1. A Telehealth Overview Mary DeVany, gpTRACJuly 30, 2013

2. Who is gpTRAC?

3. What do we do? Provide guidance Gather information Answer questions Share tools and resources Provide education Encourage collaboration Gather regional information

4. Potato/Potato Telemedicine Telehealth eHealth eCare Virtual Health Virtual Care Remote Health mHealth

5. Telehealth: Providing/receiving health care services at a distance.

6. Yesterday…

7. House Call to Clinic Visit In person care Get what’s available If not available? – The patient travels to find it…

8. Where do you go for your care?

9. History of Telemedicine in South Dakota…

10. …Brief!! Initiated in 1993 – Governor’s Telemedicine Task Force – Primarily a Collaborative effort between…(then) McKennan Hospital Rapid City Regional Sioux Valley Hospital Main Focus – Evaluate if telemedicine was a viable option for patient care in SD

11. Where/How is Telehealth used? (i.e. applications)

12. Telehealth as a “tool”: Not be viewed as a stand-alone service Not be viewed as “different” care Incorporate into standard, daily practice Blend into organization’s overall strategic goals/objectives

13. Common Applications In/Out Patient Specialty Services – Dermatology** – Mental Health** – Cardiology – Infectious Diseases – Pediatric Services – Endocrinology – Wound Care – Pulmonology – Oncology – Stroke Care …and more **Most requested – least capacity

14. Common Apps (cont) Telepharmacy TeleHome Health (home monitoring) Case/Disease Management Tele-Emergency Remote ICU Monitoring Family Connections Education – staff, provider, family, community

15. Other Applications School-based Care Dialysis Support groups Speech therapy Remote ultrasounds Pre-commitment assessments Sign Language interpretation Dietary counseling Rehab services Supervision PTSD/TBI

16. “New” Applications

17. Stroke/Emergency Stroke – 24/7 access to stroke expertise – Assistive, available “on-demand” – Supported by the American Stroke Assoc. (AHA) Emergency – Similar access, or just overnight coverage – Access to trauma experts – Assistive – does not supersede EMTALA

18. Home Health Monitoring – Manage chronic disease – Reduce hospitalizations Access to Healthcare Services from Home – “Doc, Can you please look at Tommy’s ear?” Smart Homes – Monitor patients at home – Sensors in everyday appliances – Encourages improved “quality of life”

19. Pharmacy Hospital-based – Allows for 24 hour coverage Retail-based – Maintain small-town pharmacy coverage – Patient education

20. mHealth Glucoboy iPhone Apps – iTriage, ReachMD CME, Headache Log, Epocrates Rx Wireless monitoring/peripherals – Blue Tooth enabled scopes – Contact lens that monitors Gloucoma levels Email & Secure Messaging – Appointment reminders Social Media

21. Technologies used in telehealth…

22. Technology… Big, heavy, difficult Smaller, lighter…still difficult Mostly stand-alone NOW… – Common place – Integrated – Expected – Mobile!

23. Technologies: Image transfer – Teleradiology – Pathology – Dermatology Videoconferencing Remote Monitoring Robotics Smartphones (mobile devices)

24. Examples:

25. “New” Examples:

26. Degrees of Telehealth: Innovations Center/Health Care Advisory Board

27. Healthcare Issues: Reduce Expenses Improve Access to Care Maintain/Grow Services Stretch the Workforce Strengthen Communities Manage Expectations Change is hard

28. What are the challenges?

29. Challenges: Connectivity/Interconnectivity Long Term Care Services/Asst. Living Remote Home Health Monitoring Reimbursement/Regulations Provider Preparedness/Training Organizational Structures/Buy-in Keeping Up mHealth

30. What are the rules and regulations? Licensing Credentialing Privileging Reimbursement Prescribing HIPAA

31. Others: Fraud/Abuse Malpractice Liability – (for NOT using…?)

32. Data = Value Track the data, prove the value – Why are you doing this? Was it successful? Track it right…from the beginning – Know what you want/need to track Supports budget/sustainability requests

33. What are the expectations? Patients/Families Communities/Partner Facilities Graduates/In-coming Workforce Payers -Federal Government, etc. Healthcare Reform

34. The Future: New Technologies/customer expectations will drive telehealth Migration from episodic care to continuous assessment (read accountable care…?) Care will move more into the home and will travel with the patient.

35. More… Mobile communications, sensor devices and nanotechnology will alter the way that health care is delivered Moving from cost shifting to performance and quality

36. Pending Challenges: Need to incorporate more with HIT Workforce needs – including TH skills More consumer-based, consumer- driven

37. What are the benefits and values of telehealth?

38. Organizational Access to add’l care resources Staff competency Community perception Service stability Patient Experience Peer-to-peer interactions

39. Budget-Related Stretch a tight travel budget Increase ancillary services Service continuation/expansion Enhance the quality of care Market-leader

40. Provider Benefits Support primary care providers Specialists can have “virtual” presence in a community Professional shortage/burn-out Enhance professional relationships Enhance the quality of care

41. Opportunities: Telehealth Provides access to specialty services not otherwise available within the community. Provides a level of professional support. (accustomed to during medical school) Access to continuing educational opportunities

42. Patient Benefits Increases access to specialists in local community Don’t have to travel or loose excessive work time Family can be readily present High patient satisfaction/acceptance Enhances the coordination of care

43. Community Benefits Supports the local facility Supports local main street Access to medical education Save travel dollars Provides service not otherwise available

44. Economic Development What do new business prospects look for in a community: Viable Infrastructure Strong schools Quality healthcare

45. Economic Stability Retain the current patient services Reduce what “leaves” your community Tests Pharmacy Groceries, hotel, etc General “main street” dollars

46. Economic Impact - Healthcare Health-generated employment is often 10-20% of the total employment in a rural community, second only to schools. Town with a population of 2,000 generates $ 3,000,000 in health care, with $417,000 being spent on rural primary care office visits. o Where is it going?

47. Economic Impact - Physician A rural doctor is worth $343,706 per year in economic impact and 17.8 jobs in a rural community (1998) Bringing a doctor to a rural community has the economic impact of $1 million or more annually. (MN/OK studies)

48. Who is doing what?

49. National Snapshot: Specialty Services continue to grow -Companies (provider groups) offering services…independent of hospitals/systems -Healthcare systems now involved who haven’t been before Stroke & Emergency are today’s “flavor” Remote Home Monitoring is growing mHealth is here, but still maturing -Apps coming out our ears! (Remotoscope) Rules/Regulations behind technology

50. Evangelical Good Samaritan Society Living Well@Home – Remote Monitoring – Sensors – Others?

51. Avera Health Various specialty services Tele-ICU Emergency Room Pharmacy More in the works – LTC, Stroke, etc.

52. Regional Health Oncology Specialty Services Remote ICU Pharmacy Others?

53. Sanford Health Tel-emergency Pediatrics echoes GYN Oncology Neurology Tele-dialysis Pharmacy

54. Horizon Health – Community Health Centers Access services from multiple health systems Specialty services Sharing services across offices within network

55. VA Long-time user of telehealth services. Services accessible primarily from WITHIN the VA network. Some interest now in trying to cross into other networks to provide care more effectively.

56. Indian Health Services Long-standing utilization of telehealth services – Local providers – Providers from all over the nation (don’t have the cross-state licensure issue) Access to services has been inconsistent

57. More information?

58. Resources: Great Plains Telehealth Resource & Assistance Center (gpTRAC) www.gptrac.org www.accesstelehealth.orgwww.accesstelehealth.org (a “telehealth101” site) Additional Telehealth Resource Centers www.telehealthresourcecenters.org Center for Telehealth & e-Health Law www.ctel.org American Telemedicine Association www.americantelemed.org

59. “The general concept of health care quality does not change from urban to rural settings. The focus remains on providing the right service at the right time in the right way to achieve the optimal outcome.” National Advisory Committee on Rural Health and Human Services Report, Health Care Quality: The Rural Context

60. Thank You! Contact Info: Mary DeVany, Director Email: medevany@gmail.commedevany@gmail.com Direct: 605-743-5902 www.gptrac.org Toll Free: 888-239-7092