Telemedicine in Telemedicine in Pediatrics: Pediatrics:
Increasing Access & Increasing Access & QualityQuality
James P. Marcin, MD, MPHJames P. Marcin, MD, MPH
UC Davis Children’s HospitalUC Davis Children’s Hospital
Sacramento, CASacramento, CA
[email protected]@ucdavis.edu
916-734-4726916-734-4726
DisclosuresDisclosures
I have NO financial interest or I have NO financial interest or arrangement or affiliation with any arrangement or affiliation with any organizations related to commercial organizations related to commercial products or services to be discussedproducts or services to be discussed
My presentation does NOT include My presentation does NOT include discussion of "off-label" uses of FDA discussion of "off-label" uses of FDA approved pharmaceutical products or approved pharmaceutical products or medical devicesmedical devices
RegionalizatioRegionalization improves n improves
efficiency and efficiency and qualityquality
Telemedicine Telemedicine allows our allows our
expertise to expertise to be be
everywhereeverywhere
Why TelemedicineWhy Telemedicine
UC Davis Telemedicine Network
Mayers Memorial Hospital, Fall River Mills
Humboldt Open Door Clinic
Lassen Community Hospital, Susanville
Plumas District Hospital, Quincy
Western Sierra Medical Clinic, Downieville
Oroville Community Hospital
Biggs Griddley Memorial Hosp
Camptonville Wellness Clinic
Peach Tree Clinic, Marysville
Sierra Family Medical Clinic, Nevada City
Colusa Community Hospital
Sac. County JailUC Davis, Auburn
UC Davis, Meadow Vista
UC Davis, Carmichael
UC Davis, Folsom
Tuolumne General Hospital Sonora
Motherlode
Hughson Medical Office, Hughson
Madera Family Medical Group
Hillman Health Care Center Tulare
Delano Regional MC
UC Davis, J Street
Big Valley Med Center, Lassen
Plumas Health Services, Plumas
UC Davis, Roseville
Sac Family Med Clinic, Sacramento
CA State Prison, Folsom
Valley Mt. Regional Center, Stockton
West Hills Medical Group, Coalinga
Valley Family Care Center
Willow Creek Clinic, Willow Creek
Stanislaus County Comm. Health Clinic, Hughson
Livingston Medical Group
Surprise Valley Community Hospital, Modoc
Primary Care Clinic, Sonora
Mojave Rural Health Clinic
Greenville Rancheria, Quincy
Pelican Bay State Prison, Crescent City
Shasta Community Health Center
Eureka Pediatrics
Family Healthcare Network, Porterville
Wasco Medical Center, Wasco
Substance Abuse Treatment Facility, Corcoran
CDC Ironwood State Prison, Blythe
Desert Hot Springs Clinic
Del Norte Community Health Ctr., Crescent City
Community Healthcare Center, Crescent City
Mercy Redding Hospital
Hill Country Community Clinic, Shasta
Healdsburg General Hospital
UC Davis, Davis
Round Valley Indian Health Center, Covelo
Berry Creek Health Center
Shafter Community Health Center
Modoc Medical Center, Alturas
Eureka Community Health Center
Desert Hot Springs Community Health Center
Northeastern Rural Health Clinics, Lassen
High Desert State Prison, Susanville
Burney Skilled Nursing Facility
Sierra Valley District Hospital, Loyalton
E. Plumas District Hospital, Protola
Sierra Care Miner’s Clinic, Nevada City
St. Elizabeth Medical Center, Red Bluff
Hamilton City Primary Care Clinic
Fremont/Rideout Medical Center, Yuba City / Marysville
Mammoth Lakes Clinic
Mercy Medical Center, Merced
Tulare County Health Services
Central CA Women’s Facility, Chowchilla
Mercy Medical Center, Mount Shasta
The FCC Telehealth The FCC Telehealth GrantGrant
600 Healthcare Centers for Health Broadband600 Healthcare Centers for Health Broadband
$417 Million in 42 States$417 Million in 42 States
Telemedicine:Telemedicine: Applications in Applications in
PediatricsPediatrics Outpatient specialty consultationsOutpatient specialty consultations EMS: Scene, Transport, ED consultationsEMS: Scene, Transport, ED consultations Inpatient specialty consultationsInpatient specialty consultations Procedure-Study interpretation (EEG, Echo)Procedure-Study interpretation (EEG, Echo) Intensive Care Unit consultationsIntensive Care Unit consultations Surgical and Trauma consultationsSurgical and Trauma consultations Other uses: Other uses:
– Home HealthHome Health Physician - nurse educationPhysician - nurse education– Video-interpreting Video-interpreting Chronic care facilitiesChronic care facilities– Child care centersChild care centers Connecting familiesConnecting families– HospiceHospice InternationalInternational– Interpreting servicesInterpreting services
Telemedicine in the EDTelemedicine in the ED Non-Children’s Hospitals EDs are:Non-Children’s Hospitals EDs are:
– Less prepared with regards to equipment, trainingLess prepared with regards to equipment, training Rural EDs are less likely to have access to:Rural EDs are less likely to have access to:
– Pediatricians, pediatric subspecialists, ancillary Pediatricians, pediatric subspecialists, ancillary services services
– CDC Report (Feb 2006): 40% of EDs lack 24/7 access CDC Report (Feb 2006): 40% of EDs lack 24/7 access to pediatriciansto pediatricians
IOM: Future of Emergency Care – Key Findings:IOM: Future of Emergency Care – Key Findings:– ““Children make up 27% of all ED visits, but only 6% Children make up 27% of all ED visits, but only 6%
of EDs in the US have all of the necessary supplies of EDs in the US have all of the necessary supplies for pediatric emergencies.”for pediatric emergencies.”
50% of all EDs see less than 10 children per day50% of all EDs see less than 10 children per day
Telemedicine vs Telemedicine vs TelephoneTelephone
Aspects of Quality Aspects of Quality of Careof Care
Quality of Care ScoresQuality of Care Scores
Telemed Telemed Consult Consult (n=53)(n=53)
Telephone Telephone Consult Consult (n=105)(n=105)
No No Consult Consult (n=233(n=233
))
Non-Non-Telemed Telemed (n=338)(n=338)
Initial data gatheringInitial data gathering 5.75.7 5.85.8 5.55.5 5.65.6Integration of data Integration of data and diagnosisand diagnosis 5.75.7 5.85.8 5.55.5 5.65.6
*Telemedicine Consultations Typically Occurs Here**Telemedicine Consultations Typically Occurs Here*
Initial treatment planInitial treatment plan 5.55.5 5.35.3 5.0 *5.0 * 5.1 *5.1 *Plan for disposition Plan for disposition and follow-upand follow-up 6.16.1 6.16.1 5.6*5.6* 5.75.7
Overall Quality of Overall Quality of CareCare 5.75.7 5.4*5.4* 5.2*5.2* 5.3 *5.3 *
Parent SatisfactionParent Satisfaction
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Telemedicine
Non-Telemedicine
Referring Provider Referring Provider SatisfactionSatisfaction
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Consult Experience Assistance ofTelmedicine or
Telephone Consult
Clinical Skills ofProvider
Telemedicine
Non-Telemedicine
Recommended Additions to Recommended Additions to CareCare
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Additional Studies AdditionalMedications
Change in Dispostionof Care
Telemedicine
Non-telemedicine
Telemedicine for Telemedicine for InpatientsInpatients
CDC Report (Feb 2006): 50% of hospitals admit CDC Report (Feb 2006): 50% of hospitals admit children without a specialized pediatric wardchildren without a specialized pediatric ward– In NY: Non-pediatric hospitals admitted 33% of all In NY: Non-pediatric hospitals admitted 33% of all
hospitalized childrenhospitalized children Pediatric subspecialists are regionalizedPediatric subspecialists are regionalized
– Children may not receive specialist consultations and Children may not receive specialist consultations and left for follow-upleft for follow-up
– Children may be transported only for the consultationChildren may be transported only for the consultation Hypothesis: Providing inpatient consultations Hypothesis: Providing inpatient consultations
may increase the quality of care and obviate a may increase the quality of care and obviate a transporttransport
Pediatric Inpatient Pediatric Inpatient Telemedicine ServicesTelemedicine Services
Cardiology (+ echo Cardiology (+ echo reads)reads)
Hematology - Oncology Hematology - Oncology PulmonologyPulmonology Infectious diseaseInfectious disease Neurology Neurology GastroenterologyGastroenterology Endocrinology (known Endocrinology (known
DM)DM) Others…Others…
Points to makePoints to make– Must fill clinical needMust fill clinical need– Need privilegesNeed privileges– Great model if there Great model if there
is regional bed is regional bed shortage and/or shortage and/or competitioncompetition
““Robo-doctor”Robo-doctor”
Telemedicine in the PICU-Telemedicine in the PICU-NICUNICU
Some select “less critically ill” Some select “less critically ill” children can be cared for in children can be cared for in hospitals without PICUs and NICUshospitals without PICUs and NICUs
In several states, minimal standards In several states, minimal standards for Pediatric ICUs have been for Pediatric ICUs have been established (volume, intensivists, established (volume, intensivists, etc.)etc.)
Spectrum of models:Spectrum of models:– Continuous oversight (eICU)Continuous oversight (eICU)– Consultative modelConsultative model
PICU Telemedicine PICU Telemedicine ResultsResults
UC Davis PICU-ICU model:UC Davis PICU-ICU model:– Assist in the care of “less sick” children at remote Assist in the care of “less sick” children at remote
site site Compared to non-telemedicine patients, Compared to non-telemedicine patients,
telemedicine patients are:telemedicine patients are:– Younger Younger – More ill (higher PRISM III)More ill (higher PRISM III)– Higher rates of mechanical ventilationHigher rates of mechanical ventilation– Excellent severity adjusted outcomesExcellent severity adjusted outcomes
Have higher parent satisfactionHave higher parent satisfaction– 55% parents ranked local care “extremely 55% parents ranked local care “extremely
important” versus 20% for local physiciansimportant” versus 20% for local physicians
Financial Impact of Financial Impact of TelemedicineTelemedicine
Saved costs using telemedicine Saved costs using telemedicine – $117,000 (23 pts, 71 days)$117,000 (23 pts, 71 days)– $200,000 (½ Children in ICU, 43 pts, 105 $200,000 (½ Children in ICU, 43 pts, 105
days)days) Actual revenue kept in ReddingActual revenue kept in Redding
– $186,000 (23 pts, 71 days)$186,000 (23 pts, 71 days)– $279,000 (½ Children in ICU, 43 pts, 105 $279,000 (½ Children in ICU, 43 pts, 105
days)days)
Family LinkFamily Link
Video-Interpreting Video-Interpreting ServicesServices
Links hospitals Links hospitals and clinics to and clinics to bank of bank of interpretersinterpreters
Increase Increase efficiency efficiency
Improve patient Improve patient satisfactionsatisfaction
Pediatric Telehealth ColloquiumPediatric Telehealth Colloquium
Thank You!!Thank You!!
James P. Marcin, MD, MPHJames P. Marcin, MD, MPH
UC Davis Children’s HospitalUC Davis Children’s Hospital
Sacramento, CASacramento, CA
[email protected]@ucdavis.edu
916-734-4726916-734-4726
