Essential telemedicine elements (tele-ments) for connecting the academic health center and remote community providers to enhance patient care.

The authors draw on their experience with the University of California, San Diego Medical Center's successful enterprise-level clinical telemedicine program to present a paradigm for other academic health centers (AHCs) that wish to develop such a program. They detail key telemedicine program elements, or "tele-ments," that they consider essential to the development of a centralized, structured telemedicine program and relevant to the development of smaller programs. These tele-ments include an overall organizational vision, a centralized telemedicine infrastructure, telemedicine-specific policies and procedures, medical record documentation, relationships between the AHC clinical hub and its remote (spoke) partners, identification of and training for specialty providers, a business plan based on service agreements and/or insurance billing, and licensure/privileging.

Strategies and tools for improving transcription and documentation.

Failure to accurately document care provided is a significant threat to hospital revenue and compliance. What's more, it's only expected to become more important as documentation efforts grow increasingly more sophisticated to respond to the requirements of severity-based payment, as is being seen with Medicare severity-based diagnosis-related groups (MS-DRG). With this in mind, the following discussion, sponsored by 3M Health Information Systems, explores use of process change and technology to improve transcription and clinical documentation activities.