telemedicine

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The State of Telemedicine in the Commonwealth of
Virginia 2009
David Cattell-Gordon Director of Community
Engagement Rural Network Development UVA
Telemedicine Program
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The State of Telehealth

• Current Applications
• Benefits
• Innovative Approaches
• Implications for Health
• Next Five Years
• Challenges

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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 doesnt spread a bug

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Definition of Telemedicine

• The use of advanced telecommunications and other
  technologies for
• Medical diagnosis
• Ongoing patient care
• Health-related distance learning

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Telemedicine History

• Alexander Graham Bell
• Hugo Gernsback
• Massachusetts General
• NASA
• Dept of Defense
• University of Virginia

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Mission of Telehealth

• Facilitate the Health Systems missions of
• Clinical Care
• Teaching
• Research
• Public Service

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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

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It is all about the network

• Academic-community hospital linkages
• Rural clinics (FQHCs, Veterans clinics)
• Free clinics
• Health departments
• Correctional facilities
• School health
• Nursing homes
• Home telehealth
• Workplace
• Medical offices
• Retail clinics

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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

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Telehealth Growth _at_ UVA
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Telehealth affiliations
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Telemedicine Sites Far Southwest Virginia

• 1. Abingdon
  Johnston Memorial Hospital
• 2. Abingdon Johnston Memorial Hospital Cancer
  Center
• 3. Bastian Bland County Medical Center
• 4. Big Stone Gap Wise County Behavioral Health
  Services
• 5. Big Stone Gap Mountain Empire Older Citizens
• 6. Bristol Southwest Virginia Care Connection
• 7. Bristol Twin City Medical Center
• 8. Clinchco The Health Wagon
• 9. Dungannon Clinch River Health Services
• 10. Galax Twin County Regional Hospital
• 11. Gate City Scott County Health Dept.
• 12. Grundy Buchanan General Hospital
• 13. Haysi Haysi Clinic
• 14. Konnarock Stone Mountain Health Services
• 15. Laurel Fork Tri-Area Health Clinic
• Norton Norton Community Hospital
• Oakwood College of Pharmacy
• 18. St. Paul William A. Davis Clinic
• 19. Saltville Saltville Medical Center

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Benefits of Telehealth

• Rural communities
• gt85 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

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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

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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

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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

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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

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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

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Innovative Applications

• Tele-ophthalmology
• Screening for diabetic retinopathy
• Retinopathy of prematurity
• Tele-dermatology
• Store forward/live interactive
• Tele-mental health
• Critical shortage of mental health providers

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Innovative Applications

• Acute stroke
• Time is of the essence, TPA administered in lt
  3hrs
• Increased use from 4-23 in rural hospitals

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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

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Remote Area Medical
 
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Building a Healthy Appalachia
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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

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Challenges

• Coverage Reimbursement
• Broadband Access Costs
• Comfort with Usage
• Licensure
• Inter-operability

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