A telehospitalist is a physician who provides care for hospitalized patients at a distance using telemedicine. As the US faces a projected physician shortage, telemedicine and utilizing advanced practice clinicians can help address gaps, especially in rural areas with limited access to care. The document describes a telehospitalist program launched in Oklahoma in 2014 connecting physicians in Oklahoma City to patients in rural hospitals over 60 miles away. The program has had over 3,900 telemedicine visits for more than 1,100 patients. Key lessons learned include the importance of local buy-in, flexibility, and focusing on patient-centered care.

1. Ariel E. S. Lufkin, MD

2.  what is a telehospitalist?
 engaging the patient, engaging the providers
 strategies + lessons learned

3.  hospitalist: a physician who specializes in treating
hospitalized patients7
 tele- (prefix): at a distance.
 telemedicine: the use of medical information exchanged
from one site to another via electronic communications to
improve a patient’s clinical health status.

4.  In March of 2015 the Association of American Medical Colleges (AAMC)
published an update to its 2008 report entitled“The Complexities of
Physician Supply and Demand: Projections from 2013 to 2025”.
 projected a shortage of 46,100 - 90,400 physicians by 20251
US population growth rates
aging of specific demographic groups
increased healthcare usage [Affordable Care Act]

5.  Based on demographics, the care settings expected to face the
greatest increases in demand were:
 inpatient hospital days (+23%)
 outpatient visits (+15%)
 office visits (+14%)
 ED visits (+12%)

6.  The physician deficit expected to impact rural communities the most.
 19% of the US reside in rural areas / 10% of US physicians serve these
communities4.
 Rural providers average 20% more office visits / work six more hours per
week compared to their metropolitan counterparts2.
 Rate of graduating residents choosing to practice in rural communities is
declining.

7. two solutions that would likely make the greatest impact on the
projected doctor shortage:
 the increased use of advanced practice clinicians (APCs)
[nurse practitioners / certified nurse specialists / physician assistants]
 effective utilization of technology
[health IT / advanced electronic health records / telemedicine]

8.  Utilizing technology to decrease geographic barriers to
care and increase physician bandwidth by optimizing
the physician + APC working relationship.

9. oklahoma city
el reno
watonga guthrie
(61 miles)
(33 miles)
(34 miles)

10.  local providers
 hospital staff
 new APCs and physicians
 patients

11.  strategy
◦ putting a face to the program
◦ seeking feedback
 lessons learned
◦ re-defining what telemedicine can be
◦ becoming part of their treatment team
◦ a win-win relationship

12. I’m sick.I’m really sick.

13.  strategy
◦ input / feedback / adjusting / including
◦ in person visits
 lessons learned
◦ buy in essential
◦ adjusting workflow (nursing, CM, etc)

15.  strategy
◦ autonomy + team work
◦ locally grown
 lessons learned
◦ flexibility
◦ foundation of a strong program
◦ recruit the person

16.  strategy
◦ opportunity to pioneer
◦ providing for those in need
 lessons learned
◦ growing pains
◦ little exposure in residency
◦ a team sport

17.  launched January 14, 2014.
 3,900+ telemedicine visits, >1,100 patients.
 age 18-106

18.  keep it local
 avoiding the transfer trickle down
 patient first

19. 1.) Dall et. al The Complexities of Physician Supply and Demand: Projections through 2025. Association of American Medical Colleges, March 2015.
2.) Jack M. Colwill and James M. Cultice. The Future Supply Of Family Physicians: Implications For Rural America.
Health Affairs 22, no.1 (2003):190-198
3.) Fairbanks et. al. Oklahoma Health Workforce Data Book: 2014-2015. Oklahoma State Department of Health, Center for Health Innovation and Effectiveness / Office of
Primary Care and Rural Health Development, 2015.
4.) Ewing, J. Closing the Gaps in the Rural Primary Care Workforce. The Rural Health Connection. National Conference of State Legislatures, August 2011.
5.) http://www.aha.org/research/policy/infographics/critialaccess-hospitals.shtml
6.) https://www.chausa.org/publications/catholic-health-world/article/january-15-2014/federal-rules-and-cuts-threaten-critical-access-hospitals'-viability-chi-executives-say
_________________________
Ariel E. S. Lufkin, MD
ariel.lufkin@mercy.net / 813.843.9327