1. WVPTA PT After Hours

2. At the end of this session, participants will be able to: Identify the electronic resources available to practicing clinicians to improve access to evidence regarding PT practice. Report the function of APTAs Open Door Portal Identify the location and purpose of the APTA Legislative Action Center

3. Identify the benefits to patient care from using current evidence in practice. Define tele-rehabiliation Identify the equipment necessary to create a tele-rehabilitation site within a clinical setting. List the benefits of tele-rehabilitation to the consumers of health care in WV, specifically in rural areas.

4. Efficiency in practice logistics Scheduling Billing Documentation Providing resources for clinical decision making Patient educational tools Assuring regulatory compliance Productivity/budgetary/outcomes reporting

5. iOrtho OMT – spine and extremities iMuscle WebMD Medscape Radiology Pharmacology Skyscape ICD9/10 codes And the list goes on and on and on………

6. Practice Management Software APTA Connect Rehab Optima Physical Therapy Advantage Clinic Source ReDoc

7. Evidence I dont know where to get to it. I dont have time for look for it. I dont know how to ask for it. I dont know how to evaluate it. I dont know what it means to my patient.

8. APTA 1 Open Door Hooked on Evidence PTJ and section journals PT Now Move Forward Internet Too many to list! Facebook Twitter PT Think Tank http://ptthinktank.com Physiopedia

9. Open Door - http://www.apta.org/OpenDoorhttp://www.apta.org/OpenDoor Portal that provides access to multiple databases and full text articles to APTA members. ProQuest Medline CINAHL Cochrane SportDiscus

10. Hooked on Evidence - http://www.hookedonevidence.org/reviewstatio n.cfm?CFID=90895431&CFTOKEN=43781805 http://www.hookedonevidence.org/reviewstatio n.cfm?CFID=90895431&CFTOKEN=43781805

11. Journal of Physical Therapy - http://ptjournal.apta.org/ http://ptjournal.apta.org/ full text articles Podcasts Videos

12. PT Now – Clinician portal – http://www.apta.org/PTNow Robust Google-type search Clinical summaries Examination tools and multimedia resources Quick route to clinical practice guidelines, best practice recommendations, outcomes data, systematic reviews, and policy statements News for clinical practice Drug updates Discussion forums targeted to clinical topics Customizable clinical collections for sharing with patients and colleagues

13. Move Forward – Consumer Portal http://www.moveforwardpt.com/Default.aspx Consumer portal with information regarding diagnoses, physical therapy intervention Consumer videos Interactive body Symptoms and conditions Find a PT Todays PT

14. APTA Legislative Action Center Federal Advocacy State Advocacy Take Action

15. Health Care Reform Provides summary of PPACA related to PT profession Legislative Issues http://www.apta.org/FederalIssues What APTA is addressing on Capitol Hill regarding PT practice nationwide News and Updates – PTeam newsletter Policy Resources

16. Justin Elliott – Director Angela Chasteen – Assistant Director Current issues State legislative issue tracking Grants for advocacy work

17. So why do I need to know this? And, what do I do with this information? http://app3.vocusgr.com/WebPublish/controller.as px?SiteName=APTA&Definition=Home&XSL=Ho me&SV_Section=Home http://app3.vocusgr.com/WebPublish/controller.as px?SiteName=APTA&Definition=Home&XSL=Ho me&SV_Section=Home

18. USDHHR definition: Use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.

19. Telemedicine 2 Use of technologies to assist in delivering healthcare services such as patient care and monitoring. Telerehabilitation 2 Remote delivery of rehabilitation and home care services. Assessment, monitoring, prevention, intervention, supervision, education, consultation, counseling PT, OT, SLP, audiologists, physiatrists, nurses, bioengineers, AT experts, teachers, psychologists, dieticians.

20. History 2 1880s – after the invention of the telephone US Government VA utilization 1957 – telemental health with other projects to follow Now it is system wide throughout the VA Recent past – most research activity in telehealth surrounds rural medicine 1997 telehealth business – 6.8 million 1998 telehealth business – 13.8 million

21. Benefits 3 Increases access to care/ speed of diagnosis Increased quality of care Increased access to specialized services Cost- effective Decreased travel time for patient/practitioner More time for practitioner to see more patients with less travel time Patient and practitioner satisfaction Comparable outcomes to face to face Practitioner education/mentorship

22. Lets talk dollars and sense! Very little quality economic analyses of this method of delivery Cusack 4 study results Factors affecting results – cost of face to face visit vs cost of telehealth visit, success of telehealth visit Vo 5 study results – UTMD Univ. of TN – Telehealth Network

23. Pramuka 6 Text based Audio based Video based Virtual reality Web based Wireless Integrated

24. What equipment might I need? Dont ask me!!!!! But, seriously folks…. Conferencing telephone Internet access – broadband – high speed Smart phone Videoconferencing equipment Monitoring equipment Check out the Mountaineers http://www.hsc.wvu.edu/its/MDTV

25. So, whats right for me? Consider: Data type to be transmitted Clinics budget Application purpose/patient characteristics Technical support structure Skills of client and clinician – both tech and rehab skill Ease of installation

26. Barriers Lack of professional competency standards Degree of physical contact Patient cognition Availability of resources for interventions Reimbursement models do not support TR Liability clarifications Quality of tech devices Licensure clarification HIPPA Lack of literature to base policy change on

27. Policy issues to be addressed 2 Licensure Consistent clinical standards Privacy and access to PHI Reimbursement standards across state lines Reimbursement period! For telehealth services Liability and accountability International rules on clinical consultations

28. Purpose Subjects Telerehab – 10 Out of region face to face – 10 In region face to face – 10 Results Consistent satisfaction and goal achievement among groups Telerehab group assessed sooner

29. Purpose Subjects 11 caregivers of elderly clients diagnosed with Parkinsons Disease Results Time saved Work time saved Cost savings

30. Increased access to services regardless of geography Vocational assessment Employment preparation Seeking and obtaining employment Maintaining employment (job coaching) Monitoring and follow up

31. Purpose Subjects 5 subjects (3 men and 2 women) Results Clinical outcomes improved Levels of satisfaction were high for both

32. Type in rehabilitation and what do you get? 88,200 results Type in physical therapy and what do you get? 67,900 results Posted by? Accuracy? Appropriateness?

33. So, what do I do with it? As of 2009, 68% of American households had computers with internet access Create Private Channels - Post videos specifically for your patients as homework to supplement your care Parental controls to limit access Use audio via telephone during simultaneous viewing of the video

34. …telerehabilitation is a feasible service delivery model that has the potential to improve access and reduce the costs associated with delivery of early intervention services in rural communities. 11 …telehealth services are not meant to replace face-to-face services, but when in- person services are not feasible, they provide a viable alternative. 11

35. Kentucky Telehealth Network 100 telehealth sites MDTV has 35 in the state, 1 in MD and 7 international Purpose TR as alternative deliver model for EI services in KY Subjects 2 families in rural KY receiving OT x 12 weeks Results

36. 1.American Physical Therapy Association. www.apta.orgwww.apta.org 2.Seelman KD, Hartman LM. Telerehabilitation: policy issues and research tools. Intl J Telerehab. 2008;37-48. 3.Schmeler MR, Schein RM, McCue M, Betz K. Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities and challenges. Intl J Telerehab. 2008(fall):12-24. 4.Cusack CM, et al. The value proposition in the widespread use of telehealth. J Telemed Telecare. 2008;14(4):167-68. 5. Vo AH. The telehealth promise: better health care and cost savings for the 21 st centruy. Retrived October 18, 2011 from http://ehealthvirginia.org/downloads/20080529/UTMB%20 Telemedicine%20White%20Paper%2019May2008.pdf. http://ehealthvirginia.org/downloads/20080529/UTMB%20 Telemedicine%20White%20Paper%2019May2008.pdf 6. Pramuka M, van Roosmalen L. Telerehabilitation technologies: accessibility and usability. Intl J Telerehab. 2008;1(1): 25-36.

37. 7.Barlow IG, Liu L, Sekulic A. Wheelchair seating assessment and intervnetion: a comparison between telerehabilitation and face to face service. Intl J Telerehab. 2009;1(1):17-27. 8.Tindall LR, Huebner RA. The impact of an application of telerehabilitation technology on caregiver burder. Intl J Telerehab. 2009;1(1): 3-7. 9.Tousignant M, Boissy P, Corriveau H, Moffet H, Cabana F. In-home telerehabilitation for post-knee arthroplasty: a pilot study. Intl J Telerehab. 2009;1(1):9-16. 10.Manasco HM, Barone N, Brown A. A role for YouTube in telerehabilitation. Intl J Telerehab. 2010;2(2): 15-18. 11.Cason J. Telerehabilitation: an adjunct service delivery model for early intervention services. Intl J Telerehab. 2011;3(1): 19-29. 12.Cason J. A pilot telerehabilitation program: delivering early intervention services to rural families. Intl J Telerehab. 2009;1(1): 29-37. 13. American Telemedicine Association