final presentation (with notes)
TRANSCRIPT
-
8/14/2019 Final Presentation (With Notes)
1/53
I can be reached at [email protected]
-
8/14/2019 Final Presentation (With Notes)
2/53
-
8/14/2019 Final Presentation (With Notes)
3/53
-
8/14/2019 Final Presentation (With Notes)
4/53
My research literally spanned hundreds, if not thousands of documents. In the
bibliography I have captured those that were most useful. The bibliography will also
correspond to the soft copies that are available.
I wanted to leave this behind in an orderly fashion so that others who work with the
organization who need to learn about telemedicine, which is a relatively new
concept, will not have to start from nothing.
As with all of the deliverables and data referenced in this presentation, the
bibliography and zip file will be downloaded to the folder 111 in All Modules.
-
8/14/2019 Final Presentation (With Notes)
5/53
I wrote this paper at the outset of my internship with Byrraju. It was the best way I
could think of to discipline my initial research to catch myself up to speed before
arriving in Hyderabad. The paper is a good overview of the state of telemedicine for
anyone who is knew to the field. Because I may attempt to publish this paper (or
parts thereof) sometime in the future, I would appreciate if it is properly cited when
referenced. If you desire to share it with someone outside the organization, please
contact me for approval first. See slides 11-14 for a discussion that includes themes
from this research/writing.
-
8/14/2019 Final Presentation (With Notes)
6/53
The village census was conducted in 2004. 144 villages were surveyed family by
family. Data entry is suspect, and the census process itself is open to questions. To
make any use of the data, I had to combine the documents into 5 district-level files. I
then used Microsoft Excel to pull data from each separate file. The statistics I
gathered are reviewed in a later section of this presentation. The raw statistics
(tables, not charts) are available in an accompanying Excel spreadsheet.
Unfortunately, because the calculations were drawing from files as big as 80 MB (in
the case of West Godavari district) I could not retain the original formulas that were
used to pull out the data (otherwise Excel would crash every time the formula tried to
update the results). The titles of the tables, however, should be sufficient for the
reader to understand what data was pulled. See slides 28-41 for a summary.
-
8/14/2019 Final Presentation (With Notes)
7/53
-
8/14/2019 Final Presentation (With Notes)
8/53
There are three estimates for the costs of medicine. The first is taken from West
Godavaris June report. Of course, it would be better to get the reports of all health
centers and for many months to estimate the monthly cost of providing medicines
per village. By the time I realized such a report existed, it was too late to spend much
time on a new round of data collection. There is also a project being conducted by a
group of Shiva Shivani interns, in which they have collected data on the costs of
medicines for three villages in Rangareddi District. It was from their data that I
extracted the price per unit of the medicines that I used to compute the average cost
of medicines per month. See slide 45 for a summary.
The salary information was given to me by the finance department. See slide 46-47
for a summary.
The age information was collected on my behalf by Arun Kumar and Venkata Rao,with the help of Vasundhari Alluri. See slide 48 for a summary.
-
8/14/2019 Final Presentation (With Notes)
9/53
Villages I visited include:
Vandrum
Juvvalapalem
Allavaram Kendram
Poduru
I-Bhimavarem
Jallikakanara
Kashevarem
And several others whose names I failed to record
See slides 51-53 for a summary.
-
8/14/2019 Final Presentation (With Notes)
10/53
-
8/14/2019 Final Presentation (With Notes)
11/53
My ideas on this are well-fleshed out in the white paper.
-
8/14/2019 Final Presentation (With Notes)
12/53
My ideas on this are well-fleshed out in the white paper.
-
8/14/2019 Final Presentation (With Notes)
13/53
Byrraju Foundation, both in verbal and written communication, offers the same
promise as the telemedicine field in general: lower costs, greater access, the same or
better quality of health care.
Unfortunately, it also falls into the same trap: there is no proof of any of these things.
For the Byrraju Foundation, that is okay. Telemedicine is very new program here, only
6-8 months old. However, if the organizations hopes to fulfill its mission to be a
platform by which other organizations can learn best practice, it should care deeply
to real evidence of the impact of its programs on cost, health, quality, etc. It should
also have data that proves its programs are the best option, at least for this area. That
means collecting data on alternative models, including the one it is using currently.
-
8/14/2019 Final Presentation (With Notes)
14/53
Too many organizations have fallen in love with technology, and they implement it
just because they can. More thought should be given, and more research conducted
to prove, that telemedicine (in an form or fashion) is truly what it claims to be.
Currently, there is no way to know whether the Byrraju health model is the best
solution to the health problems of Andhra Pradesh. The impact of the program is
today as much a conjecture as it was pre-implementation.
-
8/14/2019 Final Presentation (With Notes)
15/53
-
8/14/2019 Final Presentation (With Notes)
16/53
-
8/14/2019 Final Presentation (With Notes)
17/53
The benefits of a willingness to pay study are many. The Foundation benefits with
better information to make management decisions, and with which to convince
donors that its proposed model is financially sound. If a paper is published, it also
enjoys the limelight of a broad audience that will learn about its programs as they
learn about the studys conclusions.
Professor Ravi Anupindi (University of Michigan) and the research community also
benefit, precisely because there is little to no quality research published in the three
areas here mentioned. I am confident that a paper that addresses these three
subjects will be well-received and widely circulated among the telemedicine
community.
-
8/14/2019 Final Presentation (With Notes)
18/53
-
8/14/2019 Final Presentation (With Notes)
19/53
This is a side comment. The entire internship I have been thinking of a relatively basic
concept. When we say sustainable in terms of finances, we mean revenue meets
costs. When we say self-sustaining we mean that revenue is generated from within
the system by charging a fee to the consumer. When we charge a fee to the
consumer, we automatically decrease the optimal volume of transactions. In the case
of health care, that means that charging a fee automatically creates a population that
will not receive the service because it cannot afford it. Therefore, when we put
forward sustainable as our goal, we should also recognize that we are sacrificing
universal as another goal.
-
8/14/2019 Final Presentation (With Notes)
20/53
-
8/14/2019 Final Presentation (With Notes)
21/53
The Foundation has two conflicting personalities. On the one hand, it has the
management personality that wants to move forward with new ideas now. On the
other hand, it has the research personality that wants to be a platform by which
others can learn best practices. As far as telemedicine goes, if the research is going to
be done in a way that it truly demonstrates the impact of telemedicine on cost,
quality, and access in comparison with the next best alternatives, then the brakes
need to be applied to the current plans to implement the new model by year end.
The Foundation is in a wonderful position right now to do the kind of systematic
research that the research community has been calling for (unsuccessfully) for the
past 10 years. It is my opinion that the good to be gained by doing the research the
right way is worth far more than the good to be gained by moving full steam ahead.
-
8/14/2019 Final Presentation (With Notes)
22/53
I am not an expert in research design, and neither are the managers at the Byrraju
Foundation. But there are plenty of such experts who have spent their entire careers
perfecting this science who would be glad to join with the foundation to design and
implement such research. The Foundation should locate the top telemedicine
research institutes in the world and should begin talking with them about what
research could be conducted and what faculty at that particular school would be
interested in participating. For example, it could start by contacting the Telemedicine
Resource Center at the University of Michigan Health System
(http://www.med.umich.edu/telemedicine/).
-
8/14/2019 Final Presentation (With Notes)
23/53
-
8/14/2019 Final Presentation (With Notes)
24/53
-
8/14/2019 Final Presentation (With Notes)
25/53
-
8/14/2019 Final Presentation (With Notes)
26/53
This slide is just an example of what might be done. The point is simple. Too much
time is lost in the first 2 weeks. A well-planned regiment should be implemented that
will integrate the intern as quickly as possible into the work of the organization.
Personally, I think intern projects should not be stand-alone projects that only he or
she is responsible for. I would much prefer to work on a project that started before I
arrived and will finish after I leave, but to be given a sub-project(s) within the larger
project that will help the existing team to meet its overall objectives and deadlines.
There is a danger that this kind of work, if not properly planned and managed, could
become grunt work (making copies, etc.). Nevertheless, if well planned and managed,
it will create the opportunity for the intern to produce something that is immediately
and completely relevant to the work of the organization and avoid the possibility that
interns work will either miss the mark and/or be put forgotten in the fuss over what
the organization is actually working on at the very moment.
-
8/14/2019 Final Presentation (With Notes)
27/53
-
8/14/2019 Final Presentation (With Notes)
28/53
-
8/14/2019 Final Presentation (With Notes)
29/53
What is the population we are trying to serve?
-
8/14/2019 Final Presentation (With Notes)
30/53
-
8/14/2019 Final Presentation (With Notes)
31/53
-
8/14/2019 Final Presentation (With Notes)
32/53
-
8/14/2019 Final Presentation (With Notes)
33/53
Can the population afford health care by telemedicine?
There looks to be a problem with the All bar on this slide, though the formulas were
accurate. It seems like it should be closer to WGs 1.6, though not necessarily higher
than it.
-
8/14/2019 Final Presentation (With Notes)
34/53
What health facilities does the population currently patronize?
-
8/14/2019 Final Presentation (With Notes)
35/53
-
8/14/2019 Final Presentation (With Notes)
36/53
-
8/14/2019 Final Presentation (With Notes)
37/53
-
8/14/2019 Final Presentation (With Notes)
38/53
-
8/14/2019 Final Presentation (With Notes)
39/53
Is the population prepared to deal with the technology associated with telemedicine?
-
8/14/2019 Final Presentation (With Notes)
40/53
-
8/14/2019 Final Presentation (With Notes)
41/53
-
8/14/2019 Final Presentation (With Notes)
42/53
-
8/14/2019 Final Presentation (With Notes)
43/53
-
8/14/2019 Final Presentation (With Notes)
44/53
-
8/14/2019 Final Presentation (With Notes)
45/53
-
8/14/2019 Final Presentation (With Notes)
46/53
-
8/14/2019 Final Presentation (With Notes)
47/53
-
8/14/2019 Final Presentation (With Notes)
48/53
-
8/14/2019 Final Presentation (With Notes)
49/53
HMRI employs 3 physicians for a four hour shift from 4-8pm. Management feels that
the capacity of its doctors is much higher than what is shown here because the
program is new and there are not enough patients to maximize efficiency. Of course,
the question must then be asked, why employ 3 doctors instead of just 2 or 1 until
the time comes that you need more?
-
8/14/2019 Final Presentation (With Notes)
50/53
-
8/14/2019 Final Presentation (With Notes)
51/53
-
8/14/2019 Final Presentation (With Notes)
52/53
My main concern here is whether the nurses can handle the technology. Both times I
have been out to the villages with a technical person, there have been serious
technical problems that even he was unsure of how to deal with. Can the nurses
really be expected to cope with technical issues that are sure to arise? Neither the
Ashwini model or the HMRI model places any of the technology burden upon the
nurses, but instead staff a technician who is there during the consultation along with
the nurse.
-
8/14/2019 Final Presentation (With Notes)
53/53