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David Cattell-Gordon Director of Community Engagement & Rural Network Development

The State of Telemedicine in the Commonwealth of Virginia 2009. David Cattell-Gordon Director of Community Engagement & Rural Network Development UVA Telemedicine Program. The State of Telehealth. Current Applications Benefits Innovative Approaches Implications for Health

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David Cattell-Gordon Director of Community Engagement & Rural Network Development

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  1. The State of Telemedicine in the Commonwealth of Virginia 2009 David Cattell-Gordon Director of Community Engagement & Rural Network Development UVA Telemedicine Program

  2. The State of Telehealth • Current Applications • Benefits • Innovative Approaches • Implications for Health • Next Five Years • Challenges

  3. Telehealth & Telehealth-Related Prosperity: A Vision for the Future • A elderly patient takes her meds • A newborn has a chance at life • A child succeeds in school • A rural person has more time at work • A women survives breast cancer • A patient is enrolled in a clinical study • A nurse learns a new procedure • A presenter doesn’t spread a bug

  4. Definition of Telemedicine • The use of advanced telecommunications and other technologies for: • Medical diagnosis • Ongoing patient care • Health-related distance learning

  5. Telemedicine: History • Alexander Graham Bell • Hugo Gernsback • Massachusetts General • NASA • Dept of Defense • University of Virginia

  6. Mission of Telehealth Facilitate the Health System’s missions of • Clinical Care • Teaching • Research • Public Service

  7. Current Telehealth Applications • Videoconferencing for patient care • Store and forward applications • Tele-pharmacy • Remote monitoring and home telehealth • m-Health • Health information exchange • Emergency preparedness/disease surveillance • Distance learning

  8. It is all about the network… • Academic-community hospital linkages • Rural clinics (FQHCs, Veteran’s clinics) • Free clinics • Health departments • Correctional facilities • School health • Nursing homes • Home telehealth • Workplace • Medical offices • Retail clinics

  9. Childhood obesity Ophthalmology Orthopedics Adult and Pediatric Nephrology Pulmonary medicine Pain management Plastic Surgery Urology Gynecology Emergency Medicine Geriatric medicine Surgery TCV Radiology Wound care Dermatology Hepatology Pediatric Cardiology Infectious Disease (HIV) Psychiatry Other GI Genetics Endocrine Neurology Neurosurgery ENT Cardiology Hematology Rheumatology Toxicology/Poison control Telemedicine Subspecialty Participants

  10. Telehealth Growth @ UVA

  11. Telehealth affiliations

  12. Telemedicine Sites: Far Southwest Virginia 1. Abingdon Johnston Memorial Hospital 2. Abingdon Johnston Memorial Hospital Cancer Center 3. Bastian Bland County Medical Center 4. Big Stone Gap Wise County Behavioral Health Services 5. Big Stone Gap Mountain Empire Older Citizens 6. Bristol Southwest Virginia Care Connection 7. Bristol Twin City Medical Center 8. Clinchco The Health Wagon 9. Dungannon Clinch River Health Services 10. Galax Twin County Regional Hospital 11. Gate City Scott County Health Dept. 12. Grundy Buchanan General Hospital 13. Haysi Haysi Clinic 14. Konnarock Stone Mountain Health Services 15. Laurel Fork Tri-Area Health Clinic • Norton Norton Community Hospital • Oakwood College of Pharmacy 18. St. Paul William A. Davis Clinic 19. Saltville Saltville Medical Center 20. Tazewell Tazewell Community Hospital 21. Troutdale Troutdale Medical Center 22. Vansant Thompson Family Health Center 23. Whitetop Whitetop Community Health 24. Wise Wise County Health Dept. 25. Wise UVA College at Wise 26. Wise County Fairgrounds Remote Area Medical Clinic 27. Red Onion Correctional Center 28. Wallens Ridge Correctional Center

  13. Benefits of Telehealth Rural communities • >85% of patients remain in local community • Care in the community (lower cost) environment • Enhanced healthcare and local economic development Society • Lower cost of care • Improve outcomes • “Green” technology

  14. Benefits of Telehealth Health professionals • Access to consultative services • Each consultation is inherently educational • Access to continuing medical education • Reduces sense of isolation • Supports recruitment

  15. Benefits of Telehealth Patients • Timely access to locally unavailable services • Improved triage when patient transfer required • Improved quality of care • Reduced readmission for same diagnosis • Improved chronic disease management • Spared burden and cost of unnecessary travel

  16. Facilitating Expert Care: Cervical cancer/Tele-colposcopy • CDC grant to Virginia for screenings of low-income, uninsured or underinsured women • Real-time tele-colposcopy services by UVA gynecologic-oncologists supporting rural NPs • Mobile digital mammography – increases access, early diagnosis

  17. Facilitating Expert Care: Other Cancer-related Applications • Tele-radiology • Tele-pathology • Tele-hospice • Tele-pharmacy • Tele-dermatology • Tele-surgery • Collaborative tumor boards • Access to clinical trials • Community based research • Educational services

  18. Innovative Applications • Infant mortality • Arkansas Angels • Improve access to prenatal care • Reduce neonatal mortality, premature delivery (26% decrease) • Virginia Productivity Investment Fund • HRSA • Congenital heart disease • Childhood obesity • School health and daycare applications • Reduced ER visits, parental time away from work

  19. Innovative Applications • Tele-ophthalmology • Screening for diabetic retinopathy • Retinopathy of prematurity • Tele-dermatology Store forward/live interactive • Tele-mental health • Critical shortage of mental health providers

  20. Innovative Applications • Acute stroke • Time is of the essence, TPA administered in < 3hrs • Increased use from 4-23% in rural hospitals

  21. Remote Monitoring and Home Telehealth • Need • Medicare data: ($17.4 billion) unplanned hospitalizations • Hospital readmissions within 30 days - 20%, within 90 days - 34%, within 1 year 56% • MedPAC - $7,200 dollars per readmission deemed preventable • Remote monitoring/home telehealth can reduce costs • Congestive heart failure, Diabetes, Chronic obstructive pulmonary disease • Veterans Affairs - Care coordination/home telehealth • 19% reduction in hospital admissions • 25% reduction in hospital days

  22. Remote Area Medical

  23. Building a Healthy Appalachia

  24. The Next Five Years • Real-time, in-home monitoring • The use of m-health technology • Increased access to specialty care • Integration of EMR into telehealth • Movement to the desktop • Expanded access to clinical studies

  25. Challenges • Coverage & Reimbursement • Broadband Access & Costs • Comfort with Usage • Licensure • Inter-operability

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