Telemedicine Types 4/8/2014. Telemedicine, connecting people to their medical homes

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1 Telemedicine, connecting people to their medical homes Petaluma Health Center Opened 1996, FQHC since patients, >100,000 annual visits One practice site June 2011(40,000 sq. ft.) Medical Services 3 Family Medicine Teams, 1 Women s Health Team Mental Health Services Wellness Services 36 Clinicians Telemedicine Types Store and Forward (Asynchronous) Teledermatology Retinal Imaging Teleradiology Real time video (Synchronous) Specialty with PCP Tele Mental Health Home Telehealth Monitoring Tele homecare 1

2 Effectiveness of Telemedicine 21 specialties are at least as good as conventional care Examples: Geriatric Care Home Care / Monitoring Mental health Dermatology Cardiology Ophthalmology Diabetes care Leach WD, If You Bill It They Will Come: A Literature Review on Clinical Outcomes, Cost Effectiveness, and Reimbursement for Telemedicine. (Prepared by the Center for Collaborative Policy California State Univeristy Sacramento.) California Telemedicine and ehealth Center. Sacramento, CA. January 2009 Equipment then Equipment Now 2

3 Reimbursement Telehealth Advancement Act AB214 Broad definition of telehealth Any CA licensed professional Expanded locations Parity with in person care No consent necessary BUT no mandate to pay Resources: CPCA Telehealth FAQ California Telehealth Resource Center Telemedicine Reimbursement Guide Access to Medical Home Increased demand for services Low cost of telemedicine equipment including smart phones and tablets Access to primary care team can be enhanced by telemedicine applications PHC Telehealth Integration Dental Medical Mental Health Medical Case Management PCPs Health Center to Home Transition of care SNF Visits Homeless Shelter Respite beds Other Virtual PCP or Wellness visits Specialty Care Video Psychiatry Store and forward Teledermatology 3

4 RDA Varnish Program RDA with mobile cart Varnish Supplies Dental Ed/HCP/Appt.cards Wi Fi/Mobile access: Dental EDR Medical EMR Cisco WebEx Laptop with built in camera Intraoral camera Walkie talkie vs. Vocera Attends team huddles Works with Flow coordinator RDA Varnish Program Applies varnish Provides dental education, home care products and nutritional counseling Takes intraoral photos Uses WebEx to video conference with the dentist Documents the visit in the EDR Creates a follow up appointment with the dentist Dentist does screening and gives Fl Rx if needed Connects the family to their dental home! RDA Varnish Program Video conferencing station Computer station Camera (Logitech HD Pro Webcam C910) $100 Headset for privacy & sound Walkie Talkie or Vocera Dentist is notified of waiting patient Walks to Medical or attends a brief video conference between patients/procedures 4

5 RDA Varnish data at one year RDA Varnish data at one year 5

6 Expansion to further integration Dental Consults in Medical Department Medical Consults in Dental Department Hospital Transitions 2013 Safety Net Innovation Challenge (CCI) Connect recently hospitalized patients with their health home / home team using video visits. Better, Sooner medication reconciliation View of home environment Added team members Case manager, patient navigator, nutrition, behavioral health Hospital Transition Patients are identified by Case Management at Petaluma Valley Hospital Discharged with a health center owned iphone if going home. If going to SNF or homeless shelter the health center has a tablet on location. Follow up video visit is conducted as part of the regular day in clinic within 48 hours of discharge. Patients return the device in 2 3 weeks. 6

7 Lessons learned Identifying appropriate cases Able and at least somewhat reliable person or caregiver Established patient At risk for readmission (chronic illness, mult medications) Patients who are using this are not web enabled Fitting video visits in to workflow can be difficult consider rooming time Difficulty convincing Spanish speaking patients to try it Lessons learned Involve IT early iphones are locked down to one application for simplicity an security Simplification of instructions for patients Consider security of video software Audio quality has been an issue when used with video over cellphone network iphone proved easier to use with patients and less street value concern 7

8 Expansion of Psychiatry Remote psychiatrist Follow up visits ipad with Cisco Webex at home Documented and scheduled in EMR No special room or equipment at the health center Contact Information Danielle Oryn, DO, MPH, Chief Medical Informatics Officer 8