Telehealth/Informatics Imaging

1. Telehealth/Informatics Imaging Patricia Blake RN, MSN Senior Cardiovascular Quality Manager Lecturer- The Ohio State Collage of Nursing

2. Goals for Telehealth/Imaging Informatics 1) Define how Telehealth/Imaging informatics combines traditional medical imaging with information from inpatient, home monitoring devices, including pictures, video’s or interactive imaging. 2)     Discuss how the use of images contributes to documentation of clinical conditions. 3)     Describe how telemedicine is used to provide specialty support from a remote health care provider. 4)     Summarize how data from telehealth or imaging can be used in decision support, predictive modeling or research 5)     Evaluate the portability of Telehealth and Imaging Informatics to improve patient outcomes and communication to other health providers through health information sharing

3. What is Telehealth and Why/How Do We Use it in Medicine? • Difference between Telehealth and Telemedicine. • Telehealth- broad term, includes all health services provided using telecommunications technology • Telemedicine- refers specifically to clinical services • Technologies used to deliver health-related information or services through internet, phone or other methods • Mobile devices and videoconferencing technology • Telehealth- can increase health care access to remote or underserved areas and reduce costs. • Telehealth- can collect real-world data related to patient care and experiences, evaluate patient learning and implementation of health care practitioner advice, improve patient outcomes and tailor care.

4. Telehealth Specialities Teleradiology – One of the earliest fields of telemedicine, beginning in the 1960s. Developed to expand access to diagnosticians of x-rays. Used to provide specialty services to smaller hospitals with round the clock access to care for ER’s or for consults. CT, MRI, X-Rays Teledermatology – Usually store-and-forward technologies allowing general healthcare providers to send a patient photo of a rash, a mole, or another skin anomaly, for remote diagnosis. Teledermatology solutions lets PCPs continue to coordinate a patient’s care, and offer a quick answer on whether further examination is needed from a dermatologist. Teleopthamology– Allow ophthalmologists to examine patients’ eyes, or check-in about treatments from a distance. A common example is an ophthalmologist diagnosing and treating an eye infection. These solutions are usually either live or store-and-forward telemedicine. Teleobstetrics – Allows obstetricians to provide prenatal care from afar. This could mean, for example, recording a baby’s heart at one location and forwarding it to an obstetrician for diagnosis at another facility.

5. Telehealth Specialties Teleoncology – Quick expansion in the last few years to provide more accessible and convenient care to patients with cancer. While some teleoncology solutions offer store-and-forward tools to forward images for diagnosis, others are live video platforms to allow patient consults with the oncologist. Telepsychiatry- psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.” Especially for patients with severe anxiety or physical limitations. Telerehabilitation- physical therapy can receive video consultations instead of heading into an office.

6. Teleradiology at Ohio State Medical Center Clinic Clinic Clinic Central repository for images and reports OSU Main Hospital Fayette County Hospital Back up central repository

7. Benefits of Teleradiolgy Provides triaged worklist Shared physician workload distributed evenly Reduces travel for physicians Allows for others to pick up workload for physicians in an emergency situation Reports/images shared real time through central server to clinics, hospital or referral centers Allows for every facility to have onsite expertise i.e. credentialed radiologist Quality metrics tracked i.e. turnaround time

8. Telehealth Communication • Interoperability of data between servers so that various providers have concurrent information and knowledge of health care goals and treatments • Cloud image exchange platform • OSU Nuance Power Share Network image sharing • Secure, real time exchange • Reduces need for CD/DVD exchange • Expedite access to exam information, reduce imagining • Assist with pt referrals for outside clinicians using image exchange • Convenient web browser access

9. IHIS Dermatology Example *Click Create Note in progress note Click on Blue Scan link/Encounter to view Log in to IHIS Click on the in-basket Click My note and type .econsultthenenter Click on E-Consult and document Click on E-Consult Message Click on send chart Click on Brutus Smith Enter PCTE AMB Click on sign visit, click complete Take note of this patient name Click accept, chief complaint and type Click the “complete” button in the top toolbar Order questions Click on Progress note and edit

10. Chronic Disease Management Advisory Board, 2015

11. Chronic Disease Management Advisory Board, 2015

12. Wearables- MD Anderson

13. Telehealth Examples • Telehealth- HealthSpot- Private onsite clinic • Provides high-quality medical diagnostics to patients anytime, anywhere. • Platform is face-to-face dialogue with easy access to follow-up treatment with their providers. • Platform supports access to an electronic health record (EHR) and sends health information to other providers with electronic prescribing. • The HealthSpot Station is private, spacious, quiet and secure.

14. Telehealth Examples • Handheld Telemedicine Kits • Smallest mobile device on the market providing pt exams • Telehealth on the Ipad • Visual physician/NP exam or or lets you switch screens to share medical images or medical chart data. • 30 Day Readmission Prevention Apps • targeting high risk patient population and provides patient management. • Optical imaging to screen diabetics or other eye conditions • Second Opinion Online • Incorporates vital signs and electronic stethoscopes (see below) • Physioglove • https://www.youtube.com/watch?v=sECeAL9jrts • Obtains a wireless 12 lead ECG utilizing a glove on the left arm that is placed across a patient chest.

15. Telehealth Examples • HealthE Chair • https://www.youtube.com/watch?v=trGy95u0kKI • Biosensors controlled by a clinician, -chair monitors vital signs, weight, height, blood oxygenation, auscultation of heart/lung sounds, ECG, motion analysis and response reflect time. • Interactive Care- pt education module • Telemedicine Robot • Clinician to clinician communication. • Advanced Fall Detection • Fully wireless, continuously monitors a patient’s location, activity, physiologic factors • Cardiology Loop Recorders • Battery life battery life (2 to 3 years)

16. Telehealth Capabilities • Amass and share electronic medical record (EMR), data for individual patients longitudinally, essential to harnessing the economic and clinical benefits of EHR’s • Despite the rapid advancement and broadening technical capacity of digital technology for health, digital interoperability—the extent to which systems can share and make use of data—remains extraordinarily limited. • Extended use • High seas • Grocery stores • Disaster areas

17. Pro’s and Con’s of Telehealth • More accessible care for patients • More convenient care • More affordable care • Increased access to specialists • Higher quality care for every patient • Fewer in-person consultations • Poor internet connection could prevent care • Reduced care continuity • Technical training and equipment- providers

18. Telehealth Challenges • As technology changes there is a need to continually develop and update: • Standards, specifications, regulatory policies • Interfaces to ensure that patient care data and services are seamlessly and securely integrated • Patient experience is captured in real-time for continuous system-wide learning and improvement.

19. Telehealth Challenges Proprietary data ownership and use restrictions Misinterpretation of control requirements for use of clinical data as a resource for new knowledge. The recently passed 21st Century Cures Act includes provisions to encourage and facilitate sharing and use of clinical data, but those provisions will still require local action and leadership.

20. How we use the data from Telehealth or Imaging • Big data • Patient management • Incorporate evidence based medicine into treatment plan • Decision Support • Cost • Resources • Use of data • Reports

21. Telehealth Decision Support • Telehealth can supplement health care by providing specialty care to underserved or remote patient population • Coordinate care between physicians/health care workers, review of imaging to provide evidence based-care • Data collected via Telehealth can be use to create predictive modeling or research • Information gleaned can be used to predict which patients are at high risk for readmissions or falls • Protocol development can be created to improve care • Telehealth still relatively new- research is opportunity to evaluate care/ patient management/ Patient engagement. • Is it cost effective, does it improve patient outcomes

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23. References Advisory Board, 2015. https://evisit.com/what-is-telemedicine/#3 http://www.cio.com/article/2369849/healthcare/101906-12-Telemedicine-Innovations-That-Will-Shape-Healthcares-Future.html http://www.americantelemed.org/home L. Prevedello, personal communication, May 22, 2017.