This document discusses telehealth at UCSF and its three main components: live video, store-and-forward technologies, and remote patient monitoring. It describes telehealth's organizational structure and how it allows UCSF to expand its referral network and expertise. The document also discusses a model called the "Daschle Cone" that shows how telehealth can deliver different levels of care both vertically through different specialties and horizontally across locations. It notes some challenges of adopting telehealth including technology, integration, and getting clinicians onboard.

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 such as
eConsult/eReferral, Tele-Derm and
Tele-Ophthamology
– PACs and EHR integration
• Remote Patient Monitoring
– Enabling the Ubiquitous vs. Episodic care paradigm

3. Telehealth’s Organizational Position
• Governance
– The Telehealth Resource Center reports to the
Telehealth Steering Committee
• Strategic tool that allows UCSF to:
– Build an extended referral network
– Export UCSF’s expertise and brand 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. Senator Tom Daschle visits UCSF
• 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.”
Oct 3rd 2012

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

6. A patient’s journey through
the Daschle Cone
UCSF
Local Clinics
Live Homecare
Remote Patient
Monitoring
Wellness
Pro-Active
In Patient Specialized
Care and Education
Tracking
conditions
Triage
Tracking issues
Follow up New NormalConsult

7. Dr. Mault CMO Qualcomm Life

9. Agrees with Eric Dishman of Intel

12. Hands-on, high touch

13. 25X improvement?

14. How Automated Telephony Self-
Management works
TheVoicePlatform
UCSFsystems
Outbound
SMS
Inbound
SMS
Outbound
Voice
Web
Version
Inbound
Voice
BasicScripting Rules
Text toSpeech
Engine
RecordedVoice
Files
Timer
(Trigger)
Salesforce
Client
the
WWWTelephone System

16. This is why ATSM is important

17. The big picture

18. Telehealth Focus Areas
• Mission Bay
– Intra-campus consultations (MB, M/L, Mt Z.)
– Intra-campus & inter-facility case conferences
• Telehealth Outreach
– Inter-facility consultations
• Kaiser: Heart & Lung Transplant
• Pediatrics: CHO, CHCC Madera, Washington,
Mad River, Marin General
• Neurology: Contra Costa
• ED: San Joaquin General

19. Beware the hype
• “Physicians at UC Davis began practicing
telemedicine in 1992”
(http://www.ucdmc.ucdavis.edu/ucdavishealth/issues/spring2014/tele
medicine-leading-a-revolution.html)
• So why hasn’t UCD blanketed California?
• Factors:
– Technology
– Integration
– Adoption

20. Adoption
• Dis-rup-tive:
– innovative or groundbreaking;
– troublesome, undisciplined, unmanageable,
uncontrollable, obstreperous;
• Normalisation Process Theory (Carl R. May PhD)
– Four factors of success:
• Local and/or National Policy sponsor
• Structural/Technical integration
• Enrollment of cohesive, cooperative groups
• Integration at the level of professional knowledge and
practice, where clinicians are able to accommodate
technology through the development of new
procedures and protocols