A technology-enabled business model

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1 A technology-enabled business model for delivering healthcare Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean School of Medical, Director Center for Health and Technology University of California Davis

2 The US spends more than $ 2 trillion on health care with relatively yp poor impact on health Some people get too much health care, some too little People across the economic spectrum have increasing difficulty accessing specialty care Million of dollars and significant human suffering result from the lack of the right information i driving i medical care decisions i Aging population has increasing health care needs, yet there is increased difficulty with access Increasing burden of chronic disease (Costs of diabetes alone nearly $150B)

3 The explosion of new knowledge and information in the health sciences is ironically creating greater disparities in the quality of healthcare services

4 Advances in medicine have several components Discovery new basic science ce that has potential biologic applications in humans Integration taking that science and incorporating it into a treatment model such as a drug or other treatment process Application getting that treatment appropriate delivered to the right people, in the right way, when they need it

5 If we discover a cure for cancer but only half the people have access to it, we really only discover half the cure for cancer Medical Science, no matter how good it is, is worthless if not applied appropriately to patients who need it

6 Advances in telecommunications and information technologies are an essential component in the appropriate application of science, helping to redistribute knowledge and expertise where and when it is needed

7 The IOM 2001 report "Crossing the Quality Chasm" stated t that t "information technology must play a central role in the redesign of the health care system."

8 One of the problems is that we are applying new technology to a broken model of care instead of using technology to facilitate a change in the model of care

9 Clinical Care is Involves Making Decisions In order for the next best decision i to be made: It is critical that complete, current and accurate information about the patient is immediately available at the point of care (EHRs) It is critical that the most up-to-date medical scientific information is available at the point of care and can be customized and appropriately applied to that patient

10 Access to current medical science for the next clinical decision

11 Elements of a Distributed, Technology Enabled Health Care System 1. Care at Home and in the Community 2. Ambulatory, Clinic and Community Care 3. Hospital Care 4. Public and population health, disaster health, large scale emergency response

12 Level 1.Care at Home and in the Community Medical resources available to patients at home or in the community through the medium of technology Internet health sites with Physicians Personal electronic medical records Chronic disease management and electronically delivered care in the home and in the community using cellular technology

13 Chronic disease management outside of the physicians i office Information collected at the office visit is often gives an inaccurate picture of the patient s disease Visits are too infrequent for the MD to participate in a meaningful way in management Technology exists that t can provide a vehicle to address these issues

14 Improving the Efficiency Home Health Programs Tele-home health has been shown to be effective Travel times in traditional home health programs decrease the efficiency Telemedicine has the potential to improve efficiency of home health programs by allowing home health nurses to extend their expertise without travel to certain patients

15 Home Health and Chronic Disease Management Meet JL Atteberry

16 Remote Care: Convergence of Sensors and Jewelry Language Xlater Body Aggregator Pulse Oximetry Blood Press. Cell phone as gateway Fashion addresses the stigmata of care Patients: bearing greater costs of care Self care is a real possibility Approaches that address quality, productivity, efficiency and timeliness are needed. Courtesy: Paul Wright

17 Level 2. Ambulatory, Clinic and Community Care Provided by a Rural Provider Handheld Computers Online Medical Knowledge for Health Professionals Online and Video-Based Education Decisions support tools Telemedicine Consultation

18 Physician PDA s PDA

19 Handheld Computers Education (epocrates), schedule, and records access Search PubMed using PDA PDA portal: m WiFi or Blue Tooth Cell phone High Speed Network (only in select areas) Regular Cell Network

20 Online Medical Knowledge for Health Professionals Providers can access medical information electronically through logging into sites specifically designed to meet their needs.

21 Online and Video-based Education Webcasts CME, CNE Conferences Online CME Grand Rounds Distance Education UC Davis Distance Education Program

22 Inefficiencies in outpatient specialty care What if we could reduce the number of medical offices, office staff, duplication of services

23 Current specialty models often involve the transfer of patients for part of their care Requires duplication of office services Specialist to establish relationship, re-take history Develop pp plan and share with patient, then separately with primary care physician Often results in duplication of charting

24 Reimbursement models for specialty care should create incentives for: Efficiently providing correct amount of expertise needed to make the next evidenced based clinical decision for the patient Minimize the time and effort of the patient, the referring provider and the specialist Minimizing duplications of services

25 Telemedicine

26 Telemedicine Interactive healthcare over distance using technology Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient

27 Video-based out patient telemedicine

28 Medical Peripherals General Exam Camera Nasopharyngoscope Otoscope Electronic stethoscope

29

30 Store-and-Forward Telemedicine Commonly used in Radiology and in cardiology with remote ECG interpretation Increasingly used in other areas Dermatology Ophthalmology

31 Teleophthalmology

32 Video Interpreting Services Provides language and cultural interpreting, including American sign language

33 Level 3. Hospital Care Emergency Department Care Tele-pharmacy Teleradiology Inpatient Telemedicine Consultations- Psychiatry Obstetrical services Intensive care unit Infectious disease Neurology Surgery

34 Reducing costs and improving quality in the hospital Hospitalized patients are much sicker than in the past Having the right information at the point of care 24/7 is essential EMR is reducing errors made from not having correct patient related information, right dose of drug, etc. Need the right medical science at the bedside at the right time.

35 Emergency Room Telemedicine

36 Telepharmacy Hospital Based On-line pharmacy informatics Decision support tools CPOE Video tele-pharmacist review of medications and medication orders

37 Remote Fetal Monitoring Pix fetal heart

38 Inpatient Pediatric and Adult Critical Care

39 Hospital Based Telemedicine

40

41 Robotics/Telementoring

42 High Resolution Display Multiple l Inputs

43 Telesurgery

44 What is the Future of Telemedicine?

45 Changes likely to drive the future Reimbursement models telemedicine Employers and Payers demands Imaging g devices/point of care lab tests Electronic Medical Record Sensor technology Use of cell phones for health care Improved video technology using HD and 3D

46 Changes likely to drive the future models telemedicine: Governmental/cultural Consumer expectations of best practices and access to best specialists Next generation s acceptance of telecommunication eco cat o technology ogy Government Efforts to increase TM FCC grant program California Prop 1D and Broadband Initiative

47 Current Policy Environment in California Executive Order S signed by Governor Schwarzenegger Outlines California s i strategy t for the advancement of Health IT, including language to ensure access to specialists in a more timely manner for rural and underserved areas through technologies such as telemedicine. Directs the use of at least $250 million in investment funds and grant monies

48 Current Policy Environment in California Proposition 1D: K-University Public Education Facilities Bond Act of 2006 the amount of $200 million shall be used for capital improvements that expand and enhance medical education programs with an emphasis on telemedicine aimed at developing high- tech approaches to health care.

49 California s Proposition 1D Passes With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California. Governor Arnold Schwarzenegger 10/27/2006 UC Davis Pediatric Telehealth Colloquium UC Davis Pediatric Telehealth Colloquium funded in part by William Randolph Hearst Foundation

50 FCC - California Proposal Consortium formed Moderated by Governor s Office Single California i proposal put forth University of California and UC Davis Health System selected as managing partners

51 Technical Goals Extend broadband d connections to 300+ rural health care providers in 3 years Address technical and cost constraints Facilitate t use of state-of-the-art telehealth services Telemedicine Continuing Medical Education Regional Health Information Organizations (RHIO s)

52 Proposed CTN Design up to $22.1 M authorized over 3 years Up to $8.6 M of additional funding from the California Emerging Technology Fund and United Health

53 Opportunities with CITRIS Innovation Center at UC Davis Health System Prime space, in new education building California Telehealth Resource Center Virtual hospital and clinics School of Medicine and Hospital Physician, nurses, etc. New School of Nursing CTSC UC Davis Cancer Care Network CTN and UCD Telemedicine Network Serves as a test-bed

54 Summary Medical science is increasing that can significantly improve the health of people with access to it Advanced Information and telecommunications technologies have a central role to play in bringing expertise to the point of need The use of telemedicine is increasing and is demonstrating benefit and creating a new business model of collaborative care Future developments and consumer demand are likely to increase the use of these technologies in health care

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