Telemedicine and Longterm Care

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Telemedicine and Longterm Care

  1. 1. TELEMEDICINE ANDTELEMEDICINE AND LONGTERM CARELONGTERM CARE American Association of HomesAmerican Association of Homes and Services for the Agingand Services for the Aging April 7, 2003 Washington, DCApril 7, 2003 Washington, DC Don McBeath, Director of TelemedicineDon McBeath, Director of Telemedicine Texas Tech University Health SciencesTexas Tech University Health Sciences CenterCenter
  2. 2. Telemedicine…Telemedicine… ….the basics.….the basics.
  3. 3. What is Telemedicine?What is Telemedicine? . . . the use of electronic information. . . the use of electronic information and communication technologies toand communication technologies to provide and support health care whenprovide and support health care when distance separates the participants . . .distance separates the participants . . .
  4. 4. What is Telemedicine?What is Telemedicine? Telecommunications Technology + Medicine
  5. 5. Why do telemedicine?Why do telemedicine?  AccessAccess – Provide primary healthcare that would notProvide primary healthcare that would not be available otherwisebe available otherwise – Specialty care consultations for isolatedSpecialty care consultations for isolated specialists, practitioners, and other healthspecialists, practitioners, and other health care professionalscare professionals – Eliminate expensive travel and isolationEliminate expensive travel and isolation – Reduce need to move patientReduce need to move patient – CME for isolated health care providersCME for isolated health care providers
  6. 6. Telemedicine settingsTelemedicine settings  RuralRural  SchoolsSchools  ClinicsClinics  HospitalsHospitals  PrisonsPrisons  Nursing homes/ Assisted livingNursing homes/ Assisted living
  7. 7. Emerging applicationsEmerging applications  TelepharmacyTelepharmacy  TeledentistryTeledentistry  Broader Home HealthBroader Home Health  Remote SurgeryRemote Surgery
  8. 8. Telemedicine began .Telemedicine began . . .. .  In 1924, with the concept of a physicianIn 1924, with the concept of a physician seeing his patient over the radio using aseeing his patient over the radio using a television screentelevision screen  First wave of telemedicine programsFirst wave of telemedicine programs started in the 1950sstarted in the 1950s  Now in the third waveNow in the third wave  Most programs that began in the 1960s-Most programs that began in the 1960s- 1980s no longer exist, due to1980s no longer exist, due to dependence on external fundingdependence on external funding
  9. 9. Telemedicine nowTelemedicine now  Doubling in number of two-wayDoubling in number of two-way interactive video programs in 90sinteractive video programs in 90s  Teleradiology, store-and-forward,Teleradiology, store-and-forward, remains most common applicationremains most common application  Technology is rapidly changing andTechnology is rapidly changing and costs are decreasingcosts are decreasing  Correctional is heaviest useCorrectional is heaviest use  Moving into private physicians useMoving into private physicians use  Expanding applicationsExpanding applications
  10. 10. Telemedicine atTelemedicine at Texas TechTexas Tech  An early pioneer in telemedicineAn early pioneer in telemedicine  Started in 1989 as a pilot project toStarted in 1989 as a pilot project to deliver health care to the rural Bigdeliver health care to the rural Big Bend Region of TexasBend Region of Texas  First consult in June of 1990 fromFirst consult in June of 1990 from Alpine, Texas hospitalAlpine, Texas hospital
  11. 11. First consult, June 1990 Aida Porras, age 10
  12. 12. Aida Porras in Presidio, TX
  13. 13. Telemedicine atTelemedicine at Texas TechTexas Tech  Average 2,500 consults annuallyAverage 2,500 consults annually  Over 12,000 consults since 1991Over 12,000 consults since 1991  Telemedicine Hall of Fame byTelemedicine Hall of Fame by TelehealthTelehealth MagazineMagazine in August 1999in August 1999  Top Ten Telemedicine Programs inTop Ten Telemedicine Programs in 1996 and 1997 by1996 and 1997 by Telemedicine andTelemedicine and Telehealth Network MagazineTelehealth Network Magazine  Ranked in the “Top 12 List” byRanked in the “Top 12 List” by Telemedicine TodayTelemedicine Today in 1998in 1998
  14. 14. Abilene El Paso Alpine Presidio Terlingua Hart Pampa Dalhart Amarillo Childress Wichita Falls Plainview Lubbock Ft. Stockton Odessa Lamesa Snyder Coleman Stamford Anson Sierra Blanca Fort Hancock Colorado City July 2001 Levelland De Leon Texas Tech Telemedicine NetworkTexas Tech Telemedicine Network Campus Sites Amarillo Lubbock El Paso Odessa Rural Sites Alpine Hart Fort Hancock Presidio Sierra Blanca Terlingua Correctional Sites Abilene Lamesa Amarillo Lubbock Childress Pampa Colorado City Plainview Dalhart Snyder El Paso Wichita Falls Ft. Stockton Affiliated Independent Network •with Hendrick Medical Center: Abilene Anson Coleman Stamford •with FQHCs: De Leon El Paso Levelland
  15. 15. Types of telemedicineTypes of telemedicine consultsconsults  By specialtyBy specialty – PsychiatryPsychiatry 63%63% – OrthopedicsOrthopedics 11%11% – OtherOther 10%10% – PsychologyPsychology 8%8% – DermatologyDermatology 4%4% – Primary CarePrimary Care 4%4%  By typeBy type – CorrectionalCorrectional 90%90% – Non-correctional 10%Non-correctional 10%
  16. 16. Consults by year and specialty Correctional 1994 1995 1996 1997 1998 1999 2000 2001 2002 Gen. Surg. 11 79 78 81 212 192 248 80 2 Ortho 9 174 300 251 213 309 377 268 260 Internal Med. 14 101 59 22 26 13 29 19 25 Urology 0 22 25 5 26 68 75 68 42 Dermatology 0 72 76 44 61 73 82 75 85 Other Med. 10 131 154 61 50 15 17 29 19 Psychology 0 0 0 0 142 208 287 251 181 Psychiatry 0 11 146 179 187 554 1383 1326 1486 Correctional Total 44 590 838 643 917 1432 2498 2116 2100 Non- correctional 93 83 54 35 68 60 32 180 243 Total 137 673 892 678 985 1492 2530 2296 2343
  17. 17. How it worksHow it works  Video conference systemVideo conference system  Cameras each endCameras each end  TV screens/computers each endTV screens/computers each end  Various medical peripheralsVarious medical peripherals  Video connectionVideo connection  T-1 lineT-1 line  SatelliteSatellite  Phone line (POTS)Phone line (POTS)  InternetInternet
  18. 18. ) ) ) ) ) ) ) ) ))) ) ) ) ) ) ) ) ) ))) ) ) Hub Site Remote Site T-1
  19. 19. ConnectivityConnectivity  T-1 dedicated phone lineT-1 dedicated phone line  SatelliteSatellite  ISDNISDN  High speed DSL/CableHigh speed DSL/Cable  ATMATM  POTSPOTS  LAN/WANLAN/WAN  Internet, or IP-basedInternet, or IP-based
  20. 20. Compression ofCompression of bandwidthbandwidth Codecs compress the information to fit the broadband connection
  21. 21. TelemedicineTelemedicine does not/should notdoes not/should not alter the practice of medicinealter the practice of medicine .. TTU telemedicine philosophy
  22. 22. Core principles ofCore principles of telemedicinetelemedicine  Is only a tool (like a stethoscope)Is only a tool (like a stethoscope)  Must be physician directedMust be physician directed  Must be integrated into establishedMust be integrated into established clinical operations and routinesclinical operations and routines  Physician-patient relationships must bePhysician-patient relationships must be preservedpreserved
  23. 23. The barriersThe barriers  Equipment costsEquipment costs  Connectivity costsConnectivity costs  ReimbursementReimbursement
  24. 24. Getting betterGetting better  Declining equipment costsDeclining equipment costs  Shared connectivityShared connectivity  Enhanced reimbursement (still anEnhanced reimbursement (still an issue for nursing homes)issue for nursing homes)
  25. 25. Long-term careLong-term care telemedicinetelemedicine
  26. 26. Correctional telemedicine as a model
  27. 27. Similar scenariosSimilar scenarios  Desire to not transport patients off siteDesire to not transport patients off site  Limited on-site primary careLimited on-site primary care  No on-site specialty careNo on-site specialty care  Must maintain certain level of staff on-Must maintain certain level of staff on- site at all timessite at all times  Have stringent rules and regulations toHave stringent rules and regulations to followfollow
  28. 28. Prison off-site transportPrison off-site transport samplesample NumberNumber PercentagePercentage RemainRemain On UnitOn Unit 648648 57.5%57.5% TransferTransfer Off SiteOff Site 479479 42.5%42.5% For Year 2000, medical consults only.
  29. 29. Long-term careLong-term care telemedicine—telemedicine— goals and benefitsgoals and benefits  Enhance and increase on-site primaryEnhance and increase on-site primary carecare  Enhance and increase on-siteEnhance and increase on-site specialty carespecialty care  Reduce ambulance transportation forReduce ambulance transportation for off-site careoff-site care  Reduce unnecessary ER visitsReduce unnecessary ER visits
  30. 30. Goals and benefits-cont.Goals and benefits-cont.  Reduce risk of injury associated withReduce risk of injury associated with transportstransports  Reduce loss of revenue to nursingReduce loss of revenue to nursing homeshomes  Allow better community ambulanceAllow better community ambulance coverage with less nursing homecoverage with less nursing home transportstransports  On-site medial and task trainingOn-site medial and task training
  31. 31. Goals and benefits –Goals and benefits – cont.cont.  GED (high school equivalency)GED (high school equivalency) trainingtraining  Replication of operating modelReplication of operating model  Student training componentStudent training component  Expand to additional servicesExpand to additional services including dentalincluding dental
  32. 32. Goals and benefits –Goals and benefits – cont.cont.  Distant social and counseling servicesDistant social and counseling services for family and caregiversfor family and caregivers  Reduced family travel timeReduced family travel time
  33. 33. Texas Tech long-termTexas Tech long-term care projectscare projects -Carillon project – brief pilotCarillon project – brief pilot -Garrison project – April 2003Garrison project – April 2003 -West Texas Rural Nursing HomeWest Texas Rural Nursing Home Telemedicine Network - plannedTelemedicine Network - planned
  34. 34. Carillon findingsCarillon findings  Patient satisfactionPatient satisfaction - Comfort level and communications- Comfort level and communications very highvery high - Satisfaction with exam very high- Satisfaction with exam very high - Most would do again- Most would do again - Most believe no diminishing of- Most believe no diminishing of medical qualitymedical quality
  35. 35. Carillon findingsCarillon findings  Patient satisfactionPatient satisfaction - Only negatives on audio/hearing- Only negatives on audio/hearing
  36. 36. Carillon findingsCarillon findings  Physician satisfactionPhysician satisfaction - Very high overall satisfaction- Very high overall satisfaction - Reported no limitation on their ability- Reported no limitation on their ability to treat/diagnoseto treat/diagnose - Rated most consults as same as- Rated most consults as same as face-to-faceface-to-face
  37. 37. Garrison projectGarrison project  Geriatric Teaching Nursing HomeGeriatric Teaching Nursing Home  Teaching and research lab forTeaching and research lab for telemedicine applications in assistedtelemedicine applications in assisted livingliving  Expose heath care providers,Expose heath care providers, students, and nursing home staff tostudents, and nursing home staff to telemedicinetelemedicine  Serve as a resource for rural nursingServe as a resource for rural nursing homeshomes
  38. 38. West Texas RuralWest Texas Rural Nursing HomeNursing Home Telemedicine NetworkTelemedicine Network Project-plannedProject-planned  Link three rural nursing homes withLink three rural nursing homes with Medical Director with telemedicineMedical Director with telemedicine  Link with Garrison Geriatric CenterLink with Garrison Geriatric Center  Link to Texas TechLink to Texas Tech  No community hospitalNo community hospital  Medical Director in another communityMedical Director in another community
  39. 39. What is the future ofWhat is the future of assisted living/long-termassisted living/long-term care telemedicine?care telemedicine?
  40. 40. Greatest potential forGreatest potential for expanded use ofexpanded use of telemedicine!telemedicine!
  41. 41.  Broader applications – especially inBroader applications – especially in assisted living facilitiesassisted living facilities  Explosion in home useExplosion in home use  Driven by technology and theDriven by technology and the expanding role of the Internetexpanding role of the Internet

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