PowerPoint Presentation CLAY Telemedicine and Hand Surgery

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Telemedicine and Hand Surgery
Steven Williams, MD J. Grant Thomson,
MD Department of Plastic Surgery Yale University
School of MedicineNew England Hand
Society Twenty-Ninth Annual Meeting and
Scientific Program December 7, 2001
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Goals
Define Telemedicine Understanding of Costs
and Benefits of Telemedicine Particularly for
Hand Surgery Applications Results of Current
Study
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What is Telemedicine?
Telemedicine has been defined as the use of
telecommunications to provide medical information
and services. It may be as simple as two
health professionals discussing a case over the
telephone, or as sophisticated as using satellite
technology to broadcast a consultation between
providers at facilities in two countries, using
videoconferencing equipment. The first is used
daily by most health professionals, and the
latter is used by the military and some large
medical centers.
Perednia and Allen, 1995
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Risks of Telemedicine and Electronic Records

• Patient Data Security
• Security within system
• outside attack
• internal attack
• Security of data outside of system
• trusted source
• Reliability of System
• Network Access
• Fidelity of Data

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Costs of Telemedicine and Electronic Records

• Cost to Group or Program for Start-up
• Hardware
• Training
• Software
• Cost to Group or Program for Usage
• Training
• Usage
• Maintenance

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Scope of Project
Abstract Hand injuries present a complex problem
in initial assessment and communication of the
details of the particular nature of the injury.
Communication of details to experienced hand
surgeons is critical to patient prognosis. The
challenges lie in the following areas
Capturing adequate data for evaluation
Insuring patient privacy Operating in a cost
effective manner Can these challenges be
surmounted in a university hospital setting?
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Methods

• Patients presenting to Yale-New Haven ED for hand
  injury will be evaluated in the standard fashion
  and then also using the CLAY telemedicine system.
• The following data will be recorded and reviewed
  by remote attending
• Time required to perform the examination and data
  capture
• Time to record information
• Time for attending to evaluate electronic data
• Adequacy of electronic data to form initial
  assessment
• System security will also be evaluated by
  combining all CLAY telemedicine systems to assess
  the following
• System availability
• Patient data security

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CLAY - What is it?
CLAY is an internet system developed to offer
fast, secure, complete patient data to remote
locations and act as an electronic patient
record. System supports image data, video and
cine data, DICOM and has the ability to extract
data directly from legacy systems. CLAY
operates in a secure fashion with automated
back-up and security auditing functions. CLAY
is designed to provide adequate patient
evaluation information without training and with
only a computer connected to the internet via a
modem. CLAY is a HIPPA certifiable system.
CLAY was developed by mdconsult.net owned by
author and donated for use in this project.
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CLAY - Modules
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CLAY - Chart and Exam Data
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CLAY - Wound Image Data
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CLAY - Wound Image Data
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CLAY - Radiology Data
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Usage Results for Five Patients
Entries with 2 values indicate initial entry or
data capture as well as a secondary entry or
evaluation.
Average Capture Evaluation Data Capture Time 14
mins. Average Data Entry Time 13 mins. Average
Attending Evaluation Time 3 mins. Percentage of
Time Adequate 100 Of note attending
evaluation occurred at a multitude of locations
including the hospital and at home.
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Security and System Availability Results Based on
Three Systems
Data for security of a CLAY telemedicine system
is based on pooling data from three separate CLAY
incarnations (uhs.mdconsult.net,
vascular.mdconsult.net, demo.mdconsult.net) for a
total of 78 months (56,160 hours) of combined
system time uhs.mdconsult.net 31 months
vascular.mdconsult.net 25 months
demo.mdconsult.net 22 months Uptime 99.8 P
assword Failures 174 Security
Attacks 19 Patient Data Compromises 0
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Cost Analysis
Hardware Costs Digital Camera 600 Computer
w/internet 1000 Software Costs Licensing 500
0 - 20,000 per year for typical 5000 patient
population with 50 health care professionals.
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Conclusions

• CLAY successfully meets the challenge of
  providing timely data regarding patient hand
  injury in a cost effective manner in this
  relatively small patient population.
• 100 adequacy of information
• 0 patient data compromise
• Low cost
• Excellent portability
• In addition the system offers the following
  advantages
• Durable portable patient record
• Improved training for residents and junior
  attendings
• Meets HIPPA guidelines for secure
  communication with
• patient or health care professionals
• Excellent tool for outpatient or home-based
  evaluation of patients

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Conclusions

• There remain some challenges
• In untrained, unsupported user one example of
  not being able to view on-line digital video
  (incorrect computer set-up)
• Legal Concerns
• State licensing issues
• Using electronic record to make clinical
  decisions

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Thank you. For more information visit
www.mdconsult.net
Steven Williams, MD J. Grant Thomson,
MD Department of Plastic Surgery Yale University
School of MedicineNew England Hand
Society Twenty-Ninth Annual Meeting and
Scientific Program December 7, 2001