title: Utilization and cost savings of a wide-area computer network for neurosurgical consultation.
abstract: OBJECTIVE
  Telemedicine systems offer many potential advantages for health care delivery. Most reports have centered on the delivery of primary and medical subspecialty care rather than on its impact on patient care and the potential for cost savings. In 1993, we implemented NeuroLink, a wide-area teleradiology network for delivery of specialty care in neurologic surgery at Allegheny General Hospital (AGH). This study was designed to determine the potential cost savings of such a network.
  
  
  METHODS
  We prospectively reviewed 100 consecutive telemedicine neurosurgical consultations from 20 western Pennsylvania community hospitals participating in the NeuroLink network. Data related to referring hospital, diagnosis, disposition of the patient, and mode of transportation were reviewed. To determine the potential cost savings, the differential of hospital-based charges between AGH and western Pennsylvania primary hospitals was calculated based on an average length of stay (LOS), patient bed costs, and transportation charges.
  
  
  RESULTS
  Of the 100 patients, 33 did not require transfer to a tertiary facility but were instead managed at the community hospital as a direct result of the remote diagnosis and image review disclosing that neurosurgical procedures or intensive care were not required. Cost analysis, comparing the average LOS at AGH with that of the average community hospital, including transportation, showed savings of $502,638.
  
  
  CONCLUSIONS
  Our neurosurgical wide-area computer network has led to more appropriate transfer of patients to a tertiary facility and significant estimated cost savings.
authors.affiliation: Department of Neurosurgery, Allegheny University of the Health Sciences, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Bailes
authors.forename: C C
authors.initials: CC
authors.lastname: Poole
authors.forename: W
authors.initials: W
authors.lastname: Hutchison
authors.forename: J C
authors.initials: JC
authors.lastname: Maroon
authors.forename: T
authors.initials: T
authors.lastname: Fukushima
mesh_terms: D003195:Computer Communication Networks / Q000458:organization & administration*; D017046:Cost Savings; D017722:Hospital Charges; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D009493:Neurosurgery / Q000458:organization & administration*; D010414:Pennsylvania; D011446:Prospective Studies; D019114:Remote Consultation / Q000458:organization & administration*; D019112:Teleradiology / Q000458:organization & administration*