Telemedicine- the Cleveland Clinic Experience

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

2. 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 August 20, 2014 l 2

3. 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 August 20, 2014 l 3

4. 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 August 20, 2014 l 4

5. 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 August 20, 2014 l 5

6. 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 August 20, 2014 l 6

7. 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 August 20, 2014 l 7

8. Sees and hears physician; asks and answers questions The Virtual Medical Experience Cleveland Clinic Patient Virtual Medical Clinic l August 20, 2014 l 8

9. The Virtual Medical Experience Cleveland Clinic Patient Receives and complies with physician instructions Virtual Medical Clinic l August 20, 2014 l 9

10. 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 August 20, 2014 l 10

11. Virtual Medical Clinic Virtual Medical Clinic l August 20, 2014 l 11

12. The Virtual Medical Experience Cleveland Clinic Patient Is examined utilizing all pertinent diagnostic criteria; nurse / technician follows physician direction Virtual Medical Clinic l August 20, 2014 l 12

13. 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 August 20, 2014 l 13

14. 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 August 20, 2014 l 14

15. The Virtual Medical Experience Cleveland Clinic Physician Concludes Telemedicine Visit Virtual Medical Clinic l August 20, 2014 l 15

16. Telemedicine at Cleveland Clinic • Telemedicine at Cleveland Clinic: began in 2005 with a relationship with University Texas Medical Branch. • 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 August 20, 2014 l 16

17. 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 August 20, 2014 l 17

18. Virtual Medical Clinic and Telemedicine • On January 23rd,2008 services began with the Parker Virtual Medical Clinic, now at CCAC since early 2011. • This employee-based clinic sees patients for urgent visits and chronic care such as blood pressure. • To date more than 600 patients have been seen. • Patient satisfaction scores are as high or higher than regular brick and mortar visits. Virtual Medical Clinic l August 20, 2014 l 18

19. Virtual Medical Clinic and Telemedicine Other Institutes using Telemedicine: • Orthopedics: since 2008 from Wooster, approx 60 visits and 10 surgeries. In 2009 operations from Canfield (St E’s). Visit yield is 6:1 whereas dept average 10:1! • Bariatrics: first visit from CCC Toronto 6/09. • Transplant Medicine-Discussions began 1/10. Virtual Medical Clinic l August 20, 2014 l 19

20. 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. Tele-stroke service fall 2010 along with EEG. ? Las Vegas. Virtual Medical Clinic l August 20, 2014 l 20

21. 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 August 20, 2014 l 21