Purposes for Listening: BCR Prompts #6 Telemedicine has many advantages, so why isn’t telemedicine used as much as it could be? Explain the different reasons telemedicine is used in Kansas, Texas, and India.

TELEMEDICINE AND LONGTERM CARE American Association of Homes and Services for the Aging April 7, 2003 Washington, DC Don McBeath, Director of Telemedicine Texas Tech University Health Sciences Center

Telemedicine… ….the basics.

What is Telemedicine? . . . the use of electronic information and communication technologies to provide and support health care when distance separates the participants . . .

Telecommunications Technology What is Telemedicine? Telecommunications Technology + Medicine

Why do telemedicine? Access Provide primary healthcare that would not be available otherwise Specialty care consultations for isolated specialists, practitioners, and other health care professionals Eliminate expensive travel and isolation Reduce need to move patient CME for isolated health care providers

Telemedicine settings Rural Schools Clinics Hospitals Prisons Nursing homes/ Assisted living

Emerging applications Telepharmacy Teledentistry Broader Home Health Remote Surgery

Telemedicine began . . . In 1924, with the concept of a physician seeing his patient over the radio using a television screen First wave of telemedicine programs started in the 1950s Now in the third wave Most programs that began in the 1960s-1980s no longer exist, due to dependence on external funding

Telemedicine now Doubling in number of two-way interactive video programs in 90s Teleradiology, store-and-forward, remains most common application Technology is rapidly changing and costs are decreasing Correctional is heaviest use Moving into private physicians use Expanding applications

Telemedicine at Texas Tech An early pioneer in telemedicine Started in 1989 as a pilot project to deliver health care to the rural Big Bend Region of Texas First consult in June of 1990 from Alpine, Texas hospital

First consult, June 1990 Aida Porras, age 10

Aida Porras in Presidio, TX

Telemedicine at Texas Tech Average 2,500 consults annually Over 12,000 consults since 1991 Telemedicine Hall of Fame by Telehealth Magazine in August 1999 Top Ten Telemedicine Programs in 1996 and 1997 by Telemedicine and Telehealth Network Magazine Ranked in the “Top 12 List” by Telemedicine Today in 1998

Texas Tech Telemedicine Network Abilene El Paso Alpine Presidio Terlingua Hart Pampa Dalhart Amarillo Childress Wichita Falls Plainview Lubbock Ft. Stockton Odessa Lamesa Snyder Coleman Stamford Anson Sierra Blanca Fort Hancock Colorado City July 2001 Levelland De Leon Campus Sites Amarillo Lubbock El Paso Odessa Rural Sites Alpine Hart Fort Hancock Presidio Sierra Blanca Terlingua Correctional Sites Abilene Lamesa Amarillo Lubbock Childress Pampa Colorado City Plainview Dalhart Snyder El Paso Wichita Falls Ft. Stockton Affiliated Independent Network •with Hendrick Medical Center: Abilene Anson Coleman Stamford •with FQHCs: De Leon El Paso Levelland

Types of telemedicine consults By specialty Psychiatry 63% Orthopedics 11% Other 10% Psychology 8% Dermatology 4% Primary Care 4% By type Correctional 90% Non-correctional 10%

Consults by year and specialty  Correctional 1994 1995 1996 1997 1998 1999 2000 2001 2002 Gen. Surg. 11 79 78 81 212 192 248 80 2 Ortho 9 174 300 251 213 309 377 268 260 Internal Med. 14 101 59 22 26 13 29 19 25 Urology 5 68 75 42 Dermatology 72 76 44 61 73 82 85 Other Med. 10 131 154 50 15 17 Psychology 142 208 287 181 Psychiatry 146 179 187 554 1383 1326 1486 Correctional Total 590 838 643 917 1432 2498 2116 2100   Non-correctional 93 83 54 35 60 32 180 243 Total 137 673 892 678 985 1492 2530 2296 2343

How it works Video conference system Cameras each end TV screens/computers each end Various medical peripherals Video connection T-1 line Satellite Phone line (POTS) Internet

Hub Site Remote Site T-1 ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Hub Site Remote Site T-1

Connectivity T-1 dedicated phone line Satellite ISDN High speed DSL/Cable ATM POTS LAN/WAN Internet, or IP-based

Compression of bandwidth Codecs compress the information to fit the broadband connection

Telemedicine does not/should not alter the practice of medicine. TTU telemedicine philosophy Telemedicine does not/should not alter the practice of medicine.

Core principles of telemedicine Is only a tool (like a stethoscope) Must be physician directed Must be integrated into established clinical operations and routines Physician-patient relationships must be preserved

The barriers Equipment costs Connectivity costs Reimbursement

Getting better Declining equipment costs Shared connectivity Enhanced reimbursement (still an issue for nursing homes)

Long-term care telemedicine

Correctional telemedicine as a model

Similar scenarios Desire to not transport patients off site Limited on-site primary care No on-site specialty care Must maintain certain level of staff on-site at all times Have stringent rules and regulations to follow

Prison off-site transport sample Number Percentage Remain On Unit 648 57.5% Transfer Off Site 479 42.5% For Year 2000, medical consults only.

Long-term care telemedicine— goals and benefits Enhance and increase on-site primary care Enhance and increase on-site specialty care Reduce ambulance transportation for off-site care Reduce unnecessary ER visits

Goals and benefits-cont. Reduce risk of injury associated with transports Reduce loss of revenue to nursing homes Allow better community ambulance coverage with less nursing home transports On-site medial and task training

Goals and benefits – cont. GED (high school equivalency) training Replication of operating model Student training component Expand to additional services including dental

Goals and benefits – cont. Distant social and counseling services for family and caregivers Reduced family travel time

Texas Tech long-term care projects Carillon project – brief pilot Garrison project – April 2003 West Texas Rural Nursing Home Telemedicine Network - planned

Carillon findings Patient satisfaction - Comfort level and communications very high - Satisfaction with exam very high - Most would do again - Most believe no diminishing of medical quality

Carillon findings Patient satisfaction - Only negatives on audio/hearing

Carillon findings Physician satisfaction - Very high overall satisfaction - Reported no limitation on their ability to treat/diagnose - Rated most consults as same as face-to-face

Garrison project Geriatric Teaching Nursing Home Teaching and research lab for telemedicine applications in assisted living Expose heath care providers, students, and nursing home staff to telemedicine Serve as a resource for rural nursing homes

West Texas Rural Nursing Home Telemedicine Network Project-planned Link three rural nursing homes with Medical Director with telemedicine Link with Garrison Geriatric Center Link to Texas Tech No community hospital Medical Director in another community

What is the future of assisted living/long-term care telemedicine?

Greatest potential for expanded use of telemedicine!

Broader applications – especially in assisted living facilities Explosion in home use Driven by technology and the expanding role of the Internet

Telehealth and Distance Learning: Taking the KUMC to Schools Across the State KUMC Faculty Retreat September 19, 2008 Kathy Davis, Ph.D. www.connectedkansaskids.com kdavis2@kumc.edu (913) 588-6305

The Need Kansas - large rural make-up Challenges in providing accurate information to rural schools, enabling them to plan for the unique needs of kids with chronic illness broad geographic range each child/needs very different, even w/same diagnosis Need to find a way to disseminate information to schools of students with chronic or acute illness/injury

Connected Kansas Kids In the beginning…… Program to provide K-12 education professionals with education and training regarding the needs of students with chronic physical or mental health conditions Student specific Staff development

Made possible by…..

In conjunction with….

And the University of Kansas

Utilizing Technology Telemedicine Interactive distance learning Internet connectivity Website

Original Goals of CKK To serve rural and medically underserved areas To connect educators and health care providers to aid in effective planning for students with chronic illness

First 3 years of project Staff development ITV presentations from KUMC to schools 50 topics Chronic illness Special education law Special topics Website – focus on education & coping with chronic illness Child, parents, siblings, peers, educators, etc.

Connected Kansas Kids (CKK) www.connectedkansaskids.com KU Medical Kansas Center Schools

Meanwhile, back at the ranch…

Interactive Distance Learning (IDL) Consortia in Kansas Many schools in these consortia; additional schools operating independently 287 school districts in Kansas utilize IDL

Responding to Schools’ Requests Additional topics for education professionals Health topics of interest for students Later, e-mentoring program for high school students interested in careers in health care

Health Care Shortage in U.S. Rural population in US – 20%; 61 million Less than 9% of physicians practiced in nonmetropolitan counties (1) Health care labor shortage expected to last through 2050 By 2010, US will need 1.7 million nurses; 635,000 will be available (2) Ricketts TR III, ed. Rural Health in the United States. Oxford University Press; 1999. 2. Buerhaus P, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. Journal of the American Medical Association. 2000;283:2948-2954.

At KU Medical Center The KU Medical Center recognizes the importance of meeting the wide range of health care needs in Kansas – from the critical need for primary care in rural and other underserved areas of the state, to the urgent need for highly specialized knowledge to provide the latest preventive and treatment techniques available. KU Medical Center

Once again….. KU Medical Kansas Center Schools

Birth of New CKK Offerings Health Careers Promotion Health Topics of Interest for Students

Health Careers Promotion Presented by professionals at KUMC Very positive response Team approach One Health Career presentation/month One Health Topic of Interest presentation/month Up to 4 schools per presentation Interaction with presenter Interaction between schools

Presenters Physicians Nurses Physical therapists Occupational therapists Speech/language pathologists Dietitians Respiratory therapists Physician assistants Social workers Clinical lab scientist

Health Careers Careers in: Pulmonology Surgery Clinical lab science Emergency medicine Trauma Medicine Rehabilitation Medicine Dietetics and Nutrition Psychology and Psychiatry

Health Careers in Emergency Medicine

Outcomes – Student Responses Increased interest in health careers 92% Information helpful in determining what courses to take in high school 92% Satisfied with quality of instruction 100% Would recommend to others 100% Convenient method of instruction 100% Comfortable w/ method of instruction 100%

Health Topics of Interest for Students Effects of Nicotine Protect Your Bones and Joints (PB&J) Methamphetamines Bullying Responsible Decision Making Exercise and Fitness Obesity and Diabetes Prevention Depression, Anxiety and Stress

Outcomes – Student Responses Increased understanding of health issue 100% Would like to take more courses over ITV 100% Satisfied with quality of instruction 100% Would recommend to others 100% Convenient method of instruction 94% Comfortable w/ method of instruction 100%

CKK E-Mentoring 96 mentoring pairs Advanced science courses Medical student mentors Urban underserved and rural area high school mentees Advanced science courses Interest in career in medicine

Current Funding

6-week curriculum Breaking the ice Creating a resume Letters of recommendation Life as a medical student Career options Paving the way/resources

E-mentoring Wrap-Up: Sawbones Lab

Connected Kansas Kids Website Interactive Televideo Presentations Health information Health career information (Fall 2008) Interactive Televideo Presentations Staff development topics for education professionals Health topics of interest Health career promotion E-mentoring project

New in Fall 2008 Center for the Comprehensive Care of Children with Chronic Conditions (C6) Educators Child care providers Clergy/spiritual leaders Coaches Scout leaders Etc., etc., etc.

On the horizon “Live from the OR” High definition interactive televideo Internet2 Pre/post teaching Virtual field trip to the OR Live interactions with surgeon, others

For more information Kathy Davis kdavis2@kumc.edu www.connectedkansaskids.com (913) 588-6305