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Telehealth: Now and Future

Archit Bhatt MD

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

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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.

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…. 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

2014…

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No matter who you are

or

where you are

you can get

the health care you need

when you need it

The Vision

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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

What Is Telemedicine?

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Telemedicine

Telehealth

Health

Professions

Education

Administration

Evaluation

Research

Homeland Security

Public

Health

Consumer

Education

Regional

Health Information

Sharing

Telehealth vs. Telemedicine

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Clinician shortages

Misdistribution of providers

Rural/Urban underserved

Aging population

Travel time, cost & hardship

Delayed treatment

Language barriers

Clinical education programs

Administrative meetings

The Need for Telehealth

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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

Telehealth Benefits

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Clinical Services

Educational Programming

Administrative Meetings

Most Common Uses

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Principal components

Equipment

Connectivity

Two Technology Approaches

Live Interactive

Store and ForwardVidyo

Telemedicine Unit

What is the Technology

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Statewide

University Based Systems

Regional Networks

Large Healthcare

Individual & Small Group Practice

Telehealth System Models

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Live Interactive

Store and Forward

Emergency Response

Patient Education Kiosks

Home Health Monitoring

Educational Services

Videoconferencing

Different Approaches for

Various Needs

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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

Live Interactive Telemedicine

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Dental Services

Connecting friends & family

Family Counseling

Support Groups

Patient education

Administrative Meetings

Other Great Uses

For Live Interactive

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• Outpatient Clinics

• Mental Health Centers

• Intensive Care Units

• Correctional Facilities

• Emergency Departments

• Emergency Transport Units

• Surgery Suites

Can be applied in many situations and locations

In Touch Health

Live Interactive Telemedicine

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Improve Quality of Care – Avoid Medical

Errors

Multilingual

Culturally Competent

Trained in Medical Terminology

Meet legal/contract requirements

Video Interpretation Services

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Diabetic Retinopathy Screening

Round Valley Indian Health ServiceSecond Opinion Dermatology System

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

Store and Forward

When a face to face visit is not necessary

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Technology that supports

monitoring of chronic conditions

COPD – peak flow

Diabetes

Health Hero

Visiting Nurse & Health Services

of Connecticut

Courtesy of American Telecare

Home Health & Monitoring

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Medicare

Medicaid

Private Payors

• Blue Cross / Blue Shield

State Initiatives

Reimbursement

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Intellectual Property Rights

Risk Management

Credentialing and Privileging

Interstate Licensure

Telecommunications Law

Privacy

Fraud and Abuse

Legal Aspects

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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

Technology Alone Does Not

Produce Success

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Reimbursement

Physician Champions

Institutional Buy-in

Convenience

Telecommunications

Costs

Trade-offs

Program Sustainability

Credentialing, Privileging & Accreditation

Challenges

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Put in all logos

Assistance Is Available!

Federally Designated

Telehealth Resource Centers

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Telehealth Resource Centers

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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

Telehealth Resource Centers

Web Sites