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ACCESS TO CARE
THE USE OF TELEMEDICINE ACROSS THE
HEALTHCARE CONTINUUM
Kevin Broder, MD
Telehealth Director, Department of...
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
RUBE GOLDBERG (1883-1970)
HIGHLY RURAL, RURAL AND CENSUS DEFINED URBAN AREAS
Map generated by VHA Planning
Systems Support Group2nd Annual UCSD Clin...
ELDERLY TRANSPORT
• Costly Travel
• Special Assistance
Personnel
• Special Equipment
(Gurneys, Wheelchairs,
Vehicles)
• Lo...
TELEMEDICINE
4 MODALITIES
• Store and Forward Telehealth
– Images/Data obtained by remote site and uploaded Imaging Databa...
• Establish Conditions of Participation and Service
Agreements
• Formation of Telehealth Team
• Identify Patients
• IT Col...
Telehealth
Coordinator
Facility
Leadership
Providers
(Central ‘Hub’)
Informatics
Administrative Staff
Technical
Staff (IT/...
IDENTIFY THE PATIENTS
VISIT TYPES
• Wound Care/Skin Assessment
• Specialty Consultation
• Medical Optimization
• Post-Op E...
MORE VISIT TYPES
VETERAN AFFAIRS EXAMPLES
• TeleCardiology
• TeleGenomics
• TeleICU
• TeleNeurology
• TeleNutrition
• Tele...
• Broadband Network
• Tele-video Conferencing
Equipment
• Peripherals
IT SUPPORT/EQUIPMENT
PERIPHERALS
Digital Stethoscope
Exam Camera
12 Lead ECG
Ultrasound
Spirometer
Vital Signs Monitor
• Customized automated
Consult Requests for
SCAN-ECHO and CVT
• Software based query
of remote site patient
data
• Templat...
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CONTINUUM OF CARE
Interdisciplinary
Team
SCAN
Telehealth
M...
• Telehealth Coordinator - RN
• Telehealth Clinical Technician (TCT) – Health Tech/LPN
• IT Support
• Vendor Support
• Rou...
CLINICAL VIDEO TELEHEALTH
CVT
Patient/PCP at Spoke
Provider at Hub
‘Consult/Post -op/Follow-up/Pre-op’
Patient/Provider at...
USE OF TELEHEALTH REDUCES ADMISSION BED DAYS
CVT TO HOME
PROCESS
• Schedulers Create
Appointments in Custom
Web App
• Email Confirmation Sent
to Patient for Secure
Log...
CVT TO HOME
PROCESS
• Patients Connect to
Enterprise Video Network
from Home
– Desktop
– Laptop
– Tablet
• Connect to Hosp...
CVT TO HOME
EQUIPMENT
Patient/Home RN at Home
Provider at Hub
‘Real Time Home Visit’
CVT TO HOME
MEDICAL PROBLEMS ADDRESSED
• Wound Care
• Nutrition
• Smoking Cessation
• Pressure Relief
• Medication Reconci...
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
SAFETY NET
SCAN
SPECIALTY CARE ACCESS NETWORK
• An innovative model utilizing clinical tele-video
conferencing equipment to allow hea...
• Consent - verbal
• Inter-Facility Consultation Request Placed
• SCAN-ECHO Tele-Video Session
– Case Presentation
– Case ...
• Formation of an Interdisciplinary Team of Consultants
• Identify Hub and Spokes
• IT Collaboration
• Informatics Collabo...
• Plastic Surgeons
• Rehabilitation Physician
• Clinical Nurse Specialist/ Rehab Case Manager
• Physical Therapist
• Dieti...
HUBS AND SPOKES
VA SCI EXAMPLE
• Wound Debridement
• Pressure Ulcer Reconstruction
• Adjuncts to Wound Healing
• Comprehensive Assessment of Pressure Ulc...
BENEFITS FOR PATIENTS AND PROVIDERS
• No-cost continuing education credits (CME/CEU)
• Opportunity to translate new knowle...
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
SCAN
FAR REACHING
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
TELEHEALTH
CONTINUUM OF CARE
HIGH PATIENT SATISFACTION
Veteran TeleWound Care: Initial VA San Diego
Experience Utilizing Real-time Clinical Video
Teleh...
CVT TO HOME
TRANSPORT COST SAVINGS & INCREASED ADOPTION
SCI CENTER – SAN DIEGO
Projected
0
50
100
150
200
250
2011 2012 20...
CONTINUUM OF CARE
WHERE TELEMEDICINE FITS IN
• SCAN-ECHO
• Spoke Telehealth Consultation
• Home Telehealth Monitoring
• Fa...
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NO MORE WAITING FOR THE DOCTOR TO ARRIVE
THANK YOU
KEVIN B...
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2015: Access to care the use of telemedicine across the healthcare continuum-Broder

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The use of telemedicine across the healthcare continuum to improve access to care

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2015: Access to care the use of telemedicine across the healthcare continuum-Broder

  1. 1. ACCESS TO CARE THE USE OF TELEMEDICINE ACROSS THE HEALTHCARE CONTINUUM Kevin Broder, MD Telehealth Director, Department of Surgery Section of Plastic Surgery VA Medical Center – San Diego, CA October 24, 2015 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  2. 2. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium RUBE GOLDBERG (1883-1970)
  3. 3. HIGHLY RURAL, RURAL AND CENSUS DEFINED URBAN AREAS Map generated by VHA Planning Systems Support Group2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  4. 4. ELDERLY TRANSPORT • Costly Travel • Special Assistance Personnel • Special Equipment (Gurneys, Wheelchairs, Vehicles) • Long Clinic Wait Times • Family Inconvenience 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  5. 5. TELEMEDICINE 4 MODALITIES • Store and Forward Telehealth – Images/Data obtained by remote site and uploaded Imaging Database for later review by provider • Home Telehealth – Home monitoring devices • Clinical Video Telehealth (CVT) – Real Time ‘Live’ Videoconferencing • Specialty Care Access Network (SCAN) – Consultation, Care Planning and Education with Tele-video conferencing
  6. 6. • Establish Conditions of Participation and Service Agreements • Formation of Telehealth Team • Identify Patients • IT Collaboration/Equipment Allocation • Informatics Collaboration • Integration into Continuum of Care • Ongoing Provider/Patient Support 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium STEPS FOR PROGRAM DEVELOPMENT
  7. 7. Telehealth Coordinator Facility Leadership Providers (Central ‘Hub’) Informatics Administrative Staff Technical Staff (IT/BioMed) PCP RN Patient/Family (Remote ‘Spokes’) Case Manager TELEHEALTH TEAM
  8. 8. IDENTIFY THE PATIENTS VISIT TYPES • Wound Care/Skin Assessment • Specialty Consultation • Medical Optimization • Post-Op Evaluation • Medication Reconciliation • Psychology • Nutrition • Education 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  9. 9. MORE VISIT TYPES VETERAN AFFAIRS EXAMPLES • TeleCardiology • TeleGenomics • TeleICU • TeleNeurology • TeleNutrition • TelePrimary Care • TelePulmonology (Sleep Services) • TeleRehabilitation • TeleAmputation Clinics • TeleKinesiology • TeleOccupational Therapy • TeleSpinal Cord Injury/Disorder • TeleMOVE! (Weight Loss) 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  10. 10. • Broadband Network • Tele-video Conferencing Equipment • Peripherals IT SUPPORT/EQUIPMENT
  11. 11. PERIPHERALS Digital Stethoscope Exam Camera 12 Lead ECG Ultrasound Spirometer Vital Signs Monitor
  12. 12. • Customized automated Consult Requests for SCAN-ECHO and CVT • Software based query of remote site patient data • Template for guiding remote provider input INFORMATICS COLLABORATION 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  13. 13. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium CONTINUUM OF CARE Interdisciplinary Team SCAN Telehealth Modalities Spoke Clinics Hub Clinics Specialists Geriatrician/ PCP NursingNutrition Physical Therapy Psychology/ Social Work Multi- Specialty Consultation Inpatient Rounds Home Care
  14. 14. • Telehealth Coordinator - RN • Telehealth Clinical Technician (TCT) – Health Tech/LPN • IT Support • Vendor Support • Routine Education and Training • Administrative Oversight 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium ONGOING TELEHEALTH SUPPORT
  15. 15. CLINICAL VIDEO TELEHEALTH CVT Patient/PCP at Spoke Provider at Hub ‘Consult/Post -op/Follow-up/Pre-op’ Patient/Provider at Hub PCP/Family/Home RN at Spoke ‘D/C Planning’ 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  16. 16. USE OF TELEHEALTH REDUCES ADMISSION BED DAYS
  17. 17. CVT TO HOME PROCESS • Schedulers Create Appointments in Custom Web App • Email Confirmation Sent to Patient for Secure Login • HIPAA Compliant Software – Virtual waiting room 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  18. 18. CVT TO HOME PROCESS • Patients Connect to Enterprise Video Network from Home – Desktop – Laptop – Tablet • Connect to Hospital Provider for Encounter • Electronic Health Record Documentation 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  19. 19. CVT TO HOME EQUIPMENT Patient/Home RN at Home Provider at Hub ‘Real Time Home Visit’
  20. 20. CVT TO HOME MEDICAL PROBLEMS ADDRESSED • Wound Care • Nutrition • Smoking Cessation • Pressure Relief • Medication Reconciliation • Compliance • Disposition (Remain home vs Urgent Care vs ED) 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  21. 21. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium SAFETY NET
  22. 22. SCAN SPECIALTY CARE ACCESS NETWORK • An innovative model utilizing clinical tele-video conferencing equipment to allow healthcare specialists from an inter-professional care team to provide expert advice to remote providers in rural/underserved healthcare settings • A ‘Grand Rounds/Tumor Board’ style multipoint tele- video consultation 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  23. 23. • Consent - verbal • Inter-Facility Consultation Request Placed • SCAN-ECHO Tele-Video Session – Case Presentation – Case Discussion – Didactic Lecture • Documentation SCAN PROCESS
  24. 24. • Formation of an Interdisciplinary Team of Consultants • Identify Hub and Spokes • IT Collaboration • Informatics Collaboration • Develop Didactic CME/CEU Accredited Lectures 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium STEPS FOR PROGRAM DEVELOPMENT
  25. 25. • Plastic Surgeons • Rehabilitation Physician • Clinical Nurse Specialist/ Rehab Case Manager • Physical Therapist • Dietitian • Telehealth Nurse Coordinator 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium INTER-PROFESSIONAL TEAM EXAMPLE SCI PRESSURE ULCERS AND COMPLEX WOUNDS
  26. 26. HUBS AND SPOKES VA SCI EXAMPLE
  27. 27. • Wound Debridement • Pressure Ulcer Reconstruction • Adjuncts to Wound Healing • Comprehensive Assessment of Pressure Ulcer Patients • Topical Wound Care • Nutrition for Wound Healing • Pressure Relief Surfaces • Specialty Mattresses & Beds • Prevention of Amputation & Foot Screening • Bioethics Roundtable: Autonomy and Other Issues • Pre-Op Optimization Part I – The Surgical Checklist • Pre-Op Optimization Part II – Nutritional Optimization for Wound Prevention and Healing 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium DIDACTIC LECTURES
  28. 28. BENEFITS FOR PATIENTS AND PROVIDERS • No-cost continuing education credits (CME/CEU) • Opportunity to translate new knowledge into practice to improve outcomes • Professional networking with colleagues of similar interests • Avoid costly and time consuming travel to distant medical centers that puts patients at risk 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  29. 29. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium SCAN FAR REACHING
  30. 30. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium TELEHEALTH CONTINUUM OF CARE
  31. 31. HIGH PATIENT SATISFACTION Veteran TeleWound Care: Initial VA San Diego Experience Utilizing Real-time Clinical Video Telehealth, Store and Forward Telehealth and Home Telehealth Technology in Comprehensive Wound Management. Broder KW 1,2, Li A 3, Tesfamicael R 1, Bodor R 1,2 1 Section of Plastic Surgery, VA San Diego Medical Center, San Diego, CA 2 Division of Plastic Surgery, UCSD Healthcare, San Diego, CA 3 Department of Surgery, Harbor UCLA Medical Center, Torrance, CA 2010 Fall Symposium on Advanced Wound Care and Wound Healing Society Meeting, Anaheim, CA
  32. 32. CVT TO HOME TRANSPORT COST SAVINGS & INCREASED ADOPTION SCI CENTER – SAN DIEGO Projected 0 50 100 150 200 250 2011 2012 2013 2014 2015 Encounters 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
  33. 33. CONTINUUM OF CARE WHERE TELEMEDICINE FITS IN • SCAN-ECHO • Spoke Telehealth Consultation • Home Telehealth Monitoring • Face to Face Consultation • Clinic Visit • Admission • Inpatient Rounds • Education • Telehealth D/C Planning • Telehealth Follow-up
  34. 34. 2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium NO MORE WAITING FOR THE DOCTOR TO ARRIVE THANK YOU KEVIN BRODER, MD

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