Understanding the Interest and Utility of Telehealth

1. Understanding the Interest and Utility of Telehealth IHS Leadership Symposium April 17, 2012

2. What is telehealth? The practice of transcending geography by using electronic communication devices to enable face-to-face clinical services and education.

3. Why telehealth? The opportunity to improve quality, access, equity and affordability of health care. • 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

4. 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

5. BTOP Grant Partners Rural Iowa Telehealth Initiative

6. Rural Iowa Telehealth Initiative • 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

7. Clinical Telehealth Applications

8. Model Design Objectives • 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

9. Local Access to Quality Health Care • Specialty physicians (outpatient, inpatient, emergency) • Professional and community education • Quality improvement through case review • Enhance patient experience

10. Telemedicine Specialty Locations Live • Cardiology • Neurology • Nephrology • Pulmonology • General Surgery • Psychiatry • Plastics • Employee Assistance Program In Progress • Pharmacy • Urology • Podiatry • Endocrinology • Bariatric • Ambulance • Emergency Department Future • Internal Medicine • Orthopedics • Trauma Surgeons • Infectious Disease • Pathology • Oncology • Dermatology • Vascular • Wound Center • Pain Management

11. Patient Exam Devices Camera/Lightsource/Otoscope Stethoscopes (Bluetooth technology) Exam Cameras

12. Community Based Telehealth Applications

13. Unique Telemedicine Applications • Women’s Health • NICU and PICU • Pediatrics

14. Telemedicine/Telehealth Telemedicine associated with direct patient clinical services. Telehealth associated with a broader definition of remote healthcare services.

15. Telehealth Applications & Benefits • Virtual Incident Command Center • Strengthens partnerships for law enforcement, schools, fire, rescue, city/county/state government, and public health with hospital • Inmate Health Assessments • Reduced budget for sheriff's department • Safety of hospital staff

16. Telehealth Applications & Benefits • Virtual Recreation Center • Wellness education and fitness classes offered in smaller communities in the county • Health Improvement Plan intervention for obesity and cardiovascular disease • Home Care • Access to physicians, dieticians, wound care nurses, and other expertise for homebound patients

17. Telehealth Applications & Benefits • School health nursing services • School nursing services in all buildings • Health occupations education • Community and health care professional education • Wellness education, support groups • Health care professional education and CEUs • EMS volunteers train in their own communities

18. Education Based Telehealth Applications

19. GCMH School & EMS Locations

20. School Education • Current Programs • CNA course assistance • Career exploration • Infection control/prevention • Telehealth 101 • Fire Safety • 13 courses conducted • 6 schools • 19 staff hours

21. School Education Future Plans History (utilizing knowledge of LTC residents) Community Service (Long Term Care - school e-buddy program) Partnership with Hawkeye Community College for CNA course • 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

22. EMS Education • Quarterly CEH/CEU offerings • Connection to IHS-sponsored events • Connection to other video-based education • Future plans: Remote ECG transmission

23. Additional Telehealth Applications

24. Guthrie County Hospital

25. Access - Internal • 4 Family Medicine Clinic sites • Employ • Internal Medicine • Family Practice • Family Practice ARNP • Pediatrician (July 2012)

26. Access - Schools • Pediatrician – first ever • Over 8,000 kids 0-14 • School Based Health Clinics • 6 schools systems with 13 different buildings • Behavioral Health • Impact

27. Specialists – In place • Employed – IM, Pediatrics, ED • General Surgery • Plastic/Reconstructive Surgery • Vascular Surgery and Wound Care • Neurology

28. Other Connections - Dreams • Cardiology • Psychiatry • Oncology • Area Nursing Homes • Home Monitoring

29. Knowledge • Access • Collection • Distribution • Relationships

30. Telehealth Benefits Senior Affiliates • 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 • 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

31. Telehealth Benefits cont. • 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

32. Key Points • 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

33. 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

34. Resources • American Telemedicine Association • www.americantelemed.org • Great Plains Telehealth Resource & Assistance Center • http://www.gptrac.org/ • BroadbandUSA • http://www2.ntia.doc.gov/iowa