Recent UCSF ShareCase presentation. The videos referred to in the slide deck are excerpts from two Eric Dishman TedTalks with the same names as the slides they are on.

1. Telehealth
“You cannot separate the technology from the process.”

2. Three legs of Telehealth
• Live-Video
– Cisco gives us a very strong position
• Store & Forward
– Asynchronous consultations
– PACs and EHR integration
• Remote Patient Monitoring
– Leveraging the Ubiquitous vs. Episodic care paradigm
What is a data point worth?

3. Telehealth’s Organizational Position
• Strategic tool that allows UCSF to:
– Build an extended referral network
– Export our expertise via remote consultation and
education
• Tactical tool that allows UCSF to:
– Collaborate intra-campus/intra-specialty
– Create dispersed yet integrated teams
– Expand our research coverage

4. The education of newbie
• The magic of eReferral
• Take Medicine off the Mainframe
• Colonel Doctor
• The Daschle Cone
• UCSF Telehealth Resource Center
• Integration and Balance

5. The magic of eReferral
• Asynchronous “rational” triage
– Addresses supply and demand mismatch
– Enables PCP/Specialist Collaboration
– Promotes virtual co-management of certain
conditions
– Pre-visit guidance provided through
eReferral makes scheduled visits more
effective
– Specialist reviewers spend approximately 8
minutes per eReferral
– Boosts the effectiveness of in-person
specialty visits, and produces cost savings
by reducing the number of specialty visits for
conditions that can be managed by PCPs
– http://www.nejm.org/doi/full/10.1056/NEJMp1
215594
Hal F. Yee, Jr.
and Alice Chen;
SFGH –
progenitors of
eReferral

6. Workflow and Volume of eReferral, July 1, 2011,
through June 30, 2012

7. Take medicine off the mainframe
• Eric Dishman from Intel
– The hype and hope of mHealth
– TedTalk: Take Medicine off the mainframe
– Play first video here!
Eric Dishman does health care
research for Intel -- studying
how new technology can solve
big problems in the system for
the sick, the aging and, well, all
of us.

8. Peter Jeff Fabri MD, PhD
Can Health Care Engineering Fix Health Care?
“By fix the health care system, I mean
improve efficiency, minimize waste and
error, limit duplication and unnecessary
redundancy, develop "supply chain"
approaches to distribution and
access, design with safety in mind, and
change the culture of the workplace. If
this hadn't already been done in many
U.S. industries, it might sound
specious.”
“As I memorized the equations for bottleneck
analysis, down time, and throughput, I saw outpatient
clinics and emergency departments.”

9. “Jeff” asserts
• Fixing health care will require individuals who
are "bilingual" in health care and in systems
engineering.
• Understanding human error, the contributions
of system design, and the need for human
factors engineering should be as important in
medical education as the Krebs cycle and the
distribution of the coronary arteries.
• Every journey begins with a
single step. Patient safety…is
the natural starting point.

10. Col. Ron Poropatich, MD
ATA April 29th 2012
• Use Telehealth to manage patient
acuity flow!
– Proven in the “theater”
• Use mHealth to manage chronic
disease!
– Programs with troops returning from
combat.
I truly believe that telehealth can improve
efficiencies in health care. One example is how
we use telederm in the DoD. If the rash, mole or
lesion can be easily diagnosed and treatment
recommended with a simple store and forward
solution - our experience was around 70-80% of
cases, then you free up more clinic slots to not
only attend to the 20-30% that need a biopsy or
a follow up but also opened your clinic capacity
another 70-80% with improved access to care
metrics as well.
Former Director at the US
Army Telemedicine and
Advanced Technology
Research Center (TATRC)
ATA 2012 – Good times!

11. Senator Tom Daschle visits UCSF
Oct 3rd 2012
• Senator Daschle:“Health care in any society looks
like a pyramid. The base of the pyramid comprises
basic health care delivery involving wellness and
prevention. It is the least costly. As we move up
the pyramid, the care becomes more sophisticated
and technologically advanced. At the peak are the
most costly and technologically advanced
applications, such as organ transplants, available
in modern medicine today.”
• “Every country begins at the base of the pyramid
and works its way up until the money runs out.
However, in the U.S., we start at the top of the
pyramid and work our way down until the money
runs out. This is our fundamental problem.”

12. UCSF Telehealth develops
The Daschle Cone
• Tom Daschle is right however he offers no specific
solution
Telehealth
mHealth
• So we developed The Daschle Cone to explain how
distributed triage should look both vertically and
horizontally
UCSF
Local Clinic
Live
Homecare
Remote Patient
Monitoring
Wellness
Jeffrey Olgin, Chief of
Cardiology, leads a
large-scale digital
version of the
Framingham Heart
Study – Health eHeart

13. A patient’s journey through
the Daschle Cone
Wellness
Remote Patient
Monitoring
Live Homecare
Local Clinics
UCSF
In Patient Specialized
Care and Education
Consult
Pro-Active
Tracking
understanding triggers
Follow up
Triage
New Normal
Tracking for issues

14. The UCSF Telehealth Resource Center
• Telehealth Strategic Plan completed - April 30, 2013
• Goals:
– Create an extended referral network
– Counterbalance Medical Center and Professional Group
incentives
– Prioritize initial efforts by contribution margin
– Offer a broad range of Pediatric service lines
– Formalize processes and policies

15. Integration and balance
• Oh mighty ICIS
– SFGH’s PACs and EHR integration engine is driving our
TeleDerm and Diabetic Retinopathy interfaces and is
ready for more.
• MuleSoft
– ISU’s Mulesoft project allows integration with APeX and
SalesForce. Yes integration with APeX is possible.
• Integrated Practice Units
– What does Harvard know? http://hbr.org/2013/10/thestrategy-that-will-fix-health-care/ar/1
• 400,000,000 people can’t be wrong
– Can UCSF create their own “Halo Effect”?
– http://money.msn.com/technology-investment/post-whatever-happened-to-apples-halo-effect

16. HealthCare is a team sport
Play second video here!