Understanding the Interest and Utility of Telehealth
IHS Leadership Symposium
April 17, 2012
What is telehealth?
The practice of transcending geography by
using electronic communication devices to
enable face-to-face clinical services and
education.
Why telehealth?
The opportunity to improve quality, access,
equity and affordability of health care.
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The U.S. Veterans Administration reports reductions in utilization of between
20-56% when care coordination and home monitoring are employed. -- Dept.
of Veterans Affairs, June 2009
Mortality rates dropped from 13.6% to 11.8% after tele-ICU was implemented,
and LOS in the ICU fell from 13.3 days to 9.8. -- JAMA, 2011
California prison officials provided roughly 9000 telehealth consultations in
2004, saving taxpayers more than $4 million in transportation and escort
costs. -- CA Healthcare Foundation, 2008
Telemonitoring reduced hospitalizations by 75% and ER visits by 83%. -- PA
Homecare Assn.
In 2007, Sutter estimated that 425 sepsis-related deaths were prevented and
the eIUC resulted in $2.6 million in savings. -- Sutter Health EIUC, Computer
World 2007
Broadband Technology
Opportunities Program (BTOP)
Funded by the American Recovery and
Reinvestment Act (ARRA)
 Nationwide provides $4.7 billion in grant
funding for deploying broadband
infrastructure, enhancing broadband
capacity at public computing centers, and
promoting sustainable broadband adoption
projects.
 Advances the objectives of the Recovery Act
to spur job creation and stimulate economic
growth and opportunity
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BTOP Grant Partners
Rural Iowa Telehealth Initiative
Iowa Health
Des Moines
Clarke
County
Hospital
Greene
County
Medical
Center
Guthrie
County
Hospital
Grundy County
Memorial
Hospital
Rural Iowa Telehealth Initiative
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The Rural Iowa Telehealth Initiative proposes to
bring broadband capabilities to medical facilities
across rural and underserved parts of Iowa. This
project aims to improve health care and delivery,
provide education and training for rural health
care practitioners, facilitate telehealth, support
disaster readiness, and promote health education
and awareness for residents.
$8.3 million grant for 3 years through 8/31/2013,
matched by $6.2 million in partner funds = $14.5
million
Clinical Telehealth Applications
Model Design Objectives
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Increase access to quality care locally
Physician friendly & efficient
“Anywhere” patient access within CCH
Ease of use for all staff
24/7 availability
Network reliability, security
Flexible
Available for inpatient visits from family friends that are
geographically separated
Technology allows for system growth
Partnership opportunities
Community access throughout Clarke County
Opportunity for new/increased revenue
Potential for growth and expansion
Compliant with industry standards to connect with
other systems
Fiscally responsible
Local Access to Quality Health Care
 Specialty
emergency)
physicians
 Professional
(outpatient, inpatient,
and community education
 Quality improvement through case review
 Enhance patient experience
Telemedicine Specialty Locations
Live
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Cardiology
Neurology
Nephrology
Pulmonology
General Surgery
Psychiatry
Plastics
Employee
Assistance Program
In Progress
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Pharmacy
Urology
Podiatry
Endocrinology
Bariatric
Ambulance
Emergency Department
Future
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Internal Medicine
Orthopedics
Trauma Surgeons
Infectious Disease
Pathology
Oncology
Dermatology
Vascular
Wound Center
Pain Management
Patient Exam Devices
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Camera/Lightsource/Otoscope
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Stethoscopes (Bluetooth technology)
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Exam Cameras
Community Based Telehealth Applications
Unique Telemedicine Applications
Women’s Health
 NICU and PICU
 Pediatrics
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Telemedicine/Telehealth
Telemedicine associated with
direct patient clinical services.
Telehealth associated with a broader
definition of remote healthcare services.
Telehealth Applications & Benefits
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Virtual Incident Command Center
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Strengthens partnerships for law enforcement,
schools, fire, rescue, city/county/state government,
and public health with hospital
Inmate Health Assessments
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Reduced budget for sheriff's department
Safety of hospital staff
Telehealth Applications & Benefits
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Virtual Recreation Center
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Wellness education and fitness classes
offered in smaller communities in
the county
Health Improvement Plan intervention for obesity
and cardiovascular disease
Home Care
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Access to physicians, dieticians,
wound care nurses, and other expertise
for homebound patients
Telehealth Applications & Benefits
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School health nursing services
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School nursing services in all buildings
Health occupations education
Community and health care professional education
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Wellness education, support groups
Health care professional education and CEUs
EMS volunteers train in their own communities
Education Based Telehealth Applications
GCMH School & EMS Locations
School Education
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Current Programs
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CNA course assistance
Career exploration
Infection
control/prevention
Telehealth 101
Fire Safety
13 courses conducted
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6 schools
19 staff hours
School Education
Future Plans
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Healthy cooking, healthy eating
Basic functions of body systems
Medicine/drug identification
Heart health
How germs work
Process for trauma/heart attack
situations
Sports injury prevention
Death & Dying
Getting enough sleep
Preparing for Surgery
Seat Belt Safety
MRSA-Playing It Safe Diagnostic
Imaging
Risk Watch – suffocation, chocking
strangulation
Basics of health insurance
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History (utilizing knowledge of
LTC residents)
Community Service (Long
Term Care - school e-buddy
program)
Partnership with Hawkeye
Community College for CNA
course
EMS Education
Quarterly CEH/CEU
offerings
 Connection to IHSsponsored events
 Connection to other
video-based
education
 Future plans: Remote
ECG transmission
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Additional Telehealth Applications
Guthrie County Hospital
Access - Internal
4 Family Medicine Clinic sites
 Employ
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Internal Medicine
 Family Practice
 Family Practice ARNP
 Pediatrician (July 2012)
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Access - Schools
Pediatrician – first ever
 Over 8,000 kids 0-14
 School Based Health Clinics
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6 schools systems with 13 different buildings
 Behavioral Health
 Impact
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Specialists – In place
Employed – IM, Pediatrics, ED
 General Surgery
 Plastic/Reconstructive Surgery
 Vascular Surgery and Wound Care
 Neurology
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Other Connections - Dreams
Cardiology
 Psychiatry
 Oncology
 Area Nursing Homes
 Home Monitoring
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Knowledge
Access
 Collection
 Distribution
 Relationships
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Telehealth Benefits
Senior Affiliates
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Connectivity between campuses
 Increased efficiency for staff and physicians
Opportunity for business development
 Expanded service to secondary markets (neurology, nephrology,
cardiology)
 Impact referral patterns (cardiology story)
Expanded partnership with rural hospital network
 Relationship expands to the patient care level
Lead Iowa in implementation of telehealth technology
 Approximately $6 million in video conferencing equipment funded by grant
Rural Hospitals
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Supports rural hospital ability to capture outpatient ancillary services and
procedures
Support of affiliated specialty physicians and nurses
Staff education and CEUs available in local communities
Telehealth Benefits cont.
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Patient
 Health care close to home
 Decreased travel risks, travel time and cost
 Homebound patients, inmates and students can be seen by
physicians and nurses
Physician
 Decreased travel time and cost
 Decreased risk of driving in inclement weather
 Increased efficiency & ability to see more patients
Community
 Strengthens partnerships with schools, colleges, cities and
state govt.
 Patients stay in local community for care
 Wellness education & professional education can be offered
in local communities
 Increases IH-DM exposure in outlying communities
Key Points
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Planning
 Market analysis
 Technology research
Telemedicine Team Development
 Internal team of IT, clinical, administrative, fiscal
 External team
Communication and Relationships
Financial Impact/Sustainability
Technology Considerations
 Expertise
 IHS compatibility and growth
Resources
We are committed to the success of the IHS telehealth program.
Clarke County Hospital
 Brian Evans, CEO bevans@clarkehosp.org
Greene County Medical Center
 Cindy Kail, CNO/Public Health Director cindy.kail@gcmchealth.org
Grundy County Memorial Hospital
 Lynn Blythe, Ambulatory Services Manager blythelm@ihs.org
Guthrie County Hospital
 Jerry Neal, CEO geraldn@gcho.org
Iowa Health-Des Moines
 Tracy Warner, Director, Rural Health Resources warnertd@ihs.org
 Connie Karloff, Hospital/Telehealth Liaison karlofcs@ihs.org
Resources
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American Telemedicine Association
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Great Plains Telehealth Resource &
Assistance Center
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www.americantelemed.org
http://www.gptrac.org/
BroadbandUSA
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http://www2.ntia.doc.gov/iowa