The Future of Telemedicine and Telehealth. A 50 Year Perspective
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1 The Future of Telemedicine and Telehealth A 50 Year Perspective Ronald S. Weinstein, M.D. Director, Arizona Telemedicine Program University of Arizona, Tucson, AZ President Emeritus American Telemedicine Association Hall of Fame US Distance Learning Association 2013, Arizona Telemedicine Program
2 Disclosures OWLCAT (Educational Software) Corabi International Telemetrics Apollo Telemedicine Health Street DMetrix UltraClinics 2013, Arizona Telemedicine Program
3 Massachusetts General Hospital- Logan Airport Medical Station Kenneth T. Bird, M.D.
4 Where it all started Logan Airport Gate 23
5 Boston Logan Airport Medical Station Connecting to the Massachusettts General Hospital
6 Nurse aiming portable camera
7 MASSACHUSETTS GENERAL HOSPITAL TELEMEDICINE PROJECT In a test conducted at Massachusetts General Hospital (1967), Robert Scully examined a hundred remote projected slides including routine surgical specimens, stained blood smears, and white counts. He was able to identify all of them correctly using black and white television, although occasionally asking color information of the distant technician who was reviewing the slides directly.
8 Massachusetts General Hospital Pathology Staff & Residents (1966)
9 Massachusetts General Hospital Pathology Staff & Residents (1966)
10 Television microscopy at the Massachusetts General Hospital Boston, Massachusetts, USA
11 The Press Takes Note Medical World News July 26, , Arizona Telemedicine Program
12 MGH-Logan International Airport Telemedicine Program ( ) Department of Veterans Affairs STARPAHC Clones (Phelps-Dodge, Playas, N.M.) Secondary Clones (Georgia & Arizona) Innovation (i.e., 1986-Telepathology) 2013, Arizona Telemedicine Program
13
14 NASA IHS Lockheed ( ) STARPAHC Project: Sells, Tucson, Phoenix, AZ
15 Mother and newborn in STARPHAC mobile telemedicine vehicle
16 STARPAHC Mobile Telemedicine Vehicle -1975
17 MGH-Logan International Airport Telemedicine Program ( ) Department of Veterans Affairs STARPAHC (~3 Years - federal funding) Clones (Phelps-Dodge, Playas, N.M.) Secondary Clones (Georgia & Arizona) Innovation (i.e., 1986-Telepathology) ` 2013, Arizona Telemedicine Program
18 Arizona Board of Regents 2012
19 Arizona Board of Regents 2012
20 1996
21 >1.3 Million Cases 2013, Arizona Telemedicine Program
22
23 Telemedicine Training 2010, Arizona Telemedicine Program
24 Arizona Telemedicine Network
25 160+ Sites Urban & rural hospitals Native American healthcare Prisons & jails Community health centers Schools Distance learning affiliates International Sites 2013, Arizona Telemedicine Program
26 Telemedicine Services 2013, Arizona Telemedicine Program
27 IHT2 Meeting Case Study San Francisco
28 Telemedicine Subspecialty Consultations Anesthesiology Neurosurgery Peds. Orthopedics Cardiology Ob/Gyn Peds. Psychiatry Dental Ophthalmology Peds. Pulmonology Dermatology Orthopedics Peds. Rheumatology Endocrinology Otorhinolaryngology Peds. Urology Fam. & Comm. Med. Pain Clinic Psychiatry Gastroenterology Pathology Radiology Genetics Peds. Cardiology Reprod/Infertility Geriatrics Peds. Dermatology Rheumatology Hematology/Oncology Peds. Endocrinology Sports Medicine Hepatology Peds. Gastroenterology Surgery Infectious Disease Peds. Hem/Onc Surgical Oncology Integrative Medicine Peds. Infec. Disease Transplantation Internal Medicine Peds. Nephrology Toxicology Molecular Diagnostics Peds. Neurology Urology Nephrology Peds. Ophthalmology Vascular Neurology Peds. Oral Surgery Wound Management 2013, Arizona Telemedicine Program
29 Teleradiology 1,300,000+ cases 2010, Arizona Telemedicine Program
30 Telepathology
31 U.S. National Demonstration of Dynamic Robotic Telepathology El Paso Texas Washington, D.C. August 20, 1986 Alexander W. Miller III, M.D., Telepathologist.
32 U.S. Department of Veterans Affairs Milwaukee, Wisconsin (1996) Invent» patent» construct» commercialization cycle ( )
33 Innovations in Digital Pathology Slide Processors Weinstein et al, Human Pathology, 2001
34 Miniaturized microscope
35 University of Arizona College of Optical Sciences microscope format considerations Two considerations: How many objectives (N obj ) needed to span width of object (W)? How many objectives fit into size of array? Constraints on array size: Width of object (e.g., glass slide) (W) Length of array (L) Ratio () of field of view size (w FOV ) to optics size Conventional: ~1:25 Array microscope: ~1:7 N obj N obj 2 WL 2 w FOV N obj W w FOV w FOV Michael R. Descour, Ph.D. et al.
36 DMetrix lenslet array
37 3 stacked lenslet arrays = 1 lenslet array ensemble Weinstein, R.S., Descour, M.R., et al. US Patent 7,116,437 B2 Weinstein, R.S., Descour, M.R., et al. U.S Patent 7,184,610 B2
38 Patient Name S University Physicians Hospital Tucson, Arizona
39 Patient Name S University Physicians Hospital Tucson, Arizona
40 DMetrix- Whole Slide Image Telepathology
41 IBM SYSTEMS JOURNAL, VOL 46, NO 1, 2007
42 Kino-University Physicians Hospital Tucson, Arizona DMetrix Scanner
43 11:15 A.M. to 3:27 P.M.
44
45
46 Telepsychiatry 2013, Arizona Telemedicine Program
47 Teleophthalmology 2013, Arizona Telemedicine Program
48
49 Case Study Care Beyond Walls and Wires is the best thing ever for me, and the best thing for my dad. Rita Yazzie
50 Yes, telemedicine did feel weird at first. But it works. You get used to it. I think it s the wave of the future. Patient
51
52 Tele-Urgent Care Teletrauma - University of Arizona Health Network ( multiple communities) Telestroke Mayo Clinic Telestroke Network (11 rural communities) eicu (electronic Intensive Care Units) Banner Health eicu Network (7 Banner hospitals)
53 Teletrauma
54 Telepresence 2013, Arizona Telemedicine Program
55 Telestroke
56 eicu (21 Banner Hospital Network) Banner Health Electronic Intensive Care Unit eicu
57 Telemedicine Services Telepresence Telementoring
58 Telemedicine Services Telepresence Telementoring
59 Telemedicine Services Telepresence Telementoring
60
61
62 2013, Arizona Telemedicine Program
63 2013, Arizona Telemedicine Program
64 Diabetes Monitoring
65 Contingent from Shangdong University, China
66
67
68 2015 Telehealth Issues & Opportunities New drivers creating need for virtual care models (ACO, etc.) Physicians shortages and increased numbers of patients entering the system Consumer demands for more convenient health care services Killer applications A- Gap services; B-Urgent services; C-Mandated services mhealth, ehealth, wireless, implantable 2013, Arizona Telemedicine Program
69 DeWitt Baldwin, M.D.
70
71 Rep. Giffords Shot in Tucson, Saturday, January 8, , Arizona Telemedicine Program
72 Gifford Incident Saturday, January 8, 2011 Tucson Shooting of Rep. Gabrielle Gifford 6 Dead 12 Wounded Level I Trauma Center at University Medical Center in Tucson
73 Pre-Transfer Clinical Video Conferencing University of Arizona and University of Texas
74
75 Telepresence
76
77
78 Memorial on front lawn, University Medical Center Tucson, Arizona
79 Acknowledgements U of A Pathology Gail R. Barker, Ph.D. Achyut K. Bhattacharyya, M.D. Beth L. Braunhut, M.D. John B. Carpenter, M.D. Anna R. Graham, M.D. Thomas M. Grogan, M.D. Jeffery Henderson, M.D. Robert Klein, M.D. Fangru Lian, M.D. Anna Maria Lopez, M.D. Ray B. Nagel, M.D., Ph.D. Lynn Richter, M.T. (ASCP) Katherine M. Scott, M.D. U of A College of Optical Science Peter Bartels, Ph.D. Michael Descour, Ph.D. Chen Liang, Ph.D. Rene V. Slack, Ph.D. James C. Wyant, Ph.D. Arizona Telemedicine Program Kristine Erps Michael Holcomb Elizabeth A. Krupinski, Ph.D. Christopher Martin Janet Major Phyllis A. Webster Massachusetts General Hospital Stanley Bullivant, Ph.D. John Gilbertson, M.D. Frederick B. Merk, Ph.D. Jerry Nash, M.D. Roger Williams, M.D. Yukaka Yagi, Ph.D. DMetrix, Inc. James Goodall William C. Russum P. Zou, Ph.D.
80 Thank! you Ronald S. Weinstein, MD 2013, Arizona Telemedicine Program
81 2013, Arizona Telemedicine Program
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