Reducing dermatology wait times to less than 5 days with Store
Forward…Otn.teledermSF
® eHealth
May 27, 2013

Who is OTN
What is Store Forward
Impact on wait times
Utilization
Why is it working?
User feedback
Where are we going from here?
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OTN is a not-for-profit organization funded by the Government of Ontario
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®
SF means Store Forward…move the information, not the patient
Whereas videoconferencing is real-time
(synchronous), store forward is asynchronous
The information is stored and then forwarded for action by the consultant at a later time
Otn.teledermSF
® is a OTN program that incorporates technology, workflow logic to allow the secure flow of information between referring doctors and dermatologists
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The referring doctor, or their delegate, takes a digital photo of the patient’s skin lesion
Referring doc implements treatment with patient
Photo and pertinent patient information is sent to the dermatologist through OTN’s secure software/servers
Dermatologist returns a diagnosis and suggested treatment plan to the referrer
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Access: 180 dermatologists in Ontario
Wait times: The further from a major centre the longer the wait times (anecdotal):
For example:
– 45 minutes from Toronto 3-4 months
– 1.5 hours from Toronto 6 months
– 4 hours from Toronto 8-12 months
– Even reports of 18+ months in some parts of northern
Ontario
Time to treatment reduces costs
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Literature supports effectiveness of Store Forward
– Patient satisfaction is equivalent to face-to-face
– A study of nearly 1,500 shows improved clinical outcomes, with better diagnosis and disease management.
– Teledermatology, when applied to all dermatology referrals, has a probability of being cost saving to society.
Pilot 2009-2010
Operationalized 2011
Remuneration for derms
(Remuneration for referrers not until April 2012)
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600
500
400
300
200
100
FY 2011-2012 FY 2012-2013
0
Month
Currently, in FY 2013/14, 600+ consults/month…and growing
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3000
2000
1000
0
6000
5000
4000
Over 300% from FY2011/12
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2011-2012 TOTAL 2012-2013 TOTAL

18 Ontario-based dermatologists
700+ referring physicians
1000+ “delegate” referring users (NPs, Nurses, etc.)
225+ Primary Care referring sites (FHTs, FHOs,
CHCs, etc.)
The list of dermatologists and referring users grows every week.
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How is Otn.teledermSF affecting wait times?
On average wait times are less than 5 days
Current trending: Less than 3 days
Dermatologists are telling us they are not near capacity
Will add more derms as required
Derms welcome to join any time (referrers too!)
Otn.teledermSF is freeing up time for f-2-f appointments
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“[Telederm] can free up some time in my clinic so the quick patients can be done through telemedicine.”
“I do find that I can better screen subjects to see who needs to be brought in sooner, or who needs a referral to surgery sooner rather than later. I saw a woman with melanoma a couple of weeks ago through Telederm and referred her directly to
Plastics - it was excised in a week. Wouldn't have happened on real clinic referral time .”
Dr. Melinda Gooderham, Dermatologist
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Recall that wait times for a face-to-face appointment can be more than 12 months
“…and I have to say that I’ve been waiting a long time to get responses back from the consultants. I know I used to get responses back as quickly as a couple of hours and now for some, 3-5 days.
”
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Delegate model allows for distributed workflow
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Like using you iPad as a cutting board…
Work flow at some referring clinics: hybrid of
Otn.teledermSF and paper
Delegate handles Otn.teledermSF
Consult notes are printed and handed to the physician
Perhaps complete physician adoption requires full integration with
EMR
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Referring:
Standardized photo kit
Dermatologists:
Dermatologists encourage adoption with their usual referrers
General:
Supports: training, work flow, RMs, Service Desk
Continuous quality improvements
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Benefits for dermatologists
OHIP Billable
Flexibility to provide diagnosis and treatment when and where convenient
Efficient & effective way to treat patients leading to decreased wait times
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Benefits for referrers
Consults provided within 5 days on average
OHIP billable as an eReferral
Reduces “n” trials of “X” treatments
Timely referrals leading to improved patient outcomes
Increased collaboration with specialist = increased capacity
Potential to reduce costs through efficient referral process (vs. f2f)
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Other User Benefits
OTN develops relationship with dermatologists – no need to search for available derms
Pan-provincial initiative
Collaboration with OneID
OTN Service desk
OTN RMs
Advocacy
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I find Telederm incredibly useful, I have sent 3-4 patients so far and I received speedy advice within 2 days. It is an amazing service. I am very happy being able to use it.
Thanks for your help
Dr. Lili Mileva
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We had less than 24 hour turn around with 2 of our uploaded files and they were to Dr. G.
[Our] doctors had a faxed copy of consultation report in less than 24 hours. That's amazing!
I set this up approximately 3 months ago and the MD's at my clinic are really impressed with the efficient manner in which the referrals are received and processed. The MD's are also satisfied with the recommendations from the specialists. I would highly recommend this program; it meets the needs of many clients. Regular wait times for a Dermatologist can be 8 mo to 1yr. We facilitate their assessment in less than a month.
Fantastic!!!
I have found the OTN TeleDerm process to be a very quick and easy way of obtaining a specialist's opinion for our patients. The average response time is about 2 days, which is remarkable! The patients are very happy to have a diagnosis so quickly. In most of the cases the specialist recommended medication and it was beneficial to the patient to be able to start on the treatment in a timely fashion .
I got my first SF referral answered in less than 24 hrs!!
It’s amazing
.
I personally have had two consults now with Dr. W and have been thrilled with the results. One actually came back the same day I sent it. She lays out the differential diagnoses, advises if biopsy necessary to determine correct diagnosis, and then provides outline of therapeutic plan for each possible outcome. Clear as can be, and so helpful.
Patients are thrilled .
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I must say that I enjoy doing these store forward consultations. I find that the focus is somewhat different than in-office consultations. I tend to give more useful basic information to the PCP, knowing that this physician will be taking active care of the patient in most cases, especially when located some distance from major centres.
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Referring docs can bill the referral as an eConsult
E-Consultation (Physician to Physician):
– This is a service where the referring Physician, in light of his/her professional knowledge of the patient, requests the opinion of another Physician. The “consultant Physician” is able to offer competent advice to provide an accurate opinion. Both the request and the opinion are sent electronically through the use of a secure server.
Billing Code:
– K738 Physician to Physician e-consultation (Referring
Physician)
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In polite conversation topics to avoid:
1. Religion
2. Politics
3. Sex
4. OHIP fees
Consult fees were $72 up to March 31 st 2013
As of April 1 st 2013 fees moved to $44
MoHLTC and OMA have been apprised of the concerns expressed over the reduced fees eReferral cannot be billed same day
Counter productive to the efficiency of Store
Forward
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TeleWound care TelePsychiatry TeleDentistry
(in pilot now) (pilot starting summer 2013)
(exploration)
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What are the steps to get
Otn.teledermSF?
Contact OTN (info@otn.ca)
OTN will contact you
You will receive a password
The password gives you access to the online training materials/videos as well as to Otn.teledermSF itself
Once training is completed (about 45 minutes) you can start referring patients right away
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Manish Rughani
– Supervisor & Systems Administrator, Technical
Operations
Sev Derghazarian
– Telehealth Hardware/Software System Support
Specialist & Systems, Technical Operations
Joy Harris
– Provisioning Group, New Site
Matt Sherman
– Business Analyst, Service Optimization
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Contact information
Stewart Stein
Manager Store Forward
Email: sstein@otn.ca
(preferred)
Phone: 416-446-4110 x4118
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Costs
OTN is a not-for-profit funded by the
Government of Ontario
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An independent not-for-profit corporation funded by the Government of Ontario
Members include 1,000 health care and education organizations
Delivery partners include:
– e-Health Ontario
– Keewaytinook Okamakanak
Telemedicine
– Canada Health Infoway
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One of the world’s largest & most active TM networks
Programs & services delivered collaboratively at more than 1,600 sites (>3,000 systems) across
Ontario
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Teledermatology Patient Satisfaction in the Pacific Northwest - Martha T. Hsueh, R.N., Kristin
Eastman, M.D., Lynne V. McFarland, Ph.D., Gregory J. Raugi, M.D., Ph.D., and Gayle E. Reiber,
M.P.H., Ph.D.
A cost minimisation analysis in teledermatology: model-based approach - Nina Eminović1*,
Marcel G Dijkgraaf2, Rosanne M Berghout1, Astrid H Prins3, Patrick JE Bindels4, Nicolette F de
Keizer1
Netherlands study shows dermatologists using telemedicine to provide efficient care at lower costs van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L.
Teledermatology Operational Considerations, Challenges,and Benefits: The Referring
Providers’ Perspective - April W. Armstrong, M.D., M.P.H.,1 Mei W. Kwong, J.D.,2, Elizabeth P.
Chase, M.D.,1 Lynda Ledo, B.S.,1, Thomas S. Nesbitt, M.D., M.P.H.,3, and Sandra Louise Shewry,
M.P.H., M.S.W.2
Telemedicine boosting dermatology care CAROLYNE KRUPA http://www.ama-assn.org/amednews/2012/01/30/prsc0131.htm
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