Dr. stuart telenuerology panel ppt


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  • One aspect of the Center since its beginning as a 501c3, has been to extend care to a medically underserved population. The original model was to develop relationships with local neurologists. Through a PSA our goal was to develop MS focused care at local sites. Just like the rural resident has hurdles to care, we faced hurdles with availability and a workable financial model.We have been faced with the classic case jeopardizing the important services that are being afforded to a portion of a Medically underserved population vs. attempting to extend care to the untreated.
  • Dr. stuart telenuerology panel ppt

    1. 1. Telemedicine: Healthcare Paradigm Shift Douglas Stuart, MD MS Center of Atlanta Peachtree Neurological Clinic
    2. 2. Doctor-Patient Interaction and the Physical Exam  Medical School- taught medical history and full medical exam  Diagnosis should be narrowed down to 1-2 problems after the history 85% of time  Exam and testing solidify the diagnosis  Many fields of medicine lend themselves largely to the history  Cognitive fields- neurology, psychiatry  Primary care follow-ups  ER care- non surgical orthopedics  Realized quickly in my practice that I examined about 25% of my return patients and they were driving 4-6 hours to see me  Gas costing many more than the visit itself  Problem that needed a solution
    3. 3. Future Exam  Point now where technology allows us to often do remote exams, same proficiency many cases  History 100% of the time  Standard of excellence the same  Stethoscope, otoscope, opthalmoscope  Imaging  Even performing surgeries remotely with robots  Military  Technology advances making it preferable by patients  Patient demand and technology will drive this industry
    4. 4. Where Will Future Generation Seek Care?  Where will people access information and expertise in the future?  How long will they want to wait?  How far will they be willing to travel?  How will they travel?
    5. 5. Future of Medicine  Estimate that we will be short 150,000 physicians in the next 10 yrs  Primary care- rural and urban  Specialists rural  Volume driven- critical # of patients in an area to keep physician busy  Varies per specialty  Georgia- 159 counties  65 have no pediatrician  68 have no Ob/Gyn  1/3 of the state’s docs will retire in next 10 yrs
    6. 6. Future  Excellence in healthcare is driven by pattern recognition  Seeing the same thing over and over  Can’t train enough MD’s to make up for the shortage  NP’s, PA’s, and other para-professionals  Quick solution  Faster to train  Won’t be enough  Will take even longer for pattern recognition  Will not be trained in specialty and subspecialty care  Do we accept substandard delivery of care or find another solution?  Medico-legal implications!
    7. 7. Future  Specialty care will not go away  Driven by advancing, complicated knowledge in different fields of medicine  Has become too complicated for primary care alone  As mentioned, too complex for even some specialists  Complex evaluations and management of disease  Life threatening diseases  Life threatening treatments  Complex monitoring  Multidisciplinary teams
    8. 8. Neurology  13K in the USA  Many are academic- see few patients  Estimated need - 20K by 2010  New trained = those who retire  Neurologists function as PCP’s  Need more as more function as PCP’s  ACA allows patients to designate specialists as their PCP  Those with complex, chronic disease
    9. 9. Neurology  Neurologists as subspecialists  MS example  Treatment became ultra-specialized  Effective treatments, life threatening complications  Care centralized  Concussion care will follow the same path  Scarcity of providers trained, complex evaluations, life altering risks to inappropriate management  Legal implications  As evaluations becomes more complex in certain centers, leads to increased liability for others  Standard of care
    10. 10. Future Healthcare Battlefield  Technology will allow us to bring pattern recognition and experience to the provider  Bring to 1000 people vs train 1000 people  Clinical Judgment  Human, not computer quality  Patterns, voices, experience  True vs false symptoms, complaints  Science will make disease management more complex, not less
    11. 11. Future Healthcare Battlefield  Will allow for increased access and decreased cost  Transportation  Nursing home, schools, offices  Safety- patients unstable  Prison  Savings  Gas  Time off work  Reach anywhere where there is a broadband access  Georgia- most “wired” medical state  Makes sense under any healthcare model  ACO, HMO  Private insurance  Self pay/HSA
    12. 12. Not a new problem  Georgia MS (multiple sclerosis) example:  MS Center of Atlanta  Patients from 23/50 states  118/159 counties  Complex disease  Neurologists/specialists send for subspecialty care  Rural patients diagnosed 1.5 years later  Delay diagnosis leads to increased disability  Avg rural patient drives 103 miles for care  Gas, loss work
    13. 13. Challenges In Extending MS Care Outside Metro Atlanta… Original MSCA Plan for Expanding MS Care :  Develop brick and mortar sites that would be staffed by local neurologists and primary care physicians Current Satellite Location: • Weekly Office and Infusion presence in Villa Rica on the Tanner Medical Campus • Costly, ongoing operational expenses that would limit the number of satellite facilities • Because of extensive federal regulations, rigid professional services agreements are necessary between the local physician and the MS Center. These PSA’s limit availability of local physicians and restrict changes that reflect patient volume. • Limited number of neurologists that have available time for lengthy and reoccurring MS office visits • Patient apprehension to a new physician for their long-term care Hurdles to expansion of long-term care at satellite location
    14. 14. Solutions for MS Care Through Georgia Telehealth….. For the MS Patient:  Local physician versus a physician office that is an extended distance away  More available locations for ongoing MS care  Continued long term-care with the neurologist that developed their MS treatment program  Real time evaluation by a MS specialist when disease relapses or flare-ups occur.  Elimination of travel expense and time as a barrier to ongoing care For the Rural Physician: • Greater flexibility in the use of staff and resources for administering long-term MS care • Limited investment and reoccurring costs in the treatment of patients with MS • MS specialist available to assist in the comprehensive treatment of the MS patient For the MS Center: • Greater flexibility in the use of staff and resources for administering long-term MS care • Limited investment and reoccurring costs in the treatment of patients with MS • A solution that aligns with the MS Center’s mission to extend long-term, ongoing care to a medically under-served population.
    15. 15. SCI Model  Increased education  Digital  Certification process  Spoke clinics  Training on site personel  Baseline testing  Evaluation and management  Appropriate disposition  History, examination, imaging, testing presented through telemedicine  Follow up care  Telemedicine outside 25 mile radius  From schools
    16. 16. Model Challenges  Challenges  Initial evaluation  Comfort- patient and provider  Experience  Lies in education and comfort with sites  Laws regarding establishment of legal doctor-patient relationship  License, state based  Concerns for nationalizing license  Payment systems  FFS  Global  Technology Access
    17. 17. Solutions  Regional networks  SCI/MS regional centers covering 5-10 states  License laws  States- easier access to telemed license in state  Not national  State Fed laws  Payments  Care establishments  Home/Office/Medical Office
    18. 18. Summary  We have a problem  Cost, access, expansion of knowledge  Will NEVER have enough experienced healthcare providers physically located in all locations  Not a new problem, but solution has become easier  Technology and patient demand will deliver state-of- the-art specialty care to all areas at a fraction of the cost