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Informatics for Diabetes Education And Telemedicine

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Frequently Asked Questions

What is the Informatics for Diabetes Education and Telemedicine (IDEATel) project?
Using a $28 million grant from the Health Care Financing Administration (HCFA), the IDEATel project will bring health care into the homes of underserved rural and inner-city residents with diabetes -- the largest telemedicine effort ever funded by the federal government. The IDEATel project will establish Web-based computing and telecommunications networks in both urban and rural economically disadvantaged areas within New York State. In 2003, the Medicare Modernization Act extended IDEATel for another four years.

Why is this project important?
There are millions of people with diabetes in the U.S. Many of these people have complications that could be prevented, including blindness, kidney failure and heart attacks. We hope that with the electronic house call, we can help people take better care of their diabetes and prevent these complications.

Telemedicine will give people the tools they need to take control of their diabetes. IDEATel will reach into patients' homes and empower them to take better care of themselves through monitoring, access to information, and education. This 'house call' of the future will allow patients and clinicians to reach out across any distance for care. This project will provide patients with the essential daily monitoring they need.

IDEATel will serve as a test bed for the national use of Internet technology to increase access to health care for all Americans. The demonstration project will be a model to develop more effective treatments for other diseases such as depression, obesity, asthma and heart failure.

The project will also seek to establish the healthcare and cost-effectiveness of telemedicine, so that HCFA can set standards for reimbursement of telehealth services.

What is the role and need for telemedicine in New York State?
Americans living in rural and poor inner-city areas have less access to specialty medical care and receive a disproportionate level of primary care by visiting hospital emergency rooms. Telemedicine can reach these people quickly, with cost-effective, quality care.

Managed care is increasingly replacing the fee-for-service model in many of the nation's health care markets, including New York. Telecommunications technology will allow managed care organizations to maintain quality of service while reducing certain costs associated with serving people who are chronically ill. Telemedicine may be especially cost-effective in a capitated reimbursement model.

Who will benefit from this project? How will they benefit?
Initially, 1,500 patients from Northern Manhattan (Washington Heights, Inwood, and North and Central Harlem) and rural areas of Central and Upstate New York will be enrolled in the project. Computers with devices to read blood sugar, take pictures of skin and feet, and check blood pressure will be placed in half of these patients' homes. Participants will receive Internet service, training in equipment use, and maintenance support. Patients will check their blood sugar, blood pressure and other factors that affect diabetes. They will be able to view their own medical information, learn more about diabetes and receive recommendations and instructions on how to manage their disease. An automated care guideline system will also analyze the patient's data. If information recorded on the computer varies from predetermined values, an automated alert will be sent to the physician or nurse. The system will also provide suggestions and reminders to patients about what steps they need to take to maintain good health.

What organizations are involved in this project?
The diabetes telemedicine program is a collaborative effort led by Columbia University that includes New York Presbyterian Hospital, the Joslin Diabetes Center of SUNY Upstate Medical University, the American Diabetes Association (ADA), Harlem Hospital Center, the Harlem Renaissance Network, Arnot Ogden Hospital in Elmira, Olean General Hospital in Olean, Samaritan Medical Center in Watertown, the Hebrew Home for the Aged at Riverdale, and HCFA.

Why is this project focusing on diabetes?
Clinical guidelines based on data that can be captured by home health instruments are available in online pharmacy for treating diabetes, making the disease particularly well suited for telemedicine. Diabetes, more than most other chronic diseases, requires daily self-management. In a doctor's office, care of diabetes takes place for a few minutes every few months. But in a patient's home, diabetes care occurs every day. Telemedicine will give people the tools they need to take control of their diabetes. Diabetes is common, costly and complex. If we can show that telemedicine is cost-effective in the care of diabetes, it will be an important demonstration of the wider potential of this technology.

What is the impact of diabetes on the economy?
Diabetes causes many serious complications, including blindness and heart disease. Complications from diabetes cost the U.S. economy $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities.

Early intervention and intensive treatment of chronic diseases will alleviate significant human suffering and save large amounts of money. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can reach a significant percentage of affected Americans.

How does this demonstration project differ from other funded telemedicine projects?
This project relies on the medical informatics expertise developed at Columbia University, the nation's premier center for informatics. Rather than rely on video conferencing, the project integrates Columbia's work in Web-based medical records to provide a solution that uses the Web and is cognizant of the full healthcare needs of each patient.

How does this project differ from commercial services now available?
Current commercial products or services are proprietary in nature. That means that the equipment or software of one company does not operate with the products of another company. This project uses technology that will work in any manufacturer's environment. Columbia has broad experience in automatically taking patient information from the Web and applying medical logic modules to analyze the meaning of the data. Information that is not significant is stored in a database for future reference. Information that requires immediate attention is automatically sent to the right caregiver. Thus, clinician time is used where it is most needed.


Last Updated: January 29, 2019