W. Gnann’s research while affiliated with University Hospital Regensburg and other places

Die steigende Komplexität der Leistungsprozesse in der Medizin erfordert einen schnelleren und konsistenteren Informationsfluss, gerade zwischen entfernt gelegenen Versorgungseinrichtungen. Das Regensburger Modell, eine Realisation „schlanker“ Telemedizin aus dem Low-cost-Bereich unter Verwendung PC-basierter Videokonferenzsysteme, zeigt die Nutzung moderner Telekommunikation speziell im unfallchirurgischen Umfeld. Bei 203 prospektiv evaluierten Telekonsilen wurden zwischen 15 Teilnehmern insgesamt 697 Bilder per Videokonferenz verschickt. In 95% des traumatologischen Krankenguts wurde das Befundmaterial qualitativ als mindestens ausreichend beurteilt. In einer projektbegleitenden Evaluation konnten die Effizienz dieser Systeme sowie auch deren Nutzen gezeigt werden. Einsparungen an Transportkosten in einer Höhe bis zu 4400 DM pro Fall konnten erzielt werden. Durch einen schnelleren Informationsfluss resultierten Qualitätsverbesserungen für alle Beteiligten. Auf dem Boden dieser Überlegungen entsteht in Regensburg eine weiterführende Kommunikationsplattform als abgeschlossenes medizinisches Netzwerk für die Region Ostbayern.

The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95% of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.

The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95% of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.

The growing complexity of the performance processes in medicine makes it mandatory that the flow of information is faster and more consistent, especially when the sites of health care are far away from each other. The Regensburg model, a realization of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing systems shows the use of modern telecommunications, especially in trauma surgery. In 203 prospectively evaluated teleconsultations between 15 participants a total of 697 images were transmitted via videoconferencing. In 95 % of the trauma cases the transmitted material was judged as at least sufficient. In project-attending evaluations the efficacy of these systems and their use were clearly demonstrated. Savings in transportation costs of up to 4,400 DM per case were achieved. Through quicker flow of information quality improvements for all participants resulted; to some extent considerable costs for health care were avoided or reduced. Based on these thoughts, a new platform of communication will be established in Regensburg as a closed medical intranet for the region of eastern Bavaria.

In the present era of cost containment, physicians need reliable data about specific interventions. The objectives of this study were to assist practitioners in interpretation of economic analyses and estimation of their own costs of implementing recommended interventions. MEDLINE search from 1966 through 1995 using the text words cost or expense and medical subject heading (MeSH) terms costs and cost analysis, cost control, cost of illness, cost savings, or cost-benefit analysis. The 4 eligibility criteria were clinical trial with random assignment; health care quality improvement intervention tested; effects measured on the process or outcome of care; and cost calculation mentioned in the report. After independent abstraction and after consensus development, financial data were entered into a costing protocol to determine which costs related to the intervention were provided. Of 181 articles, 97 (53.6%) included actual numbers on the costs of the intervention. Of 97 articles analyzed, the most frequently reported cost figures were in the category of operating expenses (direct cost, 61.9%; labor, 42.3%; and supplies, 32.0%). General overhead was not presented in 91 (93.8%) of the 97 studies. Only 14 (14.4%) of the 97 studies mentioned start-up costs. The text word $ in the abstract and the most useful MeSH index term of cost-benefit analysis appeared with nearly equal frequency in the articles that included actual cost data (37.1 % vs 35.1%). Two thirds of articles indexed with the MeSH term cost control did not include cost figures. Statements regarding cost without substantiating data are made habitually in reports of clinical trials. In clinical trial reports presenting data on expenditures, start-up costs and general overhead are frequently disregarded. Practitioners can detect missing information by placing cost data in a standardized protocol. The costing protocol of this study can help bridge care delivery and economic analyses.

Growing complexity of performance processes in medicine require a quicker and more consistent flow of information, even between distant sites of health care. The Regensburg model, a realisation of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing--systems shows the use of modern telecommunications especially in medical spheres. In project-related evaluations, the efficacy of these systems as well as their use can clearly be proven. Through a quicker flow of information, quality improvements for all participants resulted, and to some extent considerable costs for health care were avoided or lowered.

Growing complexity of performance processes in medicine require a quicker and more consistent flow of information, even between distant sites of health care. The Regensburg model, a realisation of lean telemedicine from a low-cost domain, using PC-based standard videoconferencing — systems shows the use of modern telecommunications especially in medical spheres. In project-related evaluations, the efficacy of these systems as well as their use can clearly be proven. Through a quicker flow of information, quality improvements for all participants resulted, and to some extent considerable costs for health care were avoided or lowered.

Der wachsende Kostendruck auf den Krankenhaussektor und die damit einhergehende Tendenz zur Spezialisierung und Zentralisierung medizinischer Ressourcen gefährdet die flächendeckend hochwertige Versorgungsqualität, ein Qualitätsgefälle von Ballungsräumen in die Fläche droht.