Don McBeath, Director of Telemedicine Texas Tech University Health Sciences Center

1. TELEMEDICINE AND LONGTERM CAREAmerican Association of Homes and Services for the Aging April 7, 2003 Washington, DC Don McBeath, Director of Telemedicine Texas Tech University Health Sciences Center

2. Telemedicine… ….the basics.

3. What is Telemedicine? . . . the use of electronic information and communication technologies to provide and support health care when distance separates the participants . . .

4. What is Telemedicine? Telecommunications Technology + Medicine

5. Why do telemedicine? • Access • Provide primary healthcare that would not be available otherwise • Specialty care consultations for isolated specialists, practitioners, and other health care professionals • Eliminate expensive travel and isolation • Reduce need to move patient • CME for isolated health care providers

6. Telemedicine settings • Rural • Schools • Clinics • Hospitals • Prisons • Nursing homes/ Assisted living

7. Emerging applications • Telepharmacy • Teledentistry • Broader Home Health • Remote Surgery

8. Telemedicine began .. . • In 1924, with the concept of a physician seeing his patient over the radio using a television screen • First wave of telemedicine programs started in the 1950s • Now in the third wave • Most programs that began in the 1960s-1980s no longer exist, due to dependence on external funding

10. Telemedicine now • Doubling in number of two-way interactive video programs in 90s • Teleradiology, store-and-forward, remains most common application • Technology is rapidly changing and costs are decreasing • Correctional is heaviest use • Moving into private physicians use • Expanding applications

12. Telemedicine at Texas Tech • An early pioneer in telemedicine • Started in 1989 as a pilot project to deliver health care to the rural Big Bend Region of Texas • First consult in June of 1990 from Alpine, Texas hospital

13. First consult, June 1990 Aida Porras, age 10

14. Aida Porras in Presidio, TX

15. Telemedicine at Texas Tech • Average 2,500 consults annually • Over 12,000 consults since 1991 • Telemedicine Hall of Fame by TelehealthMagazine in August 1999 • Top Ten Telemedicine Programs in 1996 and 1997 by Telemedicine and Telehealth Network Magazine • Ranked in the “Top 12 List” by Telemedicine Today in 1998

16. Dalhart Pampa Amarillo Childress Hart Wichita Falls Plainview Lubbock Levelland Stamford Anson Lamesa Snyder Abilene Colorado City El Paso Coleman De Leon Odessa Fort Hancock Sierra Blanca Ft. Stockton Alpine Presidio Terlingua July 2001 Texas Tech Telemedicine Network Campus Sites Amarillo Lubbock El Paso Odessa Rural Sites Alpine Hart Fort Hancock Presidio Sierra Blanca Terlingua Correctional Sites Abilene Lamesa Amarillo Lubbock Childress Pampa Colorado City Plainview Dalhart Snyder El Paso Wichita Falls Ft. Stockton AffiliatedIndependent Network •with Hendrick Medical Center: Abilene Anson Coleman Stamford •with FQHCs: De Leon El Paso Levelland

17. Types of telemedicine consults • By specialty • Psychiatry 63% • Orthopedics 11% • Other 10% • Psychology 8% • Dermatology 4% • Primary Care 4% • By type • Correctional 90% • Non-correctional 10%

18. Consults by year and specialty

19. How it works • Video conference system • Cameras each end • TV screens/computers each end • Various medical peripherals • Video connection • T-1 line • Satellite • Phone line (POTS) • Internet

20. ) ) ) )))))) ) ) ) ) ) ) ) )))))) ) ) Hub Site Remote Site T-1

23. Connectivity • T-1 dedicated phone line • Satellite • ISDN • High speed DSL/Cable • ATM • POTS • LAN/WAN • Internet, or IP-based

24. Compression of bandwidth Codecs compress the information to fit the broadband connection

27. Telemedicinedoes not/should not alter the practice of medicine. TTU telemedicine philosophy

28. Core principles of telemedicine • Is only a tool (like a stethoscope) • Must be physician directed • Must be integrated into established clinical operations and routines • Physician-patient relationships must be preserved

29. The barriers • Equipment costs • Connectivity costs • Reimbursement

30. Getting better • Declining equipment costs • Shared connectivity • Enhanced reimbursement (still an issue for nursing homes)

31. Long-term caretelemedicine

32. Correctional telemedicine as a model

33. Similar scenarios • Desire to not transport patients off site • Limited on-site primary care • No on-site specialty care • Must maintain certain level of staff on-site at all times • Have stringent rules and regulations to follow

34. Prison off-site transport sample For Year 2000, medical consults only.

35. Long-term care telemedicine—goals and benefits • Enhance and increase on-site primary care • Enhance and increase on-site specialty care • Reduce ambulance transportation for off-site care • Reduce unnecessary ER visits

36. Goals and benefits-cont. • Reduce risk of injury associated with transports • Reduce loss of revenue to nursing homes • Allow better community ambulance coverage with less nursing home transports • On-site medial and task training

37. Goals and benefits – cont. • GED (high school equivalency) training • Replication of operating model • Student training component • Expand to additional services including dental

38. Goals and benefits – cont. • Distant social and counseling services for family and caregivers • Reduced family travel time

39. Texas Tech long-term care projects Carillon project – brief pilot Garrison project – April 2003 West Texas Rural Nursing Home Telemedicine Network - planned

42. Carillon findings • Patient satisfaction - Comfort level and communications very high - Satisfaction with exam very high - Most would do again - Most believe no diminishing of medical quality

43. Carillon findings • Patient satisfaction - Only negatives on audio/hearing

44. Carillon findings • Physician satisfaction - Very high overall satisfaction - Reported no limitation on their ability to treat/diagnose - Rated most consults as same as face-to-face

45. Garrison project • Geriatric Teaching Nursing Home • Teaching and research lab for telemedicine applications in assisted living • Expose heath care providers, students, and nursing home staff to telemedicine • Serve as a resource for rural nursing homes

46. West Texas Rural Nursing Home Telemedicine Network Project-planned • Link three rural nursing homes with Medical Director with telemedicine • Link with Garrison Geriatric Center • Link to Texas Tech • No community hospital • Medical Director in another community

47. What is the future of assisted living/long-term care telemedicine?

49. Greatest potential for expanded use of telemedicine!

50. Broader applications – especially in assisted living facilities • Explosion in home use • Driven by technology and the expanding role of the Internet