Dr. anne burdick
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Dr. anne burdick

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Dr. anne burdick Dr. anne burdick Presentation Transcript

  • 3/2/2014 1 Anne E. Burdick, MD, MPH Professor of Dermatology Associate Dean for TeleHealth March 20, 2014 University of Miami TeleHealth Enhancing Healthcare for Floridians UM TeleHealth is a catalyst for healthcare transformation in Florida. Access ConvenienceConvenience
  • 3/2/2014 2 QualityQuality Cost Synchronous Real-time interactive Asynchronous Store-and-forward We use all 3 operational TH modes Synchronous Real-time interactive Asynchronous Store-and-forward We use all 3 operational TH modes Hybrid
  • 3/2/2014 3 University of Miami TeleHealth • 1974: Dr Jay Sanders, prison telemedicine • 1994: Fellowship at MCG, ATA Board member •1994: Teledermatology for migrant workers, JAMA •1996: American Academy of Dermatology Telemedicine Position Statement • 1999: Founded ATA Teledermatology Special Interest Group Approved 2007 2007 Approved 2007 Endorsed by American Academy of Dermatology 2007 “Based on the history and images provided, my impression is as follows.” 2008 UM TeleHealth: Our strengths • Telehealth operations • Technology & systems engineering • Telehealth policy • Industry relationships
  • 3/2/2014 4 Our challenge: Limited TH reimbursement • Medicaid: Children’s Medical Services via waiver • Medicare: Rural, Health Provider Shortage Areas • No private payers Our challenge: Limited TH reimbursement • Medicaid: Children’s Medical Services via waiver • Medicare: Rural, Health Provider Shortage Areas • No private payers Our strategy: • Contracts • Grants • Advocate for policy change Dept of Health Children's Medical Services • Teledermatology • Telegenetics • Telenutrition • Telepsychiatry Miami-Dade School Telehealth Initiative • MD provides Pediatric care to 8 schools • RN, MA or medical or nursing students present • Specialty care with UM MDs
  • 3/2/2014 5 Miami-Dade School Telehealth Initiative • North Miami Beach schools: elementary, middle and high • Equipment: HRSA grant • Health care providers: John T MacDonald grant, Children’s Health Fund, AHEC • Specialist reimbursement: Verizon Foundation grant • Dermatology, Nutrition, Psychiatry, Cardiology, Endocrinology Miami-Dade School Telehealth Expansion • Centers for Medicare and Medicaid Services grant • 8th school • Partnering with Larkin Hospital for telemental health • Partnering with NOVA University for teledentistry Eczema herpeticum Generalized herpes simplex infection + atopic dermatitis
  • 3/2/2014 6 Eczema herpeticum Generalized herpes simplex infection + atopic dermatitis Admitted for IV Acyclovir and antibiotics for 3 days Other Pediatric TH specialities UM Pediatric Mobile Van • Sweetwater, Little Haiti, Homestead • Verizon Foundation grant for specialist reimbursement, 4G network provided • Nutrition, dermatology, cardiology Telegenetics •Statewide Newborn Screening conferences Telehealth training of health providers • Dermatology residents • Medical students • ARNP students • DNP students Core Competencies for residents American College of Graduate Medical Education • Interpersonal & Communication Skills • Systems-Based Practice • Patient Care • Practice-Based Learning & Improvement
  • 3/2/2014 7 Acute teleneurology to hospital emergency departments • Specialists on Call, Inc. Discharge planning enhancement • Patients transfers • UM Hospital to Miami Jewish Home for the Elderly • Verizon Foundation grant for a Vgo robot UM-Aetna Employee TeleHealth • UM employees • At a satellite UM clinic, • 10 miles or 45-60 minute drive or Metrorail ride • Specialty teleconsultations • Neurology, dermatology, nutrition, cardiology, pulmonary Teletrauma: Ryder Jackson Memorial/University of Miami Trauma Center • Trauma bay resuscitations • ICU bedside rounds • Air ambulance optimization from Lower Keys Medical Center • Brazil Olympic team, London • US Dept of State contract: 24/7
  • 3/2/2014 8 Store-and-forward teledermatology Nashville Area Oklahoma Area Albuquerque Area 2010: 75 Indian nations in 29 states MICMAC Pleasant Point, ME Oneida, NY Catawba, SC 4 yo: 3 days itching, sores hands & stomach 4 yo: 3 days itching, sores hands & stomach ………Scabies
  • 3/2/2014 9 UM – Alaska Teledermatology Service AFHCAN MISSION To improve access to health care for federal beneficiaries in Alaska through sustainable telehealth systems Alaska Federal Health Care Access Network Alaska’s Health Care Challenges 35 • 49% MDs in Alaska are primary care physicians, U.S. average is 28% • 59% residents live in medically underserved areas • 48th in “doctors to residents” ratio - 65% are located in Anchorage - Shortages in many specialties Average Alaska village = 350 Residents Alaska Native Medical Center • Tertiary care • Referrals to private medical providers & other states for complex care • 6 regional hospitals • 4 multi-physician health centers • 25 subregional mid-level care centers • 180 small community primary care centers 36
  • 3/2/2014 10 Human assistance and disaster response: TeleHealth in Haiti • Trauma and critical care • Teleradiology • Pediatric subspecialties Telemedicine for Trauma, Disaster, and Emergency Management Eds: Latifi R, Poropatich R. Artech House, Boston. 2010 “Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit–Cost Analysis” Dávalos ME, French MT, Burdick AE, Simmons SC Telemedicine and e-Health. 2009, 15: 933-948 2009 Manuscript Award at ATA 2010 Plenary , Cutis 88, 213: 2011
  • 3/2/2014 11 UM Cruise Ship Teledermatology • Provides rapid access to University of Miami dermatologists for crew and occasionally guests on ships all over the world • Within 72 hours or 24 hours • Royal Caribbean Cruise Lines since June 2010 • Carnival Cruise Lines since November 2012 Teledermatology at Sea • Provides dermatology care for an employee population that’s geographically dispersed • Allows ship’s medical staff to effectively manage their crew’s skin conditions • Reduces onshore dermatology visits • Assists in medical evacuation decisions • Cost avoidance • UM selected Medweb software • Cruise IT teams evaluated software • Username/password assigned to each ship • Introduced service at RCL/CCL conferences • Lab and X-Ray capabilities determined • Additional drugs recommended • MDs and RNs reviewed UM’s online training • Test case submitted by each ship before sending consults Fleetwide Rollout Dermatology at Sea: Special Issues • Limited drug formulary • Challenging to access shoreside dermatologists • Diverse occupations • Off work or “dry” work difficult, no duplicate crew • Maximum Medical Improvement • Medical isolation • Medical evacuation
  • 3/2/2014 12 Ship MD UM Dermatology ConsultantPhotos Consult Form PC PC Internet UM Server S Workflow Dermatology at Sea: Special Issues • Limited drug formulary • Challenging to access shoreside dermatologists • Diverse occupations • Off work or “dry” work difficult, no duplicate crew • Maximum Medical Improvement • Medical isolation • Medical evacuation Stat case: hand dermatitis, violinist Tinea versicolor Alopecia areataContact dermatitis Wart
  • 3/2/2014 13 Candida intertrigoErysepelis Bullous cellulitisLeishmaniasis “3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?” “3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?” Agree with Herpes zoster and treatment Rare Diseases Multiple acral reticular histiocytosis Hidradenitis suppurativa Relapsing polychondritis
  • 3/2/2014 14 Oral lesions: Torus palatinus New England Journal of Medicine, April 11, 2013 <5% consult: referred to dermatologist Present x 1 month Wart vs. squamous cell cancer vs keratoacanthoma Solitary nail pigmentation Probable melanoma Growing dark dot x 1 year Probable melanoma Stat case: Fever + coryza + rash, R/o Measles Stat case: Erythema multiforme major
  • 3/2/2014 15 UM TeleHealth is a catalyst for healthcare transformation in Florida and beyond. Anne E. Burdick, MD, MPH Associate Dean for TeleHealth Professor of Dermatology aburdick@med.miami.edu (305) 243-8252 telehealth.med.miami.edu Contact