Post on 23-Jan-2015
description
transcript
A Brave New World for Telehealth and HIT
Dale C. Alverson, MD, FAAPMedical Director, Center for Telehealth and Cybermedicine
Research, University of New Mexico
CMIO, LCF Research
Albuquerque, New Mexico
Past President, American Telemedicine Association
March 20, 2013
Impacting Lives through Applied Technology
Objectives:
To understand the current and future potential for Telehealth and Health Information Technologies; regionally, nationally, and globally
To understand how Telehealth and Health Information Exchange (HIE) can be blended and complimentary as a part of healthcare transformation.
Health Care Reform/PPACA
Economic Downturn
Critical Shortage of Healthcare Providers
Emerging Enabling Information Communication Technologies
Need for more Access to Care
A Time for Telemedicine & HIT
An Aging Population/Baby Boomers
EHR Adoption/HIE
PCMH
ACOs
Meaningful Use
ICD10
Major Public Health Issues Impacting our Rural Communities and their Economic Development
Hepatitis C Behavioral Health Diabetes Asthma Cancer Oral Health Cardiac and
Stroke Care
Gaps in Access to Health Servicesin Rural New Mexico
Telehealth and Health Information Technologies
are Part of the Solution in Closing the Gaps
How is Telehealth used? Clinical: Consultation, Direct patient Care, Case
Reviews
Educational: Providers, Students, and Patients
Research: Community-based Participatory, Outcomes driven
Administrative: Strategic planning, Operations
Health Information Exchange
Enhanced Disaster Response
Telehealth NetworksRural/Remote Health Providers Can Access Expert Medical Opinions,
Knowledge, Education via Telehealth
Rural or Remote Location
Local HealthProvider
Patient
Specialty Medical Center
Medical Specialist
AudioHigh-Resolution Images & Video
Telehealth Network
ConsultationDirect Patient CareCase ReviewsEducationTrainingHealth Information ExchangeCommunity-Based Research
Student
“Back to the Future”
Case Reviews or Consultation
ECHO: Treatment Outcomes
Outcome ECHO UNMH P-value
N=261 N=146
Minority 68% 49% P<0.01
SVR (Cure) Genotype 1/4 50% 46% NS
SVR (Cure) Genotype 2/3 70% 71% NS
SVR=sustained viral response
NEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, et.al.
Direct Patient Care
Maternal Fetal Medicine-High Risk Pregnancy
“Store and Forward” Capturing an image and storing it to then be forwarded for
review by a medical specialists Examples include teleradiology, telepathology and
teledermatology, tele-ophthalmology (retinal scans) “Telemedicine” or HIE?/Large Data Files Need Broadband
Teleradiology and Image Transfer Web-Based Portals
Video Phone or “VOIP” with videoFamily Visitation
School Based Health Centers
16
Telehealth assistants at the school or child care center provide the link to examine the eyes, ears, throat, lungs and skin.
Videoconferencing provides the “face to face” interaction.
Getting providers to think of their desktop computer as an exam room is the trick.
Trauma Triage
Moya M, Valdez J, Yonas H, Alverson DC. The Impact of a Telehealth Web-based Solution on and Consultation. Telemedicine and eHealth, 2010; 16:945-949
44% Transfer Avoidance
27% Management Recommendation Changes
IRA HAYES Project – PTSD/TBI
Videophone (H.324)Skype
Software IP Based (H.323)
Desktop IP Based (H.323)
Small Conference Room IP Based (H.323)
Telehealth Toolkit
SaaS (SIP)
Hand Held Devices- “mHealth”
BlackBerry Treo/Palm
Smart Phones
iPhone
iPhone
Droid
Remote Monitoring
The “Smart Band-Aid”
Center for Telehealth and Cybermedicine Research
The Center for Telehealthat UNM Health Sciences Center:• Developing New Programs• Technical, Operational,
Business, and Evaluation Planning
The New Mexico Telehealth Alliance
Telehealth Alliance
Represents a consortium of public and private health care stakeholders: “Neutral Territory” (501c3)
Reflects the diversity of our
health care delivery system in New Mexico
Enables collaboration
“Networks of Networks” Providers
Consumers
Telehealth Expertise
Communication Networks
Social Networks
New Mexico Telehealth Act Passed and Signed into Law 2004
Introduced by Rep. Danice Picraux (D)Supported by Sen. Susan Wilson-Beffort (R)
HOUSE BILL 58146TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION 2004
http://legis.state.nm.us
Authorization Bill for Telehealth:• Covers interactive video and “Store and Forward”
technologies• Any Licensed Health Professional authorized to use• Covers any Originating Site Where Patient Located,
including place of residence• Authorizes/Encourages Use of and Reimbursement for
Telehealth(NM Medicaid has announced policies to reimburse for telehealth services)
New NM Legislation: SB 69/HB 171
Insurance Coverage for Telemedicine Services
An act relating to health care coverage; enacting sections of the health care purchasing act, the New Mexico insurance code, the health maintenance organization law and the nonprofit health care plan law to require coverage for telemedicine services; providing for utilization review and appeal rights for denials of telemedicine coverage.
"Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall include coverage of telemedicine Services. Coverage for health care services provided through telemedicine shall be determined in a manner consistent with coverage for health care services provided through in-person consultation."
SWTAG is a “Network of Networks”
The 4 “C’s”CooperationCoordinationCollaborationCommunication
http://www.americantelemed.org
American Telemedicine Association (ATA) and Telemedicine
Hitting the Target: “The Triple AIMS”
Improve Access
Improve Health
Reduce Costs
ATA and
Telemedicine
ATA
Health Information Exchange (HIE) Engagement and Encouraging Adoption
• An HIE Solution brings health information systems together across regions and states in order to provide access to a patient’s information in one centralized record.
• Multiple healthcare providers with access to the same record of clinical information will make healthcare delivery more robust and efficient with improved continuity, better outcomes, and reduced cost. There are significant benefits to patients, healthcare providers, payers and employers.
33
Core HIE Functions
Provides access to a current patient summary from a variety of sources (From Where and When):
Problem List/Diagnosis Medications Immunizations Allergies Procedures Lab Data Radiology Data Encounter Summaries
Why the HIE is Accessed?
When and why a Provider needs to access the HIE:
New patient, not seen before Infrequent patient Patient known to have received care elsewhere Complex patient Tracking of patient Patient ER visits and
hospital stays EHR is unavailable Remote Access
35
Value/Benefits of HIE
• Access to each patient’s health information from a variety of healthcare provider sources
• Improved situational awareness regarding patient’s health and use of health systems, better coordination of care
• Better triage and evaluation capability: Dx/Problem
list, prior procedures, Rx/Medications, Allergies, tests; lab/x-ray, progress note and summaries
• Improved efficiency in making diagnosis and management plans
• Decrease unnecessary duplication of tests• Readmission avoidance• Other Benefits : Data Analytics, Public Health, PCMH,
ACO
Cloud Based
Solution: Core HIE – High Level
Web-based access to the longitudinal patient record
• Demographics• Labs, Rads• Encounters• Allergies• Diagnosis• Transcribed documents• Medications• Problems• Procedures• Immunizations
Direct Secure MessagingPatient Privacy & Consent
HIE Platform
PhysiciansPrivacy Officers
Notifications & Subscriptions
Secure Inbox
Mobile
Clinic with EMR
Hospital with EMR
Other HIEs
HL7/CCD, XDS, SSO
Seamless integration with EHRs• User Subscribed Notifications• Send to My EHR• Portal embedded within EHR
HTTPS
Health InformationExchange (HIE)
Example Integration (Epic)
Example Integration (Cerner)
41
T or C
HITREC sites(random sample of sites)
Established HIE connectivity
Future HIE connectivity (random sample of sites)
The HIE in New Mexico
Santa Fe
Albuquerque
Taos
Raton
Farmington
Silver City
Carlsbad
Roswell
Alamogordo
LasCruces
Deming
Santa Anna
Clovis
Portales
Lovington
Hobbs
Las Vegas
GrantsGallup
ClaytonLos
Alamos
Navajo Nation
El Paso
SSA
VAClayton
Tucumcari
Socorro
Magdalena
Los Lunas
Belen
Ruidoso
Cuba
Amarillo
Lubbock
International Telemedicine and eHealth: Transforming Systems of Care in the Global Community
Reasons to do International TelehealthMost health issues are global!
H1N1
H5N1
46
Distributed Medical Intelligence
• Knowledge Sharing Networks/Just in Time/On Demand
• Best Practices
• Evidence based
International Union
Against TB
La Lancha Medica en la Amazonia
49
50
Exchange of Students and Faculty
Opportunities
Blending HIE with “Telehealth”Integration with Mobile DevicesFacilitation of research, data analytics,
quality reporting, and other aggregate usesHitting the Triple AimsBecoming a Standard of CareFostering ChampionsDeveloping a National and International
Network of Networks
Navigating the Perfect Storm with Telemedicine & HIT
Use a broad spectrum of information communication technologies
Effective distribution of limited resources and expertise
Increasing Access to care
Bringing care to the patient; Aging in place
Decreasing unnecessary variations in care; evidence-based best practices
Improving continuity and coordination of care;The Patient Centered Medical Home
Improving health outcomes
Avoiding unnecessary hospitalizations, duplication of tests, & decreasing errors
Reducing costs; avoiding more costly care and complications, decreasing travel
Questions?
http://hsc.unm.edu/som/telehealth
http://www.lcfresearch.org/