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Telehealth Now and Then: A Northwest Perspective

Telehealth Now and Then: A Northwest Perspective. Jere Retzer, retzerj@ohsu.edu Oregon Health & Sciences University. 22 September 2014. Disclaimer. All views expressed in this presentation are those solely of the presenter and he doesn’t know much!. About the Northwest. Big/diverse

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Telehealth Now and Then: A Northwest Perspective

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  1. Telehealth Now and Then: A Northwest Perspective Jere Retzer, retzerj@ohsu.edu Oregon Health & Sciences University 22 September 2014

  2. Disclaimer • All views expressed in this presentation are those solely of the presenter and he doesn’t know much!

  3. About the Northwest • Big/diverse • House-calls rarely happen • Largely medically underserved – losing obstetricians, others due to malpractice • Drive/fly hours to see specialist – or go without • Independent • “Fate-sharing” usually considered a bad thing • Mostly on the network “edge”

  4. A Sampler of current activities • Lariat/BRIN • Oregon AHEC • Distance Education for nursing and Medical Informatics • Telemedicine projects in Cardiology • Rural Health Education • Argentina brain trauma training • ORPRN – AHRQ Medication list • Visions of remote surgery ….

  5. The state of telemedicine today • Most projects fail to be sustainable • More effective at demonstrating technology than medical care

  6. Why is telemedicine so unsuccessful? • Insurance reimbursement – making progress in Oregon • Independent culture • Cost of dedicated connections & poor quality available on the Internet • Northwest communities largely on the network edges

  7. Life on the edge • Problem: the lack of local connections between networks is a barrier to applications that need high quality within region • Example: historically, connections from OHSU to Portland Community College (PCC) via Sacramento, San Jose, Seattle, 20-30 ‘hops’ • Poor quality even across town

  8. A regional issue • Feb 2003 DSL Lincoln City to Intel in Hillsboro via Dallas, Texas, Chicago, Seattle • Sometimes talking to the phone company can fix

  9. Solutions • Regional exchanges • Communities of interest – future TAO • Local Health Information Infrastructures

  10. An Engineer’s View of the Internet • Law of Network Effects:“the value of a network grows as the square of the number of users.” • Both quality & connectivity important Source:Caida.org Metcalfe, Robert, “The Internet After the Fad,” Remarks at the University of Virginia, May 30, 1996

  11. National/Local Health Information Infrastructures • NHII • Improve healthcare through IT • 100,000 accidental deaths per year? • Administration 25% of healthcare cost, $1.6 Trillion industry • Focus is on LHII • Most care is local • Relationships are local • View: solutions will be local

  12. Oregon Health Information Infrastructure (OHII) • Need + opportunity spurs intense competitors to work together • “Information technology will be the key driver of change in the US Healthcare system in the 21st century.” -Tommy Thompson, Secretary HHS

  13. An opportunity for Internet2 • Internet2 created to enable advance networking and applications • Needed because commercial Internet didn’t • Works because it flattened the network and cares about quality across networks • Next phase of network applications predominantly local – connections between people • Internet2 should extend to LHII • Engage Internet experts to develop & facilitate common tools, middleware to connect LHII – “LHIItools.org?” (see sourceforge.net to see how open source projects work)

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