Sept 23, 2021 SLMC PRIME Post Grad

1. Lisa Traboco MD
Internal Medicine - Rheumatology
UP MIU GradStudent
SLMC PRIME PLUS 9.23.2021

2. covid
telemedicine
patient care

3. covid
telemedicine
patient care

4. Global concerns
Around the neighborhood
Picket fence opportunities
SLMC
PRIME
PLUS
9.23.2021
G
A
P
...gaps to fill

5. ...okay, at least Asia Pacific
then...
Global
Concerns
SLMC PRIME PLUS 09.23.2021

6. Setting up shop
How do I do History Taking?
How do I do Physical Exam?
SLMC
PRIME
PLUS
9.23.2021
?
?
?
...beyond the basics

7. Infrastructure
Rural-urban gaps
Government support and recommendation
Subsequent support (example: ambulance linkage)
Insurance coverage
Doctor to Patient; Doctor to HCW; Specialist care delivery
Robotics
Bhaskar, S., Bradley, S., Chattu, V. K., Adisesh, A., Nurtazina, A., Kyrykbayeva, S., Sakhamuri, S., Yaya, S., Sunil, T., Thomas, P., Mucci, V., Moguilner, S., Israel-Korn, S., Alacapa, J., Mishra, A., Pandya,
S., Schroeder, S., Atreja, A., Banach, M., & Ray, D. (2020). Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM)
International Consortium (Part 1). Frontiers in public health, 8, 556720. https://doi.org/10.3389/fpubh.2020.556720

8. SLMC PRIME PLUS 09.23.2021

9. 1. Development of telemedicine should use a framework to ensure explicit consideration
of the appropriateness of telemedicine with respect to the clinical effectiveness, safety
issues, patient’s perspective, economic, organizational, sociocultural, ethical, and legal
aspects with an aim for equitable health care access for all.
2. There should be shared decision between rheumatologists and patients or caregivers
before use of telemedicine, ensuring understanding advantages and limitations.
3. The telemedicine modality should be appropriate for the patient, considering the
diagnosis, disease activity and severity, availability of technology, and appropriately
trained practitioners.
SLMC
PRIME
PLUS
9.23.2021
Overarching Principles
draft

10. 1. Development of telemedicine should use a framework to ensure explicit consideration
of the appropriateness of telemedicine with respect to the clinical effectiveness, safety
issues, patient’s perspective, economic, organizational, sociocultural, ethical, and legal
aspects with an aim for equitable health care access for all.
2. There should be shared decision between rheumatologists and patients or caregivers
before use of telemedicine, ensuring understanding advantages and limitations.
3. The telemedicine modality should be appropriate for the patient, considering the
diagnosis, disease activity and severity, availability of technology, and appropriately
trained practitioners.
SLMC
PRIME
PLUS
9.23.2021
Overarching Principles
draft

11. 1. Development of telemedicine should use a framework to ensure explicit consideration
of the appropriateness of telemedicine with respect to the clinical effectiveness, safety
issues, patient’s perspective, economic, organizational, sociocultural, ethical, and legal
aspects with an aim for equitable health care access for all.
2. There should be shared decision between rheumatologists and patients or caregivers
before use of telemedicine, ensuring understanding advantages and limitations.
3. The telemedicine modality should be appropriate for the patient, considering the
diagnosis, disease activity and severity, availability of technology, and appropriately
trained practitioners.
SLMC
PRIME
PLUS
9.23.2021
Overarching Principles
draft

12. "No available study" or limited for many of our PICO questions on
outcomes, procedural, patient experiences
Experience sharing / dialogue with international colleagues
SLMC
PRIME
PLUS
9.23.2021
1
2
rheum 4 reflections

13. Connected
papers in
Telemedicine

14. Empowering the community at large
Around the
Around the
neighborhood
neighborhood
SLMC PRIME PLUS 09.23.2021
SLMC PRIME PLUS 09.23.2021

15. UP Medical Informatics Unit: bit.ly/upmiutelemed2020
Specialty societies' guidelines/guidances
SLMC
PRIME
PLUS
09.23.2021
1
2
GuidanceS

16. Digital in the
Philippines
"Telemedicine,
is great but our internet...
can you hear me? hel -"
#haiku
+6.1%
Internet users
increase 2020-
2021
43%
Individuals
using the
internet
31.44 mbps
Average download
internet speed
https://datareportal.com/reports/digital-2021-philippines

17. Step 2
Consultation
Step 3
Post consult
Step 1
Triage
Workflow

18. Step 1
Triage
Step 2
Consultation
Step 3
Post consult
Work
Telephone Screening / Triage: Nurses >
Physicians, GP > Specialists (Graversen,
2020)
Non-HCW screening? Training?
New (2nd opinion)?
Triage failure?
flow
Graversen et al. BMC Family Practice (2020) 21:84 https://doi.org/10.1186/s12875-020-01122-z

19. Step 2
Consultation
Step 3
Post consult
Step 1
Triage
Work
Pts w/ LESS axial pain & peripheral/axial
stiffness
Which (rheum) patients consider phone
consults to be useful?
López-Medina (2020)
dx.doi.org/10.1136/annrheumdis-2020-218008
flow

20. Step 2
Consultation
Step 3
Post consult
Step 1
Triage
Work
Telephone (audio) only history taking &
physical evaluation
Converting to F2F clinic, or sending to
hospital?
Ex: Med refill --> Abnormal lab result
or concerning history event;
Inflammatory joint pain --> Other
systemic symptoms
Appointment --> allows preparation?
flow

21. https://rheumatic.elsa.science/en/

22. Step 2
Consultation
Step 3
Post consult
Step 1
Triage
Work
First time phone --> next check up F2F?
when is next time?
Teleconsult summary + Rx + Lab Req?
flow

23. Barangay
Community
Health
Hospital
General/
Specialty
Service
delivery
Pharmacy,
Laboratory,
...
Outpatient
clinics
Primary Care
Health service
delivery
Fail-safe mechanisms
Primary care
Continuity of care
Social service

24. Picket fence
Picket fence
opportunities
opportunities
What can we do in our home ground?
SLMC PRIME PLUS 09.23.2021

25. Attending
5-star physician
Patient
care focus
Resident/Fellow
medical
education/experience
The TeleTeam

26. Attending
5-star physician goals
Patient
care focus
Resident/Fellow
medical
education/experience
The TeleTeam
Nurse
Pharmacy
Allied HCW
actual
Bouskill, K., Smith-Morris, C., Bresnick, G., Cuadros, J., & Pedersen, E. R. (2018). Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management.
BMC health services research, 18(1), 617. https://doi.org/10.1186/s12913-018-3427-9
Harst, L., Timpel, P., Otto, L., Wollschlaeger, B., Richter, P., & Schlieter, H. (2018). Identifying Obstacles and Research Gaps of Telemedicine Projects: Approach for a State-of-the-Art Analysis.
Studies in health technology and informatics, 247, 121–125.
Testing --> Implementation
(Harst, 2018)
Scheduling, Follow up,
Treatment adherence
(Bouskill, 2020)

27. Patient experience and satisfaction
Outcome measures / patient reported outcomes
Medical education challenges and key solutions
SLMC
PRIME
PLUS
09.23.2021
?
?
?
Looking for prime ideas?

28. SLMC
PRIME
PLUS
09.23.2021
Patient Experience
& Perceptions
~47% able to use technology on their own;
~90% using Facebook
42% think Tele is not the same as F2F
1/4 of patients encounter difficulty (in using the
technology)

29. Attending
5-star physician goals
Patient
care focus
Resident/Fellow
medical
education/experience
The TeleTeam
Nurse
Pharmacy
Allied HCW
Students
future
Bhaskar, S., Bradley, S., Sakhamuri, S., Moguilner, S., Chattu, V. K., Pandya, S., Schroeder, S., Ray, D., & Banach, M. (2020). Designing Futuristic Telemedicine Using Artificial Intelligence and
Robotics in the COVID-19 Era. Frontiers in public health, 8, 556789. https://doi.org/10.3389/fpubh.2020.556789
Triage BOTs
Autofill forms
IoT (Internet of Things): beds,
IV lines, telemetry, video
monitoring
Actual robot rounds?

30. Patient type/ Disease activity
HCW (telepresenter)
2nd opinions, Referrals SS unmet needs
Tele-nursing/pharm
MedStudent/Resident/Fellow
Phone vs Video vs Messaging
Timing/ Appropriateness
Interaction / Collaboration
of Local Health Units
Training / CME
Patient education

31. Bhaskar, S., Bradley, S., Chattu, V. K., Adisesh, A., Nurtazina, A., Kyrykbayeva, S., Sakhamuri, S., Yaya, S., Sunil, T., Thomas, P., Mucci, V., Moguilner, S., Israel-
Korn, S., Alacapa, J., Mishra, A., Pandya, S., Schroeder, S., Atreja, A., Banach, M., & Ray, D. (2020). Telemedicine Across the Globe-Position Paper From the COVID-
19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). Frontiers in public health, 8, 556720.
https://doi.org/10.3389/fpubh.2020.556720

32. lstraboco@stlukes.com.ph
THANK YOU!
THANK YOU!
SLMC PRIME PLUS 09.23.2021
@rheumarhyme
#team_UP_MIU