Transcript No Slide Title

Telemedicine
Broadband Applications for Healthcare
Confidential
Telemedicine Overview - 21/07/2015 - 2
Agenda
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine
How Broadband Can Help
Summary
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Telemedicine: What is it?
• Electronic access to CHIN database?
• Video conferencing with a specialist?
• Grand rounds/CME video conferencing
session?
• Getting healthcare advice on the
alt.rec.med.quackery?
• Just another overhyped term like virtual
reality, artificial intelligence, ...?
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A Working Definition
• The use of
telecommunications
technology to facilitate
interactions between
geographically disparate
people for the purpose of
solving medically related
problems
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Telemedicine Communications
Telemedicine
Store and Forward
• lower equipment &
telecommunications cost
Real Time
Clinical
Admin/Educational
• easier to use
• offers immediacy and clarity of
communications
• greater interactivity & knowledge transfer
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The Evolution of Telemedicine
Large Number
of Trials
First
Telemedicine
Trials
Late 50’s
Rebirth of
Telemedicine
Termination
of all Trials
Mid 70’s
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Emphasis on
Sustainability
Early 90’s
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Benefits of Telemedicine
• Economic
• reduced costs
• improved economic base for rural hospitals
and inner city clinics
• earlier therapeutic intervention resulting in
reduced long term costs
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Benefits of Telemedicine
• Social
• equal access to healthcare services
• reduced professional isolation for rural
healthcare providers
• more uniform quality
• enhanced continuity of care
• efficient use of tertiary care services
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Telemedicine Market
C om pete in a
400
m anaged-c are
350
environm ent
300
P rovide m edic al
educ ation
F ill s pec ialty
8%
ac c es s need
37%
11%
Estim ated
250
200
150
100
50
B etter phy s ic ian
c ollaboration
12%
R apid inform ation
0
1993
1994
1995
1996
1997
trans fer
M ore effic ient us e
14%
of s taff res ourc es
18%
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Telemedicine Market
56.5%
Teler adiology
46.3%
Telec ar diology
44.4%
Teleder matology
Ps y c hiatr y
NO
43.5%
28%
39.8%
Emer genc y Medic ine
Home Healthc ar e
23.1%
YES
Telepathology
21.3%
72%
20.4%
Teleonc ology
0%
10%
20%
30%
40%
50%
60%
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Agenda
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine
How Broadband Can Help
Summary
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Telemedicine
Telesurgery
Expert
Telepathology
Real-time
Ultrasound
Wide Area
Grand Rounds
Home Healthcare
Teleradiology
Telecardiology
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Continuing
Medical Education
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User Requirements
Specialists
Digital and
analog
medical
instruments
Ease of use
Integration with
existing HIS
Premium quality
multimedia conferencing
with high speed
collaboration
Low maintenance
tools
High scaleability
Flexibility
Security
Primary Care
Physician
Reliability
Accessibility
MIS
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Clinical Requirements
• Majority of “telemedicine” in the past 5 years
has simply been video conferencing applied to
healthcare
• Move towards products specifically designed for
clinical aspects of telemedicine
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teleradiology
telepathology
teledermatology
telecardiology
regulatory standards
medical instruments
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Telemedicine Peripherals
• Numerous medical devices are suitable or
have been modified to work with
telemedicine systems
• These devices are available from
companies such as Welch Allyn,
American Medical Development and
Andries Tek
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Technology Trends
• Shifting away from...
• “simple” video conferencing, dedicated telemedicine
rooms, hub and spoke network design
• Moving toward...
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standards based, open systems solutions
desktop telemedicine
new image compression technology
highly reliable and scaleable solutions
systems designed specifically for healthcare
professionals
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Agenda
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•
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine
How Broadband Can Help
Summary
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Profile of Early Adopters
• Teaching hospitals
• Managed care
organizations
• Correctional
facilities
• US military
• Urban, rural &
inner city
applications
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Telemedicine in Prisons
• Business drivers
• risks (care providers & general population)
• cost of transport
• litigation
• Benefits
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more timely delivery of healthcare services
reduced risk
reduced cost of transportation
reduction in litigation
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Telemedicine in Managed Care
• Allina Health System, Minn.
• Business drivers
• cost reduction
• increased need for communications
• competitive advantage/differentiator
• Reported results
• 83% very satisfied with telemedicine consultation
• expanded patient population
• network growing, in third year of operation...
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Case Study - Pediatric Care
Emergency
Room
(StarMED)
Radiology
(future DICOM)
T3
Consultation
Room
(StarMED)
ISDN
H.320
RBOC
Services Platform
(future)
An additional
6 sites over the
next 2 years
Lecture Hall
(StarED)
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Building a Successful Program
• People
• needs assessment, training/development of
trust, access, champion
• Technology
• needs assessment, multiple applications to
keep volume high, reliability
• Evaluation
• clinical efficacy, impact on practice patterns,
cost
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Agenda
•
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•
•
•
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine
How Broadband Can Help
Summary
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Patient Acceptance
• There is strong consensus amongst most
studies… patients love telemedicine!
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convenience
flexibility
reduced travel for healthcare services
treatment by physicians they know and trust
financial impact
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Physician Resistance
• Familiarity with the technology
• Fears of predation/disruption of referral
patterns
• Inconvenience
• Concerns about liability
• Inertia
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Barriers to Widespread Use
• Reimbursement
• Licensure & liability
• Scheduling
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Issue: Reimbursement
• The biggest single issue which is
impeding the widespread use of
telemedicine
• HCFA
• Blue Cross/Blue Shield
• Kansas, Georgia, ...
• Medicare/Medicaid
• Managed Care
• 1996 Telemedicine Development Act
(California SB 1165)
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Issue: Licensure/Liability
• Jurisdiction
• is the medicine being practiced where the
physician is, the patient is, or both?
• most favorable legal environment might be
the place sought to litigate
• these issues have the potential of
accelerating the application of national rather
than local standards of care
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Issue: Scheduling
Physician/Admin contacts Local SF requesting
consultation with possible dates & times
No nurse scheduled
Nurse needed during consultation
Local SF contacts
physician/administrator
for other dates/times
LSF contacts Hub SF
to request consultation
LSF schedules nursing
service once
appointment time is set
No
HUB SF informs local SF of
possible times
LSF requests consulting physician
availability info
Facilities match?
LSF contacts Hub physician
to schedule consultation
Physician & facilities match?
LSF contacts local physician’s
office with available times
No
Time match?
No
If consulting physician
not resident at Hub
schedule with site admin
Appropriate site
to confirm with
consulting physician
LSF contact Hub SF to
reserve appointment time
Request facilities info
No
Facilities match?
LSF notifies local
physician’s office
of consultation time
and date
Consultation scheduled
LSF confirm consultation
with local physician
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LSF confirm consultation
with consulting physician
Telemedicine Overview - 21/07/2015 - 30
Agenda
•
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•
•
•
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine
How Broadband Can Help
Summary
Confidential
Telemedicine Overview - 21/07/2015 - 31
Telemedicine Applications
Diagnostic
•Telesurgery
•Telediagnosis
• Real-time Ultrasound
• Telepathology
• Telecardiology
•Teledermatology
• Teleradiology
•Telepsychiatry
•Follow-up
•Teleconsultation
• CME/Grand Rounds
Consultation
Monitoring
• Home Healthcare
Use
Low (POTS)
Bandwidth (home)
Medium (<T1/E1)
(urban/rural)
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High (> E1)
(urban/rural)
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Advantages of Broadband
Resolution
Color
Motion
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Advantages of Broadband
Mb/Image
Images/Exam
Mb/Exam
sent @28.8kb
sent @ 10
sent @T1 Mb/sEthernet
sent at
OC3
Modality
Resolution
X-ray/Chest
2kx2kx12
59
1-2
88.4
1 hr 19 min
1 min 28 sec
8.8 sec
.6 sec
X-ray/Other
1kx1kx12
12.6
2-5
44
39 min
44 sec
4.4 sec
.3 sec
CT
512x512x16
4.2
10-50
126
1 hr 53 min
2 min 6 sec
12.6 sec
.8 sec
Fluoroscopy
512x512x10
2.6
5-10
20
18 min
20 sec
2 sec
.1 sec
MR
256x256x8
0.5
10-50
16
14 min
16 sec
1.6 sec
.1 sec
Ultrasound
512x512x8
2.1
10-50
63
56 min
1 min 3 sec
6.3 sec
.4 sec
Nuclear Med
128x128x8
0.1
10-50
4
4 min
4 sec
.4 sec
.03 sec
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ATM and Healthcare
FDDI
Ethernet
T3/OC3
PBX
T1/TDM
ATM Switch
JPEG/MPEG2
Token Ring
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Agenda
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Definition and History of Telemedicine
Telemedicine Applications
Case Studies
Challenges for Telemedicine Solutions
How Broadband Can Help
Summary
Confidential
Telemedicine Overview - 21/07/2015 - 36
Summary
• Starvision/Newbridge/Siemens have a
comprehensive, end-to-end telemedicine
solution
• based on inexpensive, widely available hardware
• designed to meet the clinical needs of a variety of medical
disciplines
• simple to use, developed specifically for healthcare
professionals
• medical standards compliant
• integrates with existing hospital information systems
• true multimedia... much more than just pointing cameras
at doctors
• available today!
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The
Right
Connection
for
Healthcare
For More Information
• A Telemedicine Primer: Understanding the
Issues
• by Jim Reid
• TIE web site
• http://tie.telemed.org
• Magazines and journals
• Telemedicine Today
• Telemedicine Journal
• Telemedicine and Telehealth Networks
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For More Information
• Conferences
• American Telemedicine Association AGM
(Orlando, April)
• Telemedicine 2000 (Chicago, June)
• TeleCON/TeleMED (Anaheim, Nov.)
• Associations
• American Telemedicine Association (ATA)
• American Telemedicine Service Providers
Association (ATSP)
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