TeleMedicine: Applications in Aging Services

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Tele-Medicine Applications in Aging Services

• Craig Lehmann, Ph.D., CC (NRCC), FACB
• Dean/Professor
• School of Health Technology Management
• Health Science Center
• State University of New York at Stony Brook
• Stony Brook, N.Y. 11794-8200
• craig.lehmann_at_sunysb.edu

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Utilization of Healthcare

• Office Visits to Physicians 765,700,000 (1999)
  823,542,000 (2000)
• Most frequent principal reason Physical
  63,000,000 (1999) same for (2000)
• Most frequent physician specialty General and
  Family Practice 170,571,000 (1999) 198,578,000
  (2000)
  
• Most frequent principal diagnosis Essential
  Hypertension 31,962,000 (1999) 35,096,000 (2000)
  

Source CDC
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Utilization of Health Care by Aged (65yrs or
older)

• Visit physicians on the average 8 times a year
  compared to 3 times a year for those lt65yrs.
• Hospitalized 3 times as often and stay 50
  longer.
• Of the 31 million hospitalizations in the US the
  Aged accounted for 40 (1997).
• It is estimated that by the year 2025 the aged
  will account for two thirds of the US health care
  budget.

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Hospital Admissions
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Utilization of Healthcare
Emergency Department

• Emergency Department Visits 102,765,000 (1999)
  108,000,000 (2000)
• Most frequent principal reason Stomach and
  Abdominal Pain 6,800,000 (2000)
• Number of Injury Related Visits 40,400,000
  
• Most Frequent Diagnostic/Screening Service
  Provided Blood Pressure (75 of all visits)
• Type of drug most frequently Prescribed
• Tylenol (10,000,000)

Source CDC
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Hospital Admissions through Emergency Departments
by Age
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Insurance Coverage for Physician Office Visits by
Age
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Chronic Conditions of the Aged

• Arthritis
• Hypertension
• Hearing Impairment
• Heart Disease
• Cataracts
• Deformity or Orthopedic Impairment
• Chronic Sinusitis
• Diabetes
• Visual Impairment

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Cost of Managing Diabetes

• 100 Billion Dollars Annually

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Health care utilization by the Diabetes Patient

• 96.1 million out patient medical encounters
• 53.4 million visits to physicians office
• 16.4 million visits to ambulatory care settings
• Visited their physician on the average 15.5 yr.
  as compared to 4.9 for the general population
  (all ages).
• Numerous visits to the clinical laboratory

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Lower Extremity Amputation

• 15 times higher

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Kidney Disease in Diabetes (End Stage Renal
Disease)

• Diabetes account for more than 35 of all end
  stage renal disease
• Costs exceed 4 billion dollars

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Incidence of diabetes will rise

• 17 million diagnosed diabetics.
• Another 5.4 million undiagnosed.
• 125 million worldwide
• Could be 30 million by 2050
• Complications associated with diabetes
• Retinopathy
• Renal Failure
• Neuropathy
• Atherosclerosis
  
• Lower Extremity Amputation

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Obesity in the USA
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Whats the Solution?

• Better Patient Management
• Tele-health
• Connectivity

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Patient Population

• CHF
• Diabetes
• Asthma
• Cancer
• High risk pregnancy
• Hospice
• Post stroke

• Frail elderly
• Wound care
• COPD
• Poor compliance
• Post operative states
• AIDS
• Spinal cord injury
• Rural locations

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Largest Users Today

• Prison population
• Federal programs Department of Defense, NASA
• Veterans Administration Home Telehealth Project

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Capabilities

• Close patient monitoring of vital signs
• Educational programs
• Video visits
• Messaging
• Medication reminders
• Digital pictures

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Provider Benefits

• Increased of patients served
• Improved access to patients
• Enhanced ability to monitor patients
• Efficient use of clinician time

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1st Generation Products
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2nd Generation Product
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3rd Generation Product
Blood oxygen
Blood sugar
Camera
Weight
ECG
Thermometer
Blood pressure
Stethoscope
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Some Tele-Health Vendors

• American Tele-care
• American Telemedicine
• Cyber-Care
• Home-med
• Motorola
• Phillips
• Tele-med
• Viterion

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Secure Viterion Network
Internet-Enabled Provider PC
Patient Monitor
Direct Dial-Up
Internet
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My Research Focus better management
via Telehealth

• Chronic Ailments
• Congestive Heart Failure
• Diabetes

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Impact of Technology on Home Bound Congestive
Heart Failure Patients

• Pilot Study Congestive Heart Failure (N20)
• Goals
• Primary Decrease Hospital and Emergency
  Department Encounters
  Secondary Nurse and Patient Acceptance of
  Telehealth Technology

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Congestive Heart failure Study Outcomes

• No patients from the study group utilized the
  emergency department. During the study three
  patients from the study group wanted to go to the
  emergency department.
• 20 (n2) of the control group were
  re-hospitalized via the emergency room.
• All patients in the study group felt that they
  had received better care because of the VST and
  connectivity

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New Study Diabetes Research

• Study Group
• Receive Telehealth
• Blood Pressure
• POCT Glucose, Cholesterol and Micro-albumin

• Control
• Telephone
• Glucometer

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Diabetes Research

• Monitor
• Compliance
• Physician Office Visits
• Home Visits
• Emergency Department Encounters
• Hospitalizations
• Clinical Evaluations

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Diabetes Research

• Compliance (other data shows greatly improved)
• Physician and Home Visits
• Emergency Department Encounters (Our Data
  Demonstrated Decline)
• Hospitalizations (should decline)
• Overall Healthcare Costs Reduced

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Diabetes Research

• Long-term Outcomes
• Overall Better Management Results in
• Improved Life Style
• Lower Heart Disease
  
• Less Lower Extremity Amputations
• Early Detection of End-Stage Renal Disease
• Much Reduced Healthcare Costs

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If patients could be monitored via the internet
20 of office visits could be eliminated

• 1999 756,700,000 physician visits
• 20 would save 150,134,000 visits _at_ 40.00 per
  visit
• Dollar Savings 6,050,400,000