9.gpt alverson presentation final 2013

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  • 1. Impacting Lives through Applied TechnologyMarch 20, 2013A Brave New World for Telehealth and HIT Dale C. Alverson, MD, FAAPMedical Director, Center for Telehealth and Cybermedicine Research, University of New Mexico CMIO, LCF Research Albuquerque, New Mexico Past President, American Telemedicine Association
  • 2. Objectives:To understand the current and future potential for Telehealth and Health Information Technologies; regionally, nationally, and globallyTo understand how Telehealth and Health Information Exchange (HIE) can be blended and complimentary as a part of healthcare transformation.
  • 3. Health Care Reform/PPACA Emerging Enabling Information Communication Technologies Economic Downturn Need for more Access to Care An Aging Population/Baby BoomersCritical Shortage of Healthcare Providers EHR Adoption/HIE Meaningful Use ICD10 PCMH ACOs A Time for Telemedicine & HIT
  • 4. Major Public Health Issues Impacting our Rural Communities and their Economic Development Gaps in Access to Health Services in Rural New Mexico Hepatitis C Behavioral Health Diabetes Asthma Cancer Oral Health Cardiac and Stroke Care
  • 5. Telehealth and Health Information Technologiesare Part of the Solution in Closing the Gaps
  • 6. How is Telehealth used? Clinical: Consultation, Direct patient Care, Case Reviews Educational: Providers, Students, and Patients Research: Community-based Participatory, Outcomes driven Administrative: Strategic planning, Operations Health Information Exchange Enhanced Disaster Response
  • 7. Telehealth Networks Rural/Remote Health Providers Can Access Expert Medical Opinions, Knowledge, Education via Telehealth Rural or Remote Specialty Location Telehealth Network Medical Center AudioPatient High-Resolution Images & Video Student Medical Local Health Consultation Specialist Provider Direct Patient Care Case Reviews Education Training Health Information Exchange Community-Based Research
  • 8. “Back tothe Future”
  • 9. Case Reviews or Consultation
  • 10. ECHO: Treatment Outcomes Outcome ECHO UNMH P-value N=261 N=146 Minority 68% 49% P<0.01 SVR (Cure) Genotype 1/4 50% 46% NS SVR (Cure) Genotype 2/3 70% 71% NSSVR=sustained viral responseNEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, et.al.
  • 11. Direct Patient CareMaternal Fetal Medicine-High Risk Pregnancy
  • 12. “Store and Forward” Capturing an image and storing it to then be forwarded for review by a medical specialists Examples include teleradiology, telepathology and teledermatology, tele-ophthalmology (retinal scans) “Telemedicine” or HIE?/Large Data Files Need Broadband Teleradiology and Image Transfer Web-Based Portals
  • 13. Video Phone or “VOIP” with video Family Visitation
  • 14. School Based Health Centers
  • 15. Telehealth assistants at the schoolor child care center provide the linkto examine the eyes, ears, throat,lungs and skin.Videoconferencing provides the“face to face” interaction.Getting providers to think of theirdesktop computer as an examroom is the trick. 16
  • 16. Trauma Triage44% TransferAvoidance27% ManagementRecommendationChangesMoya M, ValdezJ, YonasH, Alverson DC.The Impact of aTelehealth Web-based Solution onand Consultation.Telemedicine andeHealth, 2010;16:945-949
  • 17. IRA HAYES Project – PTSD/TBI
  • 18. Telehealth Toolkit SaaS (SIP) Videophone (H.324) SkypeSoftware IP Based (H.323) Desktop IP Based (H.323) Small Conference Room IP Based (H.323)
  • 19. Hand Held Devices- “mHealth” iPhone Droid iPhone BlackBerry Treo/Palm Smart Phones
  • 20. Remote Monitoring The “Smart Band-Aid”
  • 21. Center for Telehealth and Cybermedicine Research The Center for Telehealthat UNM Health Sciences Center:•Developing New Programs•Technical, Operational, Business, and Evaluation Planning
  • 22. The New Mexico Telehealth Alliance Telehealth Alliance “Networks of Networks” Providers Consumers Represents a consortium of public and private health care Telehealth stakeholders: “Neutral Expertise Territory” (501c3) Communication Networks Reflects the diversity of our health care delivery system in Social Networks New Mexico Enables collaboration
  • 23. New Mexico Telehealth Act Passed and Signed into Law 2004 http://legis.state.nm.us Introduced by Rep. Danice Picraux (D) Supported by Sen. Susan Wilson-Beffort (R) HOUSE BILL 581 46TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION 2004 Authorization Bill for Telehealth:•Covers interactive video and “Store and Forward”technologies•Any Licensed Health Professional authorized to use•Covers any Originating Site Where Patient Located,including place of residence•Authorizes/Encourages Use of and Reimbursement forTelehealth(NM Medicaid has announced policies to reimburse fortelehealth services)
  • 24. New NM Legislation: SB 69/HB 171Insurance Coverage for Telemedicine Services An act relating to health care coverage; enacting sections of the health care purchasing act, the New Mexico insurance code, the health maintenance organization law and the nonprofit health care plan law to require coverage for telemedicine services; providing for utilization review and appeal rights for denials of telemedicine coverage. "Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall include coverage of telemedicine Services. Coverage for health care services provided through telemedicine shall be determined in a manner consistent with coverage for health care services provided through in-person consultation."
  • 25. SWTAG is a “Network of Networks”
  • 26. The 4 “C’s”CooperationCoordinationCollaborationCommunication
  • 27. http://www.americantelemed.org
  • 28. American Telemedicine Association (ATA) and Telemedicine Hitting the Target: “The Triple AIMS” Improve Access ATA and ATA ImproveTelemedicine Health Reduce Costs
  • 29. Health Information Exchange (HIE)Engagement and Encouraging Adoption • An HIE Solution brings health information systems together across regions and states in order to provide access to a patient’s information in one centralized record. • Multiple healthcare providers with access to the same record of clinical information will make healthcare delivery more robust and efficient with improved continuity, better outcomes, and reduced cost. There are significant benefits to patients, healthcare providers, payers and employers. 33
  • 30. Core HIE FunctionsProvides access to a current patient summary from a variety of sources (From Where and When): Problem List/Diagnosis Medications Immunizations Allergies Procedures Lab Data Radiology Data Encounter Summaries
  • 31. Why the HIE is Accessed?When and why a Provider needs to access the HIE: New patient, not seen before Infrequent patient Patient known to have received care elsewhere Complex patient Tracking of patient Patient ER visits and hospital stays EHR is unavailable Remote Access 35
  • 32. Value/Benefits of HIE• Access to each patient’s health information from a variety of healthcare provider sources• Improved situational awareness regarding patient’s health and use of health systems, better coordination of care• Better triage and evaluation capability: Dx/Problem list, prior procedures, Rx/Medications, Allergies, tests; lab/x-ray, progress note and summaries• Improved efficiency in making diagnosis and management plans• Decrease unnecessary duplication of tests• Readmission avoidance• Other Benefits : Data Analytics, Public Health, PCMH, ACO
  • 33. Cloud Based
  • 34. Solution: Core HIE – High Level Physicians Privacy Officers HTTPS HIE Platform Web-based access to the longitudinal patient record • Demographics Health Information • Labs, Rads Hospital with Exchange (HIE) • Encounters EMR • Allergies • Diagnosis • Transcribed documents • Medications • Problems • Procedures HL7/CCD, XDS, SSO • Immunizations Direct Secure Messaging Clinic with Patient Privacy & Consent EMR Notifications & Seamless integration with EHRs Subscriptions • User Subscribed Notifications • Send to My EHR Secure Inbox • Portal embedded within EHR E-Mail Other HIEs Mobile
  • 35. Example Integration (Epic)
  • 36. Example Integration (Cerner)
  • 37. The HIE in New Mexico SS Raton A Farmington TaosNavaj VAo Clayton Clayton Los LasNation Alamo Vegas s Santa Fe Cuba Tucumca Gallup Grants ri Albuquerque Santa Amarillo Anna Socorr Los Established HIE Lunas o Clovis connectivity Magdalena Belen Portales Lubboc k Future HIE connectivity Ruidoso (random sample of sites) T or C Roswell Lovington Silver Alamogordo Hobbs City Las Carlsbad Cruces Demin g El Paso HITREC sites (random sample of sites) 41
  • 38. International Telemedicine and eHealth:Transforming Systems of Care in the Global CommunityReasons to do International Telehealth Most health issues are global!
  • 39. H1N1
  • 40. H5N1
  • 41. Distributed Medical Intelligence• Knowledge Sharing Networks/Just in Time/On Demand• Best Practices• Evidence based 46
  • 42. International Union Against TB
  • 43. La Lancha Medica en la Amazonia
  • 44. 49
  • 45. 50
  • 46. Exchange of Students and Faculty
  • 47. OpportunitiesBlending HIE with “Telehealth”Integration with Mobile DevicesFacilitation of research, data analytics, quality reporting, and other aggregate usesHitting the Triple AimsBecoming a Standard of CareFostering ChampionsDeveloping a National and International Network of Networks
  • 48. Navigating the Perfect Storm with Telemedicine & HIT Use a broad spectrum of information communication technologies Effective distribution of limited resources and expertise Increasing Access to care Bringing care to the patient; Aging in place Decreasing unnecessary variations in care; evidence-based best practicesImproving continuity and coordination of care;The Patient Centered Medical HomeAvoiding unnecessary hospitalizations, duplication of tests, & decreasing errors Improving health outcomesReducing costs; avoiding more costly care and complications, decreasing travel
  • 49. Questions?http://hsc.unm.edu/som/telehealth http://www.lcfresearch.org/