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Recent UCSF ShareCase presentation. The videos referred to in the slide deck are excerpts from two Eric Dishman TedTalks with the same names as the slides they are on.

Recent UCSF ShareCase presentation. The videos referred to in the slide deck are excerpts from two Eric Dishman TedTalks with the same names as the slides they are on.

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  • Store and forward we have a good idea of what needs to happenFor RPM we need to understand the balance between cost and value

Transcript

  • 1. Telehealth “You cannot separate the technology from the process.”
  • 2. Three legs of Telehealth • Live-Video – Cisco gives us a very strong position • Store & Forward – Asynchronous consultations – PACs and EHR integration • Remote Patient Monitoring – Leveraging the Ubiquitous vs. Episodic care paradigm What is a data point worth?
  • 3. Telehealth’s Organizational Position • Strategic tool that allows UCSF to: – Build an extended referral network – Export our expertise via remote consultation and education • Tactical tool that allows UCSF to: – Collaborate intra-campus/intra-specialty – Create dispersed yet integrated teams – Expand our research coverage
  • 4. The education of newbie • The magic of eReferral • Take Medicine off the Mainframe • Colonel Doctor • The Daschle Cone • UCSF Telehealth Resource Center • Integration and Balance
  • 5. The magic of eReferral • Asynchronous “rational” triage – Addresses supply and demand mismatch – Enables PCP/Specialist Collaboration – Promotes virtual co-management of certain conditions – Pre-visit guidance provided through eReferral makes scheduled visits more effective – Specialist reviewers spend approximately 8 minutes per eReferral – Boosts the effectiveness of in-person specialty visits, and produces cost savings by reducing the number of specialty visits for conditions that can be managed by PCPs – http://www.nejm.org/doi/full/10.1056/NEJMp1 215594 Hal F. Yee, Jr. and Alice Chen; SFGH – progenitors of eReferral
  • 6. Workflow and Volume of eReferral, July 1, 2011, through June 30, 2012
  • 7. Take medicine off the mainframe • Eric Dishman from Intel – The hype and hope of mHealth – TedTalk: Take Medicine off the mainframe – Play first video here! Eric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us.
  • 8. Peter Jeff Fabri MD, PhD Can Health Care Engineering Fix Health Care? “By fix the health care system, I mean improve efficiency, minimize waste and error, limit duplication and unnecessary redundancy, develop "supply chain" approaches to distribution and access, design with safety in mind, and change the culture of the workplace. If this hadn't already been done in many U.S. industries, it might sound specious.” “As I memorized the equations for bottleneck analysis, down time, and throughput, I saw outpatient clinics and emergency departments.”
  • 9. “Jeff” asserts • Fixing health care will require individuals who are "bilingual" in health care and in systems engineering. • Understanding human error, the contributions of system design, and the need for human factors engineering should be as important in medical education as the Krebs cycle and the distribution of the coronary arteries. • Every journey begins with a single step. Patient safety…is the natural starting point.
  • 10. Col. Ron Poropatich, MD ATA April 29th 2012 • Use Telehealth to manage patient acuity flow! – Proven in the “theater” • Use mHealth to manage chronic disease! – Programs with troops returning from combat. I truly believe that telehealth can improve efficiencies in health care. One example is how we use telederm in the DoD. If the rash, mole or lesion can be easily diagnosed and treatment recommended with a simple store and forward solution - our experience was around 70-80% of cases, then you free up more clinic slots to not only attend to the 20-30% that need a biopsy or a follow up but also opened your clinic capacity another 70-80% with improved access to care metrics as well. Former Director at the US Army Telemedicine and Advanced Technology Research Center (TATRC) ATA 2012 – Good times!
  • 11. Senator Tom Daschle visits UCSF Oct 3rd 2012 • Senator Daschle:“Health care in any society looks like a pyramid. The base of the pyramid comprises basic health care delivery involving wellness and prevention. It is the least costly. As we move up the pyramid, the care becomes more sophisticated and technologically advanced. At the peak are the most costly and technologically advanced applications, such as organ transplants, available in modern medicine today.” • “Every country begins at the base of the pyramid and works its way up until the money runs out. However, in the U.S., we start at the top of the pyramid and work our way down until the money runs out. This is our fundamental problem.”
  • 12. UCSF Telehealth develops The Daschle Cone • Tom Daschle is right however he offers no specific solution Telehealth mHealth • So we developed The Daschle Cone to explain how distributed triage should look both vertically and horizontally UCSF Local Clinic Live Homecare Remote Patient Monitoring Wellness Jeffrey Olgin, Chief of Cardiology, leads a large-scale digital version of the Framingham Heart Study – Health eHeart
  • 13. A patient’s journey through the Daschle Cone Wellness Remote Patient Monitoring Live Homecare Local Clinics UCSF In Patient Specialized Care and Education Consult Pro-Active Tracking understanding triggers Follow up Triage New Normal Tracking for issues
  • 14. The UCSF Telehealth Resource Center • Telehealth Strategic Plan completed - April 30, 2013 • Goals: – Create an extended referral network – Counterbalance Medical Center and Professional Group incentives – Prioritize initial efforts by contribution margin – Offer a broad range of Pediatric service lines – Formalize processes and policies
  • 15. Integration and balance • Oh mighty ICIS – SFGH’s PACs and EHR integration engine is driving our TeleDerm and Diabetic Retinopathy interfaces and is ready for more. • MuleSoft – ISU’s Mulesoft project allows integration with APeX and SalesForce. Yes integration with APeX is possible. • Integrated Practice Units – What does Harvard know? http://hbr.org/2013/10/thestrategy-that-will-fix-health-care/ar/1 • 400,000,000 people can’t be wrong – Can UCSF create their own “Halo Effect”? – http://money.msn.com/technology-investment/post-whatever-happened-to-apples-halo-effect
  • 16. HealthCare is a team sport Play second video here!