1. Telemedicine: The Art of Innovative Technology in Family Medicine
Oliver Oyama, PhD, ABPP, PA-C, CAQ-PSY
Elizabeth Lawrence, MD, FAAFP

2. Outline Telemedicine Basics Common Myths and Misconceptions
Trends in Telehealth
Limitations of Telehealth
BayCare Telehealth Programs
USF FMRP Telemedicine Curriculum

3. Telemedicine Modalities
Asynchronous
Synchronous
Remote Patient Monitoring
(RPM)
Mobile Health
(mHealth)
Tele-radiology
Tele-dermatology
Secure messaging
Virtual consults
Remote ICU’s
Virtual visits (acute care, tele-psych, eSNF, etc.)
Fitness trackers
Diet logs
Heart rate and glucose monitoring
Menstrual and fertility calendars
Vitals, weight (ex. CHF monitoring)
Holter monitoring
Blood sugars, diabetes mgmt
Pulse oximetry

4. The Need for Telemedicine
Primary Care Provider shortages
Limited patient financial resources
Lack of adequate access to care due to distance
Need quicker, more timely critical care treatment
Office visits inconvenient, time off from work
Difficult to get subspecialist care at times
Aging population, less mobile, sicker
Poor coordination of care at times

5. Telemedicine Myths
Telemedicine is too new ▪ Telemedicine has been in existence in various forms since the 1960s

7. A doctor's diagnosis "by radio" on the cover of the February, 1925 issue of Science and Invention magazine
The “Teledactyl”

8. History of Telemedicine

9. Telemedicine Myths Telemedicine is too new
Telemedicine has been in existence in various forms since the 1960s
You cannot arrive at a diagnosis without a physical exam
Most comparative studies estimate 56-71% of diagnoses arrived at by history alone
Telemedicine is just for rural areas ▪
Initially true, however now it is also being used for ICU monitoring, psychiatric care, SNF and wound care management, direct-to-consumer needs, employee health, etc.

10. TeleStroke In 1999 “TeleStroke” was introduced
Acute stroke care from a remote neurologist to a patient in an emergency department
Increased access to a highly effective, time-sensitive fibrinolytic therapy (tissue plasminogen activator).
In just 15 years, TeleStroke became mainstream, and now the largest care provider for patients with stroke in the country is NOT a major medical center but a telemedicine company.

11. Telehealth Growth in the US

12. Global Telehealth Growth

13. Telemedicine Myths Telemedicine is too new
Telemedicine has been in existence in various forms since the 1960s
You cannot arrive at a diagnosis without a physical exam
Most comparative studies estimate 56-71% of diagnoses arrived at by history alone
Telemedicine is just for rural areas
Initially true, however now it is also being used for ICU monitoring, psychiatric care, SNF and wound care management, direct-to-consumer needs, employee health, etc.
Telemedicine ruins the doctor/patient relationship
May safeguard relationships by keeping pts within the system and avoiding urgent care/ ER visits
My patients won’t use it ▪
2015 survey showed 84% of patients preferred telemedicine over going to the ER
(Medscape; April 18, 2016; Comparative Value of Clinical Information in Making a Diagnosis)

16. Telemedicine Myths Telemedicine is too new
Telemedicine has been in existence in various forms since the 1960s
You cannot arrive at a diagnosis without a physical exam
Most comparative studies estimate 56-71% of diagnoses arrived at by history alone
Telemedicine is just for rural areas
Initially true, however now it is also being used for ICU monitoring, psychiatric care, SNF and wound care management, direct-to-consumer needs, employee health, etc.
Telemedicine ruins the doctor/patient relationship
May safeguard relationships by keeping pts within the system and avoiding urgent care/ ER visits
My patients won’t use it
2015 survey showed 84% of patients preferred telemedicine over going to the ER
(Medscape; April 18, 2016; Comparative Value of Clinical Information in Making a Diagnosis)
It will increase my risk of malpractice ▪
Can actually decrease risk by adding another mechanism to engage with your patients

19. Episodic/ Chronic Conditions
Trends in Telehealth
Access to Care
Convenience,
Cost Reduction ▪
Acute Conditions
Episodic/ Chronic Conditions
Hospitals,
Satellite Clinics
Homes,
Mobile Devices
“The State of Telehealth”, N Engl J Med 2016; 375:154-61

21. Episodic/ Chronic Conditions
Trends in Telehealth
Access to Care
Convenience,
Cost Reduction
Acute Conditions
Episodic/ Chronic Conditions
Hospitals,
Satellite Clinics
Homes,
Mobile Devices
“The State of Telehealth”, N Engl J Med 2016; 375:154-61

22. Limitations Reimbursement CLINICAL ISSUES LEGAL ISSUES SOCIAL ISSUES
“The State of Telehealth”, N Engl J Med 2016; 375:154-61

23. BayCare Telemedicine Programs
Acute Care Publix Kiosks Urgent care load balancing
eSNF
eICU
Wound Care
mHealth
Symptom checker
Providers
eVisits
Home Monitoring
ePsych
TeleNeuro
TeleEndo .

24. Under the partnership with Publix, BayCare has established telehealth walk-in centers to treat minor emergencies at 26 Publix pharmacies around the Tampa Bay area.

25. BayCare Telemedicine Programs
Acute Care Publix Kiosks Urgent care load balancing
eSNF
eICU
Wound Care
mHealth
Symptom checker
Providers
eVisits
Home Monitoring
ePsych
TeleNeuro
TeleEndo

27. USF-MPM Telemedicine Curriculum
Three noon TM meetings/ workshops
Pre-meeting assignments
Live telemedicine experiences
Wound care
eICU, eSNF
O/P continuity visits
Electives available .

29. USF-MPM Telemedicine Curriculum
Three noon TM meetings/ workshops
Pre-meeting assignments
Live telemedicine experiences
Wound care
eICU, eSNF
O/P continuity visits

31. Successes & Challenges:
Lessons Learned
Program support – especially PD (conceptually and financially)
Health system support (conceptually and possibly financially)
Technical Support
Faculty champions
Train the trainers
Develop curricular goals and objectives
Anticipate hesitancy/reluctance from residents, faculty
Schedule sessions so all can attend
Develop scheduling, clinic and billing protocols for O/P visits
Train clinic staff
Faculty time is intensive early on but decreases over time
After the first year have graduates of the program become sideline champions
Consider offering a Certification in Telemedicine to graduates of the curriculum
Accept that not all will be open to telemedicine

32. Elizabeth.Lawrence @Baycare.org
Thanks for Listening

33. Questions Curricular questions?
What TM opportunities might benefit your patient population?
Have you had residents or students interested in TM? Graduates practicing telemedicine?
TM experiences at your program/health system (clinical and/or educational)?
If you have had TM experiences, your solutions to challenges within TM?