Alabama Telehealth Summit 2015

Transcription

1 Alabama Telehealth Summit 2015 Kim Landry, M.D., FACEP, FAAEM President/CEO Excalibur Telemedical Services Associate Professor of Clinical Medicine FSU College of Medicine

2 The Role of Telehealth in Providing Urgent and not so Urgent Care Houston ETHAN project Avera Health Avera ecare

3 Houston ETHAN Project Emergency Tele-Health And Navigation ~300 transports/day UT study reports 30 40% non emergent Cost per transport ~$1000 (base fee) $300 million in unpaid ambulance bills ED visit for low acuity: $600 - $1200

4 Houston ETHAN Project MD present in the Dispatch Center Paramedics equipped with tablets that have cameras Physician and paramedic together assess low acuity patients MD can request medic perform task

5 ETHAN Disposition MD Referral to ED MD Referral to Clinic Appt Pt agree Taxi or POV Pt disagree Taxi to ED MD Referral for Followup, as needed Pt agrees - Home care instructions Pt refuse taxi to ED

6 Cost savings from ETHAN 40% ED visits Non-urgent.if diverted to Clinics $2 million savings EMS Transport cost avoidance Units available for true emergencies Dec June 2015 ~1000 patients ~ $1 million in savings

7 Avera Health Avera ecare Sioux Falls, SD Hub and Spoke eemergency Services Board Certified ED MDs Supportive care to UC clinics and rural EDs

8 Avera Health Avera ecare 6.3 million in cost savings 900+ potential patient transfers avoided 5,000+ Video encounters 19 minute reduction in door to physician

9 Telehealth Technology Does Allow for Delivery of Remote Quality Health Care

10 Six Models of Telemedicine: Examples 1. MD examines patient directly through extender MD Extender & Patient 2. MD Specialist can assist the patient s primary MD during a virtual visit at the bedside/office MD MD & Patient 3. MD and patient discuss issues virtually face to face with little to no exam taking place. i.e.skype MD Patient

11 4. Patient sends digital data to central receiving center. Data is processed and forwarded to patient s MD Examples Extender Patient MD 5. Medical assistant helps obtain data from patient and sends to central office for processing Extender Extender & Patient MD 6. Call center triages calls and offers medical advice Extender Patient

12 Excalibur Model Diagram (Emergency Physician-EMS Telemedical Services) t Recent D/C from Hosp w/pneumonia requested for post D/C eval 65 yr roofer working in heat feeling ill 42 yr old w/ left flank pain 16 yr football player vomiting/sweating tachycaridia, near syncope during practice 45 yr old w/ burn left arm and leg Diabetic w/low BS and altered LOC Recent D/C from Hosp w/mi requested for post D/C eval EMS ZZZZZZZ EMS XXXXX EMS YYYYY Nursing Home-C Pt w/n/v/d/weakness Priamry Care MD Medical Specialist Local Clinic Health Dept Hospital Services Telemedical revisit +/- Psych facility Social Services Follow Up or Referral EMS Leon County Office Based Emergency Physicians Telemedicine Group EMS Santa Rosa County Elderly Pt w/ CHF recently discharged from Hosp requested post D/C eval Nursing Home B Fall w/skin tear Assisted Living Facility 74yr old w/ acute painful blistered rash across right back and chest 55 yr old w/ severe low back pain s/p lifting Prisoner with N/V/D Abdm Cramps Pt at home w/cellulitis EMS Columbia County Nursing Home A with UTI High School Clinic Severe Asthma Pt at home Allergic Reaction Motor vehicle Accident on scene "wants to be checked"

13 Barriers to Telehealth Limited reimbursement Location requirements for physician and patients

14 Summary Telehealth services can be used to divert non-urgent (frequent user) calls to less expensive health clinics Telehealth services can be used to evaluate and treat patients with minor problems and avoid transport altogether Telehealth services are available to provide emergency physician support to urgent care clinics and rural emergency departments If we can eliminate the barriers, telehealth can reach many more patients who rely on expensive emergency care for their health care