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Telemedicine Broadband Applications for Healthcare

Telemedicine Broadband Applications for Healthcare. Agenda. Definition and History of Telemedicine Telemedicine Applications Case Studies Challenges for Telemedicine How Broadband Can Help Summary. Telemedicine: What is it?. Electronic access to CHIN database?

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Telemedicine Broadband Applications for Healthcare

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  1. Telemedicine Broadband Applications for Healthcare Telemedicine Overview - 03/11/2014 - 2

  2. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 3

  3. Telemedicine: What is it? • Electronic access to CHIN database? • Video conferencing with a specialist? • Grand rounds/CME video conferencing session? • Getting healthcare advice on the alt.rec.med.quackery? • Just another overhyped term like virtual reality, artificial intelligence, ...? Telemedicine Overview - 03/11/2014 - 4

  4. A Working Definition • The use of telecommunications technology to facilitate interactions between geographically disparate people for the purpose of solving medically related problems Telemedicine Overview - 03/11/2014 - 5

  5. Telemedicine Store and Forward Real Time Clinical Admin/Educational Telemedicine Communications • lower equipment & telecommunications cost • easier to use • offers immediacy and clarity of communications • greater interactivity & knowledge transfer Telemedicine Overview - 03/11/2014 - 6

  6. The Evolution of Telemedicine Large Number of Trials Rebirth of Telemedicine First Telemedicine Trials Termination of all Trials Emphasis on Sustainability Late 50’s Mid 70’s Early 90’s Telemedicine Overview - 03/11/2014 - 7

  7. Benefits of Telemedicine • Economic • reduced costs • improved economic base for rural hospitals and inner city clinics • earlier therapeutic intervention resulting in reduced long term costs Telemedicine Overview - 03/11/2014 - 8

  8. Benefits of Telemedicine • Social • equal access to healthcare services • reduced professional isolation for rural healthcare providers • more uniform quality • enhanced continuity of care • efficient use of tertiary care services Telemedicine Overview - 03/11/2014 - 9

  9. Telemedicine Market Telemedicine Overview - 03/11/2014 - 10

  10. Telemedicine Market Telemedicine Overview - 03/11/2014 - 11

  11. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 12

  12. Telemedicine Expert Telesurgery Telepathology Real-time Ultrasound Wide Area Grand Rounds Home Healthcare Teleradiology Continuing Medical Education Telecardiology Telemedicine Overview - 03/11/2014 - 13

  13. User Requirements Specialists Digital and analog medical instruments Ease of use Integration with existing HIS Security Premium quality multimedia conferencing with high speed collaboration tools Primary Care Physician Low maintenance High scaleability Reliability Accessibility Flexibility MIS Telemedicine Overview - 03/11/2014 - 14

  14. Clinical Requirements • Majority of “telemedicine” in the past 5 years has simply been video conferencing applied to healthcare • Move towards products specifically designed for clinical aspects of telemedicine • teleradiology • telepathology • teledermatology • telecardiology • regulatory standards • medical instruments Telemedicine Overview - 03/11/2014 - 15

  15. Telemedicine Peripherals • Numerous medical devices are suitable or have been modified to work with telemedicine systems • These devices are available from companies such as Welch Allyn, American Medical Development and Andries Tek Telemedicine Overview - 03/11/2014 - 16

  16. Technology Trends • Shifting away from... • “simple” video conferencing, dedicated telemedicine rooms, hub and spoke network design • Moving toward... • standards based, open systems solutions • desktop telemedicine • new image compression technology • highly reliable and scaleable solutions • systems designed specifically for healthcare professionals Telemedicine Overview - 03/11/2014 - 17

  17. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 18

  18. Profile of Early Adopters • Teaching hospitals • Managed care organizations • Correctional facilities • US military • Urban, rural & inner city applications Telemedicine Overview - 03/11/2014 - 19

  19. Telemedicine in Prisons • Business drivers • risks (care providers & general population) • cost of transport • litigation • Benefits • more timely delivery of healthcare services • reduced risk • reduced cost of transportation • reduction in litigation Telemedicine Overview - 03/11/2014 - 20

  20. Telemedicine in Managed Care • Allina Health System, Minn. • Business drivers • cost reduction • increased need for communications • competitive advantage/differentiator • Reported results • 83% very satisfied with telemedicine consultation • expanded patient population • network growing, in third year of operation... Telemedicine Overview - 03/11/2014 - 21

  21. Case Study - Pediatric Care Emergency Room (StarMED) Radiology (future DICOM) Consultation Room (StarMED) RBOC Services Platform (future) T3 An additional 6 sites over the next 2 years Lecture Hall (StarED) ISDN H.320 Telemedicine Overview - 03/11/2014 - 22

  22. Building a Successful Program • People • needs assessment, training/development of trust, access, champion • Technology • needs assessment, multiple applications to keep volume high, reliability • Evaluation • clinical efficacy, impact on practice patterns, cost Telemedicine Overview - 03/11/2014 - 23

  23. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 24

  24. Patient Acceptance • There is strong consensus amongst most studies… patients love telemedicine! • convenience • flexibility • reduced travel for healthcare services • treatment by physicians they know and trust • financial impact Telemedicine Overview - 03/11/2014 - 25

  25. Physician Resistance • Familiarity with the technology • Fears of predation/disruption of referral patterns • Inconvenience • Concerns about liability • Inertia Telemedicine Overview - 03/11/2014 - 26

  26. Barriers to Widespread Use • Reimbursement • Licensure & liability • Scheduling Telemedicine Overview - 03/11/2014 - 27

  27. Issue: Reimbursement • The biggest single issue which is impeding the widespread use of telemedicine • HCFA • Blue Cross/Blue Shield • Kansas, Georgia, ... • Medicare/Medicaid • Managed Care • 1996 Telemedicine Development Act (California SB 1165) Telemedicine Overview - 03/11/2014 - 28

  28. Issue: Licensure/Liability • Jurisdiction • is the medicine being practiced where the physician is, the patient is, or both? • most favorable legal environment might be the place sought to litigate • these issues have the potential of accelerating the application of national rather than local standards of care Telemedicine Overview - 03/11/2014 - 29

  29. Issue: Scheduling No nurse scheduled Physician/Admin contacts Local SF requesting consultation with possible dates & times Nurse needed during consultation Local SF contacts physician/administrator for other dates/times LSF schedules nursing service once appointment time is set LSF contacts Hub SF to request consultation No HUB SF informs local SF of possible times LSF requests consulting physician availability info Facilities match? LSF contacts local physician’s office with available times LSF contacts Hub physician to schedule consultation No Time match? Physician & facilities match? No LSF contact Hub SF to reserve appointment time Request facilities info If consulting physician not resident at Hub schedule with site admin No Facilities match? LSF notifies local physician’s office of consultation time and date Appropriate site to confirm with consulting physician Consultation scheduled LSF confirm consultation with local physician LSF confirm consultation with consulting physician Telemedicine Overview - 03/11/2014 - 30

  30. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 31

  31. Telemedicine Applications • Telesurgery • Telediagnosis • Real-time Ultrasound • Teleradiology Diagnostic • Telepathology • Telecardiology • Teledermatology • Telepsychiatry • Follow-up • Teleconsultation Consultation • CME/Grand Rounds Monitoring • Home Healthcare Use Low (POTS) (home) (urban/rural) (urban/rural) Medium (<T1/E1) High (> E1) Bandwidth Telemedicine Overview - 03/11/2014 - 32

  32. Resolution Color Motion Advantages of Broadband Telemedicine Overview - 03/11/2014 - 33

  33. Advantages of Broadband sent @ 10 Mb/sEthernet sent at OC3 Modality Resolution Mb/Image Images/Exam Mb/Exam sent @28.8kb sent @T1 X-ray/Chest 2kx2kx12 59 1-2 88.4 1 hr 19 min 1 min 28 sec 8.8 sec .6 sec X-ray/Other 1kx1kx12 12.6 2-5 44 39 min 44 sec 4.4 sec .3 sec CT 512x512x16 4.2 10-50 126 1 hr 53 min 2 min 6 sec 12.6 sec .8 sec Fluoroscopy 512x512x10 2.6 5-10 20 18 min 20 sec 2 sec .1 sec MR 256x256x8 0.5 10-50 16 14 min 16 sec 1.6 sec .1 sec Ultrasound 512x512x8 2.1 10-50 63 56 min 1 min 3 sec 6.3 sec .4 sec Nuclear Med 128x128x8 0.1 10-50 4 4 min 4 sec .4 sec .03 sec Telemedicine Overview - 03/11/2014 - 34

  34. ATM and Healthcare FDDI Ethernet T3/OC3 PBX ATM Switch T1/TDM JPEG/MPEG2 Token Ring Telemedicine Overview - 03/11/2014 - 35

  35. Agenda • Definition and History of Telemedicine • Telemedicine Applications • Case Studies • Challenges for Telemedicine Solutions • How Broadband Can Help • Summary Telemedicine Overview - 03/11/2014 - 36

  36. Summary • Starvision/Newbridge/Siemens have a comprehensive, end-to-end telemedicine solution • based on inexpensive, widely available hardware • designed to meet the clinical needs of a variety of medical disciplines • simple to use, developed specifically for healthcare professionals • medical standards compliant • integrates with existing hospital information systems • true multimedia... much more than just pointing cameras at doctors • available today! Telemedicine Overview - 03/11/2014 - 37

  37. TheRight ConnectionforHealthcare

  38. For More Information • A Telemedicine Primer: Understanding the Issues • by Jim Reid • TIE web site • http://tie.telemed.org • Magazines and journals • Telemedicine Today • Telemedicine Journal • Telemedicine and Telehealth Networks Telemedicine Overview - 03/11/2014 - 39

  39. For More Information • Conferences • American Telemedicine Association AGM (Orlando, April) • Telemedicine 2000 (Chicago, June) • TeleCON/TeleMED (Anaheim, Nov.) • Associations • American Telemedicine Association (ATA) • American Telemedicine Service Providers Association (ATSP) Telemedicine Overview - 03/11/2014 - 40

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