Discovering Our Chosen Faith Introducing Unitarian Universalism Introducing Unitarian Universalism.
VR/AR/ER: The Future of Virtual Care...2019/11/07 · 5 The Future of TELEHEALTH 6 Biases 1....
47
VR/AR/ER: The Future of Virtual Care Jonathan Neufeld, PhD North Country Telehealth Partnership Annual Conference November 7, 2019
Transcript of VR/AR/ER: The Future of Virtual Care...2019/11/07 · 5 The Future of TELEHEALTH 6 Biases 1....
VR/AR/ER: The Future of Virtual Care
Jonathan Neufeld, PhDNorth Country Telehealth Partnership
Annual ConferenceNovember 7, 2019
Abstract
Telecommunications is infatuated with the potential of virtual and augmented realities (VR/AR). The use of these technologies is also changing healthcare, but the real potential is not in virtualizing or augmenting our perception with VR or AR, but in extending our potential to act at a distance through the use of technology -- what I am calling ER ("Extended Reality"). This presentation will explore ways we can use various technologies to extend our clinical reach.
Outline
➔ Introduction to gpTRAC
➔ Previously said TH allows “long tail” services (summarize); these drive the value of virtual care
➔ But how to maximize that value?
➔ “Virtual Reality vs. Augmented Reality” - The value is in augmenting reality, not escaping it. And when we talk about “virtual care” we really mean “augmented care” - Real + Tech components
➔ New term: “Extended Reality” - using technology to expand our range and field of action
➔ Future belongs to those who can create (real) empathy via (virtual) telecommunications
➔ Interpersonal Healthcare: The non-pharm drugs - Responsiveness and Empathy
➔ Using Technology to Augment Healthcare
➔ Telehealth has no inherent value; but it is key to realizing the “value” of “value-based” payment - reach
4
www.gptrac.org
gpTRAC Provides (like all TRCs)Resources● www.gptrac.org (toolkits, assessments, sample forms)
Contacts● A national network of telehealth programs, and close
relationships with many programs in the Great Plains region.
Training (virtual and on-site)● Clinician effectiveness with video and other technologies● Site evaluation and readiness● Resource for discussions/decision making
5
www.gptrac.org
Biases1. Universalism - the imagined future will
include care for everyone as a value.2. Incrementalism - the imagined future
will be some version of the present.3. Aspirationalism - the imagined future
will be better in some way(s) than the present.
www.gptrac.org
“We are all Telehealth Providers now”● A company that can’t do email (or documents, or spreadsheets)
can’t do business anymore.○ 2000: “We are all technology companies now.”
● A healthcare provider that is not conversant with telehealth methods and models will soon be either restricted or irrelevant in their market.○ 2020: “We are all telehealth providers now.”
www.gptrac.org
“The future is at the bottom of the pyramid”
Tert/Quat Care Facilities, Researchers
Local Hospitals and Specialty Clinics
Primary Care
www.gptrac.org
The Cure for Cancer“If you discovered the cure for cancer but could only deliver it to half of the people, you’ve really only discovered half of the cure for cancer.”
- Thomas Nesbitt, MDUC Davis Medical Center
www.gptrac.org
Keeping Under-served Areas ViableI. Acute Services
A. Emergency Room - Stroke, Trauma, Heart Attack, etc.
II. Chronic ServicesA. Primary Care
1. Chronic conditions
B. Mental Health1. Intermittent2. Chronic
www.gptrac.org
Gaming Industry - Worldwide
● All US airlines ($140B)● US Movie Revenue ($11B)
www.gptrac.org
The VR Model of TelemedicineMaking service deserts look inhabited.
Wizards = Child & Adolescent Psychiatrists
www.gptrac.org
The Virtual Reality of Mental Health AccessEffects are real:● Access improved● Outcomes equivalent
It’s immersive while it lasts...
www.gptrac.org
Virtual Services Will Not Save UsThere aren’t enough psychiatrists to go around.
Augmented Reality I - AHRQ (2016)
www.telehealthresourcecenters.org
AHRQ Review - 2016
● 58 systematic reviews● 1,494 citations
“A large volume of research reported that telehealth interventions produce positive outcomes…for several chronic conditions and for psychotherapy...”
22
www.telehealthresourcecenters.org
Key Messages of AHRQ Report
● The research literature is vast and varied, consisting of hundreds of systematic reviews and thousands of studies of use across various clinical conditions….
● There is sufficient evidence to support the effectiveness of telehealth for specific uses with some types of patients, including --
○ Remote monitoring for patients with chronic conditions
○ Communication and counseling for patients with chronic conditions
○ Psychotherapy as part of behavioral health [a chronic condition]
● For these telehealth applications, the research focus should shift to how to produce broader implementation and address barriers.
23
www.gptrac.org
Remote Monitoring Adds Real-time Data
An enhanced view of the patient:
● Aids in diagnosis and treatment
● Improves responsiveness● Improves patient self-
awareness and self-management
Augmented Reality II - MEDPAC (2018)
www.gptrac.org
MEDPAC 2018
Analysis of the implications of expanding telehealth in Medicare FFS.
www.gptrac.org
Pattern: Acute Effectiveness, Chronic NeedAcute conditions demand immediate access to expertise, and when it is available, outcomes improve dramatically.
● Stroke, MI, trauma, OB● Intensive care, hospitalist care
**Telemedicine will always be effective in these situations.**
Chronic conditions demand consistent, structured, proactive, team-based care, and when it is available, outcomes may improve.
www.gptrac.org
Access vs. Adequacy
In acute care situations, access equals adequacy.
In chronic care situations, access alone is inadequate.
Telemedicine can also help here, however.
www.gptrac.org
The Hidden “Cliff”Workforce
Workforce
Workforce
Workforce
Workforce
Workforce
www.gptrac.org
Collaborative Care - Jurgen Unutzer, MD
Half of those with depression don’t get care.
Half who get care don’t get adequate care.
Solution: ● Team-based collaborative care● Proactive treatment● Continuous assessment● Treatment to criterion
www.gptrac.org
CCM/CoCM FundamentalsKeys to Collaborative Care (and Chronic Care Management)
● Team-based care (most direct patient contact by Care Manager)
● Registry-based treatment planning● Continuous objective assessment● High-value communication (any form)
Mental Health “Service Gap”
Community Mental Health
Center
Community Health Center
Minimal MH Need
Mild/Mod Intermittent
Mild/Mod Management
Mod/Severe Management
Severe/ Inpatient
{Service Gap}Primary Care
ProvidersMH Care Providers
<<< - - LOW NEED - - - - - - - Patient MH Care Needs - - - - - - - HIGH NEED - - >>>
Collaborative Care Fills the Service Gap
Community Mental Health
Center
Community Health Center
Minimal MH Need
Mild/Mod Intermittent
Mild/Mod Management
Mod/Severe Management
Severe/ Inpatient
Psych Care Manager
Psychiatric Consultant
Collaborative Care
Primary Care Providers
MH Care Providers
<<< - - LOW NEED - - - - - - - Patient MH Care Needs - - - - - - - HIGH NEED - - >>>
www.gptrac.org
Collaborative Care Model (CMS)
38
Psychiatry Check-in (1-4x/mo)
- Review Cases- Assess
Response- Recommend
Treatments
Primary Care Check-in (1-4x/mo)
- Review Cases- Assess
Response- Prescribe
Treatments
Patient
Primary Care Provider
Psych Care Coordinator
Psychiatric Consultant
All cases reviewed
each month
Weekly contact
A subset of cases
reviewed each week
www.gptrac.org
“Extended Reality” - Tele-Chronic CareCare Manager’s reach is extended by:● Registry tools● Telecommunications tools (any modality)● The paradigm of team-based care
Necessary skill set:● Reliability● Credibility● Motivational Interviewing and Behavioral Activation skills
www.gptrac.org
DashboardsIn CCM, one skilled CM can manage up to 200 patients, and one physician can manage several CMs.
www.gptrac.org
Extending Care Through Structure
SPECPCP
CCM
PTPT
PTPT
PTPT
PTPT
PTPT
PTPT
PT
CCM
PTPT
PTPT
PTPT
PTPT
PTPT
PTPT
PT
CCM
PTPT
PTPT
PTPT
PTPT
PTPT
PTPT
PT
CCM
PTPT
PTPT
PTPT
PTPT
PTPT
PTPT
PT
CCM
PTPT
PTPT
PTPT
PTPT
PTPT
PTPT
PT
www.gptrac.org
Refining the Distribution of CareExample of UC Davis PICU
● As rural providers work with PICU specialists, both units see increasesin average acuity.
● Though independent, both units are used more efficiently by the system.
www.gptrac.org
The Next Blockbuster: Drugs Aren’t DrugsCommunicating Empathy/Instilling Hope● Measurable impact on both medical and psychological
outcomes.
Responsiveness● Actively taking on the responsibility to discover, understand,
and meet the patient’s needs.
These CAN be delivered remotely/virtually!
www.gptrac.org
The Future of TelehealthVirtual Care - Telemedicine specialty services
Augmented Care - Remote monitoring and data analysis
Extended Care - Team-based models that function as “force mutipliers” and efficiency engines
www.gptrac.org
ConclusionDiscovering the cure for cancer (or asthma, or COPD, or anxiety, or depression) will take brilliant scientists and doctors and lots of resources, but delivering those cures to all the people who need them will take all of us.
Contact Info
Jonathan Neufeld, PhDExecutive Director
Great Plains Telehealth Resource and Assistance Center, University of Minnesota
