Deployed Health Technologies Emerging Opportunities and Existing Barriers <ul><li>Karen C. Fox </li></ul><ul><li>Assistant...
A Look at the Destructive Cycle of Health Disparities for Rural Patients Poverty Education Culture Location Death Disabili...
A Glimpse Into the Problem Physical barriers to care Fragmented delivery system Disparate information systems VAMC (Nation...
Two-Pronged Solution: Innovative Health Technologies Electronic Health Records Telehealth Total Rural Clinician Support
EHR Systems in Rural Settings Establishing, utilizing and maintaining an EHR system is a challenge, made more difficult in...
Benefits of Regional EMR Systems Promote Region-Wide Standards of Care Rapid Access to Information at the Point of Care Cl...
The Memphis Area Technology Collaborative for Health (MATCH) A cooperative project of the University Medical Center Allian...
Master Patient Index <ul><li>Dynamic interface that connects separate EHR systems across the region. </li></ul><ul><li>Fac...
Master Patient Index: Benefits to Rural Communities Clinician decision-support Regional standards of care Immediate electr...
Barriers to EMRs for Rural and Remote Populations Lack of data standards Proprietary systems that don’t communicate  Patie...
The Mid-South Telehealth Network Four UT Colleges  Seven Health Departments Nine Pharmacies Six Rural Hospitals Four Commu...
Rural Hospitals Benefit from Telehealth <ul><li>Improves access to specialty health care services. </li></ul><ul><li>Incre...
Medical Specialties <ul><li>Cardiology </li></ul><ul><li>Dermatology </li></ul><ul><li>Endocrinology  </li></ul><ul><li>E....
One Example: Cardiology Specialists Accepting TennCare in Tennessee 0.3 – 2.0 2.1 – 4.5 4.6 – 7.0 7.1 – 12.0 FTE Ranges If...
Telehealth Improves Access to Cardiologists for Rural Patients 0.3 – 2.0 2.1 – 4.5 4.6 – 7.0 7.1 – 12.0 FTE Ranges By cond...
Telehealth Outcomes: STEEEP <ul><li>Safe -  Patients receiving psychiatric treatments via telehealth show that 65% of indi...
Telehealth Outcomes: STEEEP <ul><li>Efficient -   </li></ul><ul><li>Telehealth physicians average 4.3 patients per hour wi...
Telehealth Outcomes: STEEEP <ul><li>Effective -   </li></ul><ul><li>73% of telehealth patients received new, more effectiv...
Telehealth Outcomes: STEEEP <ul><li>Patient-centered -   </li></ul><ul><li>The average telehealth patient lives 117 miles ...
Health as an Economic Engine <ul><li>Known Facts:   </li></ul><ul><li>1) People living in poverty have poor health outcome...
What’s Needed <ul><li>Additional research on long-term outcomes of innovative health technologies. </li></ul><ul><li>Resea...
<ul><li>Karen C. Fox </li></ul><ul><li>Assistant Dean, College of Medicine </li></ul><ul><li>UT Health Science Center </li...
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  • Most hospital systems and major healthcare providers have already realized benefits of EMR systems, with their tremendous potential to: Reduce prescription errors Alert staff to negative medication interactions Facilitate standards of care Improve research opportunities and Save physician time Over the last 20 years,
  • Vicious feedback loop.
  • A veteran who lives in Dyersburg, TN (and normally has to come into Memphis for the VA Medical Center) comes to his local Health Department coughing up blood and running a fever while at work. The primary care physician makes a diagnosis of pneumonia and writes a prescription for an antibiotic, suggesting that the man return to Memphis for a consult with a Pulmonologist. With no access to reliable transportation, he forgoes the consultation, then has a reaction with his existing medication and decides to stop taking the prescription, . Three days later he is brought late at night to the Emergency Department of the Regional Medical Center by his nephew, who has only sketchy knowledge of the man’s medical history. Another round of expensive tests are ordered (duplicating previous work) and another course of treatment is initiated, complicating the situation even further. This gentleman is getting prescriptions filled at three different locations and has another three agencies providing healthcare, none of which talk to each other or share vital health information, including allergies, current medications, current treatment plans, and other critical care notes. Access to necessary specialists aren’t available locally in his rural community. When given a referral into Memphis, he will often delay getting an appointment which allows the condition to exacerbate, leading to poorer outcomes and increased costs of care.
  • Define for group. Using technology to overcome barriers of communication, distance and time. UTHSC utilizes a two-pronged approach to total clinical decision support. The first component provides access to specialists through the dedicated telehealth network of the University of Tennessee’s Health Science Center (UTHSC). The second component involves a distributed electronic health record (EHR) integrated with decision support systems, online management of protocols, electronic orders, and medication management systems. The primary goal is to determine the extent to which a multi-state HIT collaborative network can contribute to measurable and sustainable improvements in the cost, safety, and overall quality of health care for a region. An integrated network that provides decision support and communication technology will be an essential component to improving access to care, clinical decision-making, patient safety, and overall quality of care.
  • Most hospital systems and major healthcare providers have already realized benefits of EHR systems, with their tremendous potential to: Reduce prescription errors Alert staff to negative medication interactions Facilitate standards of care Improve research opportunities and Save physician time (via orders sets, templates for progress notes) Most of these benefits have been realized only in urban settings. Rural providers and small group practices do occasionally utilize some components of EHRs, but use is limited. But rural and remote populations need EHRs the most. Rural communities struggle with the same challenges urban communities do in providing health information systems, but these challenges are often compounded by: Poor local telecom infrastructure Lack of resources to establish an EHR Lack of support from a major healthcare provider for standards of care
  • Real Example of Rural EMRs: A young girl in rural Wisconsin is bitten by a pet prairie dog. One day later she develops cold symptoms -- fever, mild cough, congestion, nasal drainage. Five days later the bite becomes red and swollen and she is seen by her family physician at a rural Marshfield Clinic site. Her physician orders lab work and a chest X-ray, starts antibiotics and calls a specialist at Marshfield Clinic Marshfield Center for consultation. The specialist enters the child’s medical chart number in the computer and is able to review her entire medical history. The child is admitted to the hospital in Marshfield, where her electronic medical record is also available. The child is subsequently diagnosed with the first known case of monkeypox in the Western Hemisphere. This scenario was only possible because Marshfield Clinic’s electronic medical record network allows doctors to securely share critical medical information on a need-to-know basis anytime and anywhere it is needed within the Marshfield Clinic system.
  • The overall goals of the project are to reduce the incidence of medical errors and delays due to lack of health information, to improve compliance with health plans and standards of care, and to improve patient safety and quality of care. Members: University of Tennessee UT Medical Group Methodist Healthcare Regional Medical Center Le Bonheur Children’s Hospital St. Jude Children’s Research Hospital Memphis Veterans Administration Hospital Shelby County Health Department Community and Faith-Based Providers
  • Many patients in this area suffer from chronic diseases with co-morbid conditions, visiting different facilities as their needs arise. The project’s foundation is the development and maintenance of a common Enterprise Master Patient Index (eMPI).
  • A true regional network that can serve as an interface to unite the disparate EHR systems will provide: Provision of knowledge and decision-support through the use of protocols for standards of care that enhance the quality, safety, and efficiency of patient care, Longitudinal collection and programmatic dissemination of patient health information regardless of location, Immediate electronic access to information (on a person- or population-level) by authorized healthcare providers, Computerized medication management programs to improve compliance with formularies and reduce the incidence of drug interactions, Support of efficient processes for health care delivery. Linkages to payor systems and health plans to automatically verify patient eligibility, authorizations, and prior claims and reimbursements, Support for inter-agency biomedical and health systems research across the region, Support for syndromic surveillance in public health regarding emerging diseases, and Establishment of targeted patient health education.
  • These are the barriers that exist for rural regional systems IN ADDITION to the regular barriers of EHR adoption (physician acceptance, cost, disparate islands of health data within a system) Per a IOM report, commissioned last year to design a standardized model of an electronic medical record.
  • Improving access through collaborations and technologies. A NETWORK of equipment/telecommunications AND people!
  • Great physicians and good medical care in rural hospitals but lack of specialists. Benefits in detail: Access and availability of quality specialty health care Reduced isolation of local physician Greater peer-to-peer interaction Increases in number and variety of specialty services that can be accessed Provision of most up-to-date information to healthcare and administrative staff Distance learning opportunities Generates revenues for hospitals
  • Cariology is scattered, but normally where they are scattered is travelling, note FTE’s of red 0.3-2.0
  • Services provided via telehealth center around meeting the six (6) aims of health care put forth in the Institute of Medicine’s (IOM) report “Crossing the Quality Chasm: A New Health System for the 21st Century”. Although analyses of these data are preliminary, results demonstrate significant improvements for telehealth patients in these six areas: Safe - Review of 83 incarcerated adolescents receiving psychiatric treatments via telehealth show that 65% of individuals were misdiagnosed prior to telehealth consults, creating a delay in appropriate treatments. Timely - 78% of telehealth appointments occur within 10 minutes of their scheduled time, reducing the amount of wait patients have to endure. Patients scheduling telehealth visits usually receive an appointment within 2 weeks.
  • Services provided via telehealth center around meeting the six (6) aims of health care put forth in the Institute of Medicine’s (IOM) report “Crossing the Quality Chasm: A New Health System for the 21st Century”. Although analyses of these data are preliminary, results demonstrate significant improvements for telehealth patients in these six areas: Efficient - Telehealth physicians have been able to average 4.3 patients per hour with equal to better care, compared to 2.7 patients per hour in the traditional UTMG clinics. The no-show rate for telehealth patients averages 4.6%, compared to 26.5% for the traditional UTMG clinic.
  • Services provided via telehealth center around meeting the six (6) aims of health care put forth in the Institute of Medicine’s (IOM) report “Crossing the Quality Chasm: A New Health System for the 21st Century”. Although analyses of these data are preliminary, results demonstrate significant improvements for telehealth patients in these six areas: Effective - 73% of telehealth patients received new, more effective prescription medications. The average patient has been to their PCP 4.8 times for their primary complaint, and yet 90% of telehealth patients have their primary complaint resolved within 2.2 telehealth visits.
  • Services provided via telehealth center around meeting the six (6) aims of health care put forth in the Institute of Medicine’s (IOM) report “Crossing the Quality Chasm: A New Health System for the 21st Century”. Although analyses of these data are preliminary, results demonstrate significant improvements for telehealth patients in these six areas: Patient-centered - The average telehealth patient lives 117 miles from Memphis, saving the patient time and money for each visit. Patients also report equal or higher satisfaction (94%) with telehealth visits, with anecdotal patient reports that the clinician appears to be more focused on them as individuals and their concerns.
  • Health flows not only as a by-product of increased income, a healthy community is also a critical component of economic development. That is, health may be viewed as an economic engine operating in a positive feedback loop.
  • Pending Legislation (might skip or mention): Sen. Hillary Clinton (D, N.Y.) has introduced a plan to modernize the health care system which includes: Building an IT infrastructure that enables data sharing. Giving patients and clinicians instant access to health information, including research findings. Sen. Hillary Clinton (D, N.Y.) outlined a bill that would mandate the development of standards for electronic records and provide funding for physician offices to buy the systems. &amp;quot;The government should also help ensure that IT is affordable for small or rural providers, and for safety net providers,&amp;quot; Clinton said. &amp;quot;I&apos;ve supported funding this, perhaps, through a revolving loan fund, and we should be encouraging innovation in business models for how to make this affordable.“ Sen. Edward Kennedy (D, Mass.) also announced that he would introduce legislation including an electronic records provision. &amp;quot;Automated patient record-keeping can help bring real coordination to what is often a frighteningly fragmented health care system,&amp;quot; Kennedy said. &amp;quot;Today, for one in five patients with significant health problems, various health professionals order duplicate tests and procedures. One in four arrives for a doctor&apos;s appointment and finds that needed test results or records are not available.&amp;quot; Both Kennedy and Clinton serve on the Senate Health, Education, Labor and Pensions Committee, chaired by Sen. Judd Gregg (R, N.H.). The panel could be a venue for debate of the measures. Gregg has indicated support for developing electronic record standards but wants to move slowly due to the issue&apos;s complexity.
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    1. 1. Deployed Health Technologies Emerging Opportunities and Existing Barriers <ul><li>Karen C. Fox </li></ul><ul><li>Assistant Dean, College of Medicine </li></ul><ul><li>UT Health Science Center </li></ul>Innovative, collaborative solutions to meet the heath care needs of rural and remote communities.
    2. 2. A Look at the Destructive Cycle of Health Disparities for Rural Patients Poverty Education Culture Location Death Disability Long Term Care Health Disparities (uneven access to care and services) Delays in receiving adequate care, lack of follow-up and appropriate referrals. Cutbacks and denials of services or overage Increased incidents of chronic disease (ie: diabetes, stroke, heart attack) High costs associated with healthcare systems
    3. 3. A Glimpse Into the Problem Physical barriers to care Fragmented delivery system Disparate information systems VAMC (National) Rural Health Clinic The Med (Memphis) Pharmacy #3 Pharmacy #2 Pharmacy #1
    4. 4. Two-Pronged Solution: Innovative Health Technologies Electronic Health Records Telehealth Total Rural Clinician Support
    5. 5. EHR Systems in Rural Settings Establishing, utilizing and maintaining an EHR system is a challenge, made more difficult in rural or isolated settings. <ul><li>Poor local telecom infrastructure </li></ul><ul><li>Lack of resources to establish an EHR </li></ul><ul><li>Lack of support from a major healthcare provider for standards of care </li></ul>
    6. 6. Benefits of Regional EMR Systems Promote Region-Wide Standards of Care Rapid Access to Information at the Point of Care Clinician Decision Support (protocols, clinical trials) Drug / Allergy Interactions Disease Surveillance Girl bitten by prairie dog Family physician at Rural Marshfield clinic Specialist at Marshfield Center telehealth consultation shared EHR network
    7. 7. The Memphis Area Technology Collaborative for Health (MATCH) A cooperative project of the University Medical Center Alliance designed to meet the need for timely patient health information at the point of care, regardless of where the patient presents.
    8. 8. Master Patient Index <ul><li>Dynamic interface that connects separate EHR systems across the region. </li></ul><ul><li>Facilitates sharing health information across different healthcare organizations. </li></ul><ul><li>True continuity of care is the expected result. </li></ul>
    9. 9. Master Patient Index: Benefits to Rural Communities Clinician decision-support Regional standards of care Immediate electronic access to information Computerized medication management Linkages to payor systems and health plans Support for inter-agency research Support for syndromic surveillance Establishment of targeted patient health education
    10. 10. Barriers to EMRs for Rural and Remote Populations Lack of data standards Proprietary systems that don’t communicate Patient privacy and security (HIPAA) Poor existing telecom infrastructures Interface design and implementation
    11. 11. The Mid-South Telehealth Network Four UT Colleges Seven Health Departments Nine Pharmacies Six Rural Hospitals Four Community Centers Three Schools Five Group Youth Homes One Dental/Vision Van Ag Extension Agent Offices
    12. 12. Rural Hospitals Benefit from Telehealth <ul><li>Improves access to specialty health care services. </li></ul><ul><li>Increases support system for rural providers (CME, research opportunities, etc.) </li></ul><ul><li>Keeps money and services within the community. </li></ul><ul><li>Increases community confidence in local healthcare system. </li></ul>
    13. 13. Medical Specialties <ul><li>Cardiology </li></ul><ul><li>Dermatology </li></ul><ul><li>Endocrinology </li></ul><ul><li>E.N.T. </li></ul><ul><li>Geriatrics </li></ul><ul><li>Orthopedics </li></ul><ul><li>Pathology </li></ul><ul><li>Radiology </li></ul><ul><li>Dental </li></ul><ul><li>Toxicology </li></ul><ul><li>Behavioral Health </li></ul><ul><li>Wound Care </li></ul><ul><li>Case Management </li></ul><ul><li>Echocardiograms </li></ul><ul><li>Rehabilitation Therapies </li></ul><ul><li>Post-surgical Follow-up </li></ul><ul><li>Pediatric Subspecialties </li></ul><ul><li>Rheumatology </li></ul>
    14. 14. One Example: Cardiology Specialists Accepting TennCare in Tennessee 0.3 – 2.0 2.1 – 4.5 4.6 – 7.0 7.1 – 12.0 FTE Ranges If you live in a rural community, you might have to travel 175 miles to reach a cardiologist accepting patients, and have to wait up to 6 months for an appointment.
    15. 15. Telehealth Improves Access to Cardiologists for Rural Patients 0.3 – 2.0 2.1 – 4.5 4.6 – 7.0 7.1 – 12.0 FTE Ranges By conducting an appointment through a telehealth access point, travel is drastically reduced and wait times nearly eliminated.
    16. 16. Telehealth Outcomes: STEEEP <ul><li>Safe - Patients receiving psychiatric treatments via telehealth show that 65% of individuals were misdiagnosed prior to telehealth. </li></ul><ul><li>Timely - </li></ul><ul><li>78% of telehealth appointments occur within 10 minutes of their scheduled time. </li></ul><ul><li>Patients scheduling telehealth visits usually receive an appointment within 2 weeks. </li></ul>
    17. 17. Telehealth Outcomes: STEEEP <ul><li>Efficient - </li></ul><ul><li>Telehealth physicians average 4.3 patients per hour with equal to better care, compared to 2.7 patients per hour in traditional clinics. </li></ul><ul><li>The no-show rate for telehealth patients averages 4.6%, compared to 26.5% for traditional clinics. </li></ul><ul><li>Equitable - 67% of telehealth patients with a self-report family income of $20,000 or less. </li></ul>
    18. 18. Telehealth Outcomes: STEEEP <ul><li>Effective - </li></ul><ul><li>73% of telehealth patients received new, more effective prescription medications. </li></ul><ul><li>The average patient has been to their PCP 4.8 times for their primary complaint, and yet 90% of telehealth patients have their primary complaint resolved within 2.2 telehealth visits. </li></ul>
    19. 19. Telehealth Outcomes: STEEEP <ul><li>Patient-centered - </li></ul><ul><li>The average telehealth patient lives 117 miles from Memphis. </li></ul><ul><li>Patients report equal or higher satisfaction (94%) with telehealth visits. </li></ul>
    20. 20. Health as an Economic Engine <ul><li>Known Facts: </li></ul><ul><li>1) People living in poverty have poor health outcomes, more sick days, more chronic conditions. </li></ul><ul><li>2) Economic development can lead to improved health. </li></ul><ul><li>3) A healthier workforce contributes substantially to economic development. (Limitation of activity cost the Economy $73 billion annually in lost work time) </li></ul><ul><li>4) Economic costs of chronic conditions in 2001were $425 billion (14% of GNP). 80% of these costs were the result of preventable disease states. (Lerch 2002) </li></ul>
    21. 21. What’s Needed <ul><li>Additional research on long-term outcomes of innovative health technologies. </li></ul><ul><li>Research on health as an economic engine for rural communities. </li></ul><ul><li>Facilitation of nation-wide collaborations. </li></ul>In the 1900’s, we built roads into rural communities to facilitate transportation. Now in the 2000’s, we must build the technology infrastructure to support digital access, communications, data sharing and resource distribution.
    22. 22. <ul><li>Karen C. Fox </li></ul><ul><li>Assistant Dean, College of Medicine </li></ul><ul><li>UT Health Science Center </li></ul><ul><li>901-448-HEAL </li></ul><ul><li>877-821-0022 </li></ul><ul><li>www.utmem.edu/telemedicine </li></ul>Uniting Patients, Providers and Communities The University of Tennessee Outreach Center
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