Telehealth Chances to upgrade access, lower expenses, and enhance quality.


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Tele-ophthalmology. Tele-ophthalmology innovations: JPEG pressure ... 1 Flowers et al, Ophthalmology, 105:8, 1998. 2 Chiang et al, Arch Ophthal 125:1531 2007 ...
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Telehealth Opportunities to upgrade access, lower costs, and enhance quality Karen S. Rheuban MD Professor of Pediatrics University of Virginia

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Telemedicine The utilization of cutting edge information transfers and different innovations for: Medical conclusion Ongoing patient consideration Health-related separation learning

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Telemedicine: History Alexander Graham Bell Hugo Gernsback (vision) Massachusetts General University of Nebraska NASA Dept of Defense Medical College of Georgia University of Virginia

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Mission Facilitate the Health System\'s missions of Clinical Care Teaching Research Public Service

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Services Videoconferencing for patient consideration Store and forward applications Distance learning wellbeing experts patients understudies

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2004 IOM Report: Status of Rural Healthcare Fewer "center based administrations" in country territories Emergency therapeutic administrations Long term care (SNF, Hospice) Mental wellbeing and substance misuse administrations Physician enlistment/maintenance challenges Fewer pros Generally bring down repayment rates Slower to embrace new advancements Urban appropriation rate of EMR 150% of rustic

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Barriers to Access Geographic >20% of US populace dwell in provincial zones Burden of transportation to mind for the most part borne by patients Medicaid programs bear the weight of transportation costs 1999: >$50 million/year in Virginia Financial The uninsured, underinsured (> 40 million uninsured) Delayed access to administrations for uninsured High cost of go for locally occupied claim to fame care

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Barriers to Access Societal disparagement Cultural obstructions Language boundaries Maldistribution/lack of suppliers Predicted deficiency of doctors 85,000-200,000 by 2020 Urban transcendence of forte suppliers Isolation of country wellbeing suppliers Need for proceeding with wellbeing proficient instruction

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Benefits of telehealth Patients : Timely access to locally distracted administrations Spared weight and cost of transportation Health experts Access to consultative administrations Access to CME Primary consideration oversight of patient consideration Academic focus Improved triage Better usage of tertiary/quaternary offices

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Partnerships Academic-group doctor\'s facility linkages Academic-scholastic doctor\'s facility linkages Rural centers (FQHCs, Veteran\'s facilities) Virginia Department of Health Virginia Department of Corrections School wellbeing Nursing Home telehealth

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Broadband Technologies Network Virginia (statewide ATM system) Telco broadband (N\'Telos) Wireless ISDN Satellite Cable modem Bristol Virginia Utilities Mecklenburg Electric Cooperative

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Specialty/Subspecialty Division Participants Cardiology Dermatology Developmental Pediatrics Diabetes Emergency Medicine Endocrine ENT Gastroenterology Genetics Geriatrics Gynecology Hematology Infectious Disease Nephrology Neurology

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Patients served >13,100 understanding experiences >35,000 teleradiology readings Services in >30 distinctive strengths Emergency Urgent Single counsels Block booked centers Screenings with store forward Mobile computerized mammography van Retinopathy

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More than innovation and numbers: Facilitating master care

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Enhancing access Remote territory restorative facility

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Enhancing access

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Educational projects Broadcast proceeding with wellbeing proficient training Patient instruction School Health Projects

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More than innovation and numbers: Saving lives: Infant with Interrupted aortic curve

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Pediatric tele-echocardiography Primarily connecting group doctor\'s facilities with NICUs with UVa -Contracts with 3 group doctor\'s facilities -Digital picture exchange (Heartlabs - AGFA) -Other destinations "as required" with live backing or video join Referrals from neonatologists, general pediatricians, family drug, ER doctors Mandatory preparing of reverberation techs - Most locales are in groups with existing UVa field centers - Adjunct to handle facilities - "A reverberation is just in the same class as the echocardiographer" (Howard Gutgesell, MD)

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UVA Pediatric tele-reverberation program >3000 thinks about Reduced superfluous exchanges Provided auspicious mediations Improved case administration

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Telecardiology: Clinical ramifications Children\'s National Medical Center 6,300 Studies: 1998 - display No huge analytic mistakes Patient subsequent Management influenced in 60% cases 100+ patients transported for surgery 75+ transports kept away from Sable, C et al, Pediatric Telehealth Colloquium, 2008

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Telecardiology opportunities Fetal echocardiography Sharma, S et al (Mt. Sinai) Live fetal ultrasounds transmitted Bandwidth delicate Patient advising through VTC Patient acknowledgment great Sharma, S, et al, Screening fetal echocardiography by telemedicine: adequacy and group acknowledgment, J Amer Soc Echo, 16(3):202-8, 2003.

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Perinatal/neonatal consideration Premature conveyance corresponds with late access to obstetrical care High expenses regularly borne by Medicaid programs Cost of neonatal hospitalization (reserve funds to Medicaid) >$27,000 every week growth in utero for low birth weight babies Additional expenses of long haul confusions of unexpected labor UVA group wellbeing focus pilot Modeled after Arkansas Angels

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Arkansas Angels Medicaid financed statewide perinatal regionalization venture Provider instruction Collaborative high hazard ob care Case administration Counseling Referral for at danger pregnancies Referral to UAMS for conveyance for preterm newborn children and newborn children with inborn deformities

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Pediatric crisis support IOM: Future of Emergency Care – Key Findings: "Youngsters make up 27% of all ED visits, however just 6% of EDs in the US have the majority of the vital supplies for pediatric crises CDC report (Feb 2006): 40% of EDs need all day, every day access to pediatricians 21% of kids in the United States live in rustic zones 3% of board confirmed pediatric intensivists hone in provincial regions

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Pediatric ED and basic consideration bolster Access to pediatric basic consideration administrations all day, every day Expands the compass of pediatric concentrated consideration masters Decreases disparities in nature of consideration amongst country and urban Allows more patients to get fitting care locally Better triage Improved clinical results

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VISICU ® model for basic consideration (Continuous oversight model) Model for backing of grown-up escalated care units 1 Two grown-up ICUs in huge tertiary consideration healing center framework 2140 patients accepting ICU care; 6 month control period versus mediation period E-ICU administrations from 12 twelve – 7am Program used off-site intensivists, doctor extenders, electronic information show, VTC, choice bolster apparatuses Results: Hospital mortality diminished from 12.9-9.4% ICU length of stay shorter 4.35-3.63 days (Breslow et al 2004)

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Pediatric basic consideration support ( Consultation model – Davis 1 , Vermont 2) Premise: a few "less fundamentally sick" kids can be administered to in group doctor\'s facilities without PICUs and NICUs Remotely found ERS and ICUs associated by means of VTC day in and day out scope by available to come back to work group 1 Marcin et al, Pediatric Telehealth Colloquium 2008 2 Salerno, et al, Pediatric Telehealth Colloquium 2008

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Provider Satisfaction in Northern CA Marcin et al, 2004

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Pediatric basic consideration support - CA Additional income to remote site ICU 1 Decreased transportation costs Fewer helicopter transports Cost investment funds of $5,000-$10,000 per case Lower transportation costs for groups of patients Increased comfort Reduced non-attendance at work Marcin et al (2004)

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Pediatric basic consideration support 73 counsels from 13 destinations in upstate NY and Vt Patients went in age from 2 days to 17 years 69/73 patients were transported to the tertiary consideration doctor\'s facility. Counseling intensivists made an aggregate of particular 261 recommendations (mean 3.6 for each counsel) In 3 cases, the patients were triaged to the pediatric ward In 4 cases, transport was not required after meeting Salerno et al (2008)

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School/Daycare Telehealth University of Rochester system 22 urban childcare focuses and schools 66% patients Medicaid Trained lay wellbeing experts associated with UR and neighborhood hones for essential consideration pediatric administrations Reduced ER visits by 22% McConnochie, et al 2007

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Tele-emotional wellness Shortage of psychological wellness suppliers in provincial regions Consultations, solution administration Sign dialect for listening to impeded Interpreter administrations UVA tele-psychiatry administrations Adult - 900 Child – 2290 Fewer missed arrangements

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Tele-emotional wellness Comprehensive survey of the restorative writing in telepsychiatry 1 Technology transcendently intuitive videoconferencing Improve access, shorter hold up times Fewer missed appts 2 High rates of patient fulfillment in all age bunches Diagnosis change from PC supplier analysis in 91%, pharmaceutical changes in 57% Reduced geriatric doctor\'s facility confirmations from long haul care office by 59% 1 Hilty, D, et al, Can J Psych 2004; 49:12-23 2 Tucker et al, ATA 2009

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Facilitating master care: Tele-otolaryngology AFCHAN telehealth venture and utilization of video-otoscopy 1 31% reduction in the utilization of anti-infection agents when video-otoscopy administrations added to group wellbeing facility administrations 1 Peterson, K et al, Arctic Investigations Program, National Center for Infectious Diseases, CDC

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Facilitating master care: Diabetes Tele-ophthalmology Tele-ophthalmology advances: JPEG pressure calculations did not affect analyst exactness ATA: Tele-ophthalmology models

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Facilitating master care: Diabetes Tele-ophthalmology Diabetes is the main source of visual impairment in working grown-ups Retinopathy of pre

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