Remote Monitoring | 2009 Medical Summit

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Remote Monitoring | 2009 Medical Summit

  1. 1. David Cattell-Gordon Director of Community Engagement & Rural Network Development UVA Telemedicine Program The State of Telemedicine in the Commonwealth of Virginia 2009
  2. 2. The State of Telehealth <ul><li>Current Applications </li></ul><ul><li>Benefits </li></ul><ul><li>Innovative Approaches </li></ul><ul><li>Implications for Health </li></ul><ul><li>Next Five Years </li></ul><ul><li>Challenges </li></ul>
  3. 3. Telehealth & Telehealth-Related Prosperity: A Vision for the Future <ul><ul><li>A elderly patient takes her meds </li></ul></ul><ul><ul><li>A newborn has a chance at life </li></ul></ul><ul><ul><li>A child succeeds in school </li></ul></ul><ul><ul><li>A rural person has more time at work </li></ul></ul><ul><ul><li>A women survives breast cancer </li></ul></ul><ul><ul><li>A patient is enrolled in a clinical study </li></ul></ul><ul><ul><li>A nurse learns a new procedure </li></ul></ul><ul><ul><li>A presenter doesn’t spread a bug </li></ul></ul>
  4. 4. Definition of Telemedicine <ul><li>The use of advanced telecommunications and other technologies for: </li></ul><ul><ul><ul><li>Medical diagnosis </li></ul></ul></ul><ul><ul><ul><li>Ongoing patient care </li></ul></ul></ul><ul><ul><ul><li>Health-related distance learning </li></ul></ul></ul>
  5. 5. Telemedicine: History <ul><li>Alexander Graham Bell </li></ul><ul><li>Hugo Gernsback </li></ul><ul><li>Massachusetts General </li></ul><ul><li>NASA </li></ul><ul><li>Dept of Defense </li></ul><ul><li>University of Virginia </li></ul>
  6. 6. Mission of Telehealth <ul><li>Facilitate the Health System’s missions of </li></ul><ul><ul><ul><ul><ul><li>Clinical Care </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Teaching </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Research </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Public Service </li></ul></ul></ul></ul></ul>
  7. 7. Current Telehealth Applications <ul><li>Videoconferencing for patient care </li></ul><ul><li>Store and forward applications </li></ul><ul><li>Tele-pharmacy </li></ul><ul><li>Remote monitoring and home telehealth </li></ul><ul><ul><li>m-Health </li></ul></ul><ul><li>Health information exchange </li></ul><ul><li>Emergency preparedness/disease surveillance </li></ul><ul><li>Distance learning </li></ul>
  8. 8. It is all about the network… <ul><li>Academic-community hospital linkages </li></ul><ul><li>Rural clinics (FQHCs, Veteran’s clinics) </li></ul><ul><li>Free clinics </li></ul><ul><li>Health departments </li></ul><ul><li>Correctional facilities </li></ul><ul><li>School health </li></ul><ul><li>Nursing homes </li></ul><ul><li>Home telehealth </li></ul><ul><li>Workplace </li></ul><ul><li>Medical offices </li></ul><ul><li>Retail clinics </li></ul>
  9. 9. Telemedicine Subspecialty Participants <ul><li>Childhood obesity </li></ul><ul><li>Ophthalmology </li></ul><ul><li>Orthopedics </li></ul><ul><li>Adult and Pediatric Nephrology </li></ul><ul><li>Pulmonary medicine </li></ul><ul><li>Pain management </li></ul><ul><li>Plastic Surgery </li></ul><ul><li>Urology </li></ul><ul><li>Gynecology </li></ul><ul><li>Emergency Medicine </li></ul><ul><li>Geriatric medicine </li></ul><ul><li>Surgery </li></ul><ul><li>TCV </li></ul><ul><li>Radiology </li></ul><ul><li>Wound care </li></ul><ul><li>Dermatology </li></ul><ul><li>Hepatology </li></ul><ul><li>Pediatric Cardiology </li></ul><ul><li>Infectious Disease (HIV) </li></ul><ul><li>Psychiatry </li></ul><ul><li>Other GI </li></ul><ul><li>Genetics </li></ul><ul><li>Endocrine </li></ul><ul><li>Neurology </li></ul><ul><li>Neurosurgery </li></ul><ul><li>ENT </li></ul><ul><li>Cardiology </li></ul><ul><li>Hematology </li></ul><ul><li>Rheumatology </li></ul><ul><li>Toxicology/Poison control </li></ul>
  10. 10. Telehealth Growth @ UVA
  11. 11. Telehealth affiliations
  12. 12. Telemedicine Sites: Far Southwest Virginia <ul><li>1. Abingdon Johnston Memorial Hospital </li></ul><ul><li>2. Abingdon Johnston Memorial Hospital Cancer Center </li></ul><ul><li>3. Bastian Bland County Medical Center </li></ul><ul><li>4. Big Stone Gap Wise County Behavioral Health Services </li></ul><ul><li>5. Big Stone Gap Mountain Empire Older Citizens </li></ul><ul><li>6. Bristol Southwest Virginia Care Connection </li></ul><ul><li>7. Bristol Twin City Medical Center </li></ul><ul><li>8. Clinchco The Health Wagon </li></ul><ul><li>9. Dungannon Clinch River Health Services </li></ul><ul><li>10. Galax Twin County Regional Hospital </li></ul><ul><li>11. Gate City Scott County Health Dept. </li></ul><ul><li>12. Grundy Buchanan General Hospital </li></ul><ul><li>13. Haysi Haysi Clinic </li></ul><ul><li>14. Konnarock Stone Mountain Health Services </li></ul><ul><li>15. Laurel Fork Tri-Area Health Clinic </li></ul><ul><li>Norton Norton Community Hospital </li></ul><ul><li>Oakwood College of Pharmacy </li></ul><ul><li>18. St. Paul William A. Davis Clinic </li></ul><ul><li>19. Saltville Saltville Medical Center </li></ul><ul><li>20. Tazewell Tazewell Community Hospital </li></ul><ul><li>21. Troutdale Troutdale Medical Center </li></ul><ul><li>22. Vansant Thompson Family Health Center </li></ul><ul><li>23. Whitetop Whitetop Community Health </li></ul><ul><li>24. Wise Wise County Health Dept. </li></ul><ul><li>25. Wise UVA College at Wise </li></ul><ul><li>26. Wise County Fairgrounds Remote Area Medical Clinic </li></ul><ul><li>27. Red Onion Correctional Center </li></ul><ul><li>28. Wallens Ridge Correctional Center </li></ul>
  13. 13. Benefits of Telehealth <ul><li>Rural communities </li></ul><ul><ul><li>>85% of patients remain in local community </li></ul></ul><ul><ul><li>Care in the community (lower cost) environment </li></ul></ul><ul><ul><li>Enhanced healthcare and local economic development </li></ul></ul><ul><li>Society </li></ul><ul><ul><li>Lower cost of care </li></ul></ul><ul><ul><li>Improve outcomes </li></ul></ul><ul><ul><li>“Green” technology </li></ul></ul>
  14. 14. Benefits of Telehealth <ul><li>Health professionals </li></ul><ul><ul><li>Access to consultative services </li></ul></ul><ul><ul><li>Each consultation is inherently educational </li></ul></ul><ul><ul><li>Access to continuing medical education </li></ul></ul><ul><ul><li>Reduces sense of isolation </li></ul></ul><ul><ul><li>Supports recruitment </li></ul></ul>
  15. 15. Benefits of Telehealth <ul><li>Patients </li></ul><ul><ul><li>Timely access to locally unavailable services </li></ul></ul><ul><ul><li>Improved triage when patient transfer required </li></ul></ul><ul><ul><li>Improved quality of care </li></ul></ul><ul><ul><li>Reduced readmission for same diagnosis </li></ul></ul><ul><ul><li>Improved chronic disease management </li></ul></ul><ul><ul><li>Spared burden and cost of unnecessary travel </li></ul></ul>
  16. 16. Facilitating Expert Care: Cervical cancer/Tele-colposcopy <ul><li>CDC grant to Virginia for screenings of low-income, uninsured or underinsured women </li></ul><ul><li>Real-time tele-colposcopy services by UVA gynecologic-oncologists supporting rural NPs </li></ul><ul><li>Mobile digital mammography – increases access, early diagnosis </li></ul>
  17. 17. Facilitating Expert Care: Other Cancer-related Applications <ul><li>Tele-radiology </li></ul><ul><li>Tele-pathology </li></ul><ul><li>Tele-hospice </li></ul><ul><li>Tele-pharmacy </li></ul><ul><li>Tele-dermatology </li></ul><ul><li>Tele-surgery </li></ul><ul><li>Collaborative tumor boards </li></ul><ul><li>Access to clinical trials </li></ul><ul><li>Community based research </li></ul><ul><li>Educational services </li></ul>
  18. 18. Innovative Applications <ul><li>Infant mortality </li></ul><ul><ul><li>Arkansas Angels </li></ul></ul><ul><ul><ul><li>Improve access to prenatal care </li></ul></ul></ul><ul><ul><ul><li>Reduce neonatal mortality, premature delivery (26% decrease) </li></ul></ul></ul><ul><ul><li>Virginia Productivity Investment Fund </li></ul></ul><ul><ul><li>HRSA </li></ul></ul><ul><li>Congenital heart disease </li></ul><ul><li>Childhood obesity </li></ul><ul><li>School health and daycare applications </li></ul><ul><ul><li>Reduced ER visits, parental time away from work </li></ul></ul>
  19. 19. Innovative Applications <ul><li>Tele-ophthalmology </li></ul><ul><ul><li>Screening for diabetic retinopathy </li></ul></ul><ul><ul><li>Retinopathy of prematurity </li></ul></ul><ul><li>Tele-dermatology </li></ul><ul><ul><li>Store forward/live interactive </li></ul></ul><ul><li>Tele-mental health </li></ul><ul><ul><li>Critical shortage of mental health providers </li></ul></ul>
  20. 20. Innovative Applications <ul><li>Acute stroke </li></ul><ul><ul><li>Time is of the essence, TPA administered in < 3hrs </li></ul></ul><ul><ul><li>Increased use from 4-23% in rural hospitals </li></ul></ul>
  21. 21. Remote Monitoring and Home Telehealth <ul><ul><ul><li>Need </li></ul></ul></ul><ul><ul><ul><ul><li>Medicare data: ($17.4 billion) unplanned hospitalizations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hospital readmissions within 30 days - 20%, within 90 days - 34%, within 1 year 56% </li></ul></ul></ul></ul><ul><ul><ul><ul><li>MedPAC - $7,200 dollars per readmission deemed preventable </li></ul></ul></ul></ul><ul><ul><ul><li>Remote monitoring/home telehealth can reduce costs </li></ul></ul></ul><ul><ul><ul><ul><li>Congestive heart failure, Diabetes, Chronic obstructive pulmonary disease </li></ul></ul></ul></ul><ul><ul><ul><li>Veterans Affairs - Care coordination/home telehealth </li></ul></ul></ul><ul><ul><ul><ul><li>19% reduction in hospital admissions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>25% reduction in hospital days </li></ul></ul></ul></ul>
  22. 22. Remote Area Medical  
  23. 23. Building a Healthy Appalachia
  24. 24. The Next Five Years <ul><li>Real-time, in-home monitoring </li></ul><ul><li>The use of m-health technology </li></ul><ul><li>Increased access to specialty care </li></ul><ul><li>Integration of EMR into telehealth </li></ul><ul><li>Movement to the desktop </li></ul><ul><li>Expanded access to clinical studies </li></ul>
  25. 25. Challenges <ul><li>Coverage & Reimbursement </li></ul><ul><li>Broadband Access & Costs </li></ul><ul><li>Comfort with Usage </li></ul><ul><li>Licensure </li></ul><ul><li>Inter-operability </li></ul>

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