Hearing and Balance Center, Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, U.S.A.
Otol Neurotol. 2010 Apr;31(3):524-7. doi: 10.1097/MAO.0b013e3181cdd69d.
This study evaluates technical requirements, privacy and legal constraints, reimbursement considerations, and overall feasibility of a new telemedicine neurotologic patient care delivery model in post-Katrina, Southeast Louisiana.
This study is a retrospective review of the first year of a telemedicine neurotology practice with limited on-site neurotology physician availability (3-days monthly) with a full-time on-site audiologist, a full-time specialty-trained nurse practitioner, full-time neurosurgery on-site availability, and full-time otolaryngology on-site availability.
A combined "store-and-forward" and "real-time" telemedicine delivery model was implemented for a new neurotology practice. Technical requirements include secure data transfer, real-time video-streaming, high-quality video otoscopy and microscopy, infrared video eye movement visualization and recording, remote visualization of radiologic imaging studies, and formalized diagnostic algorithms for patient evaluation. Telemedicine patient evaluations occur with the patient in Baton Rouge, LA, while the examining neurotologist is linked through a secure, commercially available communication connection in Pittsburgh, PA. Specifically designed consent forms and bilocation licensing and liability insurance coverage were required. Third-party payers were consulted before implementation to assure adherence to local reimbursement requirements. During the first 12 months of operation, 450 patient encounters were accomplished purely through telemedicine, with an additional 800 on-site patient visits and 150 operative procedures, including 24 neurotologic skull base procedures.
Telemedicine is a viable delivery model for neurotology care delivery. Planning and implementation of such a model requires systematic considerations of medical, nursing, information systems, legal, reimbursement, and management parameters. Although the authors' initial motivation for this model was the resource-restricted, post-Katrina health care environment in South Louisiana, this delivery model has wider applicability in otolaryngology, other medical specialties, humanitarian outreach, and medical education. Prospective assessment of clinical outcomes and patient satisfaction is ongoing for objective validation of this delivery model.
本研究评估了新远程神经耳科学患者护理模型在卡特里娜飓风后的东南路易斯安那州的技术要求、隐私和法律限制、报销考虑因素以及整体可行性。
本研究是对远程神经耳科学实践的第一年的回顾性研究，该实践中现场神经耳科医生的可用性有限（每月 3 天），但配备了全职现场听力学家、全职专业培训的护士从业者、全职神经外科现场可用性和全职耳鼻喉科现场可用性。
为新的神经耳科学实践实施了一种结合“存储和转发”和“实时”的远程医疗交付模式。技术要求包括安全的数据传输、实时视频流、高质量的视频耳镜和显微镜、红外视频眼动可视化和记录、放射影像学研究的远程可视化以及患者评估的规范化诊断算法。远程医疗患者评估在巴吞鲁日的患者进行，而进行检查的神经耳科医生则通过匹兹堡的安全商业通信连接进行连接。具体设计的同意书和双地点许可以及责任保险覆盖范围是必需的。在实施之前，咨询了第三方付款人，以确保符合当地报销要求。在运营的头 12 个月中，仅通过远程医疗完成了 450 例患者就诊，另外还有 800 例现场患者就诊和 150 例手术，包括 24 例神经耳科学颅底手术。
远程医疗是神经耳科学护理的可行交付模式。规划和实施这样的模型需要系统地考虑医疗、护理、信息系统、法律、报销和管理参数。尽管作者最初提出该模型的动机是资源有限的路易斯安那州南部卡特里娜飓风后的医疗环境，但这种交付模式在耳鼻喉科、其他医学专业、人道主义援助和医学教育方面具有更广泛的适用性。正在对临床结果和患者满意度进行前瞻性评估，以客观验证这种交付模式。
