A Telehealth Overview
July 30, 2013
Mary DeVany, gpTRAC
Who is gpTRAC?
What do we do?
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Provide guidance
Gather information
Answer questions
Share tools and resources
Provide education
Encourage collaboration
Gather regional information
Potato/Potato
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Telemedicine
Telehealth
eHealth
eCare
Virtual Health
Virtual Care
Remote Health
mHealth
Telehealth:
Providing/receiving health
care services at a distance.
Yesterday…
House Call to
Clinic Visit
• In person care
• Get what’s available
• If not available?
– The patient travels to find it…
Where do you go for your care?
History of
Telemedicine
in South
Dakota…
…Brief!!
• Initiated in 1993
– Governor’s Telemedicine Task Force
– Primarily a Collaborative effort
between…(then)
• McKennan Hospital
• Rapid City Regional
• Sioux Valley Hospital
• Main Focus
– Evaluate if telemedicine was a viable
option for patient care in SD
Where/How is
Telehealth used?
(i.e. applications)
Telehealth as a “tool”:
• Not be viewed as a stand-alone
service
• Not be viewed as “different” care
• Incorporate into standard, daily
practice
• Blend into organization’s overall
strategic goals/objectives
Common Applications
• In/Out Patient Specialty Services
– Dermatology**
– Mental Health**
– Cardiology
– Infectious Diseases
– Pediatric Services
– Endocrinology
– Wound Care
– Pulmonology
– Oncology
– Stroke Care
…and more
**Most requested – least capacity
Common Apps (cont)
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Telepharmacy
TeleHome Health (home monitoring)
Case/Disease Management
Tele-Emergency
Remote ICU Monitoring
Family Connections
Education
– staff, provider, family, community
Other Applications
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School-based Care
Dialysis
Support groups
Speech therapy
Remote ultrasounds
Pre-commitment assessments
Sign Language interpretation
Dietary counseling
Rehab services
Supervision
PTSD/TBI
“New” Applications
Stroke/Emergency
• Stroke
– 24/7 access to stroke expertise
– Assistive, available “on-demand”
– Supported by the American Stroke Assoc.
(AHA)
• Emergency
– Similar access, or just overnight coverage
– Access to trauma experts
– Assistive – does not supersede EMTALA
Home Health
• Monitoring
– Manage chronic disease
– Reduce hospitalizations
• Access to Healthcare Services from Home
– “Doc, Can you please look at Tommy’s ear?”
• Smart Homes
– Monitor patients at home
– Sensors in everyday appliances
– Encourages improved “quality of life”
Pharmacy
• Hospital-based
– Allows for 24 hour coverage
• Retail-based
– Maintain small-town pharmacy
coverage
– Patient education
mHealth
• Glucoboy
• iPhone Apps
– iTriage, ReachMD CME, Headache Log,
Epocrates Rx
• Wireless monitoring/peripherals
– Blue Tooth enabled scopes
– Contact lens that monitors Gloucoma levels
• Email & Secure Messaging
– Appointment reminders
• Social Media
Technologies
used in
telehealth…
Technology…
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Big, heavy, difficult
Smaller, lighter…still difficult
Mostly stand-alone
NOW…
– Common place
– Integrated
– Expected
– Mobile!
Technologies:
• Image transfer
– Teleradiology
– Pathology
– Dermatology
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Videoconferencing
Remote Monitoring
Robotics
Smartphones (mobile devices)
Examples:
“New” Examples:
Degrees of Telehealth:
Innovations Center/Health Care Advisory Board
Healthcare Issues:
• Reduce Expenses
• Improve Access to Care
• Maintain/Grow Services
• Stretch the Workforce
• Strengthen Communities
• Manage Expectations
• Change is hard
What are the challenges?
Challenges:
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Connectivity/Interconnectivity
Long Term Care Services/Asst. Living
Remote Home Health Monitoring
Reimbursement/Regulations
Provider Preparedness/Training
Organizational Structures/Buy-in
Keeping Up
mHealth
What are the rules and
regulations?
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Licensing
Credentialing
Privileging
Reimbursement
Prescribing
HIPAA
Others:
• Fraud/Abuse
• Malpractice
• Liability
– (for NOT using…?)
Data = Value
• Track the data, prove the value
– Why are you doing this? Was it
successful?
• Track it right…from the beginning
– Know what you want/need to track
• Supports budget/sustainability
requests
What are the
expectations?
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Patients/Families
Communities/Partner Facilities
Graduates/In-coming Workforce
Payers
- Federal Government, etc.
• Healthcare Reform
The Future:
• New Technologies/customer
expectations will drive telehealth
• Migration from episodic care to
continuous assessment (read
accountable care…?)
• Care will move more into the home
and will travel with the patient.
More…
• Mobile communications, sensor
devices and nanotechnology will
alter the way that health care is
delivered
• Moving from cost shifting to
performance and quality
Pending Challenges:
• Need to incorporate more with HIT
• Workforce needs
– including TH skills
• More consumer-based, consumerdriven
What are the
benefits and
values of
telehealth?
Organizational
• Access to add’l care resources
• Staff competency
• Community perception
• Service stability
• Patient Experience
• Peer-to-peer interactions
Budget-Related
• Stretch a tight travel budget
• Increase ancillary services
• Service continuation/expansion
• Enhance the quality of care
• Market-leader
Provider Benefits
• Support primary care providers
• Specialists can have “virtual”
presence in a community
• Professional shortage/burn-out
• Enhance professional relationships
• Enhance the quality of care
Opportunities: Telehealth
• Provides access to specialty services not
otherwise available within the
community.
• Provides a level of professional support.
(accustomed to during medical school)
• Access to continuing educational
opportunities
Patient Benefits
• Increases access to specialists in local
community
• Don’t have to travel or loose
excessive work time
• Family can be readily present
• High patient satisfaction/acceptance
• Enhances the coordination of care
Community Benefits
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Supports the local facility
Supports local main street
Access to medical education
Save travel dollars
Provides service not otherwise
available
Economic Development
What do new business prospects look
for in a community:
• Viable Infrastructure
• Strong schools
• Quality healthcare
Economic Stability
• Retain the current patient services
• Reduce what “leaves” your community
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Tests
Pharmacy
Groceries, hotel, etc
General “main street” dollars
Economic Impact Healthcare
• Health-generated employment is often
10-20% of the total employment in a rural
community, second only to schools.
• Town with a population of 2,000
generates $ 3,000,000 in health care, with
$417,000 being spent on rural primary
care office visits.
o Where is it going?
Economic Impact Physician
• A rural doctor is worth $343,706 per
year in economic impact and 17.8 jobs
in a rural community (1998)
• Bringing a doctor to a rural community
has the economic impact of $1 million
or more annually. (MN/OK studies)
Who is doing
what?
National Snapshot:
• Specialty Services continue to grow
- Companies (provider groups) offering
services…independent of hospitals/systems
- Healthcare systems now involved who haven’t
been before
• Stroke & Emergency are today’s “flavor”
• Remote Home Monitoring is growing
• mHealth is here, but still maturing
- Apps coming out our ears! (Remotoscope)
• Rules/Regulations behind technology
Evangelical Good
Samaritan Society
• Living Well@Home
– Remote Monitoring
– Sensors
– Others?
Avera Health
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Various specialty services
Tele-ICU
Emergency Room
Pharmacy
More in the works
– LTC, Stroke, etc.
Regional Health
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Oncology
Specialty Services
Remote ICU
Pharmacy
Others?
Sanford Health
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Tel-emergency
Pediatrics echoes
GYN Oncology
Neurology
Tele-dialysis
Pharmacy
Horizon Health –
Community Health Centers
• Access services from multiple
health systems
• Specialty services
• Sharing services across offices
within network
VA
• Long-time user of telehealth
services.
• Services accessible primarily from
WITHIN the VA network.
• Some interest now in trying to
cross into other networks to
provide care more effectively.
Indian Health Services
• Long-standing utilization of
telehealth services
– Local providers
– Providers from all over the nation
(don’t have the cross-state licensure issue)
• Access to services has been
inconsistent
More information?
Resources:
• Great Plains Telehealth Resource & Assistance
Center (gpTRAC)
www.gptrac.org
www.accesstelehealth.org (a “telehealth101” site)
• Additional Telehealth Resource Centers
www.telehealthresourcecenters.org
• Center for Telehealth & e-Health Law
www.ctel.org
• American Telemedicine Association
www.americantelemed.org
“The general concept of health care
quality does not change from urban to
rural settings. The focus remains on
providing the right service at the right
time in the right way to achieve the
optimal outcome.”
National Advisory Committee on Rural Health and Human
Services Report, Health Care Quality: The Rural Context
Thank You!
Contact Info:
Mary DeVany, Director
Email: medevany@gmail.com
Direct: 605-743-5902
www.gptrac.org
Toll Free: 888-239-7092