Providing Care and Community Outreach with Telemedicine

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Providing Care and Community Outreach
with Telemedicine

• Don McBeath
• Director of Telemedicine
• Texas Tech University
• Health Sciences Center
• June 28, 2006

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Texas Tech Telemedicine
Telemedicine History at Texas Tech

• One of the longest continuous programs in the
• country
• First consult June 29, 1990 from Alpine, Texas
• hospital
• Substantial growth from TDCJ in 1994
• More than 25,000 consults since 1991
• More than 3,000 consults yearly

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Texas Tech Telemedicine
Aida Porras today
Porras consult June
29, 1990
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Texas Tech Telemedicine

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Texas Tech Telemedicine

• Primary Applications
• Access specialty care
• Access primary care
• School-based health
• Correctional
• Burn follow-up
• Nursing home care
• Diabetes education
• Nutrition counseling
• Pharmacy

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Texas Tech Telemedicine

• Consult break down by specialty (2005)
• Psychiatry 53
• Pharmacy 22
• Orthopedics 9
• Psychology 7
• Burn follow-up 3
• Other 3
• Dermatology 2
• Primary Care 1

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Texas Tech Telemedicine

• Correctional verses non-correctional
• Correctional 74
• Non-correctional 26

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Texas Tech Telemedicine

• Correctional Benefits Noted
• More than half of correctional telemedicine
• patients remain at unit
• - No transportation cost
• - No escape risk
• Consults insure proper utilization of care
• Reduces provider windshield time

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Texas Tech Telemedicine

• Correctional Benefits Noted
• Helps provide standardized care previous
• court order compliance
• Has provided an arena to better understand
• telemedicine applications and operations which
  
• can be applied in other environments such as
• rural and assisted living

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Texas Tech Telemedicine

• Source of care following telemedicine
  consultation (correctional only)

Medical Only Number Percent
Remain on unit 248 55
Transfer to medical facility 202 45
For 2005 calendar year
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Clinicians Travel Time Reduction
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Texas Tech Telemedicine

• Why telemedicine in West Texas?
• Improve access to health care
• Half of Texas but only 12 of the people
• Vast geography 108 counties
• Extremely rural - 44 counties rural / 54 frontier
• Few primary docs fewer specialists
• In some counties 90 miles to a doc

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Doctors by County - 2004
Total Doctors 0 1-3 4 HSC Service Boundary

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Texas Counties Without a Pharmacy
Source Texas State Board of Pharmacy, May
2003 Prepared by TTUHSC Office of Rural and
Community Health, May 2003
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Texas Tech Telemedicine

• Highlighted Projects
• Rural Hospital Alpine
• Rural School Based Hart
• Burn After Care El Paso
• Telepharmacy - Turkey

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Texas Tech Telemedicine

• Rural Hospital - Alpine, Texas
• First telemedicine site
• Rural hospital
• 150 miles to nearest medical center
• 275 miles to nearest academic medical center
• Remote isolated frontier area

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Telemedicine Link to Alpine
Lubbock
Alpine
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Texas Tech Telemedicine

• School Based - Hart, Texas
• Town of 1200
• Single campus K-12
• Only provider is school nurse
• 15 miles to some care
• 70 miles to Lubbock
• Limited transportation

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Telemedicine Link to Hart School Clinic
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Texas Tech Telemedicine

• Burn Aftercare Clinic El Paso, Texas
• Only burn unit between Dallas and Phoenix in
  Lubbock
• Number of patients from El Paso
• Monthly follow-ups involve 600 mile roundtrip
• Challenges from travel for burn patients and
  families

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Telemedicine Link to El Paso
Lubbock
El Paso
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El Paso
Lubbock
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Texas Tech Telemedicine

• Telepharmacy - Turkey, Texas
• First telepharmacy project in Texas
• No town pharmacy
• One doctor via telemedicine
• 90 mile roundtrip to nearest pharmacy
• Elderly population
• On-line out of the question
• Mail delay

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Telemedicine Link to Turkey
Turkey
Lubbock
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Texas Tech Telemedicine

• Future Telemedicine in Rural Areas
• Psychiatry
• Substance and alcohol abuse treatment
• Teledentistry
• Remote home monitoring
• Cancer follow-up
• Nursing homes/assisted living

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Texas Tech Telemedicine

• Growth Challenges and Barriers
• Equipment cost
• Connectivity availability and cost
• Reimbursement

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Texas Tech Telemedicine

• Texas Medicaid
• Started reimbursing in 1998
• One of the first states in the country
• Revisions of law and rules since then but
  substantially the same

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Texas Tech Telemedicine

• Medicaid Policy Limitations
• Requires MD, NP, or Nurse Midwife be with
• patients
• Limits patient location to MD office, FQHC,
• RHC, hospital or state school
• Requires Hub provider have medical school
• affiliation
• Limited to interactive video
• Limited CPT codes

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