kaap 2014 [read-only] · uc davis children’s hospital sacramento, ca [email protected]...
TRANSCRIPT
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KansasTelemedicineandAdvancesinTele‐Pediatrics
RyanSpaulding,PhDViceChancellor,CommunityEngagementDirector,CenterforTelemedicine&TelehealthAssociateProfessor,HealthPolicy&Management
Disclosure• Ihavenorelevantfinancial
relationshipswiththemanufacturers s ofanycommercialproducts s and/orproviderofcommercialservicesdiscussedinthisCMEactivity
• Idonotintendtodiscussanunapproved/investigativeuseofacommercialproduct/deviceinmypresentation.
PreviewofPresentationI. NationalOverview
I. StatusII. Trends
II. KansasTelemedicineI. ExamplesII. ReimbursementIII. Medico– Legal
III. Tele‐PediatricsI. School–basedII. AutismSpectrumIII. UCDavisIV. Otherissues
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Definitions
Telemedicine– videoconsultation Telehealth– “storeandforward”asynchronousimagesordata
DistantSite– providerlocation OriginatingSite– patientlocation mHealth– mobilehealth “apps”– smartdeviceapplications
NationalOverview Currenttelemedicinemovementbeganinlate1980’s Moststateshaveatleastonetelemedicineprogram,ofteninuniversitymedicalcenters
32%ofthe4,727reportinghospitalsuseatleastonetypeoftelehealth service HIMSS
Over100,000iOSandAndroidhealthcareapps ModernHealthcare
AmericanTelemedicineAssociationwww.americantelemed.org
mHealthSummitwww.mhealthsummit.org
StateswithMedicaid/PrivateCoverage
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Telehealth“Parity”Legislation
NationalObservations
Healthsystems;privatesector Reducedsystemutilizationasdrivers Home orotherprivate setting Patientinitiated Specialtycaretoprimarycare Mobile,smartdevices,wearable Interstate
KansasTelemedicineExperience
Firstimplementedin1991withonehospital Primarilyfacilitatedbyinteractivevideoconference Programhasexpandedintomorehospitals,schools,nursinghomes,andclinics Cardiology,mentalhealth,oncology,pediatrics,manyothers
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Mobile,multi‐pointconnectionwithadditionalcliniciansorotherstakeholders
TELEPRESENCEROOM
TABLET
SMARTPHONE
HomeParenteralNutrition
• BypassestheGItractinboweldisease
• LifelongtwicedailyInfusionofsolutionsviapumpinhome
• Riskofinfectionsandcomplications
• Currentstudywith80familiesinU.S.
• RNsobservecarefromadistance
• Limitssociallife,work,meals;depressioncommon
Research reported in this presentation was supported by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number R01EB015911. C. Smith, PhD RN Principle Investigator. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.”
Creating a Wireless Infrastructure 11
AdditionalKansasProjects
TeleStroke KUHospital TeleED KUHospital PediatricEpilepsy KUMC KansasECHO KUMC
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KansasECHO• “ExtensionforCommunity
HealthcareOutcomes”• Primarycare,case‐based
presentationstospecialtyteamusingtechnology
• PioneeredinNewMexico• Supportsruralpractices’
managementofchronicconditions
• CEprovided• Somereimbursement• Kansasimplementation
early2015– painmanagement
• Photo courtesy of ECHO and The Pain Practitioner, Vol 21, #2, p. 61
ThereisReimbursement!
Medicare 2001 KansasMedicaid 2004 Mostlarge,privateinsurersinKansas mid‐2000’s BlueCross/BlueShieldofKansaswasoneoffirstinsurersinnationtocovertelemedicine1995
KMAP 90791GT 90832GT– 90838GT 90847GT 90863GT 99201GT‐ 99205GT 99211GT‐ 99215GT 99261GT‐ 99263GT 99271GT‐ 99275GT
H0001GT H0004GT H0005GT H0006GT H0007GT H0038GT H0038HQGT
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Medico‐ Legal
CredentialingandPrivileging
Licensure
Malpractice
GenerallyTreatedsameasOutreach
Wherepatientislocatedisplaceofservice Providersneedtobecredentialed/privileged/licensedateachplace/stateofservice TJCandCMSnowbothallowcredentialingbyproxy Standardmalpracticeinsurancecoverstelehealth Verylowriskservicetodate Nationalefforttocreatetelemedicinelicense
Advances in Tele – Pediatrics
TeleKidcare
Implemented 1997 with 4 Kansas City, KS schools; 12 at peak
Primarily for urgent care with KUMC peds
Evolved to more mental health
New programs in New York and North Carolina
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AdditionalPeripherals
Stethoscope Dermascope Ophthalmascope Generalexamcamera Handheldretinacamera IntegrationofperipheralswithP.C.
AutismSpectrumService
TrainexistingAutismInterdisciplinaryTeams AIT andPartCNetworkteamsintheassessmenttoolsusedtodiagnoseautism
TeamscollecttheinformationandwritetheirfindingstopasstoalocalphysicianorCCHDteamviatelemedicinewhodetermineaDiagnosticImpression.
GOAL:Fromreferraltodiagnosis,childrenandfamiliesareseenin45days Currently,await‐timeattheavailablediagnosticclinicsvariesfrom3monthsto1year.
AutismTelemedicineServices
FortheDiagnosticImpression,teamsconnecttoCCHDstaffviatelemedicine
Thefamily,theschoolorPartCnetwork,andCCHDstaffmeettodiscusstheassessmentfindings,clarifytheinformation,discussmedicalhistory,andmakeaDiagnosis. Appointmentsare45minuteslong TelemedicinesitesthroughoutthestateusingITVnetwork
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UC Davis Telemedicine Connecting to 120 sites/year >40,000 total consults to date >6,000 pediatric consults to date Applications at UC Davis Outpatient services Interpretation of studies ED services (stroke, trauma, ICU) Inpatient ward, ICU, NICU Remote Patient Monitoring (RPM) Training, Mentoring, Education Use by Advanced Practice Provider
Interpretation of Studies Tele-radiology:
standard of care Tele-dermatology Cardiac ultrasound
– Cyanotic Congenital Heart Disease Screening
EEG interpretation Screening for retinopathy Tele-psychiatry, behavioral health
Pediatric Critical Care Telemedicine Network
As of 5-2014: 27 EDs3 Inpatient wards4 Nurseries2 ICUs
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Telehealth: Leveraging Technology to Provide Patient Centered,
High Quality, and Cost-Effective Care
Jim Marcin UC Davis Children’s Hospital Sacramento, CA [email protected] 916-734-4726
PracticeParameterforTelepsychiatrywithChildrenandAdolescentsfromAmericanAcademyofChildandAdolescentPsychiatry
Principle Definition Brief Description
1 Theneedforchildandadolescentpsychiatricservicesandwhethertelepsychiatry isanoptionformeetingthatneedshouldbedetermined.
Theclinicalneedshoulddrivetheservice,notthetechnologyorsomeotherpurpose.Aproposedservicethatdoesnotoriginatewithaclinicalneedisdoomedtofailure.Moreover,theadvantages,disadvantages,communitysupport,infrastructureandotherissuesshouldbefullyreviewedbeforeimplementation.
2 Thesustainabilityofthetelepsychiatryserviceshouldbedetermined.
Thoughsustainabilitycanbelooselydefined,someongoingsupportoftheprojectwillbeneeded.Someprogramshavechosentofundoperationsthroughcontinuousresearchfundingsupport,whileothershavedecidedtomaximizerevenueorcostsavings.Whateverthemechanism,thisdecisionshouldbemadeearlyintheproject.
3 Thepatientpopulation,themodelofhealthservicedelivery,andservicestobeofferedshouldbedetermined.
CloselyrelatedtoPrinciple1butalsoinvolvesmorespecificdetailsaboutpatientinclusioncriteria,itemizedservicesandconsultationversustherapeuticresponsibilitiesofthepsychiatrist.
HIPAAIssues InteractivetelemedicinenotgovernedbyHIPAA NotconsideredPHI NotrecordedorstoredlikeotherPHI HIPAAdoesnotrequireencryption butweencrypt Useprivateconnectionswhenpossible Telemedicineroomshouldbeprivatejustlikeanyotherclinicroom Emergingopinionsonmobiledevices
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HealthReform&Telemedicine
Handfulofdirecttelehealthprovisions Mostlyindirectviaquality,capitationorcarecoordination 30dayreadmissionrule ConcurrentwithNationalBroadbandPlan MostsignificantindirectisCMI
CreatednewCMSCenter
CenterforMedicareandMedicaidInnovationCMI
Testbothpaymentanddeliverymodels Fundedat$10billion HealthCareInnovationChallenge HCIC AnnouncedNovember2011 $1billion $1millionto$30millionawards Reportedly100,000lettersofintent
ACAalsodirectsCMIto…
“Facilitateinpatientcare,includingintensivecare,ofhospitalizedapplicableindividualsattheirlocalhospitalthroughtheuseofelectronicmonitoringbyspecialists,includingintensivistsandcriticalcarespecialists,basedatintegratedhealthsystems;”
eICUmodel
Americantelemed.org
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OtherMedicareProvisionsforTelehealth
IncludesuseofremotemonitoringforeligiblemedicalpracticesintheIndependenceatHomeDemonstrationProgram
Allowsphysicianstousetelehealth tocertifytheneedforhomehealthservicesordurablemedicalequipment
AllowstelehealthtechnologiestobeusedbyapharmacistorotherqualifiedproviderinperforminganannualcomprehensivemedicationreviewofMedicaredrugplanmedicationtherapymanagementprogramsaswellasneededfollow‐upinterventions.
ForthenewCommunity‐BasedCollaborativeCareNetworkProgram,thelegislationrecognizestheroleoftelehealth toexpandingtheprogram’scapacity
Americantelemed.org
30dayreadmission
CMSauthorizedtopenalizebeginningin2013 CHF,AMI,pneumonia 2015,COPD,bypass,percutaneousintervention,othervascularsurgeryprocedures Hometelehealthorotherremotemonitoringforpost‐dischargeperiod
Medicaid… legislationprovidesa“healthhome”optionforchronicconditionsthatincludes:
“aproposalfortheuseofhealthinformationtechnology inprovidinghealthhomeservices…andimprovingservicedeliveryandcoordinationacrossthecarecontinuum includingtheuseofwirelesspatienttechnologytoimprovecoordinationandmanagementofcareandpatientadherencetorecommendationsmadebytheirprovider ”
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Future Courtesyofmhealthwatch.com
The Telehealth Resource CenterGrant Program
www.telehealthresourcecenters.org
Technical assistance forstarting or expanding telehealth services.
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HTRC SERVICE AREA
KANSAS ‐ MISSOURI ‐ OKLAHOMA
RyanSpaulding913.588.2251