Patient referral by telemedicine: effectiveness and cost analysis of an intranet system

The clinical effectiveness and costs of telemedicine in improving the refer ral process from primary to secondary care were examined in an eight-month prospective, comparative study with one-year follow-up. The internal-medici ne outpatient clinics of two Finnish district hospitals were compared-Peija s Hospital (PH) with telemedicine and Hyvinkaa Hospital (HH) without it. Th e three primary-care centres studied referred a total of 292 adult patients to the outpatient clinics. The population-based number of referrals to PH (7.5/ 1000) from primary-care centres was twice that to HH (3.8/1000). Thir ty-seven per cent of referrals to PH included requests from general practit ioners for on-line medical advice (teleconsultation). Forty-three per cent of the total number of intranet referrals resulted in outpatient visits at PH, compared with 79% in the outpatient clinic at HH. Only 18% of the patie nts receiving a teleconsultation ended up in the outpatient department of P H within one year. These visits were mainly due to progression of chronic d isease. No deaths or missed diagnoses could be attributed to telemedicine, but one diagnosis was delayed. The direct costs of an outpatient clinic vis it in internal medicine (EU211) were seven times greater per patient than f or an email consultation (EU32), with a marginal cost decrease of EU179 for every new intranet consultation. A cost-minimization analysis of the alter native interventions showed a net benefit of EU7876 in favour of the teleco nsultation process. General practitioners sought an outpatient visit for 13 0 of their patients, and advice only for another 77. On-line advice was non etheless given in 108 cases, and only 88 patient visits were arranged. Elev en referrals were declined. The cost difference between giving on-line medi cal advice for the 108 cases and a visit to the outpatient clinic for the o ther 88 was less costly (by EU4140) than investigating the 124 patients who se original clinic referrals to the PH were not declined. Productivity in t he hospital increased over threefold by using email consultations instead o f traditional outpatient visits. The wide interactive use of the intranet r eferral system between secondary and primary care improved clinical effecti veness, lowered direct costs, increased productivity and was cost-effective .