2. 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.

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

28. Telemedicine… ….the basics.

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

30. Telecommunications Technology
What is Telemedicine?
Telecommunications Technology +
Medicine

31. 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

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

33. Emerging applications
Telepharmacy
Teledentistry
Broader Home Health
Remote Surgery

34. 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

36. 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

38. 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

39. First consult, June 1990
Aida Porras, age 10

40. Aida Porras in Presidio, TX

41. 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 by Telemedicine and Telehealth Network Magazine
Ranked in the “Top 12 List” by Telemedicine Today in 1998

42. 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

43. 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%

44. 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

45. 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

46. Hub Site Remote Site T-1 ) ) ) ) ) ) ) ) ) ) )
) ) ) ) ) ) ) ) ) ) )
) ) ) ) ) ) ) ) ) ) ) ) )
Hub Site
Remote
Site
T-1

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

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

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

54. 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

55. The barriers
Equipment costs
Connectivity costs
Reimbursement

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

57. Long-term care telemedicine

58. Correctional telemedicine as a model

59. 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

60. 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.

61. 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

62. 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

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

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

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

68. 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

69. Carillon findings Patient satisfaction
- Only negatives on audio/hearing

70. 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

71. 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

72. 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

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

75. Greatest potential for expanded use of telemedicine!

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

78. Telehealth and Distance Learning: Taking the KUMC to Schools Across the State KUMC Faculty Retreat September 19, 2008
Kathy Davis, Ph.D.
(913)

79. 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

80. 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

81. Made possible by…..

82. In conjunction with….

83. And the University of Kansas

84. Utilizing Technology Telemedicine Interactive distance learning
Internet connectivity
Website

85. 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

86. 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.

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

88. Meanwhile, back at the ranch…

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

90. 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

91. 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:

92. 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

93. Once again…..
KU Medical Kansas
Center Schools

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

95. 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

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

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

98. Health Careers in Emergency Medicine

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

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

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

102. 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

103. Current Funding

104. 6-week curriculum Breaking the ice Creating a resume
Letters of recommendation
Life as a medical student
Career options
Paving the way/resources

105. E-mentoring Wrap-Up: Sawbones Lab

106. 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

107. 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.

108. 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

109. For more information Kathy Davis kdavis2@kumc.edu
(913)