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TELEMEDICINE AND LONGTERM CARE American Association of Homes and Services for the Aging April 7, 2003 Washington, DC. Don McBeath, Director of Telemedicine Texas Tech University Health Sciences Center. Telemedicine… ….the basics.

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don mcbeath director of telemedicine texas tech university health sciences center

TELEMEDICINE AND LONGTERM CAREAmerican Association of Homes and Services for the Aging April 7, 2003 Washington, DC

Don McBeath, Director of Telemedicine

Texas Tech University Health Sciences Center

what is telemedicine
What is Telemedicine?

. . . the use of electronic information and communication technologies to provide and support health care when distance separates the participants . . .

what is telemedicine4
What is Telemedicine?

Telecommunications Technology

+

Medicine

why do telemedicine
Why do telemedicine?
  • Access
    • Provide primary healthcare that would not be available otherwise
    • Specialty care consultations for isolated specialists, practitioners, and other health care professionals
    • Eliminate expensive travel and isolation
    • Reduce need to move patient
    • CME for isolated health care providers
telemedicine settings
Telemedicine settings
  • Rural
  • Schools
  • Clinics
  • Hospitals
  • Prisons
  • Nursing homes/ Assisted living
emerging applications
Emerging applications
  • Telepharmacy
  • Teledentistry
  • Broader Home Health
  • Remote Surgery
telemedicine began
Telemedicine began .. .
  • In 1924, with the concept of a physician seeing his patient over the radio using a television screen
  • First wave of telemedicine programs started in the 1950s
  • Now in the third wave
  • Most programs that began in the 1960s-1980s no longer exist, due to dependence on external funding
telemedicine now
Telemedicine now
  • Doubling in number of two-way interactive video programs in 90s
  • Teleradiology, store-and-forward, remains most common application
  • Technology is rapidly changing and costs are decreasing
  • Correctional is heaviest use
  • Moving into private physicians use
  • Expanding applications
slide12

Telemedicine at Texas Tech

  • An early pioneer in telemedicine
  • Started in 1989 as a pilot project to deliver health care to the rural Big Bend Region of Texas
  • First consult in June of 1990 from Alpine, Texas hospital
slide13

First consult, June 1990

Aida Porras, age 10

telemedicine at texas tech
Telemedicine at Texas Tech
  • Average 2,500 consults annually
  • Over 12,000 consults since 1991
  • Telemedicine Hall of Fame by TelehealthMagazine in August 1999
  • Top Ten Telemedicine Programs in 1996 and 1997 by Telemedicine and Telehealth Network Magazine
  • Ranked in the “Top 12 List” by Telemedicine Today in 1998
slide16

Dalhart

Pampa

Amarillo

Childress

Hart

Wichita Falls

Plainview

Lubbock

Levelland

Stamford

Anson

Lamesa

Snyder

Abilene

Colorado City

El Paso

Coleman

De Leon

Odessa

Fort Hancock

Sierra Blanca

Ft. Stockton

Alpine

Presidio

Terlingua

July 2001

Texas Tech Telemedicine Network

Campus Sites

Amarillo Lubbock

El Paso Odessa

Rural Sites

Alpine Hart Fort Hancock Presidio Sierra Blanca Terlingua

Correctional Sites

Abilene Lamesa Amarillo Lubbock Childress Pampa Colorado City Plainview Dalhart Snyder El Paso Wichita Falls Ft. Stockton

AffiliatedIndependent Network

•with Hendrick Medical Center:

Abilene Anson Coleman Stamford

•with FQHCs:

De Leon El Paso Levelland

types of telemedicine consults
Types of telemedicine consults
  • By specialty
    • Psychiatry 63%
    • Orthopedics 11%
    • Other 10%
    • Psychology 8%
    • Dermatology 4%
    • Primary Care 4%
  • By type
    • Correctional 90%
    • Non-correctional 10%
how it works
How it works
  • Video conference system
  • Cameras each end
  • TV screens/computers each end
  • Various medical peripherals
  • Video connection
      • T-1 line
      • Satellite
      • Phone line (POTS)
      • Internet
slide20

) ) ) )))))) ) )

) ) ) ) ) )))))) ) )

Hub Site

Remote

Site

T-1

connectivity
Connectivity
  • T-1 dedicated phone line
  • Satellite
  • ISDN
  • High speed DSL/Cable
  • ATM
  • POTS
  • LAN/WAN
  • Internet, or IP-based
compression of bandwidth
Compression of bandwidth

Codecs compress the information to fit the broadband connection

telemedicine does not should not alter the practice of medicine
Telemedicinedoes not/should not alter the practice of medicine.

TTU telemedicine philosophy

core principles of telemedicine
Core principles of telemedicine
  • Is only a tool (like a stethoscope)
  • Must be physician directed
  • Must be integrated into established clinical operations and routines
  • Physician-patient relationships must be preserved
the barriers
The barriers
  • Equipment costs
  • Connectivity costs
  • Reimbursement
getting better
Getting better
  • Declining equipment costs
  • Shared connectivity
  • Enhanced reimbursement (still an issue for nursing homes)
similar scenarios
Similar scenarios
  • Desire to not transport patients off site
  • Limited on-site primary care
  • No on-site specialty care
  • Must maintain certain level of staff on-site at all times
  • Have stringent rules and regulations to follow
prison off site transport sample
Prison off-site transport sample

For Year 2000, medical consults only.

long term care telemedicine goals and benefits
Long-term care telemedicine—goals and benefits
  • Enhance and increase on-site primary care
  • Enhance and increase on-site specialty care
  • Reduce ambulance transportation for off-site care
  • Reduce unnecessary ER visits
goals and benefits cont
Goals and benefits-cont.
  • Reduce risk of injury associated with transports
  • Reduce loss of revenue to nursing homes
  • Allow better community ambulance coverage with less nursing home transports
  • On-site medial and task training
goals and benefits cont37
Goals and benefits – cont.
  • GED (high school equivalency) training
  • Replication of operating model
  • Student training component
  • Expand to additional services including dental
goals and benefits cont38
Goals and benefits – cont.
  • Distant social and counseling services for family and caregivers
  • Reduced family travel time
texas tech long term care projects

Texas Tech long-term care projects

Carillon project – brief pilot

Garrison project – April 2003

West Texas Rural Nursing Home Telemedicine Network - planned

carillon findings
Carillon findings
  • Patient satisfaction

- Comfort level and communications very high

- Satisfaction with exam very high

- Most would do again

- Most believe no diminishing of medical quality

carillon findings43
Carillon findings
  • Patient satisfaction

- Only negatives on audio/hearing

carillon findings44
Carillon findings
  • Physician satisfaction

- Very high overall satisfaction

- Reported no limitation on their ability to treat/diagnose

- Rated most consults as same as face-to-face

garrison project
Garrison project
  • Geriatric Teaching Nursing Home
  • Teaching and research lab for telemedicine applications in assisted living
  • Expose heath care providers, students, and nursing home staff to telemedicine
  • Serve as a resource for rural nursing homes
west texas rural nursing home telemedicine network project planned
West Texas Rural Nursing Home Telemedicine Network Project-planned
  • Link three rural nursing homes with Medical Director with telemedicine
  • Link with Garrison Geriatric Center
  • Link to Texas Tech
  • No community hospital
  • Medical Director in another community
slide50
Broader applications – especially in assisted living facilities
  • Explosion in home use
  • Driven by technology and the expanding role of the Internet