A Brave New World for Telehealth and HIT

Dale C. Alverson, MD, FAAPMedical Director, Center for Telehealth and Cybermedicine

Research, University of New Mexico

CMIO, LCF Research

Albuquerque, New Mexico

Past President, American Telemedicine Association

March 20, 2013

Impacting Lives through Applied Technology

Objectives:

To understand the current and future potential for Telehealth and Health Information Technologies; regionally, nationally, and globally

To understand how Telehealth and Health Information Exchange (HIE) can be blended and complimentary as a part of healthcare transformation.

Health Care Reform/PPACA

Economic Downturn

Critical Shortage of Healthcare Providers

Emerging Enabling Information Communication Technologies

Need for more Access to Care

A Time for Telemedicine & HIT

An Aging Population/Baby Boomers

EHR Adoption/HIE

PCMH

ACOs

Meaningful Use

ICD10

Major Public Health Issues Impacting our Rural Communities and their Economic Development

Hepatitis C Behavioral Health Diabetes Asthma Cancer Oral Health Cardiac and

Stroke Care

Gaps in Access to Health Servicesin Rural New Mexico

Telehealth and Health Information Technologies

are Part of the Solution in Closing the Gaps

How is Telehealth used? Clinical: Consultation, Direct patient Care, Case

Reviews

Educational: Providers, Students, and Patients

Research: Community-based Participatory, Outcomes driven

Administrative: Strategic planning, Operations

Health Information Exchange

Enhanced Disaster Response

Telehealth NetworksRural/Remote Health Providers Can Access Expert Medical Opinions,

Knowledge, Education via Telehealth

Rural or Remote Location

Local HealthProvider

Patient

Specialty Medical Center

Medical Specialist

AudioHigh-Resolution Images & Video

Telehealth Network

ConsultationDirect Patient CareCase ReviewsEducationTrainingHealth Information ExchangeCommunity-Based Research

Student

“Back to the Future”

Case Reviews or Consultation

ECHO: Treatment Outcomes

Outcome ECHO UNMH P-value

N=261 N=146

Minority 68% 49% P<0.01

SVR (Cure) Genotype 1/4 50% 46% NS

SVR (Cure) Genotype 2/3 70% 71% NS

SVR=sustained viral response

NEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, et.al.

Direct Patient Care

Maternal Fetal Medicine-High Risk Pregnancy

“Store and Forward” Capturing an image and storing it to then be forwarded for

review by a medical specialists Examples include teleradiology, telepathology and

teledermatology, tele-ophthalmology (retinal scans) “Telemedicine” or HIE?/Large Data Files Need Broadband

Teleradiology and Image Transfer Web-Based Portals

Video Phone or “VOIP” with videoFamily Visitation

School Based Health Centers

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Telehealth assistants at the school or child care center provide the link to examine the eyes, ears, throat, lungs and skin.

Videoconferencing provides the “face to face” interaction.

Getting providers to think of their desktop computer as an exam room is the trick.

Trauma Triage

Moya M, Valdez J, Yonas H, Alverson DC. The Impact of a Telehealth Web-based Solution on and Consultation. Telemedicine and eHealth, 2010; 16:945-949 

44% Transfer Avoidance

27% Management Recommendation Changes

IRA HAYES Project – PTSD/TBI

Videophone (H.324)Skype

Software IP Based (H.323)

Desktop IP Based (H.323)

Small Conference Room IP Based (H.323)

Telehealth Toolkit

SaaS (SIP)

Hand Held Devices- “mHealth”

BlackBerry Treo/Palm

Smart Phones

iPhone

iPhone

Droid

Remote Monitoring

The “Smart Band-Aid”

Center for Telehealth and Cybermedicine Research

The Center for Telehealthat UNM Health Sciences Center:• Developing New Programs• Technical, Operational,

Business, and Evaluation Planning

The New Mexico Telehealth Alliance

Telehealth Alliance

Represents a consortium of public and private health care stakeholders: “Neutral Territory” (501c3)

Reflects the diversity of our

health care delivery system in New Mexico

Enables collaboration

“Networks of Networks” Providers

Consumers

Telehealth Expertise

Communication Networks

Social Networks

New Mexico Telehealth Act Passed and Signed into Law 2004

Introduced by Rep. Danice Picraux (D)Supported by Sen. Susan Wilson-Beffort (R)

HOUSE BILL 58146TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION 2004

http://legis.state.nm.us

Authorization Bill for Telehealth:• Covers interactive video and “Store and Forward”

technologies• Any Licensed Health Professional authorized to use• Covers any Originating Site Where Patient Located,

including place of residence• Authorizes/Encourages Use of and Reimbursement for

Telehealth(NM Medicaid has announced policies to reimburse for telehealth services)

New NM Legislation: SB 69/HB 171

Insurance Coverage for Telemedicine Services

An act relating to health care coverage; enacting sections of the health care purchasing act, the New Mexico insurance code, the health maintenance organization law and the nonprofit health care plan law to require coverage for telemedicine services; providing for utilization review and appeal rights for denials of telemedicine coverage.

"Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall include coverage of telemedicine Services. Coverage for health care services provided through telemedicine shall be determined in a manner consistent with coverage for health care services provided through in-person consultation."

SWTAG is a “Network of Networks”

The 4 “C’s”CooperationCoordinationCollaborationCommunication

http://www.americantelemed.org

American Telemedicine Association (ATA) and Telemedicine

Hitting the Target: “The Triple AIMS”

Improve Access

Improve Health

Reduce Costs

ATA and

Telemedicine

ATA

Health Information Exchange (HIE) Engagement and Encouraging Adoption

• An HIE Solution brings health information systems together across regions and states in order to provide access to a patient’s information in one centralized record.

• Multiple healthcare providers with access to the same record of clinical information will make healthcare delivery more robust and efficient with improved continuity, better outcomes, and reduced cost. There are significant benefits to patients, healthcare providers, payers and employers.

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Core HIE Functions

Provides access to a current patient summary from a variety of sources (From Where and When):

Problem List/Diagnosis Medications Immunizations Allergies Procedures Lab Data Radiology Data Encounter Summaries

Why the HIE is Accessed?

When and why a Provider needs to access the HIE:

New patient, not seen before Infrequent patient Patient known to have received care elsewhere Complex patient Tracking of patient Patient ER visits and

hospital stays EHR is unavailable Remote Access

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Value/Benefits of HIE

• Access to each patient’s health information from a variety of healthcare provider sources

• Improved situational awareness regarding patient’s health and use of health systems, better coordination of care

• Better triage and evaluation capability: Dx/Problem

list, prior procedures, Rx/Medications, Allergies, tests; lab/x-ray, progress note and summaries

• Improved efficiency in making diagnosis and management plans

• Decrease unnecessary duplication of tests• Readmission avoidance• Other Benefits : Data Analytics, Public Health, PCMH,

ACO

Cloud Based

Solution: Core HIE – High Level

Web-based access to the longitudinal patient record

• Demographics• Labs, Rads• Encounters• Allergies• Diagnosis• Transcribed documents• Medications• Problems• Procedures• Immunizations

Direct Secure MessagingPatient Privacy & Consent

HIE Platform

PhysiciansPrivacy Officers

Notifications & Subscriptions

E-Mail

Secure Inbox

Mobile

Clinic with EMR

Hospital with EMR

Other HIEs

HL7/CCD, XDS, SSO

Seamless integration with EHRs• User Subscribed Notifications• Send to My EHR• Portal embedded within EHR

HTTPS

Health InformationExchange (HIE)

Example Integration (Epic)

Example Integration (Cerner)

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T or C

HITREC sites(random sample of sites)

Established HIE connectivity

Future HIE connectivity (random sample of sites)

The HIE in New Mexico

Santa Fe

Albuquerque

Taos

Raton

Farmington

Silver City

Carlsbad

Roswell

Alamogordo

LasCruces

Deming

Santa Anna

Clovis

Portales

Lovington

Hobbs

Las Vegas

GrantsGallup

ClaytonLos

Alamos

Navajo Nation

El Paso

SSA

VAClayton

Tucumcari

Socorro

Magdalena

Los Lunas

Belen

Ruidoso

Cuba

Amarillo

Lubbock

International Telemedicine and eHealth: Transforming Systems of Care in the Global Community

Reasons to do International TelehealthMost health issues are global!

H1N1

H5N1

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Distributed Medical Intelligence

• Knowledge Sharing Networks/Just in Time/On Demand

• Best Practices

• Evidence based

International Union

Against TB

La Lancha Medica en la Amazonia

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Exchange of Students and Faculty

Opportunities

Blending HIE with “Telehealth”Integration with Mobile DevicesFacilitation of research, data analytics,

quality reporting, and other aggregate usesHitting the Triple AimsBecoming a Standard of CareFostering ChampionsDeveloping a National and International

Network of Networks

Navigating the Perfect Storm with Telemedicine & HIT

Use a broad spectrum of information communication technologies

Effective distribution of limited resources and expertise

Increasing Access to care

Bringing care to the patient; Aging in place

Decreasing unnecessary variations in care; evidence-based best practices

Improving continuity and coordination of care;The Patient Centered Medical Home

Improving health outcomes

Avoiding unnecessary hospitalizations, duplication of tests, & decreasing errors

Reducing costs; avoiding more costly care and complications, decreasing travel

Questions?

http://hsc.unm.edu/som/telehealth

http://www.lcfresearch.org/