Improving Senior Health Care through Telemedicine
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- Ethelbert Stanley
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1 Improving Senior Health Care through Telemedicine The University of Oklahoma Health Sciences Center The Oklahoma Healthy Aging Initiative Andrew Dentino, MD (OHAI) Candace Shaw (Vice Provost, OUHSC Office of Telehealth) Claire Dowers-Nichols, MHR (OHAI)
2 Outline 1. Introduction (Dr. Dentino) 2. Oklahoma Telehealth Perspectives (Provost Shaw) 3. Overview of the Oklahoma Healthy Aging Initiative (Ms. Nichols) 4. Special Considerations in Geriatric Telehealth (Dr. Dentino) 5. The OHAI Geriatric Telehealth Program (Dr. Dentino) 6. Summary (Panel)
3 Disclosures 1. Dr. Dentino nothing to disclose 2. Provost Shaw nothing to disclose 3. Ms. Nichols nothing to disclose
4 1. Telehealth is here Introduction
5 Introduction 1. Telehealth is here 2. Telehealth is here to stay
6 Introduction 1. Telehealth is here 2. Telehealth is here to stay... the sine wave of new ideas...
7 Introduction 1. Telehealth is here 2. Telehealth is here to stay 3. Telehealth Challenges
8 Introduction 1. Telehealth is here 2. Telehealth is here to stay 3. Telehealth Challenges Rural versus Urban
9 Introduction 1. Telehealth is here 2. Telehealth is here to stay 3. Telehealth Challenges Rural versus Urban Younger versus Older
10 Introduction 1. Telehealth is here 2. Telehealth is here to stay 3. Telehealth Challenges Rural versus Urban Younger versus Older Physician Culture versus Adaptation to Change
11 Telehealth Perspectives and Oklahoma Candace Shaw Assistant Vice Provost, OUHSC Director, OUHSC Office of Telehealth Regional Director (Oklahoma), Heartland Telehealth Resource Center
12 Headlines of today. AARP: 10 startups developing digital health tools for Seniors Funding on the rise for digital health startups focused on aging Mayo s ipad study had 98 percent engagement among Seniors Mobihealthnews Dec. 10, million Seniors on internet Half of all Seniors online use Facebook Senior Citizens now largest age group in US in Oklahoma it is the fastest growing segment of our population 78 million baby boomers use technology to improve their healthcare 52 percent of Seniors are online Huffington Post- Post 50 6/8/2013 Oklahoma ranks 49 th in the health of its Seniors
13 History of Telemedicine Healthcare of Yesterday Healthcare of Today
14 Early Beginnings 1993 Oklahoma Medical Information Network Telemedical Diabetic Retinopathy pilot 1994 Oklahoma Telemedicine Network Hospital System Networks 1997 Oklahoma Telemedicine Act Medicare adopted telemedicine reimbursement 2009 Oklahoma Medicaid released policies for Telemedicine Reimbursement
15 Telemedicine in Oklahoma Telemedicine has been active since 1993 Over 400+ locations providing/receiving telemedicine services Over 52% of telemedicine services in the state are provided by a rural healthcare facility/provider
16 Who has telemedicine/telehealth technology? Hospitals (67+) Community Mental Health Centers (168* plus 352 desktop pts) Federally Qualified Health Centers (29+) Critical Access Hospital (4) Rural Health Centers (38+) City Health Department (108) Corrections (22+) Indian Health Services (33+) Tribal (not IHS) Physician Offices Schools Homes (vital sign monitoring)
17 Current Telemedicine Services Radiology Cardiology EKGs, live echos Obstetric Ultrasounds S & F Remote Vital sign monitoring ICU Home Wound Care Alzheimers/Dementia screening Infectious Diseases Geriatrics TeleDialysis Mental Health and Substance Abuse Telestroke Pediatric Endocrinology Diabetes Disease management Neonatology Child Abuse medical exams and forensic interviews Pediatric Behavioral Health Speech Therapy, Occupational Therapy Genetics Counseling Dermatology
18 Oklahoma s Seniors
19 Silver Tsunami
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21 Claire Nichols Associate Director, Oklahoma Healthy Aging Initiative A Program of the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma
22 Oklahoma Characteristics Two metropolitan areas Extreme rurality Cultural diversity 39 federally recognized American Indian tribes Growing Asian American population Large Latino population 24% population over 60 by 2020
23 Health by the Numbers 44 Oklahoma s overall health ranking 47 Oklahoma s senior health ranking
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27 Mission Statement Enhance the health and quality of life for Oklahoma s seniors by healthcare increasing access to geriatric healthcare, providing excellence in health education, and optimizing health and aging policy. education policy
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29 OHAI Infrastructure Regional Centers of Healthy Aging Senior Health Center Geriatric Primary Care Care coordination / social services Improved geriatric hospital care Geriatric consultation Senior Education Center Professional education Consumer education Family / caregiver training/support
30 Senior Education Centers Evidence based educational programming to seniors and caregivers, e.g.: o CDSMP, DSMP o REACH o Tai Chi Patient education Two educational initiatives each year Minimum of two presentations per county annually Education for healthcare providers
31 Senior Health Centers Geriatric primary care Interdisciplinary teams Integration of social services Improved geriatric hospital care Geriatric consults
32 OHAI Program Goals All OK seniors within 60 miles of geriatric care Improved management of chronic conditions Improved health literacy Improved workforce capacity for geriatric cases
33 Special Considerations in Geriatric Telehealth Andrew Neal Dentino, MD FACP, AGSF, FAPA, FAAHPM Vice Chairman and Endowed Professor OUHSC Donald W. Reynolds Department of Geriatric Medicine Director, OUHSC Geriatric Medicine Fellowship Program Co-Director, Oklahoma Healthy Aging Initiative (OHAI) Director, OHAI Geriatric Rural TelehealthProgram
34 Special Considerations: Outline 1. Unique characteristics to our state 2. Special issues specifically relevant to older adults 3. Medical issues prevalent in older adults for which telehealth is beneficial 4. Issues unique to communication with older adults via telehealth 5. Patient and caregiver satisfaction
35 1. Special Considerations: Oklahoma Pockets of extreme poverty Low levels of physical activity Poor health literacy Low utilization of screenings Lack of care coordination Rural populations Cultural diversity
36 2. Appeals of Telemedicine for Geriatrics Frailty Visual Impairment Hearing Impairment Dizziness Syncope Malnutrition Eating and Feeding Problems Urinary Incontinence
37 Appeals of Telemedicine for Geriatrics Gait Impairment and Falls Osteoporosis Dementia Behavioral Problems in Dementia Delirium Sleep Problem Pressure Ulcers and Wound Care Polypharmacy
38 Appeals of Telemedicine for Geriatrics Frailty Mobility and Balance Presence of Cognition/Memory Problem Mood Disorder Polypharmacy Multicomorbidities Skin Disorders Interdisciplinary Team Approach Home Care
39 3. Appeals of Telemedicine for Geriatrics-Special Issues Problems with the older driver: Although the number of crashes among older drivers is low... The number of crashes per mile driven and the likelihood of serious injury and death are higher than for any other age group except young adults 16 to 24 years old
40 3. Appeals of Telemedicine for Geriatrics-Special Issues Challenges of Availability of Social Supports Caregiver Burden
41 4. Cultural Considerations and Communication Use a well-lit room Avoid backlighting Minimize extraneous noise Minimize interruptions
42 4. Cultural Considerations and Introduce yourself Address patient by last name Face the patient directly Sit at eye level Speak slowly Communication Ask open-ended questions: What would you like me to do for you? Inquire about hearing deficits; raise voice volume accordingly Allow ample time for patient to answer
43 Cultural Considerations Never assume that any person s cultural background dictates his or her health choices or behavior Use respectful verbal and nonverbal communication Watch for body language cues
44 Cultural Considerations Use a well-lit room Avoid backlighting Minimize extraneous noise Minimize interruptions
45 The OHAI Geriatric Rural Telehealth Program
46 The OHAI Geriatric Rural Telehealth Program 1. Our process to engage rural communities (Culturally Competent Outreach) 2. The USDA RUS Grant 3. Our lesson
47 The OHAI Geriatric Rural Telehealth Program More challenges: Our Process to engage rural communities (Culturally Competent Outreach) Clinical care: 43 Policy: 49 Behaviors: 48 United Health Foundation, 2013
48 The OHAI Geriatric Rural Telehealth Program Our Process to engage rural communities (Culturally Competent Outreach) More challenges: Clinical Care Rankings: Health screenings: 50 Diabetes management: 46 Preventable hospitalizations: 45 United Health Foundation, 2013
49 REPORT CARD Heart disease deaths Diabetes deaths Respiratory deaths Alzheimer s deaths Fruit & vegetable consumption Suicides F F F F F D
50 The OHAI Geriatric Rural Telehealth Program Our Process to engage rural communities (Culturally Competent Outreach) More challenges: Healthcare Providership: MD s per capita: 50 Geriatrician shortfall: 47 United Health Foundation, 2013
51 The OHAI Geriatric Rural Telehealth Program - Culturally Competent Outreach Conclusion: We need partners
52 The OHAI Geriatric Rural Telehealth Program - Culturally Competent Outreach: Partners Begin with respect Learn from the community Build personal relationships with target audience Increase accessibility Maintain presence within each community
53 The OHAI Geriatric Rural Telehealth Program - Culturally Competent Outreach Partnership Considerations: Cross-sector partnerships Partnering should be driven by results, not partner types Focus on partnership added value Search for common links
54 The OHAI Geriatric Rural Telehealth Program - Culturally Competent Outreach The OHAI Geriatric Telehealth Program serves to augment, yet is not intended to entirely replace, face-to-face relationships for our current generation of older rural Oklahomans... the sine wave of new ideas...
55 The OHAI Geriatric Rural Telehealth Program USDA RUS Grant program the Process
56 The OHAI Geriatric Rural Telehealth Program USDA RUS Grant program the Process the Procedures
57 The OHAI Geriatric Rural Telehealth Program USDA RUS Grant program the Process the Procedures the Products
58 The OHAI Geriatric Rural Telehealth Program Our Lesson: The answers lie in the communities...
59 The OHAI Geriatric Rural Telehealth Program Our Lesson: The answers lie in the communities... partners, patience and persistence
60 Summary (Panel) Future Directions for Us Future Directions for You Future Directions for ALL
61 Thanks The OUHSC Office of Telehealth Ms. Cynthia Scheideman-Miller The Choctaw Nation Health System Variety Care Health Systems (OK) Stillwell, OK Regional Hospital The Heartland Telehealth Resource Center The Donald W. Reynolds Foundation
62 Contact us!
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