2. 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

3. 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

4. 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

5. Medvamc MULTIDISCIPLINARY Virtual TUMOR BOARD CONFERENCES

6. 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

7. 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

8. 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

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

10. 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)

11. MEDVAMC VTB coverage

12. 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

13. MEDVAMC VTB Referral Flowchart:

14. 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

15. 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

16. Telemedicine clinics

17. Telemedicine Clinic Model
CBOC
Virtual Houston
Psychosocial & supportive care
Palliative care
Preventive services
Hematology and Oncology services

18. Increasing access to Teleclinics

19. Patient satisfaction survey

20. Outcomes of Telemedicine

21. 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

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

23. QUESTIONS? THANK YOU