Telemedicine Applications in Clinical Genetics
Definitions Telemedicine is the use of telecommunications to
provide medical information and services It may be as simple as two health professionals discussing a patient
over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment or robotic technology.
Telehealth is a broader term and includes telemedicine, electronic medical records, online drug pharmacies, and distance education (DE) for teaching and continuing education.
Telegenetics is the application of telemedicine to clinical genetic services
Current Uses of Telemedicine
In flight Space flight Ship to shore Armed forces Mount Everest,
Antarctica Disaster areas 911 & ambulance
Current Uses of Telemedicine
HomeCare Wellness TeleMonitoring programs RX Reminder Electronic Medical Records
(EMR) TeleCase Management GPS Tracking
With current technology, any activity that you can do in person can be accomplished as a tele-genetics service
B. Schaefer
Other Genetic Uses of TM
Family counseling Multi-site (same info)
Monitoring therapy Metabolic disorders
Support groups coordination
Genetic Uses of TMEducation
Degree program Mid-America Genetic Education
Consortium (MAGEC) Team training
LEND Continuing education Patient education Public education
Genetic Uses of TMResearch
Multi-site studies Clinical trials (CTSA)
Inclusion of minority and rural patients Monitoring and compliance Evaluation of TM
Patients with autism
Genetic Uses of TMAdministration
Interview job applicants Meetings
Board, Committee, SIG, Regional, State
Orientation and staff development Compliance
Nebraska: 1995 - 2008
Examples of Services we have Provided Dysmorphology evaluations
Confirmed by on-site follow up Genetic counseling
Especially good for following up results Urgent NICU consultations Cancer genetics sessions Interdisciplinary team outreach Procedure supervision Participation in distant interdisciplinary team
1. Statewide Telehealth Services for Children with SHCN
Multiple services can be provided through these links
It is understood that each community has its own unique needs and desires for services to be utilized through such a network
As such, a ‘menu’ of services is available to chose from by the home communities. Below is a list of potential services that can be provided. This list is not comprehensive, but representative of possible applications:
Statewide Telehealth Services for Children with SHCN
1) Participation in the IEP and IFSP processesA) MMI staff could perform the entire evaluation. We suspect that this would be necessary only on a temporary basis during times of need or crisis (summer hiatus, temporary suspension of team activities, etc.)B) MMI staff could participate in the IEP / IFSP processes with an existing team as a gap - filling member (e.g. an existing team is in place , but does not have a physical therapist)
2) Direct (primary) patient assessments . These services could be provided for any of the MMI disciplines (clinical genetics, genetic counseling, physical therapy, occupational therapy, speech pathology, child psychology, developmental pediatrics, nutrition, nursing (case management), social work, recreational therapy, and diabetes / endocrinology).
Statewide Telehealth Services for Children with SHCN
3) Discipline specific consultative services on difficult cases (available for all MMI disciplines listed above)
4) Continuing education / training. An ongoing series of special topics, issues in the care of CSHCN, and new updates would be provided. These activities would be open to a broader audience than those for direct patient services.
5) Quality assurance monitoring of local teams. This would include help with Federal compliance reviews, ongoing team monitoring, and technical assistance in the development of local QA activities.
6) Provision of quaternary interdisciplinary services only available in Nebraska metropolitan areas
Speciality services in complicated disorders may only be found in Omaha and sometimes Lincoln. Even if the primary discipline is available to the patient, complex cases may require quaternary services. Examples of such services would include the interdisciplinary teams as well as services in sleep disorders, eneuresis / encopresis, autism and the neurobehavioral team.
.
..
.Omaha
Winnebago
Kearney
Scottsbluff
Outreach ClinicsOutreach Clinics
FundingTitle V $150,000 Teratogen Project $110,000Appropriations $ 35,000 Outreach Clinics $ 73,000Total $183,000
[South Dakota $ 57,000] [ IHS contract $8000] [MHCP Clinics]
Rapid City. Pierre.
.(Cerebral Palsy)
Grand Island
(Cerebral Palsy)..North Platte
(Craniofacial)
2. EPDST Transition Project
Transition Consultation Resource collection Education of HHSS Service
Coordinators Physician Education (build capacity)
Faculty Community docs
Evaluation
Transition Consultation Interdisciplinary team
Consumer / Family Advocate Nurse Adult psychiatrist (dual diagnosis) Pharmacist Developmental Pediatrician Med-Ped physician Ancillary (Genetics, Dentistry)
Transition Consultation
YSCHN 15 – 17 years old (ideal) 5 components
Initial visit (T1) Information gathering Concluding visit (T2) Medical Transition Plan Transition guidance / implementation
Health Care Transition Planning Process & Health Care Transition Clinic
Youth hears about clinic(SC, School Nurse,
Educator, etc.)
Youth & referring professional complete
paperwork & sendto CFC (in packet)
Referring professionalcalls CFC
CFC has recordsreviewed & schedules
appointment date
CSC contactsASC if
appropriateConfirmation letter& HC assessmentsent to youth &
source of referral
Clinic happens
Youth receives report with
recommendations
Assessmentsare completed
as needed
Transition plan is developed around
goals set at 1st clinic visit
2nd visit draft planis reviewed with
youth and finalized
Youth & family are
assisted in following their plan
(Referrals contacted, youth
linked with resources)
Resource Development
Physician resource notebook Individual planning resources
3. Flatlands Disability Network
4. Shriner’s Cooperative Agreement
5. Pediatric Behavioral Telehealth Services
6. Mid-America Genetics Education Consortium
7. Cosmic Services
Arkansas: 2008 - Present
ANGELS A joint venture between The University of Arkansas for
Medical Sciences, the Arkansas Department of Health and Human Services and the Arkansas Medical Society.
ANGELS is an acronym for Antenatal and Neonatal Guidelines, Education, and Learning System.
ANGELS has been an enormously successful program. ANGELS is designed to provide best practices in diagnosing
and treating high-risk pregnancies, providing continuing medical education for Arkansas obstetricians and family practice physicians, and facilitating referrals of pregnant women with severe medical complications to UAMS for specialized care.
AR-Kids
NBS-ANGELS 10 project deliverables:
Guidelines/protocols monitored, assessed and modified Consultation for appropriate health-care providers Perform second tier screening components Development, education, refinement and dissemination of the
Newborn Screening Follow-up guidelines/protocols. Develop database and reporting system Examine Medicaid claims data; cost analysis Coordinate access to services Perform an evaluation to compare outcomes Develop the infrastructure and software to aid in identification
and treatment and track case management of true-positive Augment provision of metabolic formulas and foods
UAMS Telemedicine Services
Telemedicine to 27 sites, adding 7 more this year
Challenges
7 deadly words of program development Techno-phobia Administrative inertia Cost Lack of adequate IT infrastructure Lack of colleague buy in Where to go for answers
Opportunities
Overcome barriers to access for underserved populations Distance Complicated transport
Save time and money Expand services Unexpected advantages Have a lot fun
Avoid land travel
Telegenetics consults (demo)
Top Related