Tele-Medicine: Applications in Aging Services

1. Tele-Medicine:Applications in Aging Services Craig Lehmann, Ph.D., CC (NRCC), FACB Dean/Professor School of Health Technology & Management Health Science Center State University of New York at Stony Brook Stony Brook, N.Y. 11794-8200 craig.lehmann@sunysb.edu

2. Utilization of Healthcare • Office Visits to Physicians: 765,700,000 (1999) 823,542,000 (2000) • Most frequent principal reason: Physical 63,000,000 (1999) same for (2000) • Most frequent physician specialty: General and Family Practice 170,571,000 (1999) 198,578,000 (2000) • Most frequent principal diagnosis: Essential Hypertension 31,962,000 (1999) 35,096,000 (2000) Source: CDC

3. Utilization of Health Care by Aged (65yrs or older) • Visit physicians on the average 8 times a year compared to 3 times a year for those <65yrs. • Hospitalized 3 times as often and stay 50% longer. • Of the 31 million hospitalizations in the US the Aged accounted for 40% (1997). • It is estimated that by the year 2025 the aged will account for two thirds of the US health care budget.

4. Hospital Admissions

5. Utilization of Healthcare Emergency Department • Emergency Department Visits: 102,765,000 (1999) – 108,000,000 (2000) • Most frequent principal reason: Stomach and Abdominal Pain 6,800,000 (2000) • Number of Injury Related Visits 40,400,000 • Most Frequent Diagnostic/Screening Service Provided: Blood Pressure (75% of all visits) • Type of drug most frequently Prescribed: Tylenol (10,000,000) Source: CDC

6. Hospital Admissions through Emergency Departments by Age

7. Insurance Coverage for Physician Office Visits by Age

8. Chronic Conditions of the Aged • Arthritis • Hypertension • Hearing Impairment • Heart Disease • Cataracts • Deformity or Orthopedic Impairment • Chronic Sinusitis • Diabetes • Visual Impairment

9. Cost of Managing Diabetes 100 Billion Dollars Annually

10. Health care utilization by the Diabetes Patient • 96.1 million out patient medical encounters • 53.4 million visits to physician’s office • 16.4 million visits to ambulatory care settings • Visited their physician on the average 15.5 yr. as compared to 4.9 for the general population (all ages). • Numerous visits to the clinical laboratory

11. Lower Extremity Amputation 15 times higher

12. Kidney Disease in Diabetes (End Stage Renal Disease) • Diabetes account for more than 35% of all end stage renal disease • Costs exceed 4 billion dollars

13. Incidence of diabetes will rise • 17 million diagnosed diabetics. • Another 5.4 million undiagnosed. • 125 million worldwide • Could be 30 million by 2050 • Complications associated with diabetes: Retinopathy Renal Failure Neuropathy Atherosclerosis Lower Extremity Amputation

14. Obesity in the USA

15. What’s the Solution? Better Patient Management Tele-health Connectivity

16. CHF Diabetes Asthma Cancer High risk pregnancy Hospice Post stroke Frail elderly Wound care COPD Poor compliance Post operative states AIDS Spinal cord injury Rural locations Patient Population

17. Largest Users Today… • Prison population • Federal programs – Department of Defense, NASA • Veterans Administration Home Telehealth Project

18. Capabilities • Close patient monitoring of vital signs • Educational programs • Video visits • Messaging • Medication reminders • Digital pictures

19. Provider Benefits • Increased # of patients served • Improved access to patients • Enhanced ability to monitor patients • Efficient use of clinician time

20. 1st Generation Products

21. 2nd Generation Product

22. 3rd Generation Product Blood sugar Blood oxygen Camera Weight ECG Thermometer Blood pressure Stethoscope

23. Some Tele-Health Vendors • American Tele-care • American Telemedicine • Cyber-Care • Home-med • Motorola • Phillips • Tele-med • Viterion

24. Firewall Firewall Application Server HTTP Server Database Secure Viterion Network Patient Monitor Internet-Enabled Provider PC DirectDial-Up Internet

34. My Research Focus: better management via Telehealth Chronic Ailments: Congestive Heart Failure Diabetes

35. Impact of Technology on Home Bound Congestive Heart Failure Patients • Pilot Study: Congestive Heart Failure (N=20) • Goals: Primary: Decrease Hospital and Emergency Department Encounters Secondary: Nurse and Patient Acceptance of Telehealth Technology

36. Congestive Heart failure Study Outcomes • No patients from the study group utilized the emergency department. During the study three patients from the study group wanted to go to the emergency department. • 20% (n=2) of the control group were re-hospitalized via the emergency room. • All patients in the study group felt that they had received better care because of the VST and connectivity

37. Study Group: Receive Telehealth Blood Pressure POCT: Glucose, Cholesterol and Micro-albumin Control : Telephone Glucometer New Study: Diabetes Research

38. Diabetes Research Monitor: • Compliance • Physician Office Visits • Home Visits • Emergency Department Encounters • Hospitalizations • Clinical Evaluations

39. Diabetes Research • Compliance (other data shows greatly improved) • Physician and Home Visits • Emergency Department Encounters (Our Data Demonstrated Decline) • Hospitalizations (should decline) • Overall Healthcare Costs Reduced

40. Diabetes Research Long-term Outcomes: • Overall Better Management Results in: • Improved Life Style • Lower Heart Disease • Less Lower Extremity Amputations • Early Detection of End-Stage Renal Disease • Much Reduced Healthcare Costs

41. “If patients could be monitored via the internet 20% of office visits could be eliminated” 1999 = 756,700,000 physician visits 20% would save 150,134,000 visits @ $40.00 per visit Dollar Savings $6,050,400,000