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Telehealth and Telemedicine David Charles, MD MedTenn 16 April 30, 2016

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Page 1: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Telehealth and Telemedicine

David Charles, MD

MedTenn 16

April 30, 2016

Page 2: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

David Charles, MDDisclosure of Interest

Research/Education Support

1. Allergan2. AstraZeneca3. VICTR4. Ipsen5. Medtronic6. Merz7. Vanderbilt University8. Robert Whitson9. Jeff Martin

Clinical TrialsAllergan, Merz, Medtronic

ConsultantAllergan, Ipsen, Medtronic, AfPA

Stocks or equityNone

Off Label DiscussionDBS in Early Stage Parkinson’s Disease

Page 3: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Agenda

• Overview of Telemedicine• Vanderbilt Teleneurology• Technology• Future of Telehealth

Page 4: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Defining Telemedicine

e-Health

TelehealthmHealth

Telemedicine

• Electronic processing• Exchange, storage, retrieval• All virtual health information and

services

• Clinical services• Non-clinical services (i.e., health

education, health promotion, health maintenance)

• Remote clinical services• Resolving a Chief Complaint• Individual patient interaction

Page 5: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Types of Telemedicine

• Emergent hospital and ED• Intensive Care consults and ICU monitoring• Ambulatory specialty• Home Care in home monitoring• Direct to patient• Store and Forward• eConsult

Page 6: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Why Telemedicine?

Increase access to care Increase compliance

Reduce transfers/readmitsAvoid unnecessary services Reduce costs

Page 7: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Extending Access to Providers for High-Risk, Rural, and Wellness Visits

Source: Hirst, E. J., “Walgreens App Makes Virtual Doctor Visits a Reality,” Chicago Tribune, December 2014, http://www.chicagotribune.com/business/ct-walgreen-virtual-doctor-app-1209-biz-20141208-story.html

Use Cases

Chronic disease management

Behavioral health video consults

Rural access to care

24/7 coverage

“I think [virtual visits] will become a normal part of health care in three to five years.”

Dr. Harry LeiderWalgreens CMO

Low-Cost Alternative to Traditional Primary Care

Cost of Walgreens virtual visit, most of which goes to physician

$49Interactions per week via Walgreens’ Pharmacy Chat virtual visit platform

9,000Estimated new patients added for MDLive following partnership with Walgreens

2M

Major Vendors

• MDLive

• Teladoc

• American Well

• Zipnosis

• CampusMD

• Stat Doctors

• Sentara

Page 8: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

VA Telemedicine

• 690,000 Veterans received telemedicine care

• 2 million Telemedicine visits FY 14

• 22% predicted annual growth rate

• $1.2 billion telemedicine budget FY 16

– $126 million increase over FY 15

http://m.mhealthnews.com/news/va-looks-invest-heavily-mhealth-telehealth

Page 9: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Neighboring Telemedicine Programs

University of Arkansas- State-wide network for

emergent consults - Partnered with State and other

hospital systems

University of Georgia - Georgia Regents is the pioneer

of Telestroke- Primary care in schools:

students and staff

University of Mississippi - 30+ specialties, 500,000 encounters, state-wide

Page 10: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Learning from our PeersMercy Telehealth ServicesØ Largest in U.S.; 75+ services, six states

Dartmouth-Hitchcock Ø Launching virtual clinic hospital / home

University of Michigan Ø Chronic diseases: CHF, COPD, Stroke

UPMC Ø 15 services, occupational health

UCLAØ Direct to patients

Mercy’s 120,000 square foot Virtual Health Center opens in 2015

Page 11: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Mercy Telemedicine Network32 hospitals, 300 outpatient locations39,000 co-workers1,700 integrated physicians 3 Million telehealth visits projected 2015 – 2020

By the Numbers:Hospitals: 32Outpatient Facilities: 300Service Area: Arkansas, Kansas, Missouri, OklahomaOutreach Ministries: Louisiana, Mississippi, TexasSixth largest Catholic health care system in the U.S.Co-workers: 38,000Medical Staff: 5,200Mercy Clinic Physicians: over 1,900ER Patient Visits: 596,046Outpatient Surgeries: 102,269Births: 21,506Licensed Beds: 4,571Traditional Charity Care: $131 millionUnreimbursed Medicaid Costs: $61 millionOther Community Benefits: $48.4 millionAssets: $5.2 billionOperating Revenue: $4.2 billion

Presenter
Presentation Notes
Mercy’s Internal Virtual Care Center Model (2015 launch): 120,000 sq. ft. center in Chesterfield, MO Staff: ~300 physicians, nurses specialists, researchers and support Deliver virtual care via 75+ telemedicine services to network hospitals Estimated 3 million telehealth visits in first 5 years
Page 12: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Telemedicine Barriers

• Federal policy• State law• State regulations

• Payers

• Physicians

Page 13: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Sources: “State telehealth laws and reimbursement policies,” Center for Connected Health Policy, available at http://telehealthpolicy.us; Gregg, Helen, “21 states with telemedicine parity laws,” Becker’s Hospital Review, May 22, 2014, available at http://www.beckershospitalreview.com;

1) As of 12/2014.2) Remote patient monitoring.3) As of 6/9/2013.

Medicaid Programs That Reimburse RPM1,2

Telehealth Parity Laws3

Reimbursement Policies:

• States may reimburse for telehealth under Medicaid so long as the service satisfies federal requirements of efficiency, economy, and quality of care.

• Extensive control is given to states to decide how to structure and administer their Medicaid telehealth policy.

Impact on Providers:

• Medicaid patients are often high-risk and would benefit greatly from RPM, especially if they cannot easily access healthcare services.

• More Medicaid programs reimburse for live video than RPM, but fewer reimburse store-and-forward.

Parity Policies:

• Health insurers are required to cover services delivered remotely via telemedicine at the same rate as the same service delivered in person.

• 13 other states have pending legislation on parity introduced in 2014 (AK, CT, FL, IL, IA, MA, NE, NJ, NY, OH, PA, RI, SC, TN, WA, WV).

Impact on Providers:

• Providers in these states might be able to adjust their capacities if they can take on some patient visits remotely for the same reimbursement.

• Providers should track changing legislation.

Page 14: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Vanderbilt TelemedicineGoal

Support VUMC in population health management:

oElevate community based sub-specialty careoIdentify the right patients for transfer to VUMCoTreat all others in the lowest cost environment

o Reduce unnecessary transfers

oClosest to the patient’s home

Presenter
Presentation Notes
Apply Mercy’s model to VHAN. VHAN: discuss hospital partnerships, discuss importance of attracting physicians to join – want them to join insurance plan - physicians will preferentially select patients. Note how center is good for population health management. (Vision is also similar to UCLA and Dartmouth models)
Page 15: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Vanderbilt Teleneurology

Page 16: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and
Page 17: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Why Hand-Held?

üMore versatile than other robotic systems ü Readily available for emergent visitsüMore affordable than cart technologyü Easy to use; requires minimal training

Page 18: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

More About Technology

• Three apps including Jenesis, StarPanel (EMR), and FaceTime

• IT Risk Assessment completed to demonstrate HIPAA compliance of FaceTime

• Approval by VUMC Information, Privacy & Security Executive Committee

Page 19: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and
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Physician Satisfaction

55%38%

7%

Excellent

Satisfactory

Unsatisfactory

“Teleneurology has made a positive impact on our patients. When I arrive to see the patient, the workup is already complete, and I can review the Teleneurologist’srecommendations. Neurology patients are being discharged 1-2 days earlierthan before the service started.”- Megan Mason, MD, Neurologist

Page 23: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and
Page 24: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

The Future of Telemedicine

Page 25: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Training for Primary Care Providers of Adults with IDD

Janet ShouseProgram Coordinator

IDD Toolkit(www.iddtoolkit.org)

Vanderbilt Kennedy Center

Project funded byThe Special Hope Foundation

Palo Alto, Calif.

Page 26: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Trainingfor Primary Care Providers

of Adults with IDDA grant-funded project to assess the impact of live educational videoconferencing with community primary care providers in improving the health care for adults with intellectual and developmental disabilities, such as autism, Down syndrome and Fragile X.

Page 27: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Trainingfor Primary Care Providers

of Adults with IDDA grant-funded project to assess the impact of live educational videoconferencing with community primary care providers in improving the health care for adults with intellectual and developmental disabilities, such as autism, Down syndrome and Fragile X.

Page 28: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Training for Primary Care Providers of Adults with IDD

Adults with intellectual or other developmental disabilities face a cascade of health disparities. They often:• have complex or difficult-to-treat medical conditions• have difficulty accessing health care• may receive inadequate health care• may have difficulties expressing their symptoms and

pain• receive little attention to wellness, preventive care and

health promotion

Page 29: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Training for Primary Care Providers of Adults with IDD

• Vanderbilt Kennedy Center received Special Hope Foundation grant in January 2016

• Telehealth, not telemedicine• 10 hour-long sessions, one a month, at

midday-May to February 2017• A panel of clinicians, including family

practice, neurology, psychiatry, nursing, behavior analysis, and occupational therapy

• CME credits awarded upon completion

Page 30: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Case-Based Telehealth Training for Primary Care Providers of Adults with IDD

• Content will build on information from the IDD Toolkit (www.iddtoolkit.org)

• Similar to “grand rounds”• Providers will be able to share difficult cases• Didactic presentations on specific topics will

complement the cases (e.g., autism spectrum disorder, sleep disorders, psychotropic medication management).

Page 31: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

www.iddtoolkit.org

Page 32: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

The goals of the project• Community health care providers will be better

equipped and more comfortable caring for adults with IDD.

• Patients may get better, more timely care.• Patients may receive appropriate preventive care.• Patients may have less need to rely on hospital

emergency departments or specialists for routine care.

• The rate of polypharmacy, particularly psychotropic medications, may be reduced.

Page 33: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Specifics of the project• At least 20 primary care physicians, advanced

practice nurses or physician’s assistants will participate

• Pre- and post-surveys regarding knowledge and comfort levels in treating patients with IDD

• Interactive videoconferencing• Simple, easy-to-use technology (I promise)• Midday sessions that can be joined during

lunch.• We hope to create a community of practice.

Page 34: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

Dates for our sessions• Start date- May 5• June 9• July 7• August 11• Sept. 8

• Oct. 13• Nov. 10• Dec. 8• Jan. 12, 2017• Feb. 8, 2017

Conducted from noon to 1 p.m. Central Time

Page 35: Telehealth and Telemedicine - Tennessee Medical Association Telemedicine MidTenn 16.pdf · primary care providers in improving the health care for adults with intellectual and

For Questions or Further Information

Contact Janet Shouseat

615-875-8833or

[email protected]