Telemedicine consultations: failed cases and floundering specialties

The Arizona Telemedicine Program began as a multi-service provider, with teleconsultations in over 53 subspecialties. Although new sites often use numerous subspecialties at first, this is typically followed by a longer period when only a few subspecialties are used. A retrospective analysis of the referral rates from the sites showed wide variations, some exhibiting extreme fluctuations. There was a high correlation (0.84) between personnel turnover rates at each site (i.e. the number of personnel changing) and the degree to which the fluctuations were 'out of control'. Over six years, 402 teleconsultations were scheduled but did not occur. Of these, 82% were closed with no further contact, although 63% were managed eventually via telemedicine, all in telepsychiatry. The reasons for these appointments not taking place were that the patient did not show up (45%), the patient cancelled (32%), the telepsychiatrist cancelled (22%) or bad weather prevented travel (1%). Of the unsuccessful teleconsultations, 84% were realtime and 16% were store and forward. The average cost to the provider of a missed realtime teleconsultation was US$228 for a 1 h session.