Deployed Health Deployed Health TechnologiesTechnologies

Emerging Opportunities Emerging Opportunities and Existing Barriersand Existing Barriers

Karen C. FoxAssistant Dean, College of

MedicineUT Health Science Center

Innovative, collaborative solutions to meet the heath

care needs of rural and remote communities.

A Look at the Destructive CycleA Look at the Destructive Cycleof Health Disparities for Rural of Health Disparities for Rural

PatientsPatientsPovertyEducatio

nCultureLocation

DeathDisability

Long Term Care

Health Disparities

(uneven access to care and services)

Delays in receiving adequate care, lack of

follow-up and appropriate referrals.

Cutbacks and denials of services

or overage

Increased incidents of

chronic disease (ie: diabetes, stroke, heart

attack)

High costs associated with healthcare

systems

A Glimpse Into the ProblemA Glimpse Into the Problem

Physical barriers to care

Fragmented delivery system

Disparate information systemsVAMC (Nation

al)

Rural Health Clinic

The Med

(Memphis)

Pharmacy #3

Pharmacy #2

Pharmacy #1

Two-Pronged Solution: Two-Pronged Solution: Innovative Health Innovative Health

TechnologiesTechnologies

Electronic Electronic Health Health

RecordsRecordsTelehealthTelehealth

Total Rural Total Rural Clinician Clinician SupportSupport

EHR Systems in Rural EHR Systems in Rural SettingsSettings

Establishing, utilizing and maintaining an EHR system is a challenge, made more difficult in

rural or isolated settings.•Poor local telecom infrastructure

•Lack of resources to establish an EHR

•Lack of support from a major healthcare provider for standards of care

Benefits of Regional EMR Benefits of Regional EMR SystemsSystems

Promote Region-Wide Standards of Care

Rapid Access to Information at the Point of Care

Clinician Decision Support (protocols, clinical trials)

Drug / Allergy Interactions

Disease Surveillance

Girl bitten by prairie

dog Family physician at Rural Marshfield clinic

Specialist at Marshfield

Center telehealth consultation

shared EHR

network

The Memphis Area The Memphis Area Technology Collaborative Technology Collaborative

for Health (MATCH)for Health (MATCH)A cooperative project of the University Medical Center

Alliance designed to meet the need for timely patient health

information at the point of care, regardless of where the

patient presents.

Master Patient IndexMaster Patient Index

•Dynamic interface that connects separate EHR systems across the region.

•Facilitates sharing health information across different healthcare organizations.

•True continuity of care is the expected result.

Master Patient Index:Master Patient Index:Benefits to Rural Benefits to Rural

CommunitiesCommunitiesClinician decision-supportRegional standards of careImmediate electronic access to informationComputerized medication management Linkages to payor systems and health plansSupport for inter-agency researchSupport for syndromic surveillanceEstablishment of targeted patient health education

Barriers to EMRs for Barriers to EMRs for Rural and Remote Rural and Remote

PopulationsPopulationsLack of data standardsProprietary systems that don’t communicate Patient privacy and security (HIPAA)Poor existing telecom infrastructuresInterface design and implementation

The Mid-South Telehealth Network

Four UT Colleges Seven Health DepartmentsNine PharmaciesSix Rural HospitalsFour Community CentersThree SchoolsFive Group Youth HomesOne Dental/Vision VanAg Extension Agent Offices

Rural Hospitals Benefit from Rural Hospitals Benefit from TelehealthTelehealth

Improves access to specialty health care Improves access to specialty health care services.services.

Increases support system for rural providers Increases support system for rural providers (CME, research opportunities, etc.)(CME, research opportunities, etc.)

Keeps money and services within the Keeps money and services within the community.community.

Increases community confidence in local Increases community confidence in local healthcare system.healthcare system.

Medical SpecialtiesMedical Specialties

CardiologyCardiology DermatologyDermatology Endocrinology Endocrinology E.N.T.E.N.T. GeriatricsGeriatrics OrthopedicsOrthopedics PathologyPathology RadiologyRadiology

DentalDental ToxicologyToxicology Behavioral HealthBehavioral Health Wound CareWound Care Case ManagementCase Management EchocardiogramsEchocardiograms Rehabilitation TherapiesRehabilitation Therapies Post-surgical Follow-upPost-surgical Follow-up Pediatric SubspecialtiesPediatric Subspecialties RheumatologyRheumatology

One Example: Cardiology Specialists Accepting

TennCare in Tennessee

0.3 – 2.0

2.1 – 4.5

4.6 – 7.0

7.1 – 12.0

FTE Ranges

If you live in a rural community, you might have to travel 175 miles to reach a cardiologist accepting patients, and have to wait up to 6 months for an appointment.

Telehealth Improves Access to Cardiologists for Rural

Patients

0.3 – 2.0

2.1 – 4.5

4.6 – 7.0

7.1 – 12.0

FTE Ranges

By conducting an appointment through a telehealth access point, travel is drastically reduced and wait times nearly eliminated.

Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP

Safe- Patients receiving psychiatric treatments via telehealth show that 65% of individuals were misdiagnosed prior to telehealth.Timely- •78% of telehealth appointments occur within 10 minutes of their scheduled time.•Patients scheduling telehealth visits usually receive an appointment within 2 weeks.

Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP

Efficient- • Telehealth physicians average 4.3 patients per hour with equal to better care, compared to 2.7 patients per hour in traditional clinics.• The no-show rate for telehealth patients averages 4.6%, compared to 26.5% for traditional clinics.

Equitable- 67% of telehealth patients with a self-report family income of $20,000 or less.

Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP

Effective- •73% of telehealth patients received new, more effective prescription medications.•The average patient has been to their PCP 4.8 times for their primary complaint, and yet 90% of telehealth patients have their primary complaint resolved within 2.2 telehealth visits.

Telehealth Outcomes: Telehealth Outcomes: STEEEPSTEEEP

Patient-centered-

•The average telehealth patient lives 117 miles from Memphis.

•Patients report equal or higher satisfaction (94%) with telehealth visits.

Health as an Economic Health as an Economic EngineEngineKnown Facts:Known Facts:

1) People living in poverty have poor health outcomes, more sick days, more chronic conditions.

2) Economic development can lead to improved health.

3) A healthier workforce contributes substantially to economic development. (Limitation of activity cost the Economy $73 billion annually in lost work time)

4) Economic costs of chronic conditions in 2001were $425 billion (14% of GNP). 80% of these costs were the result of preventable disease states. (Lerch 2002)

What’s NeededWhat’s Needed•Additional research on long-term outcomes of innovative health technologies.•Research on health as an economic engine for rural communities.•Facilitation of nation-wide collaborations.

In the 1900’s, we built roads into rural communities to facilitate transportation. Now in the 2000’s, we must build the technology infrastructure to support digital access, communications, data sharing and resource distribution.

Uniting Patients, Providers and Communities

Karen C. FoxKaren C. FoxAssistant Dean, College of MedicineAssistant Dean, College of Medicine

UT Health Science CenterUT Health Science Center

901-448-HEAL901-448-HEAL 877-821-0022877-821-0022 www.utmem.edu/telemedicinewww.utmem.edu/telemedicine

The University of TennesseeThe University of TennesseeOutreach CenterOutreach Center