Download - Click to view presentation
Deployed Health Deployed Health TechnologiesTechnologies
Emerging Opportunities Emerging Opportunities and Existing Barriersand Existing Barriers
Karen C. FoxAssistant Dean, College of
MedicineUT Health Science Center
Innovative, collaborative solutions to meet the heath
care needs of rural and remote communities.
A Look at the Destructive CycleA Look at the Destructive Cycleof Health Disparities for Rural of Health Disparities for Rural
PatientsPatientsPovertyEducatio
nCultureLocation
DeathDisability
Long Term Care
Health Disparities
(uneven access to care and services)
Delays in receiving adequate care, lack of
follow-up and appropriate referrals.
Cutbacks and denials of services
or overage
Increased incidents of
chronic disease (ie: diabetes, stroke, heart
attack)
High costs associated with healthcare
systems
A Glimpse Into the ProblemA Glimpse Into the Problem
Physical barriers to care
Fragmented delivery system
Disparate information systemsVAMC (Nation
al)
Rural Health Clinic
The Med
(Memphis)
Pharmacy #3
Pharmacy #2
Pharmacy #1
Two-Pronged Solution: Two-Pronged Solution: Innovative Health Innovative Health
TechnologiesTechnologies
Electronic Electronic Health Health
RecordsRecordsTelehealthTelehealth
Total Rural Total Rural Clinician Clinician SupportSupport
EHR Systems in Rural EHR Systems in Rural SettingsSettings
Establishing, utilizing and maintaining an EHR system is a challenge, made more difficult in
rural or isolated settings.•Poor local telecom infrastructure
•Lack of resources to establish an EHR
•Lack of support from a major healthcare provider for standards of care
Benefits of Regional EMR Benefits of Regional EMR SystemsSystems
Promote Region-Wide Standards of Care
Rapid Access to Information at the Point of Care
Clinician Decision Support (protocols, clinical trials)
Drug / Allergy Interactions
Disease Surveillance
Girl bitten by prairie
dog Family physician at Rural Marshfield clinic
Specialist at Marshfield
Center telehealth consultation
shared EHR
network
The Memphis Area The Memphis Area Technology Collaborative Technology Collaborative
for Health (MATCH)for Health (MATCH)A cooperative project of the University Medical Center
Alliance designed to meet the need for timely patient health
information at the point of care, regardless of where the
patient presents.
Master Patient IndexMaster Patient Index
•Dynamic interface that connects separate EHR systems across the region.
•Facilitates sharing health information across different healthcare organizations.
•True continuity of care is the expected result.
Master Patient Index:Master Patient Index:Benefits to Rural Benefits to Rural
CommunitiesCommunitiesClinician decision-supportRegional standards of careImmediate electronic access to informationComputerized medication management Linkages to payor systems and health plansSupport for inter-agency researchSupport for syndromic surveillanceEstablishment of targeted patient health education
Barriers to EMRs for Barriers to EMRs for Rural and Remote Rural and Remote
PopulationsPopulationsLack of data standardsProprietary systems that don’t communicate Patient privacy and security (HIPAA)Poor existing telecom infrastructuresInterface design and implementation
The Mid-South Telehealth Network
Four UT Colleges Seven Health DepartmentsNine PharmaciesSix Rural HospitalsFour Community CentersThree SchoolsFive Group Youth HomesOne Dental/Vision VanAg Extension Agent Offices
Rural Hospitals Benefit from Rural Hospitals Benefit from TelehealthTelehealth
Improves access to specialty health care Improves access to specialty health care services.services.
Increases support system for rural providers Increases support system for rural providers (CME, research opportunities, etc.)(CME, research opportunities, etc.)
Keeps money and services within the Keeps money and services within the community.community.
Increases community confidence in local Increases community confidence in local healthcare system.healthcare system.
Medical SpecialtiesMedical Specialties
CardiologyCardiology DermatologyDermatology Endocrinology Endocrinology E.N.T.E.N.T. GeriatricsGeriatrics OrthopedicsOrthopedics PathologyPathology RadiologyRadiology
DentalDental ToxicologyToxicology Behavioral HealthBehavioral Health Wound CareWound Care Case ManagementCase Management EchocardiogramsEchocardiograms Rehabilitation TherapiesRehabilitation Therapies Post-surgical Follow-upPost-surgical Follow-up Pediatric SubspecialtiesPediatric Subspecialties RheumatologyRheumatology
One Example: Cardiology Specialists Accepting
TennCare in Tennessee
0.3 – 2.0
2.1 – 4.5
4.6 – 7.0
7.1 – 12.0
FTE Ranges
If you live in a rural community, you might have to travel 175 miles to reach a cardiologist accepting patients, and have to wait up to 6 months for an appointment.
Telehealth Improves Access to Cardiologists for Rural
Patients
0.3 – 2.0
2.1 – 4.5
4.6 – 7.0
7.1 – 12.0
FTE Ranges
By conducting an appointment through a telehealth access point, travel is drastically reduced and wait times nearly eliminated.
Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP
Safe- Patients receiving psychiatric treatments via telehealth show that 65% of individuals were misdiagnosed prior to telehealth.Timely- •78% of telehealth appointments occur within 10 minutes of their scheduled time.•Patients scheduling telehealth visits usually receive an appointment within 2 weeks.
Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP
Efficient- • Telehealth physicians average 4.3 patients per hour with equal to better care, compared to 2.7 patients per hour in traditional clinics.• The no-show rate for telehealth patients averages 4.6%, compared to 26.5% for traditional clinics.
Equitable- 67% of telehealth patients with a self-report family income of $20,000 or less.
Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP
Effective- •73% of telehealth patients received new, more effective prescription medications.•The average patient has been to their PCP 4.8 times for their primary complaint, and yet 90% of telehealth patients have their primary complaint resolved within 2.2 telehealth visits.
Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP
Patient-centered-
•The average telehealth patient lives 117 miles from Memphis.
•Patients report equal or higher satisfaction (94%) with telehealth visits.
Health as an Economic Health as an Economic EngineEngineKnown Facts:Known Facts:
1) People living in poverty have poor health outcomes, more sick days, more chronic conditions.
2) Economic development can lead to improved health.
3) A healthier workforce contributes substantially to economic development. (Limitation of activity cost the Economy $73 billion annually in lost work time)
4) Economic costs of chronic conditions in 2001were $425 billion (14% of GNP). 80% of these costs were the result of preventable disease states. (Lerch 2002)
What’s NeededWhat’s Needed•Additional research on long-term outcomes of innovative health technologies.•Research on health as an economic engine for rural communities.•Facilitation of nation-wide collaborations.
In the 1900’s, we built roads into rural communities to facilitate transportation. Now in the 2000’s, we must build the technology infrastructure to support digital access, communications, data sharing and resource distribution.
Uniting Patients, Providers and Communities
Karen C. FoxKaren C. FoxAssistant Dean, College of MedicineAssistant Dean, College of Medicine
UT Health Science CenterUT Health Science Center
901-448-HEAL901-448-HEAL 877-821-0022877-821-0022 www.utmem.edu/telemedicinewww.utmem.edu/telemedicine
The University of TennesseeThe University of TennesseeOutreach CenterOutreach Center