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Will the next generation of doctors be ready for telehealth?

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“Will the next generation of doctors be ready
for Telehealth?”
Homero Rivas, M.D., M.B.A., F.A.C.S.
Director of Innovative...

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Disclosures
• Nothing to disclose

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Key Learning Objectives
• Learn why the business model of medicine is very inefficient
• Learn what are the characteristic...

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Will the next generation of doctors be ready for telehealth?

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Telehealth Failures & Secrets to Success Conference 2017 by VSee
Speaker: Homero Rivas
Director of Innovative Surgery of Stanford University School of Medicine
More info here: vsee.com/conference

Telehealth Failures & Secrets to Success Conference 2017 by VSee
Speaker: Homero Rivas
Director of Innovative Surgery of Stanford University School of Medicine
More info here: vsee.com/conference

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Will the next generation of doctors be ready for telehealth?

  1. 1. “Will the next generation of doctors be ready for Telehealth?” Homero Rivas, M.D., M.B.A., F.A.C.S. Director of Innovative Surgery Section of Minimally Invasive Surgery Stanford University School of Medicine Stanford, CA hrivas@stanford.edu @mHealthSurgeon Fremont, CA September 20, 2017
  2. 2. Disclosures • Nothing to disclose
  3. 3. Key Learning Objectives • Learn why the business model of medicine is very inefficient • Learn what are the characteristics of a successful innovation • Learn what is the profile of successful innovators, entrepreneurs and physicians • We will identify challenges and opportunities for formal education in Telehealth included in medical school curricula
  4. 4. Innovation of Delivery of Clinical Practice • Health care reform • Cost of US Health care 3 trillion/yr • Nearly 18 % of US GDP
  5. 5. Evolution of Surgery ImprovementsinPatientCare Technology and Innovation Open Surgery Laparoscopy Single Port Laparoscopy Natural Orifice Surgery??? Endoluminal Therapies
  6. 6. Business Model • Medicine in general has a very poor business model • Not scalable • Restricted by limited resources • Academic and Preventive Medicine are at some degree limited solutions • DIGITAL HEALTH is the clear solution
  7. 7. Essential characteristics of a successful Innovation • Simple • Scalable, easily reproducible • Cost effective • It should make sense • It should have a relative advantage • Safe • (Discrete)
  8. 8. Successful innovators • High tolerance to failure • Enthusiastic of risk • Opportunistic mindset • Eccentric personality, misfit, etc. • Networking • Open minded • Persistence
  9. 9. Safe and Successful Physicians • Focus oriented to never fail • Risk averse. Always follow predictable risk • Super specialized • Cost insensitive • Very secretive research. Rarely open source
  10. 10. Care providers as ideal adopters? • Lack of medical school curricula • Very slow FDA approval process not properly aligned to high turnover of digital innovation • Biggest hurdle is the change of mindset needed among care providers
  11. 11. • In 2011, US Secretary of Health and Human Services Kathleen Sebelius referred to mHealth as “the biggest technology breakthrough of our time” and maintained that its use would “address our greatest national challenge.”
  12. 12. Promising Technologies • Mobile Health, Telemedicine • Online patient communities • Wearable technologies • 3D Printing • Virtual and Augmented Reality • Drones • Artificial intelligence engines • Others
  13. 13. AAMC Report, March 2015 The Complexities of Physician Supply and Demand Projections from 2013 to 2025 • By 2025 the U.S. may be short 46,000 - 90,000 physicians • 12,500 to 31,100 primary care • 28,200 to 63,700 non-primary care - most notably surgery https://www.aamc.org/download/426242/data/ihsreportdownload.pdf
  14. 14. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Year1Year2 Autumn Winter Spring Year3,4,[5] ! Cells to Tissues ! Molecular Foundations of Medicine ! Applied Biochemistry ! Genetics ! Embryology ! Histology ! Anatomy ! Basic Cardiac Life Support Scholarly Concentrations ! The Nervous System ! Immunology ! Microbiology & Infectious Diseases I ! Cells and Signaling in Regenerative Medicine ! Human Health and Diseases I • Introduction to Pathology • Introduction to Pharmacological Treatment of Disease • Pulmonary System • Cardiovascular System ! Human Health and Diseases II A ! Human Health and Diseases II B ! Microbiology & Infectious Diseases II ! Human Health and Diseases III A ! Human Health and Diseases III B ! Pharmacological Treatment of Disease A ! Pharmacological Treatment of Disease B Transition to Clinical Clerkships Pathophysiology Step 1 Study/ Clinical Problem- Early Clerkship Entry Solving Scholarly Concentrations Reflections, Research, and Advances in Patient Care | Advanced Cardiac Life Support Scholarly Concentrations CLINICAL CLERKSHIPS Practice of Medicine I Practice of Medicine II Practice of Medicine III Practice of Medicine IV A & B Practice of Medicine V A & B 8 Weeks Internal Medicine Pediatrics Surgery 6 Weeks Obstetrics & Gynecology 4 Weeks Critical Care Family Medicine Ambulatory / Emergency Medicine Neurology Psychiatry 8 Weeks Selective I: Fundamentals of Clinical Care Selective II: Subinternship 6 Weeks Electives POM VI
  15. 15. Accreditation Council for Graduate Medical Education (ACGME) “Milestones” 2009 • Designed to secure six core competencies – Patient Care – Medical Knowledge – Professionalism – System-based Practice – Practice-based Learning and Improvement – Interpersonal and Communication Skills
  16. 16. The Future of Graduate Medical Education “Simply adding more doctors to the current mix is not a thoughtful solution to workforce challenges.” Pizzo et al., May 2015
  17. 17. THIS GAP IS KNOWN • In 2016, the American Medical Association adopted a policy “aimed at ensuring medical students and residents learn how to use telemedicine in clinical practice” • 32 schools are working together to "incorporate the newest technologies that will help prepare future physicians to practice in the changing health care environment and better provide health care services to underserved populations.” https://www.ama-assn.org/ama-encourages-telemedicine-training-medical-students-residents
  18. 18. CURRENT PROJECTS AND PROGRAMS • University of Hawaii Medical School • Developing a telemedicine curriculum that will be taught via telecommunication technology • University of Arizona College of Nursing • Telehealth training program • University of North Dakota School of Medicine and Health Sciences • Using telemedicine and simulation technology to teach skills in helping rural communities https://www.ama-assn.org/ama-encourages-telemedicine-training-medical-students-residents http://telemedicine.arizona.edu/blog/ua-college-nursing-launches-telehealth-training-students
  19. 19. CURRENT PROJECTS AND PROGRAMS • East Carolina University School of Medicine, Center for Health Sciences Communication • Advanced telemedicine training designed to “increase the understanding of operational, technical and administrative issues associated with on-line learning and remote healthcare delivery" • University of Texas Medical Branch at Galveston • Open Gates Tele-training Institute (not-for-profit) • Offers many comprehensive courses on telemedicine ranging from a 2 day to 5 day program http://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=769925
  20. 20. UC SAN DIEGO MEDICAL EDUCATION AND TELEMEDICINE CENTER • Provide telemedicine education and practice as well as instruction and practice in latest surgical techniques • Funding: • “Half of the funding to build the new Medical Education and Telemedicine Center comes from Proposition 1D, a bond initiative passed by California voters in September of 2006 to expand and enhance medical education programs with an emphasis on telemedicine.” https://health.ucsd.edu/news/2009/Pages/11-20-medical-telemedicine-education.aspx http://www.som.com/FILE/18243/ucsd_medicaled_sustainable_1400x800_cesarrubio_01.jpg
  21. 21. DIGITAL HEALTH CENTERS • UMass Medical School • The Center for Digital Health • University of California, San Francisco • Center for Digital Health Innovation at UCSF • Stanford University • Center for Digital Health http://centerfordigitalhealthinnovation.org/what-we-do/ https://www.umassmed.edu/news/news-archives/2016/11/new-center-for-digital-health-launched-by-umass-med
  22. 22. DIGITAL HEALTH PROGRAMS • Brown Alpert Medical School • Offers a course on Digital Health (BIOL 6677) for medical students • Tufts University School of Medicine • Students can earn a Certificate in Digital Health Communication • John Hopkins University School of Medicine • Informatics and Digital Health course (four-day course) • Indiana University School of Medicine • Teaching medical students how to use electronic health records (EHRs) using de-identified data • This training is now being implemented at other medical schools http://publichealth.tufts.edu/Academics/HCOM-Program/Certificate http://www.hopkinsmedicine.org/som/curriculum/genes_to_society/curriculum/year_one/time_informatics_digital_health.html https://www.brown.edu/academics/medical/education/biol-6677-digital-health
  23. 23. Photo by Mathieu Plourde @mathplourde
  24. 24. Opportunities • Unique platform for networking of students from different geographical and professional backgrounds • Great source of talent for entrepreneurs, investors, organizations, etc. • Scalability of delivery of Healthcare
  25. 25. “CLOSE ENCOUNTERS, DISTANCE LEARNING BY TELEMEDICINE” • Understand the value proposition of telemedicine, and how mobile and wireless platforms can be leveraged to responsibly and safely improve the efficiency, quality and extent of global delivery of healthcare and medicine. • Identify important deficiencies in using telemedicine and learn skills to overcome these challenges • Be able to think critically about using technology in healthcare and propose simple solution for health issues • Meet and network with key players in the telemedicine market. Develop with them potential academic, social or entrepreneurial collaborations
  26. 26. SCALING ACCESS TO CARE IN RURAL MEXICO VIA DIGITAL HEALTH, TELEMEDICINE AND DRONES. Funded by Center for Innovation in Global Health Seed Grant
  27. 27. PI: Homero Rivas, MD, MBA, FACS, FASMBS. Assistant Professor of Surgery Stanford Department of General Surgery hrivas@stanford.edu Co-investigators: Sharon Wulfovich, B.A. Stanford University sharonws@stanford.edu Thomas Boillat, PhD tboillat@stanford.edu Micaela Esquivel, MD Resident Physician and Research Fellow Stanford Department of General Surgery mesquive@stanford.edu Katarzyna Wac, PhD Associate Professor Department of Computer Science University of Copenhagen, Denmark Invited Professor and the Quality of Life Technologies lab leader at the Center for Informatics University of Geneva, Switzerland Visiting Scholar Stanford University, School of Medicine wac@stanford.edu M. Carolina Jimenez, MD Instructure and Researcher University of Toronto, Department of Surgery Strategic Allies: Dr. Eduardo Diaz Juárez Health Secretary of Durango, Mexico Pedro Matabuena Founder and CEO, Dialipso Consultant for Airdronix Jordi Munoz Founder and CTO, 3D Robotics
  28. 28. PROJECT DESCRIPTION Inequities of access to medical care represent a universal problem, which is especially evident in countries with large socioeconomic differences. Our pilot project centers on the use of technology to bridge access to medical care in marginalized communities. We will focus on Mezquital, a highly marginalized municipality of Durango, Mexico. We propose the use of “drone telemedicine units”. Such “unmanned aircraft vehicles” could be equipped with basic, yet advanced digital health systems, that could reach people in remote or isolated areas with otherwise very limited access to medical care. This study would evaluate the feasibility and scaling of prompt access to care by means of digital health, telemedicine and the use of drones in rural Mexico. More specifically, we would like to evaluate its potential value for acute, subacute, and chronic medical problems, in geographical locations where there is a paucity or absence of healthcare providers, and a lack of an adequate infrastructure to deliver prompt medical care when needed.
  29. 29. CLINICAL APPLICATIONS • Scorpion bites (need antiserum) • Allergy (need epi pen) • Any medical emergency
  30. 30. TELEMEDICINE PLATFORM Google Pixel Phone https://madeby.google.com/phone/ https://vsee.com VSee for Video Telemedicine Calls
  31. 31. DIGITAL HEALTH DEVICES Wireless Wrist Blood Pressure Monitor One Digital Stethoscope https://ihealthlabs.com/blood-pressure- monitors/wireless-blood-pressure-wrist-monitor/ http://www.thinklabs.com
  32. 32. DIGITAL HEALTH DEVICES CONT. https://ihealthlabs.com/fitness-devices/wireless-pulse-oximeter/ Wireless Pulse Oximeter Portable Ultrasound http://www.healcerion.com/product/ultrasound/sonon-300c/ Mobile EKG Monitor https://store.alivecor.com
  33. 33. BUILDING THE DRONE
  34. 34. LANDSCAPE
  35. 35. LOADING THE DIGITAL HEALTH AND TELEMEDICINE UNITS
  36. 36. FLIGHT PLAN
  37. 37. TELEMEDICINE AND DIGITAL HEALTH DEVICES CHALLENGES • Explaining how to use the devices • Non-reliable measurements • Setting up everything • Syncing – especially if any additional interactions are needed • Possible intereference with the drone and the bluetooth and wifi
  38. 38. Barriers for adoption • Economic • Technological – Battery life – Encryption/privacy • Mindset – Health care providers – Patients • Universal access
  39. 39. Solutions • Open source models in medicine and science. • Medical Schools, medical boards, allied health, postgraduate programs should lead implementation of telehealth • Involvement of othe key stakeholders • Patient centric strategies • Patients to lead the adoption of Innovation
  40. 40. hrivas@stanford.edu @mHealthSurgeon Thank you!

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