Telemedicine- the Cleveland Clinic Experience Matthew Faiman, MD, MBA Director Telemedicine Services

Lecture Overview Virtual Medical Clinic at Cleveland Clinic. An historical perspective of telemedicine. History of telemedicine at Cleveland Clinic. Current and Future Telemedicine projects at Cleveland Clinic. Questions. Virtual Medical Clinic l April 1, 2017 l 2

Virtual Medical Clinic and Telemedicine What is Telemedicine? It is the transfer of electronic medical data (video, sound, image, EMR) from one place to another or…. “A picture is worth a thousand words…..” (Fred Barnard 1921) Virtual Medical Clinic l April 1, 2017 l 3

Virtual Medical Clinic Uses sophisticated, real- time technology to connect Cleveland Clinic physicians with patients requiring specialized consultations, anytime, anywhere Facilitates physician collaboration and interaction for specialty consultations Cleveland Clinic physician conducting personalized patient exam utilizing real-time connectivity technology Virtual Medical Clinic l April 1, 2017 l 4

Location B: Cleveland Clinic Location A: Exam Room Patient sees and speaks to Cleveland Clinic physician in real-time through secure technology Location B: Cleveland Clinic Physician conducts examination, interacts with patient and nurse, and documents encounter in the MyPractice Electronic Medical Record system Virtual Medical Clinic l April 1, 2017 l 5

The Virtual Medical Experience Cleveland Clinic Physician Conducts interaction from Telemedicine studio Interacts with patient and nurse / technician at remote exam location Virtual Medical Clinic l April 1, 2017 l 6

The Virtual Medical Experience Cleveland Clinic Physician Easily navigates real-time views and online medical information (X-Rays, scans, etc.) Directs nurse / technician through exam, seeing and hearing diagnostic details (heart sounds, etc.) Virtual Medical Clinic l April 1, 2017 l 7

The Virtual Medical Experience Cleveland Clinic Patient Sees and hears physician; asks and answers questions Virtual Medical Clinic l April 1, 2017 l 8

The Virtual Medical Experience Cleveland Clinic Patient Receives and complies with physician instructions Virtual Medical Clinic l April 1, 2017 l 9

The Virtual Medical Experience Cleveland Clinic Patient Nurse / Technician transmits diagnostic equipment data directly to physician for review in real-time Virtual Medical Clinic l April 1, 2017 l 10

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The Virtual Medical Experience Cleveland Clinic Patient Is examined utilizing all pertinent diagnostic criteria; nurse / technician follows physician direction Virtual Medical Clinic l April 1, 2017 l 12

The Virtual Medical Experience Cleveland Clinic Physician and Patient Conclude exam with discussion, final questions, physician instructions, and appropriate future treatment strategy Virtual Medical Clinic l April 1, 2017 l 13

The Virtual Medical Experience Cleveland Clinic Physician Fully documents encounter in MyPractice Electronic Medical Record System Places orders for medications, follow-up tests or other labs into MyPractice Electronic Medical Record System Virtual Medical Clinic l April 1, 2017 l 14

The Virtual Medical Experience Cleveland Clinic Physician Concludes Telemedicine Visit Virtual Medical Clinic l April 1, 2017 l 15

Telemedicine at Cleveland Clinic Telemedicine at Cleveland Clinic: began in 2005 with a relationship with University Texas Medical Branch. Dr. Cosgrove imagined telemedicine as an opportunity for increased access for patients living in hard to reach areas. Telemedicine felt to be inline with CC/CCHS approach to innovation. Virtual Medical Clinic l April 1, 2017 l 16

Telemedicine at Cleveland Clinic In 2006, Virtual Medical visits began from Wooster to main campus in Peds GI and Neuro with Drs. Hsich, Wyllie and later Psychiatry with Dr. Tesar. In late 2006 a telemedicine council was set up to address the needs of CC/CCHS domestically and internationally. Virtual Medical Clinic l April 1, 2017 l 17

Virtual Medical Clinic and Telemedicine On January 23rd,2008 services began with the Parker Virtual Medical Clinic, now at CCAC since early 2011. This employee-based clinic sees patients for urgent visits and chronic care such as blood pressure. To date more than 600 patients have been seen. Patient satisfaction scores are as high or higher than regular brick and mortar visits. Virtual Medical Clinic l April 1, 2017 l 18

Virtual Medical Clinic and Telemedicine Other Institutes using Telemedicine: Orthopedics: since 2008 from Wooster, approx 60 visits and 10 surgeries. In 2009 operations from Canfield (St E’s). Visit yield is 6:1 whereas dept average 10:1! Bariatrics: first visit from CCC Toronto 6/09. Transplant Medicine-Discussions began 1/10. Virtual Medical Clinic l April 1, 2017 l 19

Virtual Medical Clinic and Telemedicine Other Institutes using Telemedicine: Cleveland Clinic Canada- Toronto practitioner’s utilization of main campus for 2nd opinions. Emerging Business: both domestic and international opportunities are being explored including home monitoring and wellness. Tele-stroke service fall 2010 along with EEG. ? Las Vegas. Virtual Medical Clinic l April 1, 2017 l 20

Virtual Medical Clinic and Telemedicine Final Thoughts Options are endless. In the fast-paced world that we live in, telemedicine affords a complementary approach to health care. Will not substitute but will augment the health care that we have today. Virtual Medical Clinic l April 1, 2017 l 21