engaging the participant - telehospitalist program (innotech)
TRANSCRIPT
Ariel E. S. Lufkin, MD
what is a telehospitalist?
engaging the patient, engaging the providers
strategies + lessons learned
hospitalist: a physician who specializes in treating hospitalized patients7
tele- (prefix): at a distance.
telemedicine: the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.
In March of 2015 the Association of American Medical Colleges (AAMC) published an update to its 2008 report entitled“The Complexities of Physician Supply and Demand: Projections from 2013 to 2025”.
projected a shortage of 46,100 - 90,400 physicians by 20251
US population growth rates
aging of specific demographic groups
increased healthcare usage [Affordable Care Act]
Based on demographics, the care settings expected to face the greatest increases in demand were:
inpatient hospital days (+23%)
outpatient visits (+15%)
office visits (+14%)
ED visits (+12%)
The physician deficit expected to impact rural communities the most.
19% of the US reside in rural areas / 10% of US physicians serve these communities4.
Rural providers average 20% more office visits / work six more hours per week compared to their metropolitan counterparts2.
Rate of graduating residents choosing to practice in rural communities is declining.
two solutions that would likely make the greatest impact on the projected doctor shortage:
the increased use of advanced practice clinicians (APCs) [nurse practitioners / certified nurse specialists / physician assistants]
effective utilization of technology [health IT / advanced electronic health records / telemedicine]
Utilizing technology to decrease geographic barriers to care and increase physician bandwidth by optimizing the physician + APC working relationship.
oklahoma city
el reno
watonga guthrie
(61 miles)
(33 miles)
(34 miles)
local providers
hospital staff
new APCs and physicians
patients
strategy◦ putting a face to the program
◦ seeking feedback
lessons learned◦ re-defining what telemedicine can be
◦ becoming part of their treatment team
◦ a win-win relationship
I’m sick.I’m really sick.
strategy◦ input / feedback / adjusting / including
◦ in person visits
lessons learned◦ buy in essential
◦ adjusting workflow (nursing, CM, etc)
strategy◦ autonomy + team work
◦ locally grown
lessons learned◦ flexibility
◦ foundation of a strong program
◦ recruit the person
strategy◦ opportunity to pioneer
◦ providing for those in need
lessons learned◦ growing pains
◦ little exposure in residency
◦ a team sport
launched January 14, 2014.
3,900+ telemedicine visits, >1,100 patients.
age 18-106
keep it local
avoiding the transfer trickle down
patient first
1.) Dall et. al The Complexities of Physician Supply and Demand: Projections through 2025. Association of American Medical Colleges, March 2015.
2.) Jack M. Colwill and James M. Cultice. The Future Supply Of Family Physicians: Implications For Rural America.Health Affairs 22, no.1 (2003):190-198
3.) Fairbanks et. al. Oklahoma Health Workforce Data Book: 2014-2015. Oklahoma State Department of Health, Center for Health Innovation and Effectiveness / Office of Primary Care and Rural Health Development, 2015.
4.) Ewing, J. Closing the Gaps in the Rural Primary Care Workforce. The Rural Health Connection. National Conference of State Legislatures, August 2011.
5.) http://www.aha.org/research/policy/infographics/critialaccess-hospitals.shtml
6.) https://www.chausa.org/publications/catholic-health-world/article/january-15-2014/federal-rules-and-cuts-threaten-critical-access-hospitals'-viability-chi-executives-say
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Ariel E. S. Lufkin, MD
[email protected] / 813.843.9327
