remote monitoring | 2009 medical summit
Post on 18-Oct-2014
1.044 views
DESCRIPTION
TRANSCRIPT
David Cattell-GordonDirector of Community Engagement &Rural Network DevelopmentUVA Telemedicine Program
The State of Telemedicinein the
Commonwealth of Virginia2009
The State of Telehealth
Current Applications Benefits Innovative Approaches Implications for Health Next Five Years Challenges
Telehealth & Telehealth-Related Prosperity: A Vision for the Future
• A elderly patient takes her meds • A newborn has a chance at life• A child succeeds in school• A rural person has more time at work• A women survives breast cancer• A patient is enrolled in a clinical study• A nurse learns a new procedure• A presenter doesn’t spread a bug
Definition of Telemedicine
The use of advanced telecommunications and other technologies for:
Medical diagnosis Ongoing patient care Health-related distance learning
Telemedicine: History
Alexander Graham Bell Hugo Gernsback Massachusetts General NASA Dept of Defense University of Virginia
Mission of Telehealth
Facilitate the Health System’s missions of
• Clinical Care• Teaching• Research• Public Service
Current Telehealth Applications
Videoconferencing for patient care Store and forward applications Tele-pharmacy Remote monitoring and home telehealth
m-Health Health information exchange Emergency preparedness/disease surveillance Distance learning
It is all about the network…
Academic-community hospital linkages Rural clinics (FQHCs, Veteran’s clinics) Free clinics Health departments Correctional facilities School health Nursing homes Home telehealth Workplace Medical offices Retail clinics
Telemedicine Subspecialty Participants
Childhood obesity Ophthalmology Orthopedics Adult and Pediatric Nephrology Pulmonary medicine Pain management Plastic Surgery Urology Gynecology Emergency Medicine Geriatric medicine Surgery TCV Radiology Wound care
Dermatology Hepatology Pediatric Cardiology Infectious Disease (HIV) Psychiatry Other GI Genetics Endocrine Neurology Neurosurgery ENT Cardiology Hematology Rheumatology Toxicology/Poison control
Telehealth Growth @ UVA
Progress Report
0
500
1000
1500
2000
2500
3000
3500
FY1997 FY1998 FY1999 FY2000 FY2001 FY2002 FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009
Fiscal Year
Pat
ien
t E
nco
un
ters
Telehealth affiliations
Telemedicine Sites: Far Southwest Virginia
1. Abingdon Johnston Memorial Hospital2. Abingdon Johnston Memorial Hospital Cancer Center3. Bastian Bland County Medical Center4. Big Stone Gap Wise County Behavioral Health Services5. Big Stone Gap Mountain Empire Older Citizens6. Bristol Southwest Virginia Care Connection7. Bristol Twin City Medical Center8. Clinchco The Health Wagon9. Dungannon Clinch River Health Services10. Galax Twin County Regional Hospital11. Gate City Scott County Health Dept.12. Grundy Buchanan General Hospital13. Haysi Haysi Clinic14. Konnarock Stone Mountain Health Services15. Laurel Fork Tri-Area Health Clinic16. Norton Norton Community Hospital17. Oakwood College of Pharmacy18. St. Paul William A. Davis Clinic19. Saltville Saltville Medical Center20. Tazewell Tazewell Community Hospital21. Troutdale Troutdale Medical Center22. Vansant Thompson Family Health Center23. Whitetop Whitetop Community Health24. Wise Wise County Health Dept.25. Wise UVA College at Wise26. Wise County Fairgrounds Remote Area Medical Clinic27. Red Onion Correctional Center28. Wallens Ridge Correctional Center
Benefits of Telehealth
Rural communities• >85% of patients remain in local community• Care in the community (lower cost) environment• Enhanced healthcare and local economic development
Society• Lower cost of care• Improve outcomes• “Green” technology
Benefits of Telehealth
Health professionals • Access to consultative services• Each consultation is inherently educational• Access to continuing medical education• Reduces sense of isolation• Supports recruitment
Benefits of Telehealth
Patients• Timely access to locally unavailable services• Improved triage when patient transfer required• Improved quality of care• Reduced readmission for same diagnosis• Improved chronic disease management• Spared burden and cost of unnecessary travel
Facilitating Expert Care: Cervical cancer/Tele-colposcopy
CDC grant to Virginia for screenings of low-income, uninsured or underinsured women
Real-time tele-colposcopy services by UVA gynecologic-oncologists supporting rural NPs
Mobile digital mammography – increases access, early diagnosis
Facilitating Expert Care: Other Cancer-related Applications
Tele-radiology Tele-pathology Tele-hospice Tele-pharmacy Tele-dermatology Tele-surgery Collaborative tumor boards Access to clinical trials Community based research Educational services
Innovative Applications
Infant mortality • Arkansas Angels
– Improve access to prenatal care– Reduce neonatal mortality, premature delivery (26% decrease)
• Virginia Productivity Investment Fund• HRSA
Congenital heart disease Childhood obesity School health and daycare applications
• Reduced ER visits, parental time away from work
Innovative Applications
Tele-ophthalmology• Screening for diabetic retinopathy• Retinopathy of prematurity
Tele-dermatologyStore forward/live interactive
Tele-mental health• Critical shortage of mental health providers
Innovative Applications
Acute stroke • Time is of the essence, TPA
administered in < 3hrs
• Increased use from 4-23% in rural hospitals
Remote Monitoring and Home Telehealth
Need• Medicare data: ($17.4 billion) unplanned hospitalizations• Hospital readmissions within 30 days - 20%, within 90 days - 34%, within 1 year
56%• MedPAC - $7,200 dollars per readmission deemed preventable
Remote monitoring/home telehealth can reduce costs • Congestive heart failure, Diabetes, Chronic obstructive pulmonary disease
Veterans Affairs - Care coordination/home telehealth • 19% reduction in hospital admissions• 25% reduction in hospital days
Remote Area Medical
Building a Healthy Appalachia
The Next Five Years
Real-time, in-home monitoring The use of m-health technology Increased access to specialty care Integration of EMR into telehealth Movement to the desktop Expanded access to clinical studies
Challenges
Coverage & Reimbursement Broadband Access & Costs Comfort with Usage Licensure Inter-operability