Telehealth: Now and Future Archit Bhatt MD
1 www.smithsonian.org 2 “The Teledactyl (Tele, far; Dactyl, finger — from the Greek) is a future instrument by which it will be possible for us to “feel at a distance.” This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance….The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.”
www.smithsonian.org 3 “As our civilization progresses we find it more and more necessary to act at a distance.” The busy doctor, fifty years hence, will not be able to visit his patients as he does now. It takes too much time, and he can only, at best, see a limited number today. Whereas the services of a really big doctor are so important that he should never have to leave his office; on the other hand, his patients cannot always come to him. This is where the teledactyl and diagnosis by radio comes in. www.smithsonian.org 4 www.smithsonian.org 5 Integrated Medical and Behavioral Laboratories and Measurement Systems (IMBLMS) program in 1964
6 NASA began trial runs of its Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) program for telemedical help for people living in remote locations with little or no medical services, like Arizona's Papago Indian Reservation. Engineered by NASA and Lockheed Missiles and Space Co. (now Lockheed-Martin), the system used two-way microwave transmissions to link paramedical personnel located in mobile (vans) and fixed stations with medical experts at hospitals in Tucson and Phoenix. The program lasted until 1975.
7 2014…
…. clinical care was available anytime and anywhere …. clinicians could obtain consultations with medical centers of excellence anytime and anywhere …. home bound patients could be monitored remotely anytime and anywhere …. medical education programs were available anytime and anywhere
This is the potential of telehealth
8 The Vision
No matter who you are or where you are you can get the health care you need when you need it
9 What Is Telemedicine?
Clinical care provided from a distance
The use of electronic communication and information technologies to provide or support clinical care . Primary Care . Medical Specialties . Intensive Care Services . Emergency Departments
10 Telehealth vs. Telemedicine
Telehealth
Health Regional Professions Health Information Education Sharing
Administration Consumer Telemedicine Education
Evaluation Public Research Health
Homeland Security
11 The Need for Telehealth
Clinician shortages
Misdistribution of providers
Rural/Urban underserved
Aging population
Travel time, cost & hardship
Delayed treatment
Language barriers
Clinical education programs
Administrative meetings
12 Telehealth Benefits
Reduces barriers to access Increases efficiency for providers Reduces overall health care costs Reduces delays in care Retains resources locally Increases patient satisfaction Improves quality of care . Consultant and primary provider communication . Education to providers Improves health outcomes Virtual accessibility
13 Most Common Uses
Clinical Services
Educational Programming
Administrative Meetings
14 What is the Technology
Principal components Equipment Connectivity
Two Technology Approaches Live Interactive Store and Forward
Vidyo Telemedicine Unit
15 Telehealth System Models
Statewide University Based Systems Regional Networks Large Healthcare Individual & Small Group Practice
16 Different Approaches for Various Needs
Live Interactive Store and Forward Emergency Response Patient Education Kiosks Home Health Monitoring Educational Services Videoconferencing
17 Live Interactive Telemedicine
Patient visits using videoconferencing where patient & provider are communicating in real time. Allows provider to assess patient using medical scopes adapted for image transmittal
Specialty services Dermatology Urology Psychiatry Orthopedics Neurology Pain Management Endocrinology ENT Rheumatology
18 Other Great Uses For Live Interactive
Dental Services Connecting friends & family Family Counseling Support Groups Patient education Administrative Meetings
19 Live Interactive Telemedicine Can be applied in many situations and locations
• Outpatient Clinics • Mental Health Centers • Intensive Care Units • Correctional Facilities
In Touch Health
• Emergency Departments • Emergency Transport Units • Surgery Suites
20 Video Interpretation Services
Improve Quality of Care – Avoid Medical Errors Multilingual Culturally Competent Trained in Medical Terminology Meet legal/contract requirements
21 Store and Forward When a face to face visit is not necessary
Diabetic Retinopathy Screening Second Opinion Dermatology System Round Valley Indian Health Service Images are obtained at a local care center and transmitted for review by a clinician at a remote site Picture and history adequate for diagnosis Allows clinician to do work when convenient Maximizes use of clinician time
22 Home Health & Monitoring
Technology that supports monitoring of chronic conditions
COPD – peak flow Diabetes
Health Hero
Courtesy of American Telecare
Visiting Nurse & Health Services of Connecticut
23 Reimbursement
Medicare Medicaid Private Payors • Blue Cross / Blue Shield State Initiatives
24 Legal Aspects
Intellectual Property Rights Risk Management Credentialing and Privileging Interstate Licensure Telecommunications Law Privacy Fraud and Abuse
25 Technology Alone Does Not Produce Success
Some success factors Champion Coordinator Education and training Engagement of primary care providers Availability of services Technical and program support Stable technology Funding & reimbursement mechanisms
26 Challenges
Reimbursement Physician Champions Institutional Buy-in Convenience Telecommunications . Costs . Trade-offs Program Sustainability Credentialing, Privileging & Accreditation
27 Assistance Is Available! Federally Designated Telehealth Resource Centers
Put in all logos
28 Telehealth Resource Centers
29 Telehealth Resource Centers Web Sites
National Telehealth Resource Center www.telehealthlawcenter.org California Telemedicine & eHealth Center www.cteconline.org Great Plains Telehealth Resource & Assistance Center www.gptrac.org Midwest Alliance for Telehealth and Technology Resources www.midwesttrc.org Northeast Telehealth Resource Center www.northeasttrc.org Northwest Regional Telehealth Resource Center www.nrtrc.org
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