Telehealth in the New Millennium

1. 1 Telehealth in the New Millennium Helen R. Connors, RN,Ph.D. University of Kansas School of Nursing

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3. 3 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)

4. 4 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)

6. 6 Why Telemedicine Failed: Lack of sustaining financial support Complex telecommunication solutions Lack of technological standards Technology focus

7. 7 Why Telemedicine Resurfaced: Technological advancements Funding opportunities Political climate Economic constraints Broad array of services (telehealth)

8. 8 OPPORTUNITIES Competitive edge Streamlined operations Improved quality Improvements in health

10. POTS Systems

11. PC System

12. Room Systems

13. Web-based Systems

15. 15 Telecommunications Act 1996 February 1996 Telecommunications can extend the benefits of medical services and technology to Americans in rural areas.

16. 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

20. 20 KUMC Program 4th most active site in the United States �Multi-Specialty� care approach Selected as TOP 10 program Innovative contexts Innovative technologies

21. 21 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

22. 22 Top Sites (continued) East Carolina University University of California/Davis Baylor MGH Ohio State University Georgia Statewide Telemedicine Program

24. 24 Broad Clinical Services Pediatric Cardiology Neurology Adult Cardiology Psychiatry: Adult / Child Rheumatology Dermatology Oncology Pain Management Gastroenterology Allergy / Immunology Urology Plastic Surgery Pediatrics Hematology

25. 25 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

26. 26 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

29. 29 Tele-KidCare� Update Findings consistent with Pilot Study Almost 400 consults Status of equipment No major equipment problems Wide Community and National Interest

30. 30 Tele-KidCare� Research Cost Tracking Reimbursement Outcomes absenteeism access Acceptance/Satisfaction Patient/Parent/Provider

31. 31 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

32. 32 Tele-KidCare� Lessons Learned Organizational infrastructure essential Changing role of the school nurse Dedicated Staff physician nurses telemedicine coordinator

33. 33 Tele-KidCare� 1999:Expansion of Services Six additional schools Grant funding Clinical services expansion of practitioners additional nurses trained addressing other needs Educational services

34. 34 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

37. 37 Other Telehealth Projects Tele-Hospice Care Tele- Psychiatry Services acute care facilities community mental health centers group homes jail systems

38. 38 Educational Services Continuing Education Community Service/Consumer education Hospital Inservice Academic Programs

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44. 44 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

45. 45 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

46. 46 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.

49. 49 Policy Issues Credentialing Standards, guidelines, and protocols Liability Reimbursement Privacy and Security Professional Licensure Fraud Ethical issues of tele-diagnosis

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51. 51 Thank You