1. How Nephrology is keeping up with technology

2. Theme

3. THENNOW

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8. THENNOW

9.  Conceived before I came to Nephrology  Administrative hurdles  First visit September 2014

10. How in the World? COW/TOW Presenter takes in front of each dialysis chair Review BPs, weights, meds, issues Visit Examine

11.  Blood pressures and weights are given by presenter (to save time)  Heavily rely on presenter  More difficult to hear

12.  Weekly visits  Monitor more closely  Intervene early

13.  Doubled Sheridan dialysis patient visits  & doubled Nephrology telemed visits  Reimbursement based on # of visits/mo  1 visit $364 / pt  2-3 visits $504 / pt  4 visits $625 / pt

14.  Privacy  Patient perception  Patients in chair, limits exam  Initially - organization, something new (RN)  Scheduling

15.  CE  64 yo female w/ ESRD  9/17/14 dx w/ calciphylaxis as inpatient, started on sodium thiosulfate  Discharge 9/20/14  First telemed 9/24/14  10/15/14 worsening pain, lesions, overall health. Spoke with PCP Dr. Hunter  11/6/14 admitted with progression, started on Pamidronate  D/C 12/04/14  Telemed 12/8/14  12/15/14 comfort care

16.  LP  66yo gentleman w/ ESRD due to atherosclerosis  11/17/14

17.  LH

18.  Trained in Baltimore, MD. (12,406 sq miles)  Montana 147,000, Wyoming 97,818  How can you use telemedicine or other technologies to better serve your patients?  Just because no one has done it doesn’t mean it can’t be done!