Post on 15-Jan-2017
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACCESS TO CARETHE USE OF TELEMEDICINE ACROSS THE
HEALTHCARE CONTINUUM
Kevin Broder, MDTelehealth Director, Department of SurgerySection of Plastic SurgeryVA Medical Center – San Diego, CA
October 24, 2015
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
RUBE GOLDBERG (1883-1970)
HIGHLY RURAL, RURAL AND CENSUS DEFINED URBAN AREAS
Map generated by VHA Planning Systems Support Group2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ELDERLY TRANSPORT
• Costly Travel
• Special Assistance Personnel
• Special Equipment (Gurneys, Wheelchairs, Vehicles)
• Long Clinic Wait Times
• Family Inconvenience
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
TELEMEDICINE4 MODALITIES
• Store and Forward Telehealth– Images/Data obtained by remote site and uploaded Imaging Database
for later review by provider
• Home Telehealth– Home monitoring devices
• Clinical Video Telehealth (CVT)– Real Time ‘Live’ Videoconferencing
• Specialty Care Access Network (SCAN)– Consultation, Care Planning and Education with Tele-video conferencing
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
• Establish Conditions of Participation and Service Agreements
• Formation of Telehealth Team• Identify Patients• IT Collaboration/Equipment Allocation• Informatics Collaboration• Integration into Continuum of Care• Ongoing Provider/Patient Support
STEPS FOR PROGRAM DEVELOPMENT
TelehealthCoordinator
Facility Leadership
Providers(Central ‘Hub’)
Informatics
Administrative Staff
TechnicalStaff (IT/BioMed)
PCPRN
Patient/Family(Remote ‘Spokes’)
Case Manager
TELEHEALTH TEAM
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
IDENTIFY THE PATIENTSVISIT TYPES
• Wound Care/Skin Assessment• Specialty Consultation• Medical Optimization• Post-Op Evaluation• Medication Reconciliation• Psychology• Nutrition• Education
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
MORE VISIT TYPESVETERAN AFFAIRS EXAMPLES
• TeleCardiology• TeleGenomics• TeleICU• TeleNeurology• TeleNutrition• TelePrimary Care• TelePulmonology (Sleep Services)• TeleRehabilitation• TeleAmputation Clinics• TeleKinesiology• TeleOccupational Therapy• TeleSpinal Cord Injury/Disorder• TeleMOVE! (Weight Loss)
• Broadband Network• Tele-video Conferencing
Equipment• Peripherals
IT SUPPORT/EQUIPMENT
PERIPHERALS
Digital Stethoscope
Exam Camera
12 Lead ECG
UltrasoundSpirometer
Vital Signs Monitor
• Customized automated Consult Requests for SCAN-ECHO and CVT
• Software based query of remote site patient data
• Template for guiding remote provider input
INFORMATICS COLLABORATION
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CONTINUUM OF CARE
InterdisciplinaryTeam
SCAN
TelehealthModalities
Spoke Clinics
HubClinics
Specialists
Geriatrician/PCP
NursingNutrition
Physical Therapy
Psychology/Social Work
Multi-Specialty
Consultation
Inpatient Rounds
Home Care
• Telehealth Coordinator - RN• Telehealth Clinical Technician (TCT) – Health Tech/LPN• IT Support• Vendor Support• Routine Education and Training• Administrative Oversight
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ONGOING TELEHEALTH SUPPORT
CLINICAL VIDEO TELEHEALTHCVT
Patient/PCP at SpokeProvider at Hub
‘Consult/Post -op/Follow-up/Pre-op’
Patient/Provider at HubPCP/Family/Home RN at Spoke
‘D/C Planning’
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
USE OF TELEHEALTH REDUCES ADMISSION BED DAYS
CVT TO HOMEPROCESS
• Schedulers Create Appointments in Custom Web App
• Email Confirmation Sent to Patient for Secure Login
• HIPAA Compliant Software– Virtual waiting room
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CVT TO HOMEPROCESS
• Patients Connect to Enterprise Video Network from Home– Desktop– Laptop– Tablet
• Connect to Hospital Provider for Encounter
• Electronic Health Record Documentation
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CVT TO HOMEEQUIPMENT
Patient/Home RN at HomeProvider at Hub
‘Real Time Home Visit’
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CVT TO HOMEMEDICAL PROBLEMS ADDRESSED
• Wound Care• Nutrition• Smoking Cessation• Pressure Relief• Medication Reconciliation• Compliance• Disposition (Remain home vs Urgent Care vs ED)
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
SAFETY NET
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
SCANSPECIALTY CARE ACCESS NETWORK
• An innovative model utilizing clinical tele-video conferencing equipment to allow healthcare specialists from an inter-professional care team to provide expert advice to remote providers in rural/underserved healthcare settings
• A ‘Grand Rounds/Tumor Board’ style multipoint tele-video consultation
• Consent - verbal• Inter-Facility Consultation Request Placed• SCAN-ECHO Tele-Video Session
– Case Presentation– Case Discussion– Didactic Lecture
• Documentation
SCAN PROCESS
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
• Formation of an Interdisciplinary Team of Consultants• Identify Hub and Spokes• IT Collaboration• Informatics Collaboration• Develop Didactic CME/CEU Accredited Lectures
STEPS FOR PROGRAM DEVELOPMENT
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
• Plastic Surgeons• Rehabilitation Physician• Clinical Nurse Specialist/ Rehab Case Manager• Physical Therapist• Dietitian• Telehealth Nurse Coordinator
INTER-PROFESSIONAL TEAM EXAMPLESCI PRESSURE ULCERS AND COMPLEX WOUNDS
HUBS AND SPOKESVA SCI EXAMPLE
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
• Wound Debridement• Pressure Ulcer Reconstruction• Adjuncts to Wound Healing• Comprehensive Assessment of Pressure Ulcer Patients• Topical Wound Care• Nutrition for Wound Healing• Pressure Relief Surfaces• Specialty Mattresses & Beds• Prevention of Amputation & Foot Screening• Bioethics Roundtable: Autonomy and Other Issues• Pre-Op Optimization Part I – The Surgical Checklist• Pre-Op Optimization Part II – Nutritional Optimization for Wound
Prevention and Healing
DIDACTIC LECTURES
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
BENEFITS FOR PATIENTS AND PROVIDERS
• No-cost continuing education credits (CME/CEU)• Opportunity to translate new knowledge into practice to
improve outcomes• Professional networking with colleagues of similar interests• Avoid costly and time consuming travel to distant medical
centers that puts patients at risk
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
SCANFAR REACHING
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
TELEHEALTHCONTINUUM OF CARE
HIGH PATIENT SATISFACTION
Veteran TeleWound Care: Initial VA San Diego Experience Utilizing Real-time Clinical Video Telehealth, Store and Forward Telehealth and
Home Telehealth Technology in Comprehensive Wound Management.
Broder KW 1,2, Li A 3, Tesfamicael R 1, Bodor R 1,2
1 Section of Plastic Surgery, VA San Diego Medical Center, San Diego, CA 2 Division of Plastic Surgery, UCSD Healthcare, San Diego, CA
3 Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
2010 Fall Symposium on Advanced Wound Care and Wound Healing Society Meeting, Anaheim, CA
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CVT TO HOMETRANSPORT COST SAVINGS & INCREASED ADOPTION
SCI CENTER – SAN DIEGO
2011 2012 2013 2014 20150
50
100
150
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250
Projected
Encounters
CONTINUUM OF CAREWHERE TELEMEDICINE FITS IN
• SCAN-ECHO• Spoke Telehealth Consultation• Home Telehealth Monitoring• Face to Face Consultation• Clinic Visit• Admission• Inpatient Rounds• Education• Telehealth D/C Planning• Telehealth Follow-up
2nd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NO MORE WAITING FOR THE DOCTOR TO ARRIVE
THANK YOUKEVIN BRODER, MD