Telemedicine

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(No Transcript)
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• Telemedicine
• Broadband Applications for Healthcare

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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine
• How Broadband Can Help
• Summary

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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, ...?

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A Working Definition

• The use of telecommunications technology to
  facilitate interactions between geographically
  disparate people for the purpose of solving
  medically related problems

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Telemedicine Communications

• lower equipment telecommunications cost

• easier to use
• offers immediacy and clarity of
  communications
• greater interactivity knowledge transfer

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The Evolution of Telemedicine
Large Number of Trials
Rebirth of Telemedicine
First Telemedicine Trials
Termination of all Trials
Emphasis on Sustainability
Late 50s
Mid 70s
Early 90s
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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

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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

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Telemedicine Market
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Telemedicine Market
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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine
• How Broadband Can Help
• Summary

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Telemedicine
Expert
Telesurgery
Telepathology
Real-time Ultrasound
Wide Area
Grand Rounds
Home Healthcare
Teleradiology
Continuing Medical Education
Telecardiology
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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
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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

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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

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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

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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine
• How Broadband Can Help
• Summary

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Profile of Early Adopters

• Teaching hospitals
• Managed care organizations
• Correctional facilities
• US military
• Urban, rural inner city applications

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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

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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...

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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
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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

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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine
• How Broadband Can Help
• Summary

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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

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Physician Resistance

• Familiarity with the technology
• Fears of predation/disruption of referral
  patterns
• Inconvenience
• Concerns about liability
• Inertia

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Barriers to Widespread Use

• Reimbursement
• Licensure liability
• Scheduling

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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)

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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

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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 physicians 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 physicians office of
consultation time and date
Appropriate site to confirm with consulting
physician
Consultation scheduled
LSF confirm consultation with consulting physician
LSF confirm consultation with local physician
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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine
• How Broadband Can Help
• Summary

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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 (ltT1/E1)
High (gt E1)
Bandwidth
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Advantages of Broadband
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Advantages of Broadband
sent _at_ 10 Mb/sEthernet
sent at OC3
Modality
Resolution
Mb/Image
Images/Exam
Mb/Exam
sent _at_28.8kb
sent _at_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
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ATM and Healthcare
FDDI
Ethernet
T3/OC3
PBX
ATM Switch
T1/TDM
JPEG/MPEG2
Token Ring
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Agenda

• Definition and History of Telemedicine
• Telemedicine Applications
• Case Studies
• Challenges for Telemedicine Solutions
• How Broadband Can Help
• Summary

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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!

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TheRight ConnectionforHealthcare
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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

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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)