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TeleHealth Overview

TeleHealth Overview. EMS Stroke Conference—June 2014. No disclosures (darn). Objectives. Describe applications of telemedicine Learn about future applications of telemedicine Learn how about performance metrics See a demo of telemedicine Understand challenges of telemedicine.

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TeleHealth Overview

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  1. TeleHealth Overview EMS Stroke Conference—June 2014

  2. No disclosures (darn).

  3. Objectives • Describe applications of telemedicine • Learn about future applications of telemedicine • Learn how about performance metrics • See a demo of telemedicine • Understand challenges of telemedicine

  4. What Is Telemedicine? Interactive Healthcare over Distance Using telecommunication technology (aka video-conferencing equipment) Improves • Access to Care • Quality of Care • Provider & Patient Satisfaction Reduces Cost

  5. Triage Decisions • Consult calls received 24/7 • The Dilemma for ER Providers & OHSU Providers Whether to Transport based on a verbal report plus institutional, provider, & parental comfort levels • Who is impacted by the Decision? Patient Family Transport Team Financial Impacts to Healthcare System, Family, & Local Economy PANDA to Eugene (by ground ambulance): $6,322 PANDA to Medford (fixed wing plane): $21,572

  6. Telemedicine Becoming Mainstream

  7. TeleHealth Across the Continuum of Care Continuum of Care Prehospital care—Where is it?

  8. Acute Care Telemedicine • Program began 2007 • PICU to Sacred Heart, Eugene • Motivations • Improve care pre-transport • Better Triage • Avoidance of unnecessary, expensive, & risky transports • Expansion – Service lines • Stroke, PICU, NICU, Trauma, Neurosx • Genetics, Psychiatry • Expansion – 16 sites • based on local needs

  9. Emergency/Nursery Consults by Month • Since May 2010: • 734 emergent consults • 418 Transfers to OHSU (57%) • 315 remained in home community (43%)

  10. Telemedicine Consults by Service Line • Total Consults (May 2010-June 2014): 734 • Averted transport savings: > $4,700,000

  11. OHSU: TeleStroke Program • Local OHSU Stroke Neurologist activates the robot- if transferred they are involved in the patients care. • 24/7/365 Neuro- interventionalist coverage- > 300 cases of stroke thrombectomy experience. • 23 year track record of “Tele”-phone stroke coverage which we are making even better with video.

  12. TeleStroke Experience…

  13. Quality Review – TeleStroke Results • 501 telestroke consults since May 2010 • 24% of patients received tPA vs. national average 2-3% • “Drip & Ship” vs. “Drip and Keep” • 54% of pts stayed in the community

  14. OHSU Connection…

  15. TeleStroke Consult to Mercy MC, Roseburg Telestroke Demo

  16. Rogue Regional Tele-Stroke Stats • 109 Total Tele-Stroke Consults • 75% of those patients stayed in their home community • Estimated Transport Savings: $1,929,500 • Demo Time!

  17. Telestroke: Use in Stroke Tx Stroke onset 8:15; OSH 70 miles from OHSU 1. Patient examined 10:15 via telestroke; TPA given 2. INR TX explained and consent obtained from his wife 10:45. 4. Arrived OHSU 11:40; exam repeated Stentriever11:50(3’35” post onset) 3. Case and ETA reviewed with Lifeflight- left 10:55

  18. Ambulatory TeleHealth • Delivering Value to Patients and Payers • Access to appropriate follow-up care improves compliance & outcomes • Cost containment • Multiple applications • Post-op checks • Chronic disease mgmt • Less mobile populations OHSU Pt home • including prisons

  19. TeleStroke: Use in Clinical Care Yearly F/U visit La Grande 225 miles from OHSU

  20. Ambulatory Outreach

  21. Ambulatory Outreach • New Tools • 3M Littman Stethoscope • Total ExamCamHD

  22. SNF/LTACH Discharges TeleHealth • Readmissions can be reduced by more effective discharge transitions • 167 readmissions from SNF/LTACH (30 day all cause) in FY 2013 • Linked to strategically important continuum sites • Vibra - Prestige – Avamere • “Warm” Video-enabled nurse-to-nurse Handoffs • Educational “Brown Bags” • Telemedicine consults

  23. In Home Monitoring – Congestive Heart Failure • 79 patients enrolled since December, 2012 • 80% of patients completed the program • Some patients dropped out, couldn’t connect, etc • Average number patients monitored per day ranges from 2 to 6 ,with a high of 9 • Average Telephone Encounters per patient is 7calls per month versus 11 - 14 encounters prior to program • Average call length is shorter in duration and more focused • Reported ED visits in the interim of 30 days with 65 patients • Self efficacy scores improving • Expanding to diabetes via Internal Medicine primary care practice

  24. Telemedicine and EMS: • Started in the 70’s with ECG telemetry • On-site decision support • Routine and disaster triage • Exchange of information • Voice, data, images • Information (12-lead reports, treatment protocols) • Transport decision support (acuity based) • Language interpretation • Transport support

  25. Special Rolling Stroke Response UnitGermany • Includes: • Mobile 8-slice CT scanner w/ ability for angiography and perfusion • POC laboratory • Data transmitted over encrypted 3G, 4G and satellite • Rural application for Oregon?

  26. Mobile CT…In an Ambulance

  27. Clinical Service Pilots & in Development • Oregon Perinatal & Neonatal Network (OPNN) • CCO Cardiology demonstration with HealthShare • ED Virtual Bunker as Triage Center • Tele-Psychiatry Expansion • Tele-Retinopathy of Prematurity Exams • Pediatric Hospice • Tele-Genetics Expansion • Tele-Trauma • Tele-EEG, Echo, Ultrasound

  28. Telemedicine Challenges Starting a Program Takes Time & Money • Infrastructure (staff, equipment, connectivity, time) • Adoption (administrative, providers, patients) Roadblocks - Legislative, Rules, Tech, etc. • Credentials & Licenses • Equipment re Stark Implications • Connectivity • Reimbursement • Senate Bill 24 passed by ‘09 Oregon Legislature • Medicare billing limitations (urban vs. rural)

  29. Resources • OHSU Telemedicine ohsu.edu/telemedicine • Telehealth Alliance of Oregon ortelehealth.org • Northwest Regional Telehealth Resource Center, Spokane, WA nrtrc.org • American Telemedicine Association americantelemed.org • Center for Telehealth & E-Health Law ctel.org • Office for the Advancement of Telehealth telehealth.hrsa.gov

  30. Thank You OHSU TeleHealth Services 503-418-3625

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