Telemedicine s Potential

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Telemedicine’s

P

i l

Potential

Enhancing Access &

Efficiency of Quality Inmate Care

Lemuel Shattuck Hospital / UMass Correctional Health Experience

Ken Freedman, MD, MS, MBA, CMO, LSH Pat Herald, RN, BSN, CNN, LSH

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Learning Objectives

Learning Objectives

Advantages of a well-designed telemedicine program,

including reduced security risks, costs, inmate comfort.

Careful planning steps to set up a telemedicine

program, including management support, equipment

purchases IT connectivity consensus clinical criteria

purchases, IT connectivity, consensus clinical criteria,

staff scheduling and documentation of encounters.

Obt i th

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Obtain the engagement and support of medical staff,

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Telehealth: Defined

Telehealth: Defined

Differing modalities designed to exchange health

information and/or deliver health care despite

impediments such as:

impediments such as:

 Time  Geography  PersonnelTransportation  Mobilityy  Finances  Safety

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Telehealth: History

Telehealth: History

1900’s

 Shore-to-ship public health physicians

 Australia’s Royal Flying Doctor Service

 Australia s Royal Flying Doctor Service

United States’ teledoctor

1990’s

 Pre-hospital  In-hospital  In hospital  Private  Public C ti  Corrections

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Telehealth: Modalities

Telehealth: Modalities

Telemedicine

Telemonitoring

Telemonitoring

Teleconferencing

g

Telepresence

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Rationale For

Telemedicine Programs

Improve timeliness of care:

 Travel schedule, including correctional officers’ schedules

 Ease of scheduling clinicians

Reduce ED visits and hospitalizations.

Reduce transportation need and community safety

risks:

 Reduce discomfort for inmates

 Reduce waiting time - reduce inmate grievances

Decrease costs, improve efficiency and increase

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Telemedicine

Clinical Opportunities

Documented experiences in inmates with:

 HIV/AIDS  HCV  HCV  CardiologyDermatology  Psychiatry  Ophthalmology  Orthopedics  GastroenterologyPrimary Care

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Background:

A Trilateral Relationship

Specialty clinics at LSH

Volume of correctional health care encounters

Volume of correctional health care encounters

Specialty service of high volume correctional clinics

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Implementation/

Operational Stages

GI telemedicine history

Interdisciplinary taskforce

Interdisciplinary taskforce

Consensus on milestones

C

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Milestone #1:

Milestone #1:

IT Standardization / Connectivity / Equipment

Lessons learned:

 Standardize IT equipment

Acquire the latest proven technologyq p gy

 Assure training and technical support is available

 Determine ideal setup at remote and HUB locations

How did we apply the lessons:

LSH and DOC purchased three (3) ProvidiaTelemedicine units

 Technical / training service contract / support

 Technical / training service contract / support

Dedicated telemedicine suites

 Dedicated ISDN lines

D di t d DOC IT t ff

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Milestone #2:

Milestone #2:

Medical Standardization

Lessons learned:

 Physician support necessary for program growth

 Clinical specialists define appropriate telemedicine encounters

 Clinical specialists define appropriate telemedicine encounters

Pre-encounter planning and review

Telemedicine coordinators strive for “best practice” standard

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Inclusion Criteria

Inclusion Criteria

SPECIALTY EXCLUSION (NO) INCLUSION (YES) CLINICAL DATA NEEDED Gastroenterology •Complex medical problems

•Acute medical problems

•Review of pathology •Initial Hepatitis C •Initial, non-acute GER

•Initial non-acute constipation

Intake sheet Problem list MAR/allergies Studies •Initial, non-acute constipation Studies

Referenced SOAP note Referral

Infectious Disease •Follow-up without new complaint.

Intake sheet Problem list MAR/allergiesg Studies

Referenced SOAP note Referral

Orthopedic Surgery •Complex fractures •Infection

•Evaluation as to whether or not elective surgery is needed

Intake sheet Problem list •Dislocation •Non-acute sprain

•Non-acute low back pain •Pre-op identified by Pat Clifford •Post-op identified by LSH ortho

MAR/allergies Studies

Referenced SOAP note Referral

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Milestone #3:

Scheduling / Logistics

“Today’s preparation determines tomorrow’s achievement.” – Anon.

Lessons learned:

Lessons learned:

 Define timelines/schedules for clinical, inmate and support staff

availability through LSH, DOC and UMCH

Pre-register all approved telemedicine patients

Prepare medical records/correspondence

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Future Vision

Future Vision

Asynchronous telemedicine encounters

Store and forward encounter data and results

Store-and-forward encounter data and results

Acquire advanced equipment for diagnostic purposes

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p p

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Effective Teleconferencing

Effective Teleconferencing

Preparedness

 Be prepared … know the patient.

Communication

Optimize position of clinician and patient with cameras.

Scheduling

Try to keep each conference to 7 minutes This ensures all

 Try to keep each conference to 7 minutes. This ensures all

patients will be seen and other sites will have opportunity to have their patients seen.

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Effective Teleconferencing

Effective Teleconferencing

Flexibility

 If additional time becomes necessary, plan on follow-up with

Clinical Specialist by phone or in-clinic. Clinical Specialist by phone or in clinic.

Care Coordination

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Operationalizing

Teleconferencing

Inmate/Patient DOC Site/Transportation LSH Specialty IT Support UMCH

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February Schedule

February Schedule

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Post-Encounter

Questionnaire

Please circle the number you feel best describes your experience with teleconferencing/telemedicine Please circle the number you feel best describes your experience with teleconferencing/telemedicine. 1= least describes your experience 2=maybe describes your experience 3= most describes your experience

1 Teleconference/telemedicine improves communication between referring clinician and the Specialist? 1. Teleconference/telemedicine improves communication between referring clinician and the Specialist?

1 3 5

2. Teleconference/telemedicine reduces the amount of wait time for an appointment with a specialist.

1 3 5

1 3 5

3. Teleconference/telemedicine improves quality of care for otherwise difficult to treat patients.

1 3 5

4 T l di i / l f d h f i i li i 4. Telemedicine/teleconference made the process of seeing a specialist easier.

1 3 5

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Measurements of Success

Measurements of Success

Timeliness of care …

 Reduction in length of time before specialty consult is scheduled

 Reduction in patient grievances

Reduce trips out …

 Reduction in urgent visits out of DOC facilities

 Reduction in trips to LSH and other hospitals

 Increased community safety

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Coordination of care …

 Increase consultative care planning

 Improve communication between primary care provider and

consultative specialist consultative specialist

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References

References

Anogianakis, G., Ilonidis, G., Spyros, M., Anogeianaki, A., Vlachakis-Milliava, E. Developing Prism Telemedicine Systems: The Greek Experience

Developing Prism Telemedicine Systems: The Greek Experience J. Telemedicine and Telecare 2003; 9(Suppl. 2):S2:4-7

Bashshur, R.L., Reardon, T.G., Shannon, G.W. Telemedicine: A New Health Care Delivery System Annual Review Public Health 2000; 21:613-637 Bradley, J.

T l di i Telemedicine

Today’s Caregiver, 1995-2011 Broens, T.

Determinants of Successful Telemedicine Implementations: A Literature Study J. Telemedicine and Telecare 2007; 13:303-309

Broens, T., Grealish, A., Hunter, A., Glaze, R., Potter, L.

Telemedicine in a child and adolescent mental health service: participants’ acceptance and utilization J. Telemedicine and Telecare, 2005: 11(Suppl. 1):53-6

Fox, K.C., et. al.

Journal of Adolescent Health 41, 2007; 161-167 NCCHC

Position Statements: Use of Telemedicine Technology in Correctional Facilities, 1997gy , Wade, V., Karnon, J., Elshaug, A.G., Hiller, J.E.

A systematic review of economic analyses of telehealth services using real time video communication. BMC Health Services Research 2010; 10:233

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References

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