TELEMEDICINE AND TELEMEDICINE AND

LONGTERM CARE LONGTERM CARE

American Association of Homes American Association of Homes and Services for the Aging and Services for the Aging April 7, 2003 Washington, April 7, 2003 Washington, DCDC

Don McBeath, Director of TelemedicineDon McBeath, Director of Telemedicine

Texas Tech University Health Sciences Texas Tech University Health Sciences CenterCenter

Telemedicine…Telemedicine…

….the basics.….the basics.

What is Telemedicine?What is Telemedicine?

. . . the use of electronic . . . the use of electronic information and communication information and communication technologies to provide and technologies to provide and support health care when support health care when distance separates the distance separates the participants . . .participants . . .

What is Telemedicine?What is Telemedicine?

Telecommunications Technology

+

Medicine

Why do telemedicine?Why do telemedicine? AccessAccess

– Provide primary healthcare that would Provide primary healthcare that would not be available otherwisenot be available otherwise

– Specialty care consultations for Specialty care consultations for isolated specialists, practitioners, and isolated specialists, practitioners, and other health care professionalsother health care professionals

– Eliminate expensive travel and Eliminate expensive travel and isolationisolation

– Reduce need to move patientReduce need to move patient– CME for isolated health care providersCME for isolated health care providers

Telemedicine settingsTelemedicine settings

RuralRural SchoolsSchools ClinicsClinics HospitalsHospitals PrisonsPrisons Nursing homes/ Assisted livingNursing homes/ Assisted living

Emerging applicationsEmerging applications

TelepharmacyTelepharmacy TeledentistryTeledentistry Broader Home HealthBroader Home Health Remote SurgeryRemote Surgery

Telemedicine began .Telemedicine began . . . . . In 1924, with the concept of a In 1924, with the concept of a

physician seeing his patient over physician seeing his patient over the radio using a television screenthe radio using a television screen

First wave of telemedicine programs First wave of telemedicine programs started in the 1950sstarted in the 1950s

Now in the third waveNow in the third wave Most programs that began in the Most programs that began in the

1960s-1980s no longer exist, due to 1960s-1980s no longer exist, due to dependence on external fundingdependence on external funding

Telemedicine nowTelemedicine now Doubling in number of two-way Doubling in number of two-way

interactive video programs in 90sinteractive video programs in 90s Teleradiology, store-and-forward, Teleradiology, store-and-forward,

remains most common applicationremains most common application Technology is rapidly changing and Technology is rapidly changing and

costs are decreasingcosts are decreasing Correctional is heaviest useCorrectional is heaviest use Moving into private physicians useMoving into private physicians use Expanding applicationsExpanding applications

Telemedicine at Telemedicine at Texas TechTexas Tech

An early pioneer in telemedicineAn early pioneer in telemedicine Started in 1989 as a pilot project Started in 1989 as a pilot project

to deliver health care to the rural to deliver health care to the rural Big Bend Region of TexasBig Bend Region of Texas

First consult in June of 1990 from First consult in June of 1990 from Alpine, Texas hospitalAlpine, Texas hospital

First consult, June 1990

Aida Porras, age 10

Aida Porras in Presidio, TX

Telemedicine at Telemedicine at Texas TechTexas Tech

Average 2,500 consults annuallyAverage 2,500 consults annually Over 12,000 consults since 1991Over 12,000 consults since 1991 Telemedicine Hall of Fame by Telemedicine Hall of Fame by

TelehealthTelehealth MagazineMagazine in August 1999 in August 1999 Top Ten Telemedicine Programs in Top Ten Telemedicine Programs in

1996 and 1997 by 1996 and 1997 by Telemedicine Telemedicine and Telehealth Network Magazineand Telehealth Network Magazine

Ranked in the “Top 12 List” by Ranked in the “Top 12 List” by Telemedicine TodayTelemedicine Today in 1998 in 1998

Abilene

El Paso

Alpine

Presidio

Terlingua

Hart

Pampa

Dalhart

Amarillo

Childress

Wichita FallsPlainview

Lubbock

Ft. Stockton

Odessa

Lamesa Snyder

Coleman

StamfordAnson

Sierra Blanca

Fort Hancock

Colorado City

July 2001

Levelland

De Leon

Texas Tech Telemedicine Network

Texas Tech Telemedicine Network

Campus SitesAmarillo LubbockEl Paso Odessa

Rural SitesAlpine Hart Fort Hancock Presidio Sierra Blanca Terlingua

Correctional SitesAbilene Lamesa Amarillo Lubbock Childress Pampa Colorado City Plainview Dalhart Snyder El Paso Wichita Falls Ft. Stockton

Affiliated Independent Network•with Hendrick Medical Center:Abilene Anson Coleman Stamford

•with FQHCs:De Leon El Paso Levelland

Types of telemedicine Types of telemedicine consultsconsults By specialtyBy specialty

– PsychiatryPsychiatry 63%63%– OrthopedicsOrthopedics 11%11%– OtherOther 10%10%– PsychologyPsychology 8% 8%– DermatologyDermatology 4% 4%– Primary CarePrimary Care 4% 4%

By typeBy type– CorrectionalCorrectional 90%90%– Non-correctional 10% Non-correctional 10%

Consults by year and specialty Correctional 1994 1995 1996 1997 1998 1999 2000 2001 2002

Gen. Surg. 11 79 78 81 212 192 248 80 2

Ortho 9 174 300 251 213 309 377 268 260

Internal Med. 14 101 59 22 26 13 29 19 25

Urology 0 22 25 5 26 68 75 68 42

Dermatology 0 72 76 44 61 73 82 75 85

Other Med. 10 131 154 61 50 15 17 29 19

Psychology 0 0 0 0 142 208 287 251 181

Psychiatry 0 11 146 179 187 554 1383 1326 1486

Correctional Total 44 590 838 643 917 1432 2498 2116 2100

                   

Non-correctional 93 83 54 35 68 60 32 180 243

                   

Total 137 673 892 678 985 1492 2530 2296 2343

How it worksHow it works Video conference systemVideo conference system Cameras each endCameras each end TV screens/computers each endTV screens/computers each end Various medical peripheralsVarious medical peripherals Video connectionVideo connection

T-1 lineT-1 line SatelliteSatellite Phone line (POTS)Phone line (POTS) InternetInternet

) ) )

) )

) ) )

) )

) ) )

) ) ) ) ) ) ) ) ) ) )

Hub SiteRemote

Site

T-1

ConnectivityConnectivity T-1 dedicated phone lineT-1 dedicated phone line SatelliteSatellite ISDNISDN High speed DSL/Cable High speed DSL/Cable ATMATM POTSPOTS LAN/WANLAN/WAN Internet, or IP-basedInternet, or IP-based

Compression of Compression of bandwidthbandwidth

Codecs compress the information to fit the broadband connection

TelemedicineTelemedicine does not/should does not/should not alter the practice of not alter the practice of

medicinemedicine..

TTU telemedicine philosophy

Core principles of Core principles of telemedicinetelemedicine

Is only a tool (like a stethoscope)Is only a tool (like a stethoscope) Must be physician directedMust be physician directed Must be integrated into established Must be integrated into established

clinical operations and routinesclinical operations and routines Physician-patient relationships must Physician-patient relationships must

be preservedbe preserved

The barriersThe barriers

Equipment costsEquipment costs

Connectivity costsConnectivity costs

ReimbursementReimbursement

Getting betterGetting better

Declining equipment costsDeclining equipment costs

Shared connectivityShared connectivity

Enhanced reimbursement (still an Enhanced reimbursement (still an

issue for nursing homes)issue for nursing homes)

Long-term careLong-term care telemedicinetelemedicine

Correctional telemedicine as a model

Similar scenariosSimilar scenarios

Desire to not transport patients off Desire to not transport patients off sitesite

Limited on-site primary careLimited on-site primary care No on-site specialty careNo on-site specialty care Must maintain certain level of staff Must maintain certain level of staff

on-site at all timeson-site at all times Have stringent rules and Have stringent rules and

regulations to followregulations to follow

Prison off-site Prison off-site transport sampletransport sample

NumberNumber PercentagePercentage

Remain Remain On UnitOn Unit

648648 57.5%57.5%

Transfer Transfer Off SiteOff Site

479479 42.5%42.5%

For Year 2000, medical consults only.

Long-term care Long-term care telemedicine—telemedicine—goals and benefitsgoals and benefits Enhance and increase on-site Enhance and increase on-site

primary careprimary care Enhance and increase on-site Enhance and increase on-site

specialty carespecialty care Reduce ambulance transportation Reduce ambulance transportation

for off-site carefor off-site care Reduce unnecessary ER visitsReduce unnecessary ER visits

Goals and benefits-Goals and benefits-cont.cont. Reduce risk of injury associated Reduce risk of injury associated

with transportswith transports Reduce loss of revenue to nursing Reduce loss of revenue to nursing

homeshomes Allow better community Allow better community

ambulance coverage with less ambulance coverage with less nursing home transportsnursing home transports

On-site medial and task trainingOn-site medial and task training

Goals and benefits – Goals and benefits – cont.cont.

GED (high school equivalency) GED (high school equivalency) trainingtraining

Replication of operating modelReplication of operating model Student training componentStudent training component Expand to additional services Expand to additional services

including dentalincluding dental

Goals and benefits – Goals and benefits – cont.cont. Distant social and counseling Distant social and counseling

services for family and caregiversservices for family and caregivers Reduced family travel timeReduced family travel time

Texas Tech long-term Texas Tech long-term care projectscare projects

-Carillon project – brief pilotCarillon project – brief pilot-Garrison project – April 2003Garrison project – April 2003-West Texas Rural Nursing West Texas Rural Nursing Home Telemedicine Network - Home Telemedicine Network - plannedplanned

Carillon findingsCarillon findings

Patient satisfactionPatient satisfaction

- Comfort level and - Comfort level and communications very highcommunications very high

- Satisfaction with exam very high- Satisfaction with exam very high

- Most would do again- Most would do again

- Most believe no diminishing of - Most believe no diminishing of medical qualitymedical quality

Carillon findingsCarillon findings

Patient satisfactionPatient satisfaction

- Only negatives on audio/hearing- Only negatives on audio/hearing

Carillon findingsCarillon findings Physician satisfactionPhysician satisfaction

- Very high overall satisfaction- Very high overall satisfaction

- Reported no limitation on their - Reported no limitation on their ability to treat/diagnoseability to treat/diagnose

- Rated most consults as same as - Rated most consults as same as face-to-faceface-to-face

Garrison projectGarrison project

Geriatric Teaching Nursing HomeGeriatric Teaching Nursing Home Teaching and research lab for Teaching and research lab for

telemedicine applications in telemedicine applications in assisted livingassisted living

Expose heath care providers, Expose heath care providers, students, and nursing home staff students, and nursing home staff to telemedicineto telemedicine

Serve as a resource for rural Serve as a resource for rural nursing homesnursing homes

West Texas Rural West Texas Rural Nursing Home Nursing Home Telemedicine Network Telemedicine Network Project-plannedProject-planned

Link three rural nursing homes with Link three rural nursing homes with Medical Director with telemedicineMedical Director with telemedicine

Link with Garrison Geriatric CenterLink with Garrison Geriatric Center Link to Texas TechLink to Texas Tech No community hospitalNo community hospital Medical Director in another Medical Director in another

communitycommunity

What is the future of What is the future of assisted living/long-assisted living/long-term care term care telemedicine?telemedicine?

Greatest potential for Greatest potential for expanded use of expanded use of telemedicine!telemedicine!

Broader applications – especially Broader applications – especially in assisted living facilitiesin assisted living facilities

Explosion in home useExplosion in home use

Driven by technology and the Driven by technology and the expanding role of the Internetexpanding role of the Internet