Telemedicine in Hematology &Oncology Care November 27th, 2018| 4 pm Telemedicine in Hematology &Oncology Care Sarvari Yellapragada, MD Michael E DeBakey VA Medical Center Dan L Duncan Cancer Center, Baylor College of Medicine

Role of Telemedicine at the Michael E DeBakey Medical Center (MEDVAMC) The MEDVAMC has pioneered telemedicine in various disciplines Practical applications of telemedicine in hematology & oncology Tele-consultation and multidisciplinary care Tele-medicine for patient centered care

SESSION LEARNING OBJECTIVES Variety of applications of telemedicine for blood & cancer disorders Telemedicine for specialty care: interface with consultants Telemedicine to improve access for Veterans (patients) & care-givers

Medvamc MULTIDISCIPLINARY Virtual TUMOR BOARD CONFERENCES

Oncologic Expertise Offered at MEDVAMC Medical Specialties Medical Oncology Hematology Oncology Genetics Pulmonary Palliative Care Gastroenterology Hepatology Women’s Health Center Surgical Specialties Surgical Oncology Breast Surgical Oncology Hepatobiliary Surgery Transplant Surgery Cardiothoracic Surgery Head & Neck Surgery Diagnostic Specialties Radiology Nuclear Medicine Breast radiology Interventional Radiology Radiation Oncology Pathology

Unique MEDVAMC Oncology Services Genetics One of 3 programs nationally Transplant Hepatology One of 6 hepatology transplant programs nationally Palliative Care One of 2 programs nationally Radiation Oncology MEDVAMC is the only one offering Cyberknife radiation program nationally Interventional Radiology One of few interventional radiology programs nationally Breast Radiology One of the largest breast imaging programs nationally Consulting other VHA facilities for the breast imaging programs Consulting other VHA facilities for mammogram checklist nationally Women’s Health Center One of the largest Women’s Health Center program nationally

What is MEDVAMC Virtual Tumor Board (VTB) Multi-institutional collaborative developed in 2010 Goal to improve access, timeliness, and quality of cancer care Telemedicine technology and teleconsultation to link providers at two different Veterans Affairs (VA) facilities Videoconference equipment Electronic Medical Records MEDVAMC Cancer Program is one of the largest VA Medical Centers in the nation Primary referral institution for complex cancer care within VISN16 National referral center for select services

All hospitals across VISN 16 Development of VTB Timeline Pilot project started NOLA 2010 All hospitals across VISN 16 2011-2015 Expanded outside VISN 2016 - current Tumor Board Conference Offered General Hepatocellular Carcinoma (HCC) Head & Neck Pulmonary Genitourinary

Multidisciplinary VTB Conferences VIRTUAL TUMOR BOARD SITES   PILOT PROJECT Successful VTB pilot project lead to expansion to other sites within V16 over the years, and recently expanded across the nation 2010 2011 2012 2013 2015 2017 2018 NEW ORLEANS (VISN16) ALEXANDRIA (VISN16) SHREVEPORT (VISN16) OKLAHOMA (VISN19) FAYETTEVILLE (VISN16) SAN ANTONIO (VISN17) KANSAS (VISN 14) BILOXI (VISN16) MIAMI (VISN8) JACKSON (VISN16) TUCSON (VISN18) MUSKOGEE (VISN19)

MEDVAMC VTB coverage

How MEDVAMC VTB Works 1. 2. 3. Repeat as necessary Referral VA: IFC VTB consult placed Houston: Triaged and scheduled 2. Referral VA: Case presented to Houston VTB Houston: Treatment/Diagnostic recommendations made and conveyed to local team in real-time 3. Referral VA: Studies ordered, consults placed, and treatment plan instituted Houston: For patients referred to MEDVAMC through VTB, appointments/studies coordinated to minimize multiple visits Repeat as necessary

MEDVAMC VTB Referral Flowchart:

How V-TB is presented Radiology images reviewed in real-time Referral facility video-conferenced to screen Presenter gives relevant oncologic history Radiology images reviewed in real-time Pathology slides reviewed in real-time Discussion with the multidisciplinary subspecialty Houston team and referring facility for the final treatment plan. Multidisciplinary VTB Houston Team Leaders: Sarvari Yellapragada, MD, Hematologist/Oncologist; Alka Mulchandani, CTR, Lead Cancer Registrar, Anita Sabichi, MD, Acting Chief Hematology/Oncology Section and Nader Massarweh, MD, Surgical Oncology

Benefits of VTB Efficiency in diagnosis and treatment planning Increased timeliness in creating and initiating care plan Decreased system-level costs Reduction of unnecessary diagnostic studies Decrease in costs associated with patient travel and lodging Increased patient-centric care Decrease in travel burden on patients/families For patients who do travel to Houston Increased efficiency in scheduling appointments and diagnostic studies Better coordination of multidisciplinary care Increase networking and communications between VHA facilities

Telemedicine clinics

Telemedicine Clinic Model Veteran @ CBOC Virtual clinic @ Houston Psychosocial & supportive care Palliative care Preventive services Hematology and Oncology services

Increasing access to Teleclinics

Patient satisfaction survey

Outcomes of Telemedicine

Conclusion Advantages Barriers Tele consultation modality Improve individual patient access Reduce travel costs Improve caregiver engagement Palliative care Limitations in physical exam and emergency services Appropriate selection Provider engagement Technological limitations Contingency plans if natural disasters

Thank you to all Veterans, the MEDVAMC and Cancer Center team

QUESTIONS? THANK YOU