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A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER. Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community & Migrant Health, Inc. Penn Yan, NY 14527 1-800-724-0862. Agenda for Our Presentation.
Terry Jean Yonker, RN, MS, FNP-BC
Telemedicine Clinical Coordinator
Finger Lakes Community & Migrant Health, Inc.
Penn Yan, NY 14527
1. Discuss needs of underserved populations seen in primary care setting 2. discuss the role of telehealth in medical home3. discuss administrative, technical, and clinical processes needed for success4. observe telepresentation and use of peripherals to conduct remote exams5. participate in review of literature and clinical cases relevant to tele-ent, tele-mental health, tele-opthalmology,andteledentistry6. List opportunities for future telehealth applications in community and migrant health centers
Mission Statement….to ensure accessible and affordable health care to the communities we serveMedical Home Concept…patient-centered approach whereby health care team works together to coordinate and support primary and preventive care for an individualCelebrate Diversity … a dedicated, culturally sensitive staff who are committed to high quality , comprehensive care and are Passionate about the work that they do501(c) (3), Article 28 Federally Qualified Health CentersMigrant Health 330g FundingMobile health servicesEnabling Services
Culture beliefsLanguage differencestransportation barrierslack of Child careno insurancelack of trust in health care systempovertymigrant lifestyle
NYS Office of the Professions defines telemedicine as the provision of professional services over geographical distances by means of modern telecommunications technology.
Telehealth is the delivery of health-related services and information via telecommunications technologies.
Telehealth is an expansion of telemedicine that encompasses administrative or educational functions related to telemedicine.
Established in 1993 as a non-profit organization……….
The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership, works to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world.
Telemedicine will be fully integrated into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world.
The mission of ATA is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. This will be achieved through the following means:
Educating and engaging government, payers and the public about telemedicine
Providing a clearinghouse of information and services for both newcomers and experienced professionals
Fostering networking and collaboration among allied interests in medicine and technology
Promoting research, innovation and education
Developing and disseminating policies and standards
Ensuring a strong financial basis for the association to support operations
Creating consumer awareness and support
Patients/Families Providers Health Care System*reduced travel* *direct patient interaction* * improved access* *timely appointments* *expanded services* *improved health outcomes*
*remain in their community* *access to other experts* *resource utilization* *additional support* *access to CME* * expansion to rural &
Video Codec with LCD Monitor
Digital Images Videoconferencing
USDA - DLT
HRSA – Rural Network Development
FINGER LAKES COMMUNITY & MIGRANT HEALTH – HIT INFRASTRUCTURE DEVELOPMENT
NYS DOH – Office of HIT
FCC – Rural Healthcare Broadband Project
What the Literature Says:cost effectivefeasablereduced travel (“greener”)reduced un-necessary transfer to tertiary centerhigh patient satisfactionimages comparable to in-person assessment
What the Literature Says:increased access achievedclinically effective as face to facecost effectiveDecreased time to treatmenthigh patient satisfactioneffective way to manage medication (in conjunctIon with pcp)
FLcmh retrospective chart reviewapril – September 2010pilot site: geneva community health center Dr Charles lilly – Deb cole LCSW6 referrals Dx: depression, PTSD, Bipolarmean time to consult: 15.6 daysmean time to treatment: 4 daysed/hospitalization: 0Mean satisfaction survey score (concurrent) Patient: 4.77/5.0telepresenter: 4.024/5.0symptoms improved:
What the Literature Says:cost effectivepreserved sightincreased access for patients in remote and rural areasdecreased time to treatmentdecreased time and distance traveled
Flcmh outcomes of pilot 2008-2009pilot site: sodus community healthdrchetscerra, od# screened = 408uninsured = 88%pathology = 23 (5%)retinopathy – 3 macular degeneration -1 glaucoma - 11 cataracts – 6 mottled macula – 1 suspicious lesion -1refractory error – 47referred for dilated exam – 13
2) Urgent Care Consults
3) Specialty Care Consults
What the Literature Says:reliable = no statistical difference in face to face visual exam when compared to intraoral camera digital photos improved access to preventive dental care screeningfeasible for screening, diagnosis, and treatment consultationcost effective
Seneca County ABCD/Headstart
33 children screened
9 out of 33 diagnosed with pathology (27%)
100% have accessed follow-up treatment
Finger lakes : Eastman Pediatric dentistry case studies9 referralsseneca county (5) Ages 0-5: (7)wayne county (3) 6-12: (2)ontario county (1)mean Time to consult: 13.1 daysmean time to treatment: 9.9 dayspatient survey: 4.57telepresenter survey 4.5specialist survey: 4.28
(NYS Rate 87.7)
- NYSDOH County Health Incidators
FLMHCP CLINICS AND NEAREST METROPOLITAN CENTERS
A TALE FROM SENECA COUNTY ABCD
Agri-Business Child Development
Finger Lakes Migrant Health Care Project
University of Rochester Medical Center-Eastman Dental Program
13 April 2010
Here, Phyllis begins a consultation by providing a case presentation to Dr. Jeff Karp, DDS, at Eastman Dental, with the University of Rochester Medical Center. Information shared included medical history, diagnosis at prior screening/exam, and any social or economic barriers affecting the family’s ability to complete treatment.
While Phyllis presents her information to Dr. Karp, we see him on the Tandberg unit, listening to the case.
Here is an example of a tooth with severe decay. Thanks to the precision of the camera’s focus and image capture, Dr. Karp is able to use these images to determine the level of treatment a child needs, including sedation methods, (which will also determine treatment locations, i.e. OR vs. dentist’s office) preoperative medications, and behavioral considerations.
Goofing around with Dr. Jeff before the examination!
Hugs for Miss Phyllis!
S: Vision, Passion, Positive attitude, Project Management
W: Financial limitation, technology resources, change is hard work!
learning as we go, Project Management
O: Limitless if + time, money, staff
T: doubts, stamina, fear of IT, payors, malpractice, mobility and special needs of MFW
Dorrian, C. Ferguson, J., Ah-See, K., Bow, C., Lalla, K., VAnderpol, M., McKenzie, L., Wooton, R. (2009). Feasibility of ENT tele-endocopy as suitable method of health care delivery. Journal of Telemedicine and Telecare, 15 (3), 118-121.Duka, M. Mikalovic, B., Miladinovic, M., Jankovic, A. , Vujicic, B. (2009). Evaluation of telemedicine systems for impacted molar diagnosis. VognosactetskiPreglid, 66 (12), 985-991.Frictor, J. and Chen, H. (2009). Using teledentistry to improve access to dental care for underserved. Dental Clinics of North America, 53 (3), 537-548. Garcia-Lizana, F. and Munoz-Mayora, J. (2010). What about telepsychiatry? a systematic review. Journal of Clinical Psychiatry. 12 (2). Jones, S. and Edwards, Rt. (2010). Diabetic retinopathy screening: a systematic review of economic evidence. Diabetic medicare, 27 (30 , 249-256. Kokesh, J., Ferguson, A. PAtriocoski, C., Koller, K., Zwack, G., Provost, E., Holk, P. (2008). Digital images for post-surgical followup of tympanosomy in rural Alaska. 139 (1), 87-93.Kopyka-Kedzierawski, D. , Billings, R., McConnonchie, K. (2007). Feasibility and reliability to screen pre-school children or oral disease. Pediatric Dentistry, 29 (3), 209-213. Ng, M., Nthos, N., Rudinski, CJ, tennant, MT. (2009). Improving access to eye care in albertacanand. Journal of diabetic scientist technology, 3 (2), 289-296. Xu, CO. Smith, AC, Scuffhem, PA, Wooton, R. (2008). A cost analysis of telepediatric otolaryngology services. BMC Health Services Research 4:8.