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

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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