Dynamics of Telehealth, Telemedicine, and Telehomehealth

1
Dynamics of Telehealth, Telemedicine, and
Telehomehealth

• How they will help us
• Successfully Age in Place

2
What it will mean for you (when youre
older - )

• For every older person who remains healthy and
  independent through technologies such as
  preventative weight and gait monitoring, pill
  dispensation devices, emergency alert systems, or
  telemedicine
• One less person will have to rely on a nurse's
  aide to bathe them, an emergency room visit to
  detect a simple urinary tract infection, or .
• Institutionalization to provide physical therapy
  for a broken hip after a fall.
• Progress and Possibilities State of Technology
  and Aging Services, 2003, CAST

3
What it means for us now

• Telehealth solutions help physicians and nurses
  better monitor the health of
• Older adults by addressing health problems
  before they get worse
• Reducing emergency room visits and
  hospitalizations.
• Remote monitoring can help medical providers
  understand trends that they never before had
  access to, and
• Better respond to the care of an individual.
• Progress and Possibilities State of Technology
  and Aging Services, 2003, CAST

4
Heres an Example Ch. 2
5
Some first things first

• Telemedicine is the original term used by mostly
  U.S. healthcare providers to mean
• The use of medical information exchanged from
  one site to another through electronic
  communications to improve patients' health
  status. (ATA definition)
• Originally, TM was used to bridge distance or
  make specialty care available.

6
Types of Telemedicine Services

• Specialty consultations mean seeing a clinical
  specialist through electronic means. Usually
  these are through real-time interactive
  videoconferences.
• A specialist also may interpret medical
  information that is stored and forwarded for
  examination later.

7
Store and Forward Services

• Such medical information as
• digital images of the skin can be examined later
  by dermatologists
• human tissue samples can be examined later by
  pathologists
• an EKG or an EEG can be examined later by a
  cardiologist or neurologist.

8
Teleradiology

• Radiology is the medical specialty that uses
  telemedicine most frequently.
• Teleradiologists can examine digital images
  either in a medical facility or even at home.

9
Some telemedicine facts

• Almost 50 different medical subspecialties have
  successfully used telemedicine.
• There are about 200 existing telemedicine
  networks in the United States.
• Of these, estimates are that about half are
  actively providing patient care services on a
  daily basis.

10
Veterans Administration has the most
comprehensive federal program

• Care Coordination Home Telehealth (CCHT) Care
  coordination involving home telehealth
  technologies and focused on supporting the care
  of veterans in the home.
• Care Coordination General Telehealth (CCGT) Care
  coordination involving videoconferencing
  technologies with supportive peripheral devices
  between clinics and hospitals and hospitals and
  other hospitals e.g. telemental health,
  telesurgery.
• Care Coordination involving Store-and-Forward
  Telehealth (CCSF) Care coordination involving
  store-and-forwards is based upon the national
  implementation of a primary care-based program
  will assess veterans with diabetes for
  retinopathy using teleretinal imaging that
  expedites referral for treatment and provides
  health information.

11
Heres an example Ch 3
12
Making telemedicine broader

• Telehealth and e-Health are terms meant to widen
  the boundaries for what we mean by making care
  available by
• lots of different kinds of providers
• in lots of different places.

13
Telehealth is

• Often used to encompass a broader definition of
  remote healthcare that does not always involve
  clinical services. It can involve support groups,
  health education or prevention activities.
• Some of the means to get this done include
• The Internet or e-Health, including patient
  portals, remote monitoring of vital signs,
  continuing medical education, patient education,
  Internet support groups and nursing call centers.

14
Example of Telehealth Services

• Mid-Appalachia Telehealth Project
• Clinic extension into the home
• Diabetes
• Congestive heart failure
• School Asthma Project
• Audio-connect Diabetes Support Groups
• Quality Home Health

15
Diabetes Program

• The Mid-Appalachia Telehealth Project began in
  2003.
• Telehealth services in 4 underserved counties in
  the traditional coal mining Appalachian region of
  Tennessee and on the Cumberland Plateau for
  diabetic Hispanics.

16
Electronic Monitoring

• Up to 100 blood sugars can be stored in the
  different types of glucose monitors.
• The stored data is sent over POTS to the public
  health clinic nurses.

17
Video-Phone
18
Diabetes Program
19
Home Telehealth

• Quality Home Health Agency
• Morgan County
• Use specific vendor solution equipment
• All remote monitoring devices are contained in
  one machine
• Data sent to central monitoring station
  accessible by nurses via the Internet

20
(No Transcript)
21
More on Home Telehealth

• Telehomehealth
• Home Telehealth is a service that gives a health
  care provider the ability to monitor and measure
  patient health data and information over
  geographical, social, and cultural distances.
• This monitoring includes use of both video and
  non-video technologies.

22
And more specifically
Disease Management is the concept of reducing
health care costs and improving quality of life
for individuals with chronic disease conditions
by preventing or minimizing the effects of a
disease through integrative care.
23
What can be monitored remotely?
Viterion scale
Web VMC Virtual Medical Care
24
Disease management is done viaCh4

• Remote monitoring
• Uses devices to remotely collect and send data to
  a monitoring station for interpretation.

25
Home telehealth reduces costs

• Home monitoring programs for the elderly are
  particularly cost-effective. Telehealth can
  provide effective patient monitoring for a cost
  of only 30 per day in the U.S., less than half
  the cost per day of home care and one-third the
  cost per day for nursing care.
• The cost savings are most dramatic when compared
  to the 820 per day cost for inpatient hospital
  care.

26

• We demonstrated significant savings in home
  telehealth in TN. More than 62,000 miles of
  travel were saved for a savings of 16,191 in
  mileage that did not have to be reimbursed.
• Additionally, nurse drive time did not have to be
  reimbursed. Overall this represented a savings of
  50.29 per home visit.
• The more visits that are done through telehealth
  over time, the greater the cost savings per
  visit.

27

• In a recent study by Wakefield et al., results
  indicated that 72 percent of telemedical
  consultations conducted to skilled nursing
  facilities resulted in avoidance of transport for
  health care evaluation.

28
Legislation introduced this year

• 109th Congress Proposed legislation,
  Appropriations/Funding, Initiatives
• HR 3588, S 2282 Medicare Home Health Telehealth
  Access Act of 2005
• S 1733 Fostering Independence through
  Technology Act (FITT)
• S 2022 Remote Monitoring Access Act of 2005
• S 1356 Medicare Value Purchasing Act of 2005
• HR 2807, S 1909 Medicare Telehealth Enhancement
  Act of 2005

29
Legislation that takes effect this year

• Under a new law with provisions that will take
  effect in 2007, states will have the ability to
  seek federal approval to spend Medicaid funds to
  provide home and community care for elderly
  beneficiaries.

30
More and more, remote monitoring is becoming
synonymous with The Aware Home The Smart Home

• Home builders in Florida are offering smart
  floors that can sense when an elderly person has
  fallen and then summon emergency help.
• There also is the digital family portrait
  designed to hang on the wall of an elderly
  persons home. It provides a visual record of
  what an individual did during the day (Ga. Inst.
  Of Tech).

31
Microsoft is involved

• Telemedicine is no longer limited to academic
  medical centers, the military or rural health. 
  Anyone can do telemedicine, and it involves much
  more than establishing an audio-video link
  between those providing and receiving care.
• It may include rich content, remote physiological
  monitoring, and robotics.  It is just as likely
  to be delivered by a television, Xbox, or
  Smartphone as it is a computer.
• Dr. Bill Crounse, M.D., is the global
  healthcare industry manager for Microsoft
  Corporation

32
And so is Intel

• Intel is using its considerable clout to urge
  government leaders to tap the burgeoning
  technology to help solve the economic and social
  challenges brought on by skyrocketing healthcare
  costs and a rapidly growing population of aging
  citizens.
• Intel is researching innovations in sensors,
  software and wireless technologies that allow
  vital information about heart rate, respiratory
  rate, blood pressure and sleep patterns to be
  tracked remotely.
• (Source Sci-Tech Today, March 2, 2006)

33
Non-profit advocacy

• If we are to deliver quality care to todays and
  tomorrows seniors, we need a wellness
  revolution. That is, we need to apply American
  innovation to wellness technologies that enable
  prevention, early detection, increased compliance
  and new modes of remote caregiving and family
  support.
• - Eric Dishman, CAST Chairman and General
  Manager, Intel Health Research Innovation

34
More advocates

• Big idea3 Enable technology applications.
• Technology has great potential to maximize older
  adults' independence, improve quality of care and
  life, support caregivers, increase efficiency,
  and reduce our nation's health care costs. We are
  working to identify technology possibilities,
  demonstrate emerging technologies and advance a
  policy agenda that is focused on quality
  technologies to meet consumer needs.
• Source American Association of Homes and
  Services for the Aging (AAHSA) 2006 Policy
  Objectives

35
A home for the ages Ch. 5
36

• The American Telemedicine Association is a
  resource and advocate promoting access to medical
  care for consumers and health professionals via
  telecommunications technology.
• Its resources are located at
• www.atmeda.org

37
Resource for Home Telehealth

• ATA Home Telehealth Special Interest Group
• Has Home Telehealth Toolkit available
• www.atmeda.org/ICOT/sighomehealth.htm
• New Home Telehealth book also available
• www.rsmpress.co.uk/bkwootton6.htm

38
Thank you!

• Contact information
• Susan L. Dimmick, PhD
• ORAU/ORISE, 865.241.3584
• dimmicks_at_orau.gov or sdimmick_at_utmem.edu
• Telehealth presentation available at
• www.lasell.edu/aging