1. My Experience with Telemedicine Jay M Portnoy, MD Director, Division of Allergy, Asthma & Immunology Children’s Mercy Hospitals & Clinics Kansas City, Missouri

2. Disclosures I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this cME activity I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation

3. Patient Care: 2001 Patient care is: Safe Effective Efficient Patient Centered Timely Equitable

4. Alternative types of encounter Synchronous Clinic visits Telephone- ad hoc Telephone- Scheduled Group meetings Webinars Asynchronous E-mail Patient portals Telephone visits Charged $20 or $40 Most patients were very happy A few complained that the doctor “didn’t do anything” because no physical contact Currently there is no charge

5. Telemedicine: My Workflow Set up the laptop and audio device Log in to the EMR Log in to telemedicine Connect to St. Joseph or Wichita

6. The Encounter I ask my usual questions Notes entered into EMR Instructions printed to patient’s location E-prescriptions sent to pharmacy Orders entered including blood tests Spirometry is available

7. The Physical Exam

8. Patient instructions Handouts printed to patient Nurse reviews instructions Inhaler technique

9. Patient Experience (telemedicine video)

10. Asthma study Patients scheduled in allergy clinic from Wichita or St. Joseph Offered telemedicine or face-to- face Asked to participate in a study Consent signed (IRB approved) Measured day 1, 30 and 180: Asthma Control test Quality of Life (caregiver and patient) Satisfaction AgeStudyControlTotal < 4201131 4 to 11271643 12 +10414 Total573188

11. Satisfaction After my experience today, I would recommend health care appointments by telemedicine to a family member or friend. ResponseNumber of Responses Strongly Agree/YES!51 Agree/Mostly3 Neutral/No Opinion3 Grand Total57 The appointment using telemedicine was as good as an appointment in person. ResponseNumber of Responses Strongly Agree/YES!51 Agree/Mostly3 Neutral/No Opinion3 Grand Total57

12. Asthma Control Test *TRACK for <4 years normalized to 25 points

13. Quality of Life

14. Integrating Telemed into Practice TimePatientLocation 8:00xxxxSC- New 8:45xxxxTH- Joplin- new 9:30xxxxTH- St. Joseph- new 10:15xxxxSC- New 11:00xxxxTH- Joplin- F/U 11:30xxxxSC- F/U Lunch 13:00xxxxSC- New 13:45xxxxTH- Wichita- new 14:30xxxxSC- New 15:15xxxxTH- Joplin- new 16:00xxxxSC- F/U 16:30xxxxSC- F/U Patients can be seen wherever they are Demand determines distribution of Telemed Pct seen in August, 2015 ClinicTelemedPhone New53%18%0 F/U16%4%9%

15. Extending Telemed into Additional Communities It just takes a tablet to connect PCP can connect via iPad. Ad hoc or scheduled consultations from PCP office

16. Billing and Coding At least 40 miles between patient and provider Facility fee may be billed for by the facility with the patient Professional fee billed by the provider Can bill if a provider does the exam and relates that to the consultant (so can use an iPOD instead of a robot) Need to indicate in note that it was a telemedicine encounter

17. So where are we going? Telemedicine in patient homes? Why not? Telemedicine interface with the EMR directly Audio/video documentation Robodoc?

18. Who knows? But it is cool…