TELEHEALTH: IDENTIFYING GEOGRAPHIES WITH GREATEST POTENTIAL IMPACT Expected X - IoT HealthSlam ‘16 - 12/2/2016 Presenter: John Sukup, Principal Consultant

First, a brief comment on the recent election... Study does not account for impact of president-elect’s healthcare agenda Trump: Full repeal of ACA (?) No stance specifically on telemedicine Acknowledges telemedicine as contributing technology to VA reforms

Telehealth, Telemedicine, IoT...what’s it all mean? Telemedicine: The practice of exchanging medical information electronically between two sites

Telemedicine implementation: Not as simple as 1,2,3 Federal and state law misalignment Inadequate systems/consumerization of technology Two other considerations: Need Opportunity

Telemedicine Needs Assessment The Telemedicine Impact Score

Healthcare: A Wealth of Publicly Available Data

County Health Rankings and Roadmaps (CHR&R) Percent “Poor or Fair Health”: Self-reported health status from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) -- a randomly-selected, annual survey of adults 18+ Diabetes prevalence: Estimates from the CDC's Behavioral Risk Factor Surveillance System (BRFSS) for the percentage of adults aged 20 and above with diagnosed diabetes

Community Health Status Indicators (CHSI) Deaths per 100,000 (Heart Disease): Proportion of coronary heart disease-related deaths (identified by ICD-10 codes) by average population within county for all available years’ data Deaths per 100,000 (Cancer): Proportion of cancer deaths (identified by ICD-10 codes) by average population within county for all available years’ data

Health Professional Shortage Area (HPSA) HPSA Score: A variety of measures are considered during the HPSA designation process. The HPSA Score metric is an aggregate measure that we felt sufficiently covered important aspects Patient/provider ratio Percent population below poverty level Infant health index (combines low birth weight and mortality) Distance to nearest medical facility These are then summed to create the HPSA Score from 0 to 26 with higher values indicating a greater need

Hospital Compare Rate of readmission after discharge from hospital (30-day): The rate of readmission hospital-wide following a discharge Able to receive lab results electronically and Able to track patients’ lab results, tests, and referrals electronically between visits: Both measures are used to serve as a proxy for a hospital’s ability to effectively implement a telemedicine solution

National Broadband Map National Broadband Map: Database designed to help measure, promote, and develop broadband access across the country Originally built by the National Telecommunications and Information Administration (NTIA) and Federal Communications Commission (FCC)

Calculating the Telemedicine Impact Score (TIS) Each measure is a county-level measure Hospital Compare data is hospital-level; input for county hospital is located in Examined each in respect to state-level and national-level aggregation Measures normalized by dividing each by the maximum value: Each “raw score” multiplied by 10 Summated to create a “raw TIS” which was multiplied by a factor of 100 to create the final TIS on a scale from 0 - 100

Telemedicine Impact Score (TIS) - Illinois Cook County -- highest score in nation and within state of Illinois Chicago helps Cook county’s score Highest possible score in broadband availability and hospital IT readiness (opportunity scores) Highest possible score in hospital readmissions (need score)

Telemedicine Impact Score (TIS) - Illinois (cont.) Distribution highly skewed Population distribution concentrated in Chicago area

Telemedicine Impact Score (TIS) - California More favorable legal environment than Illinois Population less concentrated than Illinois San Francisco County Shown to display TIS is not just population dependent

Telemedicine Impact Score (TIS) - California (cont.) Greater uniformity in TIS distribution than IL

Future Considerations Apply an additional weight to each input variable to vary their impact in the final scoring Greater incorporation of legal measures to determine opportunity A potentially larger issue in telemedicine adoption is the patient’s willingness to accept and utilize it TIS is just one way of working with public data to assess telehealth readiness

http://expectedx.com/blog/tis