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A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community.

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Presentation on theme: "A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community."— Presentation transcript:

1 A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community & Migrant Health, Inc. Penn Yan, NY

2 1. DISCUSS NEEDS OF UNDERSERVED POPULATIONS SEEN IN PRIMARY CARE SETTING 2. DISCUSS THE ROLE OF TELEHEALTH IN MEDICAL HOME 3. DISCUSS ADMINISTRATIVE, TECHNICAL, AND CLINICAL PROCESSES NEEDED FOR SUCCESS 4. OBSERVE TELEPRESENTATION AND USE OF PERIPHERALS TO CONDUCT REMOTE EXAMS 5. PARTICIPATE IN REVIEW OF LITERATURE AND CLINICAL CASES RELEVANT TO TELE-ENT, TELE- MENTAL HEALTH, TELE-OPTHALMOLOGY,AND TELEDENTISTRY 6. LIST OPPORTUNITIES FOR FUTURE TELEHEALTH APPLICATIONS IN COMMUNITY AND MIGRANT HEALTH CENTERS Agenda for Our Presentation

3 MISSION STATEMENT …. TO ENSURE ACCESSIBLE AND AFFORDABLE HEALTH CARE TO THE COMMUNITIES WE SERVE MEDICAL HOME CONCEPT … PATIENT-CENTERED APPROACH WHEREBY HEALTH CARE TEAM WORKS TOGETHER TO COORDINATE AND SUPPORT PRIMARY AND PREVENTIVE CARE FOR AN INDIVIDUAL CELEBRATE DIVERSITY … A DEDICATED, CULTURALLY SENSITIVE STAFF WHO ARE COMMITTED TO HIGH QUALITY, COMPREHENSIVE CARE AND ARE PASSIONATE ABOUT THE WORK THAT THEY DO 501(C) (3), ARTICLE 28 FEDERALLY QUALIFIED HEALTH CENTERS MIGRANT HEALTH 330G FUNDING MOBILE HEALTH SERVICES ENABLING SERVICES Finger Lakes Community & Migrant Health

4 FLMHCP VOUCHER SITES AND HEALTH CENTERS IN NY STATE

5 50 miles 60 miles 35 miles 55 miles FLMHCP CLINICS AND NEAREST METROPOLITAN CENTERS 110 miles

6 OUR CLIENTS Finger Lakes Community & Migrant Health

7 CULTURE BELIEFS LANGUAGE DIFFERENCES TRANSPORTATION BARRIERS LACK OF CHILD CARE NO INSURANCE LACK OF TRUST IN HEALTH CARE SYSTEM POVERTY MIGRANT LIFESTYLE Challenges In Providing Health Care To Rural Poor

8 . Bilingual/Bicultural Staff Clinic Hours Conducive to Work Hours Community Health Workers Case Management Passionate/Compassionate Staff Visionary Leadership One Stop Shopping (Medical Home) Telemedicine Creative Ways to Provide Care

9 What is Telemedicine? NYS Office of the Professions defines telemedicine as the provision of professional services over geographical distances by means of modern telecommunications technology.

10 What is Telehealth?. Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth is an expansion of telemedicine that encompasses administrative or educational functions related to telemedicine.

11 History of telemedicine

12 American Telemedicine Association Established in 1993 as a non-profit organization………. The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership, works to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Vision Statement Telemedicine will be fully integrated into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Mission Statement The mission of ATA is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. This will be achieved through the following means: Educating and engaging government, payers and the public about telemedicine Providing a clearinghouse of information and services for both newcomers and experienced professionals Fostering networking and collaboration among allied interests in medicine and technology Promoting research, innovation and education Developing and disseminating policies and standards Ensuring a strong financial basis for the association to support operations Creating consumer awareness and support National Headquarters American Telemedicine Association 1100 Connecticut Avenue, NW, Suite 540 Washington, DC Phone: Fax:

13 APPLICATIONS OF TELEMEDICINE Teleradiology Telepathology Teledermatology Wound care consults Home Based Monitoring Urgent Care Consults Pre & Post Op Care Specialty Care Consults Teledentistry Burn/Trauma ED – Stroke Initiative Telehome Healthcare ICU Intensivist Inpatient /Nursing Home Consults Outpatient/ Primary Care Telepsychiatry Counseling Preventive Screenings Health Education

14 Benefits of Telehealth Patients/Families Providers Health Care System *reduced travel* *direct patient interaction** improved access* *timely appointments* *expanded services* *improved health outcomes* *remain in their community* *access to other experts* *resource utilization* *additional support* *access to CME* * expansion to rural & underserved*

15 Typical Telemedicine System in Our Clinics General Exam Camera Dental Intraoral Camera Telephonic Stethoscope Electronic Medical Record(EMR) Video Codec with LCD Monitor ENT Scope

16 Store and Forward vs. Real Time Digital Images Videoconferencing

17 2 BIG “R”s R EIMBURSEMENT Medicare Medicaid Blues Preferred Care NP Office Visits R EGULATION Licensure Standards of Care No substitute for in- person care Confidentiality HIPPA Secure

18 HOW WE STARTED…. HOW WE PLANNED…. WHAT WE USED…. HOW WE DID…. WHERE WE ARE HEADED…. Telehealth Services At FLCMH Diabetic Retinopathy Screening Tele ENT Tele Dentistry Tele Psychiatry Distance Learning EMR

19 FINGER LAKES COMMUNITY & MIGRANT HEALTH – HIT INFRASTRUCTURE DEVELOPMENT USDA - DLTHRSA – Rural Network Development FCC – Rural Healthcare Broadband Project NYS DOH – Office of HIT Telehealth Program Development FUNDING SOURCES

20 From Vision to Reality Workscope (Who, What, Where, When, Why, How, & How much) Development Workplan Deployment Workplan Quality Improvement Document for Replication

21 SPECIALTY CARE CONSULT URGENT CARE CONSULT PRE/POST OP CARE FOLLOW UP Tele-ENT

22 Tele ENT Real Time -OR- Store and Forward

23 WHAT THE LITERATURE SAYS: COST EFFECTIVE FEASABLE REDUCED TRAVEL (“GREENER”) REDUCED UN-NECESSARY TRANSFER TO TERTIARY CENTER HIGH PATIENT SATISFACTION IMAGES COMPARABLE TO IN-PERSON ASSESSMENT Tele-ENT

24 FINGER LAKES CASE STUDY 56 YEAR OLD FEMALE WITH VERTIGO….. Tele-ENT

25 REAL TIME APPLICATION A) CONSULTATION B) MEDICATION MANAGEMENT C) PSYCHOTHERAPY D) CLINICAL CONFERENCING E) EDUCATION Tele- Mental Health

26 WHAT THE LITERATURE SAYS: INCREASED ACCESS ACHIEVED CLINICALLY EFFECTIVE AS FACE TO FACE COST EFFECTIVE DECREASED TIME TO TREATMENT HIGH PATIENT SATISFACTION EFFECTIVE WAY TO MANAGE MEDICATION ( IN CONJUNCTION WITH PCP) Tele- Mental Health

27 FLCMH RETROSPECTIVE CHART REVIEW APRIL – SEPTEMBER 2010 PILOT SITE: GENEVA COMMUNITY HEALTH CENTER DR CHARLES LILLY – DEB COLE LCSW 6 REFERRALS DX: DEPRESSION, PTSD, BIPOLAR MEAN TIME TO CONSULT: 15.6 DAYS MEAN TIME TO TREATMENT: 4 DAYS ED/HOSPITALIZATION: 0 MEAN SATISFACTION SURVEY SCORE (CONCURRENT) PATIENT: 4.77/5.0 TELEPRESENTER: 4.024/5.0 SYMPTOMS IMPROVED: Tele- Mental Health

28 Diabetic Retinopathy Screening

29 WHAT THE LITERATURE SAYS: COST EFFECTIVE PRESERVED SIGHT INCREASED ACCESS FOR PATIENTS IN REMOTE AND RURAL AREAS DECREASED TIME TO TREATMENT DECREASED TIME AND DISTANCE TRAVELED DIABETIC RETINOPATHY SCREENING

30 FLCMH OUTCOMES OF PILOT PILOT SITE: SODUS COMMUNITY HEALTH DR CHET SCERRA, OD # SCREENED = 408 UNINSURED = 88% PATHOLOGY = 23 (5%) RETINOPATHY – 3 MACULAR DEGENERATION -1GLAUCOMA- 11 CATARACTS – 6MOTTLED MACULA – 1 SUSPICIOUS LESION -1 REFRACTORY ERROR – 47 REFERRED FOR DILATED EXAM – 13 DIABETIC RETINOPATHY SCREENING

31 Teledentistry Consultation

32 TELEDENTISTRY Clinical Applications 1) Screening 2) Urgent Care Consults 3) Specialty Care Consults

33 WHAT THE LITERATURE SAYS: RELIABLE = NO STATISTICAL DIFFERENCE IN FACE TO FACE VISUAL EXAM WHEN COMPARED TO INTRAORAL CAMERA DIGITAL PHOTOS IMPROVED ACCESS TO PREVENTIVE DENTAL CARE SCREENING FEASIBLE FOR SCREENING, DIAGNOSIS, AND TREATMENT CONSULTATION COST EFFECTIVE TELEDENTISTRY

34 TeleDentistry Remote screening PILOT December 2009 Holley ABCD & Seneca County ABCD/Headstart 33 children screened 9 out of 33 diagnosed with pathology (27%) 100% have accessed follow-up treatment

35 FINGER LAKES : EASTMAN PEDIATRIC DENTISTRY CASE STUDIES 9 REFERRALS SENECA COUNTY (5)AGES 0-5: (7) WAYNE COUNTY (3) 6-12: (2) ONTARIO COUNTY (1) MEAN TIME TO CONSULT: 13.1 DAYS MEAN TIME TO TREATMENT: 9.9 DAYS PATIENT SURVEY: 4.57 TELEPRESENTER SURVEY 4.5 SPECIALIST SURVEY: 4.28 TELEDENTISTRY

36 A TALE FROM SENECA COUNTY POPULATION = 34,228 CHILDREN LIVING IN POVERTY = 18% (NYS 13%) OUTPATIENT VISITS FOR CARIES IN 3-5 YEAR OLDS = Rate 143/10,000 (NYS Rate 87.7) - NYSDOH County Health Incidators 2007

37 50 miles 60 miles 35 miles 55 miles FLMHCP CLINICS AND NEAREST METROPOLITAN CENTERS A TALE FROM SENECA COUNTY ABCD 110 miles

38 TeleDentistry Pediatric Dentist Consultations Seneca County ABCD/Head Start Agri-Business Child Development Finger Lakes Migrant Health Care Project University of Rochester Medical Center-Eastman Dental Program 13 April 2010

39 Telemedicine Equipment Sometec Intraoral Camera Tandberg Portable Videoconferencing Unit

40 Case Presentation Here, Phyllis begins a consultation by providing a case presentation to Dr. Jeff Karp, DDS, at Eastman Dental, with the University of Rochester Medical Center. Information shared included medical history, diagnosis at prior screening/exam, and any social or economic barriers affecting the family’s ability to complete treatment.

41 Case Presentation While Phyllis presents her information to Dr. Karp, we see him on the Tandberg unit, listening to the case.

42 Intraoral Examination

43

44 Here is an example of a tooth with severe decay. Thanks to the precision of the camera’s focus and image capture, Dr. Karp is able to use these images to determine the level of treatment a child needs, including sedation methods, (which will also determine treatment locations, i.e. OR vs. dentist’s office) preoperative medications, and behavioral considerations.

45 Other Highlights Goofing around with Dr. Jeff before the examination!

46 Other Highlights Hugs for Miss Phyllis!

47 Thank You!

48 Distance Learning, EMR, Etc. FLCMH Board Training Cultural Training E-Clinical Works Meetings ETC….. ETC……

49 SWOT Analysis & Lessons Learned S: Vision, Passion, Positive attitude, Project Management W: Financial limitation, technology resources, change is hard work! learning as we go, Project Management O: Limitless if + time, money, staff T: doubts, stamina, fear of IT, payors, malpractice, mobility and special needs of MFW

50 What Does The Future Hold TelePulmonary Consults Tele-Occ Med Consults Home Based Monitoring Expand Teledentistry to PCP, Headstart, HCCN

51

52 DORRIAN, C. FERGUSON, J., AH-SEE, K., BOW, C., LALLA, K., VANDERPOL, M., MCKENZIE, L., WOOTON, R. (2009). FEASIBILITY OF ENT TELE-ENDOCOPY AS SUITABLE METHOD OF HEALTH CARE DELIVERY. JOURNAL OF TELEMEDICINE AND TELECARE, 15 (3), DUKA, M. MIKALOVIC, B., MILADINOVIC, M., JANKOVIC, A., VUJICIC, B. (2009). EVALUATION OF TELEMEDICINE SYSTEMS FOR IMPACTED MOLAR DIAGNOSIS. VOGNOSACTETSKI PREGLID, 66 (12), FRICTOR, J. AND CHEN, H. (2009). USING TELEDENTISTRY TO IMPROVE ACCESS TO DENTAL CARE FOR UNDERSERVED. DENTAL CLINICS OF NORTH AMERICA, 53 (3), GARCIA-LIZANA, F. AND MUNOZ-MAYORA, J. (2010). WHAT ABOUT TELEPSYCHIATRY? A SYSTEMATIC REVIEW. JOURNAL OF CLINICAL PSYCHIATRY. 12 (2). JONES, S. AND EDWARDS, RT. (2010). DIABETIC RETINOPATHY SCREENING: A SYSTEMATIC REVIEW OF ECONOMIC EVIDENCE. DIABETIC MEDICARE, 27 (30, KOKESH, J., FERGUSON, A. PATRIOCOSKI, C., KOLLER, K., ZWACK, G., PROVOST, E., HOLK, P. (2008). DIGITAL IMAGES FOR POST-SURGICAL FOLLOWUP OF TYMPANOSOMY IN RURAL ALASKA. 139 (1), KOPYKA-KEDZIERAWSKI, D., BILLINGS, R., MCCONNONCHIE, K. (2007). FEASIBILITY AND RELIABILITY TO SCREEN PRE-SCHOOL CHILDREN OR ORAL DISEASE. PEDIATRIC DENTISTRY, 29 (3), NG, M., NTHOS, N., RUDINSKI, CJ, TENNANT, MT. (2009). IMPROVING ACCESS TO EYE CARE IN ALBERTA CANAND. JOURNAL OF DIABETIC SCIENTIST TECHNOLOGY, 3 (2), XU, CO. SMITH, AC, SCUFFHEM, PA, WOOTON, R. (2008). A COST ANALYSIS OF TELEPEDIATRIC OTOLARYNGOLOGY SERVICES. BMC HEALTH SERVICES RESEARCH 4:8. RESOURCES


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