Transatlantic Health Care Provision – a concrete example

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EU-US cooperation on eHealth

• Transatlantic Health Care Provision a concrete
  example
• Laura Raimondo
• Senior Vice President, UPMC

2
UPMC at a glance

• 10 billion in revenue
• 20 hospitals operating over 4,200 licensed beds
  187,000 admissions per year
• 4.6 million outpatient visits 480,000 emergency
  visits per year
• 1.6 million UPMC Health Plan members
• 400 outpatient locations
• 55,000 employees
• 2,800 employed physicians
• UPMC is closely affiliated with the University of
  Pittsburgh, which ranks fifth in National
  Institutes of Health Research Funding

3
UPMC and University of Pittsburgh Relationship
NIH Funding
NIH funding comparisons include affiliated
hospitals/research institutes Based on FY 08
preliminary data
4
Global experience
Our locations are world-wide and world-class.
China Colombia Cyprus France Israel Ireland Ita
ly Japan Kenya Korea Mexico Nigeria Pittsburgh
Philippines Singapore Spain Turkey United
Kingdom
UPMC and University of Pittsburgh world-wide
locations.
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UPMC in Italy

• MANAGEMENT ACTIVITIES ISMETT - Mediterranean
  Institute for Transplantation and High
  Specialization Therapies is a 78-bed facility
  located in Palermo, Sicily. Managed and operated
  by UPMC from the very beginning, ISMETT is one of
  the leading organ transplant centers in Europe.
  ISMETTs new infrastructure was opened in March
  2004 130,000 square feet over five levels, 14
  ICU, 7 ORs Radiology (CT, MRI, Nuclear
  Medicine), Endoscopy, Interventional cardiology,
  Pathology, Laboratory.
•  Ri.MED Foundation Based on UPMCs success in
  managing ISMETT, the Italian Government has
  selected UPMC to be the qualified technical
  partner of the Foundation. The primary goals of
  the foundation are to enhance scientific culture
  with special reference to the role of
  biotechnology, to train scientific, technical and
  administrative staff with specific skills in
  biotechnology, and to create the Biomedical
  Research and Biotechnology Center (BRBC) in
  Carini, near Palermo. UPMC Italy will implement
  and manage the BRBC to be established in 2016.
• UPMC San Pietro FBF -  The UPMC Center will
  offer cancer patients stereotactic radiosurgery,
  a radiation treatment that uses advanced
  treatment planning and sophisticated imaging
  technology to deliver precisely focused radiation
  to treat tumors and other abnormal masses or
  disorders. The UPMC Center will host the TrueBeam
  technology and will be the only one providing
  such an advanced technology in Central Italy,
  one of the few in the whole country.
• TRAINING ACTIVITIES  Simulation
  Center Renato Fiandaca - The center is hosted at
  ISMETT in cooperation with UPMCs Peter M. Winter
  Institute for Simulation, Education and
  Research (WISER). The mission of the Center is to
  train health care providers, improve quality of
  care, reduce medical errors, and increase safety
  standards.
• RESEARCH PROJECTS UPMC Italy conducts and funds
  various projects in translational research,
  technological development and training in
  biotechnology and regenerative medicine.
• - Transplantation of human fetal liver cells for
  the treatment of chronic liver disease in
  patients on the waiting list for liver
  transplantation- fetal skin progenitor cell
  transplantation for the treatment of acute
  and chronic skin lesions

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UPMC in Ireland

• UPMC Beacon  is a 183-bed facility located in
  Dublin, Ireland. This state of the art facility
  opened in January 2007 and has been operated by
  UPMC since 2008
• UPMC Beacon Hospital is a full service hospital
  which combines the best in Irish and US health
  care. As the showcase site for General Electric
  in Europe, it has the latest Radiology systems,
  including MRI, CT scanner with cardiac
  capabilities, CT Sim, and PET/CT. It also
  features Digital Radiology suites with advanced
  Mammography, Nuclear Medicine, and Ultrasound, as
  well as Angiography suites and lab with advanced
  single-plane and bi-plane systems and
  Fluoroscopy
• UPMC Beacon Cancer Centre provides a
  comprehensive range of cancer services including
  Oncology Surgery, Chemotherapy, and Radiotherapy.
  The Radiotherapy includes intensity modulated
  radiation therapy (IMRT) and image guided
  radiation therapy and stereotactic radiosurgery.
  UPMC also operates a cancer center in Waterford,
  in the South East of Ireland - UPMC Whitfield
  Cancer Center 

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UPMC global investments in ICT
IT Expenses (Capital Operating in millions)
Wembley Stadium 800 million ( 1.3 billion US)
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Innovation at UPMC

• Center for Connected Medicine
• Collaboration of industry leaders in health care,
  IT, communications, and application solutions to
  provide answers for all facets of the complex
  requirements for health care.
• Technology Development Center
• Brings the health care expertise and the ability
  to marry innovative processes with cutting edge
  technology to produce commercial grade products.

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Telemedicine Why Now?

• Scientific evidence emerging
• Evidence is emerging that outcomes at least
  remain unchanged between tele-visits and
  traditional visits
• Early evidence suggests that outcomes, follow up
  and compliance are improved in telemedicine
  chronic disease management
• Provider shortages (GPs and Specialists)
• Costs are lower for a tele-visit
• Funding for pilot cases and research
• EU funding supporting the Digital Agenda
• US is supporting 55 million annually in grants
• Technology innovation, user adoption and
  affordability

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Telemedicine at UPMC

• Telepathology
• Teledermatology
• Teleconsults
• Telewound care
• TeleICU
• Teleophthalmology
• Telecardiology
• Pre-/Post-surgical care

• Telepsychiatry
• Telestroke
• Teleradiology
• TeleMFM (Maternal Fetal Medicine)
• TeleEndocrine
• TeleTrauma
• TelePediatrics
• eVisits

Teleradiology
16 Service Lines 19 Facilities
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EU/US Telemedicine concrete experienceTELE
PATHOLOGY at ISMETT
UPMC ISMETT Project Starting 1999

• Principal Players
• Technician responsible for the preparation of
  the samples and the transfer of the images
• Doctor responsible for filling in the
  appropriate form indicating the clinical notes,
  the diagnostic hypothesis and the administrative
  personnel for the statistics

• Main purposes
• Diagnostic obtaining a second opinion
• Scientific set-up of a database of specialists
• Educational e learning
• Professional Development the spread of
  skills/know-how

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EU/US Telemedicine concrete experienceTELE
PATHOLOGY at ISMETT

• Tele pathology was vital to
• develop a transplantation program which became
  more and more sophisticated
• Develop a pediatric transplantation program
• Cure rare and difficult pathologies
• Provide complex and highly specialized care
• all
• with 1 Pathologist
• Since 1999 ISMETT, with 70 beds (78 from 2011) of
  which 14 ICU beds, has performed 1250 (April
  2012) transplantations with among the best
  European survival rates

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Telepathology ISMETT - Cina

• KingMed Diagnostics is the largest independent
  medical diagnostic laboratory in China. (250,000
  anatomical pathology tests per year and growing).
• KingMed has established 19 regional pathology
  labs around the country and is providing
  pathologic diagnosis consultation services for
  about 9,000 hospitals nation-wide.
• Using equipment that scans glass pathology
  slides, stores the images and transmits them
  electronically, KingMed will deliver second
  opinions on patient diagnoses from UPMCs
  pathologists through a secure, Web-based
  telepathology portal.
• The partnership will provide KingMeds customers
  with access to UPMCs broad pathology
  subspecialty expertise, which is not widely
  available in China
• Next step Continue to broaden and target
  marketing outreach

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TELE - PATHOLOGY
AvailableTechnologies
A few significant fields of a hystological,
cytological or bio technical sample are
photographed and sent to a consultant as an
attachment in an e-mail message or via FTP
technology

• Tele-Pathology Statistics

Through appropriate motorized microscopes the
remote control of the movement of the instrument
is carried out and simultaneously the
microscopes images are recorded by a camera and
sent out. At the same time the case can be
discussed in video conference between
pathologists
2. Tele-Pathology Statistics
Automatic execution of numerous photos with
appropriate enlargement, which are put side by
side until they cover the entire surface of the
glass slide. All of the information on the glass
slide is then transferred onto a file easily
archived , catalogued and duplicated for
consultation and/or quality control.
3. Digital Slides
GE and UPMC new company to digitize pathology
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Tele-ICU for pediatrics

• Transplant Surgery at Childrens Hospital of
  Pittsburgh
• International center for liver and small-bowel
  transplantation
• 60 transplants a year (half are multi-visceral)
• Survivals are best in the US
• Liver Transplant Survival Rate
• 3-year survival - 95 (national average 89)
• Intestine Transplant Survival Rate
• 3-year survival - 74 (national average 65)

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Tele-ICU

• Childrens Hospital of Pittsburgh of UPMC
• Remote consultation for pediatric patients in
  critical care units located around the world is
  offered by Childrens hospital intensivists when
  complex critical care expertise is needed. The
  TeleICU coordination between UPMC Childrens
  Hospital and external locations via Bedside
  monitoring and Electronic health record
• Two critical care specialties have developed
  international programs
• Cardiac Intensive Care Colombia
• Post operative management of pediatric liver
  transplant patients ISMETT, Italia

• Locations
• Colombia
• Italy

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Tele-ICU at ISMETT

• Tele-ICU started in November 2010 and was fully
  implemented in February 2011. It is mainly used
  in the Intensive Care Unit (ICU) for
  post-surgical liver transplant cases in pediatric
  patients

• 18 of pediatric patients treated in the ICU
  (30 of total hospital stay was spent in ICU)
• 95 days of ICU pediatric hospital stay covered
  by the tele-ICU service
• Setting up a multi disciplinary team ISMETT-
  UPMC Childrens Hospital
• Interventionist (s)
• Surgeon (s)
• Pediatrician
• Specialized nurse
• Rounds every day at 3pm Italy time zone

• Observable results
• Access to highly-specialized and specific
  competencies
• Uniformity of protocols used and reduction of
  variance of care
• Educational training function. We expect to
  improve our competencies
• Cost savings Ismett could not afford a
  diversified group of specialized physicians for
  only 9 pediatric beds

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HOME MONITORING
Patients concerned
All patients residing in Sicily, who
consecutively underwent a liver transplant at
ISMETT and were discharged starting the 15th of
July 2011 through the 31th of March 2012 ? (TOT.
30 patients)
Clinical Protocols

• recurrent clinical monitoring in the time of
  post-discharge (first 3 months or until the
  stabilization of clinical conditions)
• Verify therapeutic compliance (immune
  soppresion, other drugs)
• Verify compliance of surveillance scheme
  biohumural and instrumental post-transplant

Main Functions of the Device

• Periodical measuring of the vital parameters
• Visual display of the calendar with the planned
  activities
• Visual display of audio/visual reminders to
  encourage patients to follow their health protocol

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HOME-MONITORING
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What other Tele Medicine programs at ISMETT?

• We have already launched Tele-dermatology for
  pediatric patients (Childrens Hospital Ismett)
• We launched Teleradiology for pediatric
  neuroimaging (Childrens Hospital Ismett) last
  January
• OUR GOAL IN PERSPECTIVE TELE-Stroke program in
  Sicily
• Very wide experience in UPMC and in the USA
• High impact on costs savings and clinical outcome
• Larger impact if surrounding hospitals do not
  have a stroke specialist and have never treated a
  patient with tPA

Next programs 1. Home monitoring for post
surgical lung translanted patients and LVAD
patients with Ismett-UPMC connection 2. Tele-ICU
program with ISMETT as HUB and 7 Sicilian
hospital satellites to support ICU management of
organ collection
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Stroke, tPA and Telemedicine

• tPA saves 6074 and adds 0.75 quality
• adjusted life year per use (1)
• Telestroke is associated with increased
• delivery of tPA (2)
• (1) The Economic Case for New Stroke
  Thromobolytics Stroke, October 2010
• (2) Telemedicine in Acute Stroke Management
  Systematic Review International
• Journal of Technology Assessment in Health
  Care, 262 (2010)

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Telemedicine Systems in US
Schwamm et al. Stroke 2009
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Telestroke v. SC Patients Treated with IV tPA
90 day Outcomes
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Waiting for you at2012 UPMC International
Telemedicine Symposium
For more information www.UPMC.com/Telemedicine