Telemedicine - French healthcare innovation

This case study by INSEAD's James Téboul and Dr Joe Tabet chronicles the introduction of the Telemedecine Project launched in 1994, involving the Assistance Publique-Hôpitaux de Paris, one of Europe's biggest hospital networks, covering 50 state/university hospitals and serving a total population of more than 11 million people.

by James Teboul and Joe Tabet

Although the use of Telemedecine was initially limited to neurosurgery, it was subsequently extended to all hospital departments. It focuses on the introduction of the new technology, the benefits it was designed to bring and the resistance it encountered.

In May 2005, the French research agency Agence Nationale de la Recherche launched an appeal on behalf of its national network of healthcare technologies (RNTS) for research projects based on technological innovations designed not only to improve the quality and speed of medical care, minimise risk to patients and facilitate access to treatment, but also to enhance the way handicapped and dependency cases were dealt with. These objectives were at the heart of the Telemedicine Project.

The handling of emergency cases for neurosurgery was the responsibility of the Grande Garde, a highly structured organisation whose job was to deal with patients in a coma following an accident and whose critical condition could swiftly deteriorate. Telemedecine was designed to send x-ray images via a scanner, in parallel to telephone communication, in order to facilitate the task of the Grande Garde, particularly with regard to patient transportation.

The core aims of the Telemedecine Project were to reduce the risks associated with moving patients unnecessarily, improve the medical information sent to the neurosurgical team of the Grande Garde, foster closer collaboration and decision-making between the doctors on duty, slash costs related to unnecessary transportation and reduce the time when hospital vehicles or drivers were 'out of action'.

The equipment required for the transmission was very basic: a workstation with a dedicated PC connected to the Numeris network of France Telecom which provided a high-speed internet connection. The PC was linked to the image-scanner and to a closed circuit camera which made it possible to digitise images in addition to the scanner. All data was completely secure.

Initial resistance to the technology tended to be related to lack of user familiarity. Furthermore, pressure from the medical authorities was needed to integrate the new technology into the day-to-day routine and overall strategy.

The follow-up to the project revealed that the technology was used on average about once per day, which was a relatively low rate compared to the use of telephone calls, which amounted to between 30 and 40 per day, hence the full benefit of the system could not really be exploited. Only later would Telemedicine become a regular feature of hospital services across the board.

The case allows students to analyse the problems associated with the implementation of a new technology and the difficulty of realising its potential economic gains when resistance is encountered and before critical mass is reached. It provides a basis upon which to assess the role of management in the implementation of a project and related critical success factors.

Assistance Publique-Hôpitaux de Paris
INSEAD Case Study: Telemedicine

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