Telemedicine- the Cleveland Clinic Experience

1. Telemedicine- the Cleveland Clinic Experience February 25, 2010 Matthew Faiman, MD, MBA Director Telemedicine Services

2. Disclosures • There is no FDA on-label or off-label content in this lecture. • Abbott Laboratories- speaker’s bureau, which has no relationship with the content of this lecture. Virtual Medical Clinic l November 13, 2014 l 2

3. Lecture Overview • Virtual Medical Clinic at Cleveland Clinic. • An historical perspective of telemedicine. • History of telemedicine at Cleveland Clinic. • Current and Future Telemedicine projects at Cleveland Clinic. • Questions. Virtual Medical Clinic l November 13, 2014 l 3

4. Virtual Medical Clinicand Telemedicine • What is Telemedicine? It is the transfer of electronic medical data (video, sound, image, EMR) from one place to another or…. • “A picture is worth a thousand words…..” (Fred Barnard 1921) Virtual Medical Clinic l November 13, 2014 l 4

5. Virtual Medical Clinic • Uses sophisticated, real- time technology to connect Cleveland Clinic physicians with patients requiring specialized consultations, anytime, anywhere • Facilitates physician collaboration and interaction for specialty consultations Cleveland Clinic physician conducting personalized patient exam utilizing real-time connectivity technology Virtual Medical Clinic l November 13, 2014 l 5

6. Location A: Exam Room Patient sees and speaks to Cleveland Clinic physician in real-time through secure technology Location B: Cleveland Clinic Physician conducts examination, interacts with patient and nurse, and documents encounter in the MyPractice Electronic Medical Record system Virtual Medical Clinic l November 13, 2014 l 6

7. Interacts with patient and nurse / technician at remote exam location Conducts interaction from Telemedicine studio The Virtual Medical Experience Cleveland Clinic Physician Virtual Medical Clinic l November 13, 2014 l 7

8. Directs nurse / technician through exam, seeing and hearing diagnostic details (heart sounds, etc.) Easily navigates real-time views and online medical information (X-Rays, scans, etc.) The Virtual Medical Experience Cleveland Clinic Physician Virtual Medical Clinic l November 13, 2014 l 8

9. Sees and hears physician; asks and answers questions The Virtual Medical Experience Cleveland Clinic Patient Virtual Medical Clinic l November 13, 2014 l 9

10. CCAC Areas of Telemedicine PARKER ITC CCAD CC MAIN FHC INSTITUTES CCHS HOSPITALS CCC WC FLORIDA WPB WC Key: Double arrow: Existing Telemedicine Service Single arrow: Previous Telemedicine Service Unbolded Lines: Future Telemedicine Service CCAC= Cleveland Clinic Administrative Campus; ITC= Independence Technology Center; CCAD= Cleveland Clinic Abu Dhabi; CC Main= Cleveland Clinic Main; FHC= Family Health Center; CCC WC= Cleveland Clinic Canada Wellness Center; WPB WC= West Palm Beach Wellness Center Virtual Medical Clinic l November 13, 2014 l 10

11. The Virtual Medical Experience Cleveland Clinic Patient Receives and complies with physician instructions Virtual Medical Clinic l November 13, 2014 l 11

12. The Virtual Medical Experience Cleveland Clinic Patient Nurse / Technician transmits diagnostic equipment data directly to physician for review in real-time Virtual Medical Clinic l November 13, 2014 l 12

13. Virtual Medical Clinic Virtual Medical Clinic l November 13, 2014 l 13

14. The Virtual Medical Experience Cleveland Clinic Patient Is examined utilizing all pertinent diagnostic criteria; nurse / technician follows physician direction Virtual Medical Clinic l November 13, 2014 l 14

15. The Virtual Medical Experience Cleveland Clinic Physician and Patient Conclude exam with discussion, final questions, physician instructions, and appropriate future treatment strategy Virtual Medical Clinic l November 13, 2014 l 15

16. Fully documents encounter in MyPractice Electronic Medical Record System The Virtual Medical Experience Cleveland Clinic Physician Places orders for medications, follow-up tests or other labs into MyPractice Electronic Medical Record System Virtual Medical Clinic l November 13, 2014 l 16

17. The Virtual Medical Experience Cleveland Clinic Physician Concludes Telemedicine Visit Virtual Medical Clinic l November 13, 2014 l 17

18. Telemedicine- Historical Review • Since the creation of EKG by Einthoven, there has been an attempt to transmit EKG over telephone lines circa,1906. • In the 1920s, telemedicine was used by radio to help ships in distress. This would link physicians standing watch on shore stations for emergencies. Virtual Medical Clinic l November 13, 2014 l 18

19. Telemedicine- Historical Review • 1924, Radio Marvel Magazine illustrated this in action: Courtesy of Dennis J. Streveler, PhD. Virtual Medical Clinic l November 13, 2014 l 19

20. Telemedicine- Historical Review • 1950s- Nebraska Medical Center. Their psychiatry unit was one of the first in the US to have closed-circuit tv in 1955. In 1964 and later 1971, developed links between psychiatric institute and hospitals (including the VA) remotely. • 1960s- NASA began to use telemedicine during its space program as physiological parameters were sent via telemetery from both space suits and spacecraft during missions. • NASA provided much of the funding for most other projects and demonstrations, specifically satellites. Virtual Medical Clinic l November 13, 2014 l 20

21. Telemedicine- Historical Review • 1967- Mass General/Logan International Airport. This station was established to provide occ. health and emergency services to travelers. Staffed 24 hrs/day and used a two-way audiovisual microwave circuit. • 1971- Alaska ATS-6 Satellite Demo. Utilized satellites from NASA to deliver video consultation to rural health care in 26 remote villages in Alaska and Canada. • 1972-STARPAHC; NASA and Papago reservation in Arizona. Staffed by 2 Indian paramedics in a van and linked to a public hospital via 2-way microwave audio and video transmission. Virtual Medical Clinic l November 13, 2014 l 21

22. Telemedicine- Historical Review • 1984- Australia. Satellite communications network set up to provide health care to remote towns of which 2/3rds were Aborigines. • 1989- NASA SpaceBridge to Armenia/Ufa. After the earthquake that hit in December 1988, the US extended an offer to assist the disaster site for medical consultation. Same assistance to the burn victims after railway accident in Ufa. Virtual Medical Clinic l November 13, 2014 l 22

23. Telemedicine- Historical Review • 2010. Price Waterhouse Coopers lists the top 10 healthcare issues for 2010 and #8: Alternative care delivery models will emerge as traditional care delivery models will give way to alternative models of care outside of physicians’ offices and hospitals. Expect to see an increase in the number and scope of services offered by work site… email, telehealth and remote patient monitoring. ( http://www.pwc.com/us/en/healthcare/publications/top-ten-health-industry-issues-in-2010.jhtml) Virtual Medical Clinic l November 13, 2014 l 23

24. Telemedicine at Cleveland Clinic • Telemedicine at Cleveland Clinic: began in 2005 with a relationship with UTMB. • Dr. Cosgrove imagined telemedicine as an opportunity for increased access for patients living in hard to reach areas. • Telemedicine felt to be inline with CC/CCHS approach to innovation. Virtual Medical Clinic l November 13, 2014 l 24

25. Telemedicine at Cleveland Clinic • In 2006, Virtual Medical visits began from Wooster to main campus in Peds GI and Neuro with Drs. Hsich, Wyllie and later Psychiatry with Dr. Tesar. • In late 2006 a telemedicine council was set up to address the needs of CC/CCHS domestically and internationally. Virtual Medical Clinic l November 13, 2014 l 25

26. Virtual Medical Clinic and Telemedicine • On January 23rd,2008 services began with the Parker Virtual Medical Clinic. • This employee-based clinic sees patients for urgent visits and some chronic care. • To date almost 500 patients have been seen. • Patient satisfaction scores are as high or higher than regular brick and mortar visits. Virtual Medical Clinic l November 13, 2014 l 26

27. Virtual Medical Clinic and Telemedicine Other Institutes using Telemedicine: Orthopedics: from Wooster since 2008, approx 60 visits and 6 surgeries. In 2009 operations from Youngtsown (St E’s). Visit yield is 6:1 whereas dept average 10:1! Bariatrics: first visit from CCCToronto 6/09. Transplant Medicine-first visit in 1/2010.

28. Virtual Medical Clinic and Telemedicine Other Institutes using Telemedicine: Cleveland Clinic Canada- Toronto practitioner’s utilization of main campus for 2nd opinions. Emerging Business: both domestic and international opportunities are being explored including home monitoring and wellness.

29. Virtual Medical Clinic and TelemedicineFinal Thoughts • Options are endless. • In the fast-paced world that we live in, telemedicine affords a complementary approach to health care. • Will not substitute but will augment the health care that we have today. Virtual Medical Clinic l November 13, 2014 l 29

30. Scheduling Telemedicine and Outpatient Clinic X= patient to be seen Virtual Medical Clinic l November 13, 2014 l 30