Telemedicine- the Cleveland Clinic Experience February 25, 2010 Matthew Faiman, MD, MBA Director...

Telemedicine- the Cleveland Clinic Experience

February 25, 2010 Matthew Faiman, MD, MBADirector Telemedicine Services

DisclosuresThere is no FDA on-label or off-label content

in this lecture.

Abbott Laboratories- speaker’s bureau, which has no relationship with the content of this lecture.

Virtual Medical Clinic l April 19, 2023 l 2

Lecture OverviewVirtual Medical Clinic at Cleveland Clinic.An historical perspective of telemedicine.History of telemedicine at Cleveland Clinic.Current and Future Telemedicine projects at

Cleveland Clinic.Questions.


Virtual Medical Clinicand Telemedicine

What is Telemedicine? It is the transfer of electronic medical data (video, sound, image, EMR) from one place to another or….

“A picture is worth a thousand words…..” (Fred Barnard 1921)



• Uses sophisticated, real-time technology to connect Cleveland Clinicphysicians with patientsrequiring specializedconsultations, anytime,anywhere

• Facilitates physiciancollaboration and interaction for specialty consultations

Cleveland Clinic physician conducting personalized patient exam utilizing real-

time connectivity technology

Virtual Medical Clinic


Location A: Exam RoomPatient sees and speaks to Cleveland Clinic physician in real-time through secure technology

Location B: Cleveland ClinicPhysician conducts examination, interacts with patient and nurse, and documents encounter in the MyPractice Electronic Medical Record system


The Virtual Medical Experience

Conducts interaction from Telemedicine studio

Cleveland Clinic Physician

Interacts with patient and nurse / technician at remote exam location



Easily navigates real-time views and online medical information (X-Rays, scans, etc.)


Directs nurse / technician through exam, seeing and hearing diagnostic details (heart sounds, etc.)



Sees and hears physician; asks and answers questions

Cleveland Clinic Patient

Areas of Telemedicine


Cleveland Clinic Admin

CampusHome Care

PARKER

Cleveland Clinic Abu Dhabi

CC MAIN

Cleveland Clinic CanadaWC

Cleveland Clinic FHCs

CCHS HOSPITALSFLORIDA

West Palm Beach WC

CCAC= Cleveland Clinic Administrative Campus; ITC= Independence Technology Center; CCAD= Cleveland Clinic Abu Dhabi; CC Main= Cleveland Clinic Main; FHC= Family Health Center; CCC WC= Cleveland Clinic Canada Wellness Center; WPB WC= West Palm Beach Wellness Center

Key: Double arrow: Existing Telemedicine ServiceSingle arrow: Previous Telemedicine ServiceUnbolded Lines: Future Telemedicine Service

INSTITUTES

ORI

NI

Bariatrics



Receives and complies with physician instructions




Nurse / Technician transmits diagnostic equipment data directly to physician for review in real-time


Virtual Medical Clinic



Is examined utilizing all pertinent diagnostic criteria; nurse / technician follows physician direction





Conclude exam with discussion, final questions, physician instructions, and appropriate future

treatment strategy

Cleveland Clinic Physician and Patient



Places orders for medications, follow-up tests or other labs into MyPractice Electronic Medical

Record System


Fully documents encounter in MyPractice Electronic Medical Record System



Concludes Telemedicine Visit


Telemedicine- Historical Review

Since the creation of EKG by Einthoven, there has been an attempt to transmit EKG over telephone lines circa,1906.

In the 1920s, telemedicine was used by radio to help ships in distress. This would link physicians standing watch on shore stations for emergencies.



1924, Radio Marvel Magazine illustrated this in action:


Courtesy of Dennis J. Streveler, PhD.


1950s- Nebraska Medical Center. Their psychiatry unit was one of the first in the US to have closed-circuit tv in 1955. In 1964 and later 1971, developed links between psychiatric institute and hospitals (including the VA) remotely.

1960s- NASA began to use telemedicine during its space program as physiological parameters were sent via telemetery from both space suits and spacecraft during missions.

NASA provided much of the funding for most other projects and demonstrations, specifically satellites.


Telemedicine- Historical Review 1967- Mass General/Logan International

Airport. This station was established to provide occ. health and emergency services to travelers. Staffed 24 hrs/day and used a two-way audiovisual microwave circuit.

1971- Alaska ATS-6 Satellite Demo. Utilized satellites from NASA to deliver video consultation to rural health care in 26 remote villages in Alaska and Canada.

1972-STARPAHC; NASA and Papago reservation in Arizona. Staffed by 2 Indian paramedics in a van and linked to a public hospital via 2-way microwave audio and video transmission.



1984- Australia. Satellite communications network set up to provide health care to remote towns of which 2/3rds were Aborigines.

1989- NASA SpaceBridge to Armenia/Ufa. After the earthquake that hit in December 1988, the US extended an offer to assist the disaster site for medical consultation. Same assistance to the burn victims after railway accident in Ufa.



2010. Price Waterhouse Coopers lists the top 10 healthcare issues for 2010 and #8: Alternative care delivery models will emerge as traditional care delivery models will give way to alternative models of care outside of physicians’ offices and hospitals. Expect to see an increase in the number and scope of services offered by work site… email, telehealth and remote patient monitoring.

( http://www.pwc.com/us/en/healthcare/publications/top-ten-health-industry-issues-in-2010.jhtml)


Telemedicine at Cleveland Clinic

Telemedicine at Cleveland Clinic: began in 2005 with a relationship with UTMB.

Dr. Cosgrove imagined telemedicine as an opportunity for increased access for patients living in hard to reach areas.

Telemedicine felt to be inline with CC/CCHS approach to innovation.


Telemedicine at Cleveland Clinic

In 2006, Virtual Medical visits began from Wooster to main campus in Peds GI and Neuro with Drs. Hsich, Wyllie and later Psychiatry with Dr. Tesar.

In late 2006 a telemedicine council was set up to address the needs of CC/CCHS domestically and internationally.


Virtual Medical Clinic and Telemedicine On January 23rd,2008 services began

with the Parker Virtual Medical Clinic.This employee-based clinic sees patients

for urgent visits and some chronic care.To date almost 500 patients have been

seen.Patient satisfaction scores are as high or

higher than regular brick and mortar visits.


Virtual Medical Clinic and Telemedicine

Other Institutes using Telemedicine:Orthopedics: from Wooster since 2008,

approx 60 visits and 6 surgeries. In 2009 operations from Youngtsown (St E’s). Visit yield is 6:1 whereas dept average 10:1!

Bariatrics: first visit from CCCToronto 6/09.Transplant Medicine-first visit in 1/2010.

Virtual Medical Clinic and Telemedicine

Other Institutes using Telemedicine:Cleveland Clinic Canada- Toronto

practitioner’s utilization of main campus for 2nd opinions.

Emerging Business: both domestic and international opportunities are being explored including home monitoring and wellness.

Virtual Medical Clinic and TelemedicineFinal Thoughts Options are endless.

In the fast-paced world that we live in, telemedicine affords a complementary approach to health care.

Will not substitute but will augment the health care that we have today.


Scheduling Telemedicine and Outpatient Clinic

X= patient to be seen


Time Outpatient Telemedicine

9:00 am X none

9:30 am none X

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Telemedicine- the Cleveland Clinic Experience February 25, 2010 Matthew Faiman, MD, MBA Director...

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