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A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER

A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER. Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community & Migrant Health, Inc. Penn Yan, NY 14527 1-800-724-0862. Agenda for Our Presentation.

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A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER

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  1. A FIRST-HAND LOOK AT TELEHEALTH IN A PRIMARY HEALTH CARE CENTER Terry Jean Yonker, RN, MS, FNP-BC Telemedicine Clinical Coordinator Finger Lakes Community & Migrant Health, Inc. Penn Yan, NY 14527 1-800-724-0862

  2. Agenda for Our Presentation 1. Discuss needs of underserved populations seen in primary care setting 2. discuss the role of telehealth in medical home3. discuss administrative, technical, and clinical processes needed for success4. observe telepresentation and use of peripherals to conduct remote exams5. participate in review of literature and clinical cases relevant to tele-ent, tele-mental health, tele-opthalmology,andteledentistry6. List opportunities for future telehealth applications in community and migrant health centers

  3. Finger Lakes Community & Migrant Health Mission Statement….to ensure accessible and affordable health care to the communities we serveMedical Home Concept…patient-centered approach whereby health care team works together to coordinate and support primary and preventive care for an individualCelebrate Diversity … a dedicated, culturally sensitive staff who are committed to high quality , comprehensive care and are Passionate about the work that they do501(c) (3), Article 28 Federally Qualified Health CentersMigrant Health 330g FundingMobile health servicesEnabling Services

  4. FLMHCP VOUCHER SITES AND HEALTH CENTERS IN NY STATE

  5. FLMHCP CLINICS AND NEAREST METROPOLITAN CENTERS 35 miles 55 miles 50 miles 60 miles 110 miles

  6. Finger Lakes Community & Migrant Health OUR CLients

  7. Challenges In Providing Health Care To Rural Poor Culture beliefsLanguage differencestransportation barrierslack of Child careno insurancelack of trust in health care systempovertymigrant lifestyle

  8. Creative Ways to Provide Care . • Bilingual/Bicultural Staff • Clinic Hours Conducive to Work Hours • Community Health Workers • Case Management • Passionate/Compassionate Staff • Visionary Leadership • One Stop Shopping (Medical Home) • Telemedicine

  9. What is Telemedicine? NYS Office of the Professions defines telemedicine as the provision of professional services over geographical distances by means of modern telecommunications technology.

  10. What is Telehealth? Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth is an expansion of telemedicine that encompasses administrative or educational functions related to telemedicine. .

  11. History of telemedicine

  12. American Telemedicine Association Established in 1993 as a non-profit organization………. The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership, works to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Vision Statement Telemedicine will be fully integrated into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Mission Statement The mission of ATA is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. This will be achieved through the following means: Educating and engaging government, payers and the public about telemedicine Providing a clearinghouse of information and services for both newcomers and experienced professionals Fostering networking and collaboration among allied interests in medicine and technology Promoting research, innovation and education Developing and disseminating policies and standards Ensuring a strong financial basis for the association to support operations Creating consumer awareness and support • National Headquarters • American Telemedicine Association 1100 Connecticut Avenue, NW, Suite 540 Washington, DC 20036 Phone: 202.223.3333 Fax: 202.223.2787 E-mail: info@americantelemed.org www.americantelemed.org

  13. APPLICATIONS OF TELEMEDICINE • Teleradiology • Telepathology • Teledermatology • Wound care consults • Home Based Monitoring • Urgent Care Consults • Pre & Post Op Care • Specialty Care Consults • Teledentistry • Burn/Trauma • ED – Stroke Initiative • Telehome Healthcare • ICU Intensivist • Inpatient /Nursing Home Consults • Outpatient/ Primary Care • Telepsychiatry • Counseling • Preventive Screenings • Health Education

  14. Benefits of Telehealth Patients/Families Providers Health Care System*reduced travel* *direct patient interaction* * improved access* *timely appointments* *expanded services* *improved health outcomes* *remain in their community* *access to other experts* *resource utilization* *additional support* *access to CME* * expansion to rural & underserved*

  15. Typical Telemedicine System in Our Clinics GeneralExam Camera Telephonic Stethoscope Video Codec with LCD Monitor Electronic Medical Record ( EMR ) Dental Intraoral Camera ENT Scope

  16. Store and Forward vs. Real Time Digital Images Videoconferencing

  17. 2 BIG “R”s • REGULATION • Licensure • Standards of Care • No substitute for in-person care • Confidentiality REIMBURSEMENT • Medicare • Medicaid • Blues • Preferred Care • NP Office Visits • HIPPA Secure

  18. Telehealth Services At FLCMH Diabetic Retinopathy Screening Tele ENT Tele Dentistry Tele Psychiatry Distance Learning EMR How we started…. How we planned…. What we used…. How we did…. where we are headed….

  19. Telehealth Program DevelopmentFUNDING SOURCES USDA - DLT HRSA – Rural Network Development FINGER LAKES COMMUNITY & MIGRANT HEALTH – HIT INFRASTRUCTURE DEVELOPMENT NYS DOH – Office of HIT FCC – Rural Healthcare Broadband Project

  20. From Vision to Reality • Workscope (Who, What, Where, When, Why, How, & How much) • Development Workplan • Deployment Workplan • Quality Improvement • Document for Replication

  21. Tele-ENT Specialty care consulturgent care consultpre/post op carefollow up

  22. Tele ENT • Real Time -OR- Store and Forward

  23. Tele-ENT What the Literature Says:cost effectivefeasablereduced travel (“greener”)reduced un-necessary transfer to tertiary centerhigh patient satisfactionimages comparable to in-person assessment

  24. Tele-ENT Finger LAKES CASE STUDY56 YEAR OLD FEMALE WITH VERTIGO…..

  25. Tele- Mental Health Real Time applicationa) Consultationb) Medication Managementc) psychotherapyd) Clinical conferencinge) education

  26. Tele- Mental Health What the Literature Says:increased access achievedclinically effective as face to facecost effectiveDecreased time to treatmenthigh patient satisfactioneffective way to manage medication (in conjunctIon with pcp)

  27. Tele- Mental Health FLcmh retrospective chart reviewapril – September 2010pilot site: geneva community health center Dr Charles lilly – Deb cole LCSW6 referrals Dx: depression, PTSD, Bipolarmean time to consult: 15.6 daysmean time to treatment: 4 daysed/hospitalization: 0Mean satisfaction survey score (concurrent) Patient: 4.77/5.0telepresenter: 4.024/5.0symptoms improved:

  28. Diabetic Retinopathy Screening

  29. DIABETIC RETINOPATHY SCREENING What the Literature Says:cost effectivepreserved sightincreased access for patients in remote and rural areasdecreased time to treatmentdecreased time and distance traveled

  30. DIABETIC RETINOPATHY SCREENING Flcmh outcomes of pilot 2008-2009pilot site: sodus community healthdrchetscerra, od# screened = 408uninsured = 88%pathology = 23 (5%)retinopathy – 3 macular degeneration -1 glaucoma - 11 cataracts – 6 mottled macula – 1 suspicious lesion -1refractory error – 47referred for dilated exam – 13

  31. Teledentistry Consultation

  32. TELEDENTISTRY Clinical Applications 1) Screening 2) Urgent Care Consults 3) Specialty Care Consults

  33. TELEDENTISTRY What the Literature Says:reliable = no statistical difference in face to face visual exam when compared to intraoral camera digital photos improved access to preventive dental care screeningfeasible for screening, diagnosis, and treatment consultationcost effective

  34. TeleDentistry Remote screening PILOTDecember 2009 Holley ABCD & Seneca County ABCD/Headstart 33 children screened 9 out of 33 diagnosed with pathology (27%) 100% have accessed follow-up treatment

  35. TELEDENTISTRY Finger lakes : Eastman Pediatric dentistry case studies9 referralsseneca county (5) Ages 0-5: (7)wayne county (3) 6-12: (2)ontario county (1)mean Time to consult: 13.1 daysmean time to treatment: 9.9 dayspatient survey: 4.57telepresenter survey 4.5specialist survey: 4.28

  36. A TALE FROM SENECA COUNTY • POPULATION = 34,228 • CHILDREN LIVING IN POVERTY = 18% (NYS 13%) • 2005-2007 OUTPATIENT VISITS FOR CARIES IN 3-5 YEAR OLDS = Rate 143/10,000 (NYS Rate 87.7) - NYSDOH County Health Incidators 2007

  37. 35 miles 55 miles 50 miles 60 miles 110 miles FLMHCP CLINICS AND NEAREST METROPOLITAN CENTERS A TALE FROM SENECA COUNTY ABCD

  38. TeleDentistry Pediatric Dentist ConsultationsSeneca County ABCD/Head Start Agri-Business Child Development Finger Lakes Migrant Health Care Project University of Rochester Medical Center-Eastman Dental Program 13 April 2010

  39. Telemedicine Equipment • Sometec Intraoral Camera • Tandberg Portable Videoconferencing Unit

  40. Case Presentation Here, Phyllis begins a consultation by providing a case presentation to Dr. Jeff Karp, DDS, at Eastman Dental, with the University of Rochester Medical Center. Information shared included medical history, diagnosis at prior screening/exam, and any social or economic barriers affecting the family’s ability to complete treatment.

  41. Case Presentation While Phyllis presents her information to Dr. Karp, we see him on the Tandberg unit, listening to the case.

  42. Intraoral Examination

  43. Intraoral Examination

  44. Intraoral Examination Here is an example of a tooth with severe decay. Thanks to the precision of the camera’s focus and image capture, Dr. Karp is able to use these images to determine the level of treatment a child needs, including sedation methods, (which will also determine treatment locations, i.e. OR vs. dentist’s office) preoperative medications, and behavioral considerations.

  45. Other Highlights Goofing around with Dr. Jeff before the examination!

  46. Other Highlights Hugs for Miss Phyllis!

  47. Thank You!

  48. Distance Learning, EMR, Etc. • FLCMH Board Training • Cultural Training • E-Clinical Works • Meetings • ETC….. ETC……

  49. SWOT Analysis & Lessons Learned S: Vision, Passion, Positive attitude, Project Management W: Financial limitation, technology resources, change is hard work! learning as we go, Project Management O: Limitless if + time, money, staff T: doubts, stamina, fear of IT, payors, malpractice, mobility and special needs of MFW

  50. What Does The Future Hold • TelePulmonary Consults • Tele-Occ Med Consults • Home Based Monitoring • Expand Teledentistry to PCP, Headstart, • HCCN

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