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Tele-Medicine: Applications in Aging Services. Craig Lehmann, Ph.D., CC (NRCC), FACB Dean/Professor School of Health Technology & Management Health Science Center State University of New York at Stony Brook Stony Brook, N.Y. 11794-8200 [email protected] Utilization of Healthcare.

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Tele-Medicine:Applications in Aging Services

Craig Lehmann, Ph.D., CC (NRCC), FACB

Dean/Professor

School of Health Technology & Management

Health Science Center

State University of New York at Stony Brook

Stony Brook, N.Y. 11794-8200

[email protected]


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Utilization of Healthcare

  • Office Visits to Physicians: 765,700,000 (1999) 823,542,000 (2000)

  • Most frequent principal reason: Physical 63,000,000 (1999) same for (2000)

  • Most frequent physician specialty: General and Family Practice 170,571,000 (1999) 198,578,000 (2000)

  • Most frequent principal diagnosis: Essential Hypertension 31,962,000 (1999) 35,096,000 (2000)

Source: CDC


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Utilization of Health Care by Aged (65yrs or older)

  • Visit physicians on the average 8 times a year compared to 3 times a year for those <65yrs.

  • Hospitalized 3 times as often and stay 50% longer.

  • Of the 31 million hospitalizations in the US the Aged accounted for 40% (1997).

  • It is estimated that by the year 2025 the aged will account for two thirds of the US health care budget.



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Utilization of Healthcare

Emergency Department

  • Emergency Department Visits: 102,765,000 (1999) – 108,000,000 (2000)

  • Most frequent principal reason: Stomach and Abdominal Pain 6,800,000 (2000)

  • Number of Injury Related Visits 40,400,000

  • Most Frequent Diagnostic/Screening Service Provided: Blood Pressure (75% of all visits)

  • Type of drug most frequently Prescribed:

    Tylenol (10,000,000)

Source: CDC




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Chronic Conditions of the Aged

  • Arthritis

  • Hypertension

  • Hearing Impairment

  • Heart Disease

  • Cataracts

  • Deformity or Orthopedic Impairment

  • Chronic Sinusitis

  • Diabetes

  • Visual Impairment


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Cost of Managing Diabetes

100 Billion Dollars Annually


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Health care utilization by the Diabetes Patient

  • 96.1 million out patient medical encounters

  • 53.4 million visits to physician’s office

  • 16.4 million visits to ambulatory care settings

  • Visited their physician on the average 15.5 yr. as compared to 4.9 for the general population (all ages).

  • Numerous visits to the clinical laboratory



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Kidney Disease in Diabetes (End Stage Renal Disease)

  • Diabetes account for more than 35% of all end stage renal disease

  • Costs exceed 4 billion dollars


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Incidence of diabetes will rise

  • 17 million diagnosed diabetics.

  • Another 5.4 million undiagnosed.

  • 125 million worldwide

  • Could be 30 million by 2050

  • Complications associated with diabetes:

    Retinopathy

    Renal Failure

    Neuropathy

    Atherosclerosis

    Lower Extremity Amputation



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What’s the Solution?

Better Patient Management

Tele-health

Connectivity


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CHF

Diabetes

Asthma

Cancer

High risk pregnancy

Hospice

Post stroke

Frail elderly

Wound care

COPD

Poor compliance

Post operative states

AIDS

Spinal cord injury

Rural locations

Patient Population


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Largest Users Today…

  • Prison population

  • Federal programs – Department of Defense, NASA

  • Veterans Administration Home Telehealth Project


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Capabilities

  • Close patient monitoring of vital signs

  • Educational programs

  • Video visits

  • Messaging

  • Medication reminders

  • Digital pictures


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Provider Benefits

  • Increased # of patients served

  • Improved access to patients

  • Enhanced ability to monitor patients

  • Efficient use of clinician time


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1st Generation Products


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2nd Generation Product


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3rd Generation Product

Blood

sugar

Blood

oxygen

Camera

Weight

ECG

Thermometer

Blood

pressure

Stethoscope


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Some Tele-Health Vendors

  • American Tele-care

  • American Telemedicine

  • Cyber-Care

  • Home-med

  • Motorola

  • Phillips

  • Tele-med

  • Viterion


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Firewall

Firewall

Application

Server

HTTP

Server

Database

Secure Viterion Network

Patient Monitor

Internet-Enabled Provider PC

DirectDial-Up

Internet


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My Research Focus: better management via Telehealth

Chronic Ailments:

Congestive Heart Failure

Diabetes


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Impact of Technology on Home Bound Congestive Heart Failure Patients

  • Pilot Study: Congestive Heart Failure (N=20)

  • Goals:

    Primary: Decrease Hospital and Emergency Department Encounters Secondary: Nurse and Patient Acceptance of Telehealth Technology


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Congestive Heart failure Study Outcomes Patients

  • No patients from the study group utilized the emergency department. During the study three patients from the study group wanted to go to the emergency department.

  • 20% (n=2) of the control group were re-hospitalized via the emergency room.

  • All patients in the study group felt that they had received better care because of the VST and connectivity


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Study Group: Patients

Receive Telehealth

Blood Pressure

POCT: Glucose, Cholesterol and Micro-albumin

Control :

Telephone

Glucometer

New Study: Diabetes Research


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Diabetes Research Patients

Monitor:

  • Compliance

  • Physician Office Visits

  • Home Visits

  • Emergency Department Encounters

  • Hospitalizations

  • Clinical Evaluations


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Diabetes Research Patients

  • Compliance (other data shows greatly improved)

  • Physician and Home Visits

  • Emergency Department Encounters (Our Data Demonstrated Decline)

  • Hospitalizations (should decline)

  • Overall Healthcare Costs Reduced


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Diabetes Research Patients

Long-term Outcomes:

  • Overall Better Management Results in:

  • Improved Life Style

  • Lower Heart Disease

  • Less Lower Extremity Amputations

  • Early Detection of End-Stage Renal Disease

  • Much Reduced Healthcare Costs


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“If patients could be monitored via the internet 20% of office visits could be eliminated”

1999 = 756,700,000 physician visits

20% would save 150,134,000 visits @ $40.00 per visit

Dollar Savings $6,050,400,000


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