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Health Care In a Perfect Storm


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Health Care In a Perfect Storm

  1. 1. The Role of Tele-health in the Management of Rural Neuro-Emergencies Conference September 14, 2012 Healthcare in a Perfect Storm: A Time for Telemedicine & HIT Dale C. Alverson, MD, FAAP Medical Director, Center for Telehealth and Cybermedicine Research, University of New Mexico October 3, 2011 IT Medical Director, LCF Research Albuquerque, New Mexico Past President, American Telemedicine Association Health Care Reform/PPACA Emerging Enabling Information Communication Technologies Economic Downturn Need for more Access to Care An Aging Population/Baby BoomersCritical Shortage of Healthcare Providers EHR Adoption/HIE Meaningful Use ICD10 PCMH ACOs A Time for Telemedicine & HIT Major Public Health Issues Impacting our Rural Communities and their Economic Development Gaps in Access to Health Services in Rural New Mexico  Hepatitis C  Behavioral Health  Diabetes  Asthma  Cancer  Oral Health  Cardiac and Stroke Care 1
  2. 2. Critical Gaps in Health Expertise and Services in New Mexico  Mal-distribution of Providers  Lack of Access to Health Services in Rural Communities  Only 3/33 counties exceed the National average of physicians per 100,000 population  64% of physicians practice in 3/33 counties.  These three counties comprise only 39% of New Mexico’s Population NMBME 2003 Mal-distribution of Health Specialty Providers in New Mexico The blue circles indicate 65 mile distances from the 6 major specialist centers •Albuquerque •Santa Fe •Las Cruces •Farmington •Gallup •Roswell NMBME 2003 5 Telehealth and Health Information Technologiesare Part of the Solution in Closing the Gaps 2
  3. 3. Defining Telemedicine and Telehealth 1. “Tele-” comes from the Greek root word meaning “distant or remote”/ “at a distance”. • Tele-phone • Tele-vision • Tele-graph • Tele-scope • Tele-Etc, etc, etc How is Telehealth used? Clinical: Consultation, Direct patient Care, Case Reviews Educational: Providers, Students, and Patients Research: Community-based Participatory, Outcomes driven Administrative: Strategic planning, Operations Health Information Exchange Enhanced Disaster Response Telehealth NetworksRural/Remote Health Providers Can Access Expert Medical Opinions, Knowledge, Education via Telehealth Rural or Remote Specialty Location Telehealth Network Medical Center Audio Patient High-Resolution Images & Video Medical Student Local Health Consultation Specialist Provider Direct Patient Care Case Reviews Education Training Health Information Exchange Community-Based Research 3
  4. 4. “Back tothe Future” Case Reviews or Consultation 4
  5. 5. ECHO: Treatment Outcomes Outcome ECHO UNMH P-value N=261 N=146 Minority 68% 49% P<0.01 SVR (Cure) Genotype 1/4 50% 46% NS SVR (Cure) Genotype 2/3 70% 71% NSSVR=sustained viral responseNEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, Direct Patient Care Maternal Fetal Medicine-High Risk Pregnancy “Store and Forward” Capturing an image and storing it to then be forwarded for review by a medical specialists Examples include teleradiology, telepathology and teledermatology, tele-ophthalmology (retinal scans) “Telemedicine” or HIE?/Large Data Files Need Broadband Teleradiology and Image Transfer Web‐Based Portals 5
  6. 6. Video Phone or “VOIP” with video Family Visitation School Based Health Centers Telehealth assistants at the school or child care center provide the link to examine the eyes, ears, throat, lungs and skin. Videoconferencing provides the “face to face” interaction. Getting providers to think of their desktop computer as an exam room is the trick. 18 6
  7. 7. Trauma Triage44% TransferAvoidance27% ManagementRecommendationChangesMoya M, Valdez J,Yonas H, AlversonDC. The Impact ofa Telehealth Web-based Solution onand Consultation.Telemedicine andeHealth, 2010;16:945-949 IRA HAYES Project – PTSD/TBI Telehealth Toolkit Skype Videophone (H.324)Software IP Based (H.323) Desktop IP Based (H.323) Small Conference Room IP Based (H.323) 7
  8. 8. Telehealth Toolkit SaaS (SIP) Videophone (H.324) SkypeSoftware IP Based (H.323) Desktop IP Based (H.323) Small Conference Room IP Based (H.323) Hand Held Devices- “mHealth” iPhone Droid iPhone BlackBerry Treo/Palm Smart Phones 8
  9. 9. Remote Monitoring The “Smart Band-Aid” Geospatial Information Systems (GIS) and Public Health  Superimposing health data onto maps for enhanced visualization  Improves situational awareness and consequence management  Allows distribution of resources in a more targeted manner, better mitigation of consequences, and improved outcomes.  A transdisciplinary collaborative approach between experts in:  GIS, modeling and simulation,  public health  health providers Center for Telehealth and Cybermedicine Research The Center for Telehealthat UNM Health Sciences Center: •Developing New Programs •Technical, Operational,  Business, and Evaluation  Planning 9
  10. 10. Http://www.lcfresearch.orgLCF Research’s Mission Statement To improve the quality, access, and cost-effectiveness of health care provided to the US population by conducting research in healthcare delivery and public health, providing continuing professional education, and advancing the meaningful use of health information technology. • Health Services Research and Development (HSRD) • Health Information Exchange (HIE): NMHIC • HIT REC: EHR Adoption, Achieving Meaningful Use • Direct Secure Messaging (DSM) •Task Force to Explore Expanding Access to and use of 28 Patient Information via NMHIC (TEAPIN) How the NMHIC HIE WorksClinician Requests Access to Patient Records with Patient Consent EHR Gateway State Public Health Depts. Hospital Locates the Patient’s Records Clinician Patient NMHIC Office HIE Network Gathers & Lab Assembles the Patient’s Records Clinician Emergency RoomNationwide Health Information Network (NwHIN) 29 Cloud Based 10
  11. 11. CernerExample Integration (Cerner)Epic Example Integration (Epic) Value/Benefits of HIE  Access to each patient’s health information  Improved situational awareness regarding patient’s health and use of health systems, better coordination of care  Better triage and evaluation capability: Dx/Problem list, prior procedures, Rx/Medications, Allergies, tests; lab/x-ray  Improved efficiency in making diagnosis and management plans  Decrease unnecessary duplication of tests  Readmission avoidance© LCF Research 2010 33 11
  12. 12. ROI of HIE in EDHumana WI: [A. Tzeel, MD, MHSA; et. al. American Health & Drug Benefits l July/August 2011, Vol 4, No 4] Average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost- savings. e.g. UNMH ED: 93,566 visits 2011 = $2.7 million potential savings! Thus when clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decreased. HIE obviates unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care© LCF Research 2010 34 The New Mexico Telehealth Alliance Telehealth Alliance “Networks of Networks” Providers Consumers  Represents a consortium of public and private health care Telehealth stakeholders: “Neutral Expertise Territory” (501c3) Communication Networks  Reflects the diversity of our health care delivery system in Social Networks New Mexico  Enables collaboration New Mexico Telehealth Act Passed and Signed into Law 2004 Introduced by Rep. Danice Picraux (D) Supported by Sen. Susan Wilson-Beffort (R) HOUSE BILL 581 46TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION 2004 Authorization Bill for Telehealth: •Covers interactive video and “Store and Forward” technologies •Any Licensed Health Professional authorized to use •Covers any Originating Site Where Patient Located, including place of residence •Authorizes/Encourages Use of and Reimbursement for Telehealth (NM Medicaid has announced policies to reimburse for telehealth services) 12
  13. 13. UNM and Other Healthcare Entities Have Established a Working IHS Taos Clinic Telehealth Network in New Mexico through Collaboration Taos Public Health Office IHS Dulce Clinic Health Centers Of NNM Raton Public Health OfficeUNM and Other HealthcareEntities Have Established a Las Vegas Working Telehealth Public Health Network in New Mexico Office through Collaboration Health Centers IHS Zuni Clinic Of NNM First Choice Albuquerque South Valley SDCCHP Adm. Office First Choice-Edgewood Hidalgo Medical Services Albuquerque Indian Health Service Area Office•Sangre de Cristo CHP -SBIRT NM TechNet -SBHC Albuquerque Office•DOH LCDF East Mesa•DOC Hidalgo Medical Already over 50•UNM: Services -ECHO NM communities -REACH LCDF Chaparral and over 200•CHECS Net LCDF Anthony sites connected LCDF Las Cruces and still growing SBIRT partner sitesSWTAG is a “Network of Networks” The 4 “C’s” Cooperation Coordination Collaboration Communication 13
  14. 14. Telemedicine and Licensure PortabilityAll of these Telehealth Technologies and their Health Applications have the potential for interstate use and would benefit from licensure portability 14
  15. 15. The Elephant in the Living Room Credentialing and Privileging Allowing by “Proxy” The fundamental telemedicine question: Who’s being transported to whom?The provider to the patient or the patient to the provider?  If you transport yourself physically to a provider in another state, you rely on their licensure, credentialing and privileging in that state where the provider practices  The provider doesn’t need to be licensed, credentialed and privileged in your state of residence  Why not the same for a telemedicine transport? Telemedicine and Need for Interstate Licensure Information and Communication Technologies can transcend state borders Provides a means to distribute and share limited resources among states and fill gaps in access to services and decrease health disparities Healthcare Reform will increase the demand for primary and specialty services and telemedicine can play an important role in meeting that demand Consumers of care will see the advantages of accessing services independent of state borders 15
  16. 16. Telemedicine and Licensure Portability  A more uniform system can enhance the interstate CVS process and better insure effective monitoring, patient safety, and quality of care without compromising state medical board autonomy, authority, and responsibility  A Web-base system can improve efficiency and ease of use (The “VetPro” model)  Three elements are crucial for portability success: 1] Uniform online applications 2] Centralized credentialing 3] Faster processing  Allow the option of Credentialing and Privileging “by proxy” with appropriate CVS (TJC Model)Liability and Risk Management• Misuse• Failure to use• Becoming a Standard of Care• Standards and Guidelines 16
  17. 17. American Telemedicine Association (ATA) and Telemedicine Hitting the Target: “The Triple AIMS” Improve Access ATA and ATA ImproveTelemedicine Health Reduce Costs International Telemedicine and eHealth: Transforming Systems of Care in the Global Community Reasons to do International Telehealth Most health issues are global! 17
  18. 18. H1N1 H5N1 18
  19. 19. Distributed Medical Intelligence• Knowledge Sharing Networks/Just in Time/On Demand• Best Practices• Evidence based 55 International Union Against TB La Lancha Medica en la Amazonia 19
  20. 20. 5859 20
  21. 21. Exchange of Students and Faculty Health Care Reform/PPACA Emerging Enabling Information Communication Technologies Economic Downturn Need for more Access to Care An Aging Population/Baby BoomersCritical Shortage of Healthcare Providers EHR Adoption/HIE Meaningful Use ICD10 PCMH ACOs A Time for Telemedicine & HIT 21
  22. 22. Navigating the Perfect Storm with Telemedicine & HIT Use a broad spectrum of information communication technologies Effective distribution of limited resources and expertise Increasing Access to care Bringing care to the patient; Aging in place Decreasing unnecessary variations in care; evidence-based best practicesImproving continuity and coordination of care;The Patient Centered Medical HomeAvoiding unnecessary hospitalizations, duplication of tests, & decreasing errors Improving health outcomesReducing costs; avoiding more costly care and complications, decreasing travel Questions? 22