The Role of Technology in Community Engagement Tom Nesbitt, MD, MPH Executive Associate Dean Clinical and Administrative Affairs UC Davis Health System Chancellor’s Fall Retreat Sept 17, 2007

Overview of presentation  Rationale for the use of technology in the Health System’s community engagement activities  Define and describe telemedicine  Impact of this program on current and future academic activities  One faculty member’s story

Shortages in Rural California

 There is a shortage of physicians statewide  Nearly 200 California communities are located in the 109 rural health professional shortage areas  Rural areas often lack access to the full spectrum of health services  Many generalists will not practice in areas without specialty back-up  The University has significant expertise and resources that potentially address some of these issues California’s Health Care Expertise State-of-the-Art, Yet Unavailable to Millions

There is an explosion of new knowledge and information that is ironically creating even greater disparities in access to state-of-the-art health care

The Role of Technology Advances in telecommunications and information technologies can help overcome some of these disparities by helping to redistribute knowledge and expertise

Telemedicine  Interactive health care over distance using information or telecommunications technology  Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient

Telemedicine Improves Access to Expertise

UC Davis Telemedicine Services  Pediatric Critical Care  Pediatric Sexual Abuse QA  OB/GYN  Pediatric Cardiology  Surgical Oncology  Allergy  Occupational Medicine  Child Development  Burn  Genetics  Transplant  Urology  Pediatric Rheumatology  Pulmonary  Plastic Surgery  Pediatric PM&R  Podiatry  Hematology  Pediatric Urology  Pediatric Gastroenterology  Oncology  Pediatric Hematology/Oncology  Surgery  Cardiology  Pediatric Endocrinology  Pediatric Nephrology  Gastroenterology  Infectious Diseases  Pediatric Neurology  Pain Management  Pediatric Genetics  Nephrology  Psychology  Rheumatology  Neurology  Hepatology  Otolaryngology  Pediatric Obesity  Orthopaedics  Nutrition  Endrocrinology  Psychiatry  Dermatology

Other Applications  Real-time emergency care  In-patient ICU and infectious disease consultation  Tele-pharmacy  Tele-interpreting  Diabetic retinal screening Remote Telepharmacy funded by California HealthCare Foundation

Telemedicine Training Telemedicine Learning Center funded by The California Endowment

Organizations trained by the TLC 569 Attendees 1,200 Sessions at the UC Davis TLC 35 Sessions off-campus 14 Makeup of Attendees: Clinical/Technical staff (59%) MDs (14%) Nursing (16%) Executives (11%) Other states: AZ, FL, HI, IN, MA, MI, MO, NE, NY, OH, OR, TX, DC, WA Other countries: Brazil, Mexico, Nigeria, Saipan Telemedicine Learning Center at UC Davis April 2007

UC Davis Telemedicine Programs Supported by Foundations in California  Sierra Health Foundation  , Access to Prenatal Care in Northern California ($100,000)  , Improving Access to Care in Rural Northern California ($500,000)  California HealthCare Foundation  , Pediatric Telemedicine Outreach to Rural Underserved Emergency Departments ($290,000)  , Pharmacy Consultation for Rural Hospitals ($400,000)  The California Endowment and California Telehealth and e-Health Center  , Telemedicine Learning Center ($2,000,000)  , Telehealth via Portable Satellite Terminal: Conquering the Geographic and Telecommunication Barriers ($250,000)  , e-mental Health ($250,000)  William Randolph Hearst Foundation  , The Northern California Rural Telemedicine Program for the Acutely Ill and Injured Child (Rural Child Abuse and Pediatric Emergency Medicine) ($350,000)  , Using Telemedicine to Provide Inpatient Pediatric Consultations ($250,000)  Children’s Miracle Network  Pediatric Telemedicine for PICU care ($25,000)  Blue Shield of California Foundation  , Store & Forward Telepsychiatry: A Cross Cultural Validation Study in Rural California ($500,000)  Robert Wood Johnson Foundation  , Palliative Care in Assisted Living ($960,000)

Benefits for Research and Education  Greater than $40 million grants and contracts since 1997  Researchers  40 faculty members  15 have made telemedicine a substantial part of their research  36 staff members  TM is a component of other UC initiatives  Clinical Translational Science Center  Betty Irene Moore School of Nursing  Center for IT Research in the Interest of Society Pediatric ER sites funded by California HealthCare Foundation

State Funding for Telehealth  Nearly $500M currently available state-wide  $200 million to five University of California medical schools to leverage telemedicine technology  $36 million to UC Davis for major new facility, statewide leadership role  $10 million for statewide community partners for technology for clinical TM and training medical students Teleophthalmology with support from The California Endowment

California’s Proposition 1D Passes “With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California.” Governor Arnold Schwarzenegger 10/27/2006 UC Davis Pediatric Telehealth Colloquium UC Davis Pediatric Telehealth Colloquium funded in part by William Randolph Hearst Foundation

PRIME (Programs in Medical Education)  Focus: expand infrastructure and teaching programs at each UC medical campus in order to help tomorrow’s physicians meet the needs of underserved patients  All of the PRIME programs involve using TM as part of the training program  At UC Davis, the PRIME program has increased our class by 12 students per year and will train rural physicians, building on our strengths:  Excellence in primary care education  Commitment to rural outreach  Expertise in the use of telecommunications technology  Public health and community service orientation

A new model of collaboration through partnership in education, research, and clinical expertise using Advanced Information and telecommunications Technologies The Future: Rural Centers of Excellence Education Research Clinical RURAL CENTER OF EXCELLENCE

Summary  California is in the midst of a major transformation in the way that rural health care is delivered and rural physicians are trained  Technology and outreach are key elements in this transformation  Innovative models of community engagement by the University using technology played an essential role in setting the directions for this transformation  TM and the UCD TM network have contributed to other system-wide activities in the Health System