“Advances in Telemedicine & Telehealth: New Models of ... · History of Telemedicine R.S....

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“Advances in Telemedicine & Telehealth: New Models of Healthcare Delivery” Ronald S. Weinstein, MD, FCAP, FATA Director, Arizona Telemedicine Program Professor, Colleges of Medicine, Pharmacy and Public Health The University of Arizona Tucson, Arizona Corabi International Telemetric, Inc. Apollo Telemedicine, Inc. DMetrix, Inc. GlobalMed (Medical Advisory Committee) AmericanWell (IP- expert advisor) Disclosures © 2013, Arizona Telemedicine Program

Transcript of “Advances in Telemedicine & Telehealth: New Models of ... · History of Telemedicine R.S....

  • “Advances in Telemedicine & Telehealth:

    New Models of Healthcare Delivery”

    Ronald S. Weinstein, MD, FCAP, FATA

    Director, Arizona Telemedicine ProgramProfessor, Colleges of Medicine, Pharmacy

    and Public HealthThe University of ArizonaTucson, Arizona

    Corabi International Telemetric, Inc. Apollo Telemedicine, Inc. DMetrix, Inc. GlobalMed (Medical Advisory Committee) AmericanWell (IP- expert advisor)

    Disclosures

    © 2013, Arizona Telemedicine Program

  • Innovations in Medicine

    © 2013, Arizona Telemedicine Program

    Technical

    Societal Organizational

    Direct-to-Consumer Telehealth

    https://www.youtube.com/watch?v=gnVmHZRSOnQ

    United HealthCare Virtual Visits

  • (Single Click on the link)

    Direct-to-Consumer Telemedicine

    https://www.youtube.com/watch?v=sBryMAxi5tE

    American Well

  • © 2013, Arizona Telemedicine ProgramRandall Moore, M.D.

    Mercy Virtual

    Mercy VirtualChesterville, MO - 2017

    © 2013, Arizona Telemedicine Program

  • Mercy Virtual

    © 2013, Arizona Telemedicine Program

    Brief History of Early Telemedicine1. telepsychiatry, teleradiology (1959)

    2. prototype telemedicine service (1968)

    Aggregation of Enabling Technologies

    > Television

    > Videoconferencing (bi-directional)

    > Teleradiology

    > Television microscopy (precursor of telepathology)

    > Electronic stethoscopes, etc.

  • © 2013, Arizona Telemedicine Program

    1952

    1955

    1956-2015Center of Excellence

    (1960-1962)

    Woods Hole Marine Biology Laboratory

    1968-1977Massachusetts General

    Hospital; Harvard(1962-1975)

    Origins of Television Microscopy(remote clinical microscopy)

    Diffusion of Innovations in Medicine--Example: Telemedicine microscopy--

    © 2013, Arizona Telemedicine Program

    MGH

    Logan International Airport *

  • Television microscopy Massachusetts General Hospital

    Boston, Massachusetts, USA

    Blood smears Urines

    © 2013, Arizona Telemedicine Program

    Boston Logan Airport Medical Station – Connecting to the Massachusetts General Hospital

    1968

    A

    B C

  • The Press Takes NoteMedical World News

    July 26, 19681968

    R.S. Weinstein et al, Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

    Medical Clinics of North America, 102; 533-544. 2018

    History of Telemedicine

  • History of Telemedicine

    R.S. Weinstein et al, Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.

    Medical Clinics of North America, 102; 533-544. 2018

    Telemedicine Peripheral Devices

    Tele‐ophthalmoscope

    Video‐otoscope

    Multi‐lead ECGGeneral patient exam camera

    Electronic stethoscope

    Teleradiology

    Legacy Appliances (1968-1980)

    Television microscopy

  • Telemedicine Peripheral Devices

    Tele‐ophthalmoscope

    Video‐otoscope

    Multi‐lead ECGGeneral patient exam camera

    Electronic stethoscope

    Teleradiology

    Video‐endoscope

    Electronic scale

    Smartphone

    Wearables 

    Video dermatoscope

    Video‐colposcope

    Blood pressure monitor

    Innovations (1995-present)

    Television microscopy

    Telepathology

    • Proof-of-Concept

    • High user and provider satisfaction

    • Multi-specialty services

    • Innovations in “peripheral devices”

    MGH-Logan International Airport Telemedicine

    © 2013, Arizona Telemedicine Program

  • 1972-1975

    Space Technology Applied to Rural Papago Health Care Program(Lockheed Missile Space Company)

    Arizona Story

    STARPAHC Project: Sells, Tucson & Phoenix, AZ

    NASAIHS

    Lockheed(1972-1975)

    Regional Telemedicine Program

  • STARPAHC Mobile Telemedicine Vehicle -1975

    © 2018, Arizona Telemedicine Program

    Dozens of Telemedicine

    Programsby 1978

  • © 2018, Arizona Telemedicine Program

    President Lyndon Johnson -- “Great Society”

    President Ronald Reagan -- “Reaganomics”

  • © 2018, Arizona Telemedicine Program

    Telemedicine Issues (1986)• Legal

    • Regulatory

    • Reimbursement

    • Quality-of-care

    • Standards-of-care

    “Telemedicine is a technical as well as an organizational

    and social innovation.” --Bashshur et al, 2000

    © 2018, Arizona Telemedicine Program

    Western Governor’s AssociationReport on Telemedicine

    Telemedicine Issues (1993-1994)• Legal

    • Regulatory

    • Reimbursement

    • Quality-of-care

    • Standards-of-care

  • 1996

    Arizona Rural Telemedicine Network

  • • > Rural and urban hospitals• > Native American healthcare• > Prisons & jails• > Community health centers• > Schools• > Distance learning affiliates

    250+ Sites in Arizona

    © 2013, Arizona Telemedicine Program

    Telecardiology

    Mayo Clinic -Telestroke

    Yuma NICU Tele-echocardiology

    Tele-infectious diseaseAIDS tele-nursing

    Banner eICU program

    Diabetes retinal screening

    Breast Cancer “Virtual” Survivor Groups

    Flagstaff –Navajo/CHF Program

    Telemedicine/Telehealth Services (61 total at U of A)

  • Teleradiology1,400,000 cases

    Teledermatology

  • Teleophthalmology

    Telerheumatology

  • Teleneurology

    Dr. Conrad Clemens uses real-time video conferencing and digital stethoscope technology to evaluate a child's asthma.

    Tele-pediatrics

  • Telepsychiatry

    “The talk is the treatment”• Psychiatry/psychology• Genetic Counseling• Pain Management• Nutrition• Support group• Hospice care

  • Cancer Genetic Counseling

    Support Groups

  • Home Health Care Applications• Wound care• Post-operative care• Pre-organ

    transplantation• Physical therapy

    Wound Management

  • Telemedicine & Telehealth Services

    1. Gap Services2. Urgent Services3. Mobile Telehealth4. Direct-to-Consumer Telehealth5. Cloud Computing Applications

    Gap Service and Tele-urgent Services

    1. Gap Services

    2. Urgent Services

    © 2013, Arizona Telemedicine Program

  • Gap Services - Teleradiology

    Urgent Service – TeleStroke

  • Telestroke

    Telemedicine & Telehealth Services

    1. Gap Services2. Urgent Services

    3. Mobile Telehealth4. Direct-to-Consumer Telehealth

    5. Cloud Computing Applications

  • “Care Beyond Walls and Wires is the

    best thing ever for me, and the best thing for my dad.”

    Rita Yazzie

    Case StudyMobile Telehealth

    Telemedicine & Telehealth Services

    1. Gap Services2. Urgent Services

    3. Mobile Telehealth4. Direct-to-Consumer Telehealth

    5. Cloud Computing Applications

  • (Single Click on the link)

    Doctor On Demand

    Direct-to-Consumer Telehealth

    (Single Click on the link)

    MDLive

    Direct-to-Consumer Telehealth

  • 1850

    0

    500

    1,000

    2,000

    2,500

    3,000

    3,500

    4,000

    1,500

    1880 1910 1940 1970 2000

    Managers

    Technicians

    Therapists

    Aides

    LPNs

    RNs

    Pharmacists

    Dentists

    NPCs

    Physicians

    Physicians, Non‐physician Clinicians,and other Health Workers

    1850‐2010

    Health

    Employmen

    t per

    100,000of

    Popu

    latio

    n

    Adapted from Kendix and Getzen, and the Bureau of Labor Statistics

    FlexnerReport

    HillBurton

    Medicare

    Telemedicine & Telehealth Services

    A. Gap ServicesB. Urgent Servicesc. Mobile TelehealthD. Direct-to-Consumer Telehealth

    E. Cloud Computing Applications

  • Cloud Computing: zoom.us

    Cloud Computing

    © 2013, Arizona Telemedicine Program

  • Project ECHO Programs(Extension for Community Healthcare Outcomes)

    • Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative model of medical education and care management that empowers clinicians everywhere to provide better care to more people, right where they live.

    • The ECHO model™ does not actually “provide” care to patients. Instead, it dramatically increases access to specialty treatment in rural and underserved areas by providing front-line clinicians with the knowledge and support they need to manage patients with complex conditions such as: hepatitis C, HIV, tuberculosis, chronic pain, endocrinology, behavioral health disorders, and many others.

    • It does this by engaging clinicians in a continuous learning system and partnering them with specialist mentors at an academic medical center or hub.

    About Project ECHO

    © 2013, Arizona Telemedicine Program

  • Why Project ECHO?

    121,697 square miles

    Sanjeev Arora, M.D.

    Arizona TelemedicineProgram

  • ATP Rheumatology TeleECHO Clinic

    ECHO TeleRheumatology Clinic

  • ECHO TeleRheumatology Clinic

    Physicians in Bisbee, AZ Attending from a rural hospital conference room

  • PCORI Programs(PCORI - Patient-Centered Outcomes Research Institute)

    “Ostomy Telehealth for Cancer Survivors: A Program of Collaborative Research”

    Robert Krouse, M.D., FACS, Principal InvestigatorRonald S. Weinstein, M.D., Co-P.I.

    Ostomy Surgery

  • Session/Content• Session 1: Self-management & immediate

    concerns• Nutrition• Pouching System• Goals/Resources

    • Session 2: Social well-being and body image

    • Social/Interpersonal relationship

    • Sexuality/Intimacy

    • Psychological Health

    • Session 3: Caregiver/Support Person only

    • Ostomy review

    • Concerns regarding ostomates

    • Caregiver/Support person well-being

    • Session 4: Healthy Lifestyle

    • Interpersonal Relationships

    • Travel Concerns

    • Physical Activity

    • Improving Attitudes

    • Psychological Health

    • Session 5: Booster session for ostomateand support person

    • Content Review

    • Available Resources

    • Goal Progress

    PCORI Funding

    Ostomy Self-Management Clinical Research Sites

    City of HopeUniversity of Arizona & Arizona Telemedicine Program

    Penn MedicineYale New Haven

  • Steven Moore: Las Vegas Review-Journal 2/15/2005

    In-Person Support Group Setting

    In-Person Support Group Setting

    https://www.reviewjournal.com/life/health/ostmate-support-groups-filled-with-stories-of-past-successes-hopes-for-future/

  • Ostomy Telehealth Patient Group Session

    “Social reinforcement by peers”

    Panel of Peer Ostomates• Nurse Educators• Engineer

    4-6 New Ostomates

    In-Person Model

    Telehealth Model

    • “Ostomate Peers”

  • © 2013, Arizona Telemedicine Program

    Photo – Ostomate Peer at Home

    Take Home Lessons

  • • Telemedicine/telehealth is focused on patients

    Take Home Lessons

    • Telemedicine/telehealth is focused on patients

    • Regulatory uncertainty is no longer slowing momentum

    Take Home Lessons

  • • Telemedicine/telehealth is focused on patients

    • Regulatory uncertainty is no longer slowing momentum

    • Top-challenges are related to reimbursement

    Take Home Lessons

    • Telemedicine/telehealth is focused on patients

    • Regulatory uncertainty is no longer slowing momentum

    • Top-challenges are related to reimbursement

    • EHR is frequently inadequate for telemedicine

    Take Home Lessons

  • • Identifying, selecting, contracting with, and establishing long term working relationships with, telehealth service providers

    • Creating realistic outcome expectations

    Significant Challenges

    © 2013, Arizona Telemedicine Program

    © 2013, Arizona Telemedicine Program

    Resources

    > Arizona Telemedicine Program -- In-state

    > Southwest Telehealth Resources Center – Out-of-state

    www.telemedicine.arizona.edu

  • © 2013, Arizona Telemedicine Program

    Resources

    > Arizona Telemedicine Program -- In-state

    Federally - Funded Telehealth Resources Centers – Out-of-state

    www.telemedicine.arizona.edu

    4th National Service Provider SummitGlendale, Arizona October 2-3, 2018

    Arizona Telemedicine Council, Quarterly meetingsAZ State Capitol Campus

    April 8, 1968-April 8, 2018

    50th Anniversary of Telemedicine Systems

    96th Arizona Osteopathic Medical Association Conference

    Lecture

  • Thank you

    [email protected]

    Ronald S. Weinstein, MD

    © 2013, Arizona Telemedicine Program