Telehealth in the New Millennium

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Telehealth in the New Millennium

• Helen R. Connors, RN,Ph.D.
• University of Kansas
• School of Nursing

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Telemedicine Vs Telehealth
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Telemedicine

• Telemedicine is the use of telecommunication and
  information technology to provide clinical care
  to individuals at distant sites and the
  transmission of information needed to provide
  that care.
• 
  Institute of Medicine (1996)

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Telehealth

• Telehealth is the use of modern information and
  telecommunication technologies to provide health
  care services and access to health information
  for health professionals and consumers to train
  and educate health professionals to increase
  awareness and educate the public about
  health-related issues and to facilitate research
  about health care issues ,across a distance.
  Institute of Medicine (1996)

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Telemedicine Activity
IATV programs - N. America
60
40
of
20
programs
0
1960
1965
1970
1975
1980
1985
1990
1995
1960
1965
1970
1975
1980
1985
1990
1995
Year
Source Telemedicine Today
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Why Telemedicine Failed

• Lack of sustaining financial support
• Complex telecommunication solutions
• Lack of technological standards
• Technology focus

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Why Telemedicine Resurfaced

• Technological advancements
• Funding opportunities
• Political climate
• Economic constraints
• Broad array of services (telehealth)

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OPPORTUNITIES

• Competitive edge
• Streamlined operations
• Improved quality
• Improvements in health

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So how does it work? Its all about bandwidth . .
.
POTS 56 kbps
128 kbps ISDN
1.544 Mb T1
Standard phone
384 kbps 1/4 T1
140 Mb Cable
Computer screen
Room-based systems
TV
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POTS Systems
Hardware Solutions
56-64 Kbps
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PC System
Hardware Solutions
64 - 384 Kbps
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Room Systems
Hardware Solutions
128 Kbps - Cable
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Web-based Systems
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Web, E-mail Reports
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Telecommunications Act 1996

• February 1996
• Telecommunications can extend the benefits of
  medical services and technology to Americans in
  rural areas.

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Telecommunications Act 1996

• Affordable telecommunications services to all
  Americans (Universal Service).
• Telehealth
• Discounted rates
• 400 million
• Schools and libraries
• Discounted rates - 20 -90
• 2.25 billion cap

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The KANSAS Model
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Telemedicine in Kansas1991
Kansas City
Hays AHEC
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Telemedicine in KansasCURRENT SITES
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KUMC Program

• 4th most active site in the United States
• Multi-Specialty care approach
• Selected as TOP 10 program
• Innovative contexts
• Innovative technologies

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Top Telemedicine Site

• The University of Vermont/Fletcher Allen Health
  Care
• The University of Texas Medical Branch, Galveston
• Allina Health System, Minneapolis
• Texas Tech University/HealthNet
• East Montana Telemed Network

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Top Sites (continued)

• East Carolina University
• University of California/Davis
• Baylor
• MGH
• Ohio State University
• Georgia Statewide Telemedicine Program

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Telehealth Contexts

• Rural Hospitals
• Community Mental Health Centers
• Jail Systems
• Home Health Care
• Hospice Care
• Nursing Homes
• Schools

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Broad Clinical Services

• Pediatric Cardiology
• Neurology
• Adult Cardiology
• Psychiatry Adult / Child
• Rheumatology
• Dermatology
• Oncology

• Pain Management
• Gastroenterology
• Allergy / Immunology
• Urology
• Plastic Surgery
• Pediatrics
• Hematology

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Tele-KidCare Project Development

• Collaborative Organizations
• University of Kansas Medical Center
• USD 500 Schools, Kansas City, KS
• Provider Teams
• KUMC, Department of Pediatrics
• USD 500 School Nurses
• Service Infrastructure
• KUMC TeleMedicine Services

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Tele-KidCare Project Goals

• Increase access to care--urban underserved
• Promote health
• Improve functional status
• Contain costs
• Emphasize prevention and early detection
• Improve service quality
• Pilot template for other contexts
• rural, urban served, international

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Tele-KidCare Update

• Findings consistent with Pilot Study
• Almost 400 consults
• Status of equipment
• No major equipment problems
• Wide Community and National Interest

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Tele-KidCare Research

• Cost
• Tracking
• Reimbursement
• Outcomes
• absenteeism
• access
• Acceptance/Satisfaction
• Patient/Parent/Provider

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Tele-KidCare Lessons Learned

• Telemedicine effectively provides access to an
  underserved urban population
• Tele-KidCare quickly adopted
• Technology becomes secondary
• To begin, expect a significant investment in time
  

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Tele-KidCare Lessons Learned

• Organizational infrastructure essential
• Changing role of the school nurse
• Dedicated Staff
• physician
• nurses
• telemedicine coordinator

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Tele-KidCare 1999Expansion of Services

• Six additional schools
• Grant funding
• Clinical services
• expansion of practitioners
• additional nurses trained
• addressing other needs
• Educational services

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TeleKidCare for Rural Kansans

• KUMC Budget Proposal 255,000
• Equipment for 10 sites
• computer, software, stethoscope, otoscope
• Funding for Project Coordinator
• Providers--identification of health care team
• physicians, nurses, psychologists
• Services--dictated by the local need

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Tele-Home Care
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Other Telehealth Projects

• Tele-Hospice Care
• Tele- Psychiatry Services
• acute care facilities
• community mental health centers
• group homes
• jail systems

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Educational Services

• Continuing Education
• Community Service/Consumer education
• Hospital Inservice
• Academic Programs

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1994
NP Practice Sites
State Locations Kansas- 26 Missouri - 2 Michigan
- 1 Texas - 7
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1998
NP Practice Sites
State Locations Kansas- 208 Missouri -
33 Oklahoma - 9 Texas - 7 Illinois - 3 Iowa -
3 New Mexico - 3 Arizona - 2 Arkansas - 2 North
Carolina - 2 Alaska - 1 California - 1 Colorado
- 1 Florida - 1 Georgia - 1 Nebraska - 1 South
Dakota - 1 South Carolina - 1 Germany - 1
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Telehealth Evaluation applied research to . . .

• assist policymakers with decisions regarding
  infrastructure, funding, or barriers
• provide clinicians and patients with adequate
  reassurance or precautions
• assess feasibility, cost-effectiveness, and
  acceptance
• guide invested programs for improvement, direction

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Telehealth EvaluationWhat do we want to know?

• Quality of patient care
• Clinical Process
• Health Outcomes
• Appropriateness of patient care
• Issues related to access
• Barriers
• Utilization
• Acceptance
• Costs / Cost-Effectiveness
• Best Practices - Benchmarking

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I Predict...

• Telehealth will win out over telemedicine.
• The use of telehealth will steadily increase
  especially for Medicare and rural populations.
• Telehealth will survive and thrive when the
  focus is NOT on the telehealth aspect.
• The focus should be on the SERVICE. Telehealth
  will simply be a means to link the service
  providers with their clients.

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Health Management Process
Primary Care Provider
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Digital Nervous System

• Components
• Up-to-date Computer
• Productivity Site
• Internet Connections
• Seamless integrated applications

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Policy Issues

• Credentialing
• Standards, guidelines, and protocols
• Liability
• Reimbursement
• Privacy and Security
• Professional Licensure
• Fraud
• Ethical issues of tele-diagnosis

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Thank You