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TELEWOUND CARE REDUCES COSTS AND INCREASES ACCESS
- 1. TELEWOUND CARE Kevin Broder, MD Telemedicine & Wound Care Director, San Diego GWEP Telehealth Director, Department of Surgery Plastic Surgeon VA Medical Center – San Diego, CA November 10, 2018
- 3. 2010
- 4. 2018
- 5. HIGHLY RURAL, RURAL AND CENSUS DEFINED URBAN AREAS Map generated by VHA Planning Systems Support Group
- 6. ELDERLY TRANSPORT • Costly Travel • Special Assistance Personnel • Special Equipment (Gurneys, Wheelchairs, Vehicles) • Long Clinic Wait Times • Family Inconvenience
- 7. 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
- 8. • 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 STEPS FOR PROGRAM DEVELOPMENT http://www.telehealthresourcecenter.org/sites/main/files/file-attachments/complete-program-developer-kit-2014-web1.pdf
- 9. Telehealth Coordinator Facility Leadership Providers (Central ‘Hub’) Informatics Administrative Staff Technical Staff (IT/BioMed) PCP RN Patient/Family (Remote ‘Spokes’) Case Manager INTER-PROFESSIONAL TELEHEALTH TEAM
- 10. IDENTIFY THE PATIENTS VISIT TYPES • Wound Care/Skin Assessment • Specialty Consultation • Medical Optimization • Post-Op Evaluation • Medication Reconciliation • Psychology • Nutrition • Education
- 11. MORE VISIT TYPES INTERDISCIPLINARY • TeleNutrition • TelePrimary Care • TeleRehabilitation • TeleAmputation Clinics • TelePhysical Therapy • TeleOccupational Therapy • TeleSpinal Cord Injury/Disorder • TeleMOVE! (Weight Loss) • TelePsychology
- 12. • Broadband Network • WiFi • Mobile • Tele-video Conferencing Equipment • Peripherals IT SUPPORT/EQUIPMENT
- 13. PERIPHERALS Digital Stethoscope Exam Camera 12 Lead ECG Ultrasound Spirometer Vital Signs Monitor
- 14. • Templated Consult Requests and Notes • EHR Synergy ELECTRONIC HEALTH RECORD
- 15. • Telehealth Coordinator - RN • Telehealth Clinical Technician (TCT) – Health Tech/LPN • IT Support • Vendor Support • Routine Education and Training • Administrative Oversight KEY COLLABORATION ONGOING TELEHEALTH SUPPORT
- 16. 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’
- 17. WOUND IMAGES
- 19. WOUND IMAGING CAPTURE, STORAGE & RETRIEVAL STORE & FORWARD TELEHEALTH MOBILE TABLET - 3D VOLUMETRIC MEASUREMENTS - COMPUTER VISION
- 20. WOUND IMAGING CAPTURE, STORAGE & RETRIEVAL STORE & FORWARD TELEHEALTH DASHBOARD
- 21. USE OF TELEHEALTH REDUCES ADMISSION BED DAYS
- 22. 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
- 23. CVT TO HOME PROCESS • Patients Connect to Enterprise Video Network from Home – Desktop – Laptop – Tablet – Smartphone • Connect to Hospital Provider for Encounter • Electronic Health Record Documentation
- 24. CVT TO HOME EQUIPMENT Patient/Home RN at Home Provider at Hub ‘Real Time Home Visit’
- 25. CVT TO HOME MEDICAL PROBLEMS ADDRESSED • Wound Care • Nutrition • Smoking Cessation • Pressure Relief • Medication Reconciliation • Compliance • Disposition (Remain home vs Urgent Care vs ED)
- 26. SAFETY NET
- 27. 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
- 28. • Consent - verbal • Inter-Facility Consultation Request Placed • SCAN-ECHO Tele-Video Session – Case Presentation – Case Discussion – Didactic Lecture • Documentation SCAN PROCESS
- 29. • Formation of an Interdisciplinary Team of Consultants • Identify Hub and Spokes • IT Collaboration • Informatics Collaboration • Develop Didactic CME/CEU Accredited Lectures STEPS FOR PROGRAM DEVELOPMENT
- 30. • Plastic Surgeons • Rehabilitation Physician • Clinical Nurse Specialist/ Rehab Case Manager • Physical Therapist • Dietitian • Telehealth Nurse Coordinator INTER-PROFESSIONAL TEAM EXAMPLE SCI PRESSURE ULCERS AND COMPLEX WOUNDS
- 31. HUBS AND SPOKES VA SCI EXAMPLE
- 32. • 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 DIDACTIC LECTURES
- 33. 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
- 34. 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
- 35. CVT TO HOME TRANSPORT COST SAVINGS & INCREASED ADOPTION SCI CENTER – SAN DIEGO 0 75 150 225 300 2011 2012 2013 2014 2015 Encounters
- 37. CONTINUUM OF CARE WHERE TELEHEALTH 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
- 38. NO MORE WAITING FOR THE DOCTOR TO ARRIVE THANK YOU KEVIN BRODER, MD