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Telemedicine

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Eric Anderson

on 23 September 2015

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Transcript of Telemedicine

Metropolitan statistical area
Health Professional Shortage Area
State administered program for low income individuals and families.

Medicaid
Telehealth & Telemedicine
Telehealth: (HRSA definition)
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Telemedicine
Eric R Anderson MD, PhD
Feb 7, 1906
- Willem Leister Einthoven invented the electrocardiogram (EKG), as well as the first portable EKG. In 1906, Einthoven sent an EKG over telephone lines, the first example of modern telecardiology.
History
Balanced Budget Act of 1997
Federal Register 1998
BIPA 2000
Medicare Prescription Drug and Modernization Act of 2003
Medicare Fix Bills 2006, 2007
Health Care Reform Act 2010
Accountable Care Act 2011

Different forms of Healthcare delivery
Telemedicine: (ATA definition)
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status
April 15, 1924
- "The First Exposition of Telecare": The Radio Doctor

"Radio News" magazine from April 1924.
August 14, 1955
- The Nebraska Psychiatric Program

"Founded under doctor Cecil Wittson at the Department of Neurology and Psychiatry at the University of Nebraska in conjunction with Ron Dutton. The institute was the first to practically use closed circuit television and radio transmitted records for treating psychiatric patients." (Source: History of Telemedicine) Communicated with norfolk state hospital 122 miles away.
May 24, 1965
- NASA'S IMBLMS Outline Released

(Integrated Medical Behavioral Laboratory Measurement System. The IMBLMS document describes an "essentially complete telemedicine system that could ultimately connect the entire nation."
Utilization: Dependent on reimbursemt
Each state is free to determine what medicaid will and will not cover for telehealth

Federal health insurance program for people 65 and older, or with certain disabilities.
"Today, no one clinician can retain all the information necessary for sound, evidence-based practice. No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature."
IOM report
Poor access to specialty care
absence of expertise = poorer quality of care
Increased costs for travel, missed work
Time, money, work, inconvenience = more likely to miss appointments.
Fragmented care
episodic care = less likely to control disease
Hospital to Hospital transfer costs
transfers to referral centers costs the state a lot.


Geographic disparities
Interactive 2 way video conferencing
Store and forward
Remote monitoring





What about the rest?
Immobile urban beneficiaries
-Nursing homes
-Rehab centers
The story of the rural doc
Medicine is a team sport
UPMC PCMH pilot 2008-2010

medical/pharmacy costs
↓hospital admissions/readmissions/ED use
160% RoI


Health Buddy program - Chronic disease management
↓health care spending by 7-13%/person/quarter


'Hospital at Home' model
↓costs from ↓LoS and ↓lab/diagnostic tests
↑outcomes
↑satisfaction
Evidence is accumulating: Cost effectiveness
Evidence is accumulating: Cost effectiveness
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001, pp. 1, 13-14, 236, 237
Telemedicine in EDs
↓ED to ED transfer (estimated 2.2 million/year for $1.39B)
Avoid 850,000 transfers = $537M saved/year

Telemedicine in Correctional facilities
↓Transfer to EDs (estimated 94,180/year for $158M)
Avoid 40,000 transfers = $60.3M/year
↓Transfer to Physician offices (estimated 691,000/year for $302M)
Avoid 543,000 transfers = $210M/year

Telemedicine in NHs
↓Transfer to EDs (estimated 2.7M/year for $3.62B)
Avoid 387,000 transfers = $327M/year
↓Transfer to Physician offices (estimated 10.1M/year for $1.29B)
Avoid 6.87M transfers = $479M/year
Evidence is accumulating: Quality of Care
Telemedicine and Diabetes
↑compliance and ↑number of diabetics who brought glucose under control


Telenursing and Heart Failure
↓ hospital admissions


Telepsychiatry
Remote == Face to Face


Home based telehealth
Improves clinical outcomes
Thank you!
Where do we go from here?
Continue to push legislation for better reimbursement
-better coverage
-better reimbursement/incentives

Continue to push for a uniform telemedicine licensure

Continue to develop new workflows and models of care that maximize patient care and minimize administrative obstacles

Continue to educate physicians, patients, and payers
Results From A Patient-Centered Medical Home Pilot At UPMC Health Plan Hold Lessons For Broader Adoption Of The Model Cynthia Napier Rosenberg, Pamela Peele, Donna Keyser, Sandra McAnallen, and Diane Holder Health Affairs November 2012 31:112423-2431; doi:10.1377/hlthaff.2011.1002
Integrated Telehealth And Care Management Program For Medicare Beneficiaries With Chronic Disease Linked To Savings Laurence C. Baker, Scott J. Johnson, Dendy Macaulay, and Howard Birnbaum Health Affairs September 2011 30:91689-1697; doi:10.1377/hlthaff.2011.0216
Costs For ‘Hospital At Home’ Patients Were 19 Percent Lower, With Equal Or Better Outcomes Compared To Similar Inpatients Lesley Cryer, Scott B. Shannon, Melanie Van Amsterdam, and Bruce Leff Health Affairs June 2012 31:61237-1243; doi:10.1377/hlthaff.2011.1132
Telemedicine and Diabetes Dimmick et. al. Telemed Journal and e-Health, 9(1): 13-23 (2003)
Jerant AF, Azari R, Martinez C, Nesbitt TS.A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators. Home Health Care Serv Q. 2003;22(1):1-20.
Janca, 2000. Telepsychiatry: an update on technology and its implications. Curr Op in Psych 13: 591-7.
Home-based telehealth: a review and meta analysis Dellifraine JL, Dansky KH. J Telemed Telecare. 2008;14(2):62-6
The Value of Provider-to-Provider Telehealth Technologies Center for Information Technology Leadership Partners HealthCare System, Inc, 2007
In or out of an MSA
Summary
Telemedicine allows for:
Improved access to care
Improved quality of care
Decreased health care usage and overall costs
Current obstacles:
Poor reimbursement
Multi-state licensing
Licensing
Licensing
Regulated by each state regarding the practice of medicine within its boundaries
Enforced by the state boards
Ensures that physicians meet academic and clinical competence standards to protect the public

Licensing

Can be used as an anti-compete device
Can harm a population by restricting access if none exists locally
Can protect providers but the non uniformity between states may expose them to liability risk.
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