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

2. 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

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

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

5. Telemedicine Needs Assessment The Telemedicine Impact Score

6. Healthcare: A Wealth of Publicly Available Data

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

14. 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)

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

16. 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

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

18. 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