NH Broadband Conference May 16, 2014 Grappone Conference Center - Concord, NH

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1 NH Broadband Conference May 16, 2014 Grappone Conference Center - Concord, NH

2 Track: Telehealth and Telemedicine SESSION 1-10:45 am - 11:20 am Telehealth and Telemedicine -The Dartmouth-Hitchcock Perspective Tom Winchell, Center for Telehealth at Dartmouth-Hitchcock Medical Center; Fred Glazer, Dartmouth Medical (Video Production) This presentation will address a general overview of telemedicine technology, applications, operations, etc., and will explore the strategic and tactical elements of the DHMC Center for Telehealth s program.

3 In line with the conference goals- Understand the role of broadband for health care in NH Highlight broadband accomplishments, future plans, and what is needed to ensure continued broadband support in NH

4 Agenda Telehealth- history, scope and scale Introduction to the D-H Center for Telehealth Vision for telehealth in Northern New England

5 Telemedicine History Scope Scale

6

7 Telemedicine The use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth. Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA Website

8 Services provided by telemed Primary and specialist services Remote patient monitoring Education

9 Evolution of telemedicine Early use of telemed connecting between Mass General Hosp with Logan Airport Microwave 1990s T-1 dedicated circuits, expensive equipment ($100,000+) ISDN IP based networks

10 Telemedicine is a significant and rapidly growing component of healthcare in the United States currently about 200 telemedicine networks, with 3,500 service sites in the US. Nearly 1 million Americans are currently using remote cardiac monitors and in 2011, the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. Over half of all U.S. hospitals now use some form of telemedicine. patients use telemedicine to monitor their vital signs, remain healthy and out of hospitals and emergency rooms. Consumers and physicians download health and wellness applications for use on their cell phones.

11 Benefits of Telehealth Improved access Cost efficiencies Improved quality Response to Patient demand

12 12

13 TECHNOLOGY AT THE BEDSIDE

14 14

15 15

16 16

17 17

18 18

19 The many faces of technology

20 DARTMOUTH-HITCHCOCK We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation.

21 Dartmouth-Hitchcock Medical Center (DHMC) offers Level 1 trauma services to nearly 2 million people scattered across 16,000 square miles of northern New England.

22

23

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25 RURAL TRAUMA Rural locations result in 40% more injury-related deaths and 35% more accidental deaths Trauma patients living in our rural regions die TWICE AS OFTEN as those living in urban areas Someone in New Hampshire dies of trauma EVERY 20 hours Over 87% of pediatric traumas don t survive to reach a Level 1 hospital

26

27 Air Ground

28 Dartmouth-Hitchcock Service Area

29 How do we plan to bring our patients the best possible care, in the right place, at the right time, all the time? Telehealth & Technology

30 D-H Center for Telehealth The Center for Telehealth at Dartmouth-Hitchcock is facilitating the application of video, web, and mobile (mhealth) technologies to connect health care providers and patients - at the right place and time, while strengthening delivery of value-based care. Provide comprehensive telehealth services aimed at improving population health by focusing on patient outcomes Extend key medical services in a timely and reliable manner Utilize cutting edge technology and the expertise of the D-H health system to extend our services outward to the community on many levels.

31 Telehealth is an interactive video conferencing tool which allows real time access to expert care to support the assessment and treatment of patient s experiencing illness while still at their local hospital. DHMC Mission: We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time.

32 Anywhere. Anytime

33 24 / 7

34 Outpatient Clinics & Virtual Visits Hospital-Based Acute Care Consults Second Opinions/ E-Consults mhealth Home Monitoring Education & Outreach

35

36 Outpatient Specialty Clinics Rheumatology Spine Psychiatry Dermatology Ortho&Surg F/U Resp. Therapy Pulmonology Wound Care Neurology Coming soon

37 Virtual Visits Direct-to-patient care Easy, convenient, lower cost Mental Health Primary Care Specialty follow-up care (chronic conditions)

38 Second Opinions / Online Consults

39 mhealth

40 Home Monitoring Remote monitoring for chronic disease: Keeping patients at home & Preventing readmissions

41 e.g. Congestive Heart Failure Home Care Pilot Program

42

43 Image Sharing

44 Education & Outreach Web lectures Skill workshops Case Reviews Video Library Just in time education Podcasts Patient education Sim Center DHMC Mission: We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time.

45 Acute Care Emergency Department Stroke Trauma Inpatient/SNF Consults

46 The goal is to create partnering networks to improve patient outcomes and satisfaction in a cost effective environment DHMC Mission: We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time.

47 Operating Platform IP based Commodity internet access Encrypted communications Vidyo infrastructure deployed in separate data centers Gateway access to other video systems

48 Plans for CTH/NE Telehealth USDA RUS Distance Learning and Telemedicine 41 sites in VT and NH Acute, Ambulatory, Skilled nursing/rehab, Mental Health Home based services NICU Transport team enhanced communications Acute Stroke, Trauma, etc. Interpreter services/support Regional ACO based relationships

49 Thank you! Questions????

50 Tom Winchell - Fred Glazer - dartmouth-hitchcock.org

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