Lawrence Wechsler, M.D.

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Telehealth Transformational opportunities for
academic medical centers in workforce, clinical
care, teaching, research, innovation and public
service

• Lawrence Wechsler, M.D.
• Vice President for Telemedicine, UPMC Physician
  Services Division
• Professor and Chair, Department of Neurology
• University of Pittsburgh Medical School

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UPMC Background

• 9 billion in revenue
• 20 hospitals operating over 4,200 beds 187,000
  admissions per year
• 4.5 million outpatient admissions 750,000
  emergency visits per year
• 1.5 million UPMC Health Plan members
• More than 400 outpatient locations
• 54,000 employees 2,700 employed physicians
• 1.3 billion invested in IT over past 5 years

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Telehealth Why do we need it?

• Addresses an unmet clinical need
• Enhances physician productivity
• Extend high quality care to regions/communities
  in need

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Regional Hospital Affiliations

• EHR
• HIE
• ED staffing
• Hospitalists
• Revenue cycle
• Administrative support
• Telemedicine

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UPMC PSD Telemedicine Activities

• Telestroke
• Teledermatology
• Teleconsults
• Telewound care
• TeleICU
• Teleophthalmology
• Telecardiology
• Pre and post-surgical care

• Telepsychiatry
• Telepathology
• Teleradiology
• TeleMFM
• TeleEndocrine
• TeleTrauma
• TelePediatrics
• eVisits

16 Service Lines 19 Facilities in WPA 3
International Sites
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Telestroke

• Unmet need for stroke expertise at small rural
  hospitals
• 2-8 of stroke patients treated with IV tPA
• 64 of hospitals did not treat with tPA over 2
  years

Audebert et al. Cerebrovasc Dis 2005
Kleindorfer et al. Stroke 2009
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UPMC Stroke InstituteIV tPA - PUH v. Outside
Hospital Transfers
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UPMC Stroke Institute Telemedicine Sites 2011
UPMC
Non - UPMC

• Passavant
• St. Margarets
• McKeesport
• Northwest
• Horizon Greenville
• Horizon Shenango
• Bedford
• Cranberry
• Magee
• Mercy

• Mon Valley
• Jefferson
• Meritus - MD
• Washington Hosp
• Jameson
• Heritage Valley - Beaver

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Telestroke By Hospital
Consults by Hospital 2007-2011
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Telestroke Metrics and Outcomes
Results (N239)
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141 min
83 min
38
9
3
90 day Outcomes - (N183)
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14
41
39
45
48
10
5
2
6
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Telestroke v. Stroke Center tPA Patients 90 day
Outcomes
Zaidi et al. Stroke 2011
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TPA Use Before and After Telestroke All UPMC
Hospitals
1235 Pts Before 2175 Pts After
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Elements of Telestroke Program

• Bidirectional real time video and audio
• Protocols / order sets
• In service training
• Stroke team
• Community education
• EMS awareness

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How Do We Pay for Telehealth?

• Grants
• Government
• Insurance reimbursement
• Contractual arrangements
• Subsidies from insurers or hospitals
• Self-pay

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Telemedicine Platform UPMC and ALU