Population health management outcomes obtained through a hospital-based and telehealth informatics-enabled telecare service

Effective population health management has emerged as an important public policy measure for achieving strategic objectives concerning sustaining budget plans and ensuring competitiveness in the era of an aging society and a pandemic environment. ICT solutions can greatly facilitate achievement of these strategic objectives. In this report, we describe promising outcomes obtained from the use of a hospital-based and telehealth informatics-enabled telecare service model. This 24/7/365 service model features (1) effective integration of health data such as electronic health record, electronic medical record and personal health record, (2) establishment and use of personalized vital sign base lines, (3) design and use of insightful new specific rating scales, and (4) use of well-defined operating procedures for conducting performance in a stringent regulatory environment. Our novel service model has demonstrated its capability to achieve important population health management related strategic goals such as (1) reducing time to access proper medical service, (2) reducing rate of emergency visit, (3) reducing rate of readmission, (4) reducing hospital stay, (5) reducing possible medical errors, and (6) reducing harms caused by possible overuse and/or underuse of medical services. Significant outcome examples in relation to management and prevention of hypertension, stroke and medical error are presented. Potentially, this service model can also be used for evaluation and validation of technological solutions for medicine.