plan, but much less widely in other settings.
商业模式和财务复苏问题主导着关于利用远程医疗改善慢性病管理的讨论。技术问题众多、艰巨且复杂，但许多问题可以利用大型、整合良好的临床信息系统中现有的资源和基础设施来解决。当能够使用患者日常使用的设备，而不是安装用于远程医疗的专用设备时，成本效益平衡将会改变。技术和通信能力主要由医疗保健用途以外的市场因素驱动。随着技术的发展，供应商端的远程医疗能力，特别是用于家庭医疗数据的上传、存储和显示的能力将会提高。医疗保健提供者将如何处理远程医疗提供的大量数据是一个临床问题，但很可能会出现软件来协助完成这项任务。医疗保健提供者的财务激励措施是否一致，是理解为什么远程医疗在美国退伍军人医院管理系统内、在一定程度上在监狱卫生系统和凯撒医疗保健计划内得到了大量应用，但在其他环境中应用较少的一个决定性因素。
