telemedicine - moving beyond the video visit
TRANSCRIPT
TelemedicineMoving Beyond the Video Visit
Sponsored by HIMSS NY State Chapter
Recognizing our current sponsors:
Telemedicine is becoming a big business
Video Visit Companies
Each has raised over $50 Million in Venture Capital
Moving Beyond the Video VisitTelemedicine continues to become more accepted as a method for delivery of healthcare services.
Existing and new offerings are pushing the envelope in areas of technology and patient engagement.
This talk examines some exciting new developments and highlights some of the challenges faced by the HIMSS community in support of telemedicine.
Respondents indicated:
Consumer and patient considerations, such as patient engagement, satisfaction and quality of care would be the business issue that would most impact their organization.
26th Annual HIMSS Leadership Survey
Information technology (IT) seen as a tool that can support patient care, delivery and quality..
Their organizations engage either a physician or nursing leader in their organization’s IT process.
Telemedicine: Moving Beyond the Video Visit
Issues to be addressed in this webinar:
1. Business opportunity?
2. Patient considerations
3. Technical Challenges
4. Future Developments
Telemedicine: Moving Beyond the Video Visit
Mini case studies to highlight these issues:
Building a successful tele-dermatology business
Finding value in inner-city pediatric care
Addressing cervical care in developing countries
Addressing the palliative care shortage in the U.S.
Challenges of Data Driven Medicine & Deep Learning
Mark Seraly, physician/ entrepreneur was• Frustrated that in-office slots become rapidly
consumed by chronic repetitive case mix• Unable to offer both established and new patients
timely access to his services• Realizing he was “doing the work” but not being
compensated for care rendered outside of “face-to-face” contact
• Recognizing….”There is a better way!!!!”
Case 1: Building a successful tele-dermatology business
Source: iagnosis
Consultative
Tele-triage
Direct toPatientCare
FollowUp Care
TertiaryCare
Challenge: Choosing the right care model
Source: iagnosis
Connects a patient to a dermatologist through a patient portal Provides the dermatologist with all of the telemedicine tools to diagnose, treat, and counsel patients
Utilizes proprietary store and forward virtual office platform
Solution chosen among a number of options:
Source: iagnosis
100M annual skin care
visits
Dermatologyprojectedto grow to
$13.1b market by
2017
Increased melanoma cases year over year
as US population
ages
Increased access/self
referral, health
awareness & favorable
demographic trends
Longer than ever wait
times to see
dermatologists 3-6
months in most
markets for new patientsNet impact = Patients with common, non-urgent and acute
needs no longer have timely access to services.
Demand is Growing -> No Timely Access
Source: iagnosis
• Rapidly expanding network - DermatologistOnCall is currently in 23 states with over 100 providers
• Developing channels with strategic, national companies to drive patient access to specialty care
• Covered benefit with Highmark Jan. 2015 (5.3 million lives) in 3 states (PA, WV, and DE) - nation’s 5th largest carrier
• Customer satisfaction (98% enjoyed the experience and would refer friends and family)
• Coming soon to NY and NJ
Initial service is developing a successful business model
Source: iagnosis
Age 10 mo., dropped off at childcare, 7:30 this morning.
Wakening from naptime,temp 104. Tomorrow
Diagnosis: acute otitis media
Case 2: Finding value in inner city pediatric care
Source: U of Rochester
Child site Provider site
Video conference window -view at clinician site
Video conference window -view at child site
Secure internetconnection
Pediatric Carecomponents
Source: U of Rochester
Benefits
Usual Care
Child seen 4 hr laterFirst dose of medication 6 hr later
Benefits
Patient to Provider Telemedicine
Child seen nowFirst pain medication nowFirst antibiotic 1-2 hr later
Outcomes that Matter: Benefits are Greater
Source: U of Rochester
Cost
Usual Care
• Office , Urgent Care or ED exam room space
• Personnel costs: nurses and med-techs
• Parent misses ½ day of work• Transportation costs (?ambulance)• Parking cost• Payment for ED visit: $750
• Little or no cost for patient exam room space
• Patient-end equipment and connectivity
• No incremental cost for provider space or equipment
• Personnel costs: med-tech (telemed assistant) and scheduler
• No transportation or parking cost• Parent misses no work • Payment for telemed visit: $75
Cost
Patient to Provider Telemedicine
Outcomes that Matter: Costs are Smaller
Source: U of Rochester
In the 1930s, cervical cancer was the most common cause of cancer deaths in women in the United States.
Today it is not even one of the top ten in the United States.
The significant decline in both the incidence and mortality of cervical cancer is attributed to the Papanicolaou (Pap) test.
Fewer than 5% of women in underdeveloped countries have ever had a Pap test due to shortage of medical resources.
Some believe that the disease has reached an epidemic proportion
Case 3: Cervical cancer in underdeveloped countries
Source: U of Kansas
Pathologists
PathologistGynecologist
Cytotechnologist
Advanced staining Digital scanningCellblock
machinePap smear
Solution: TelePAPologytm
Source: U of Kansas
Case 4: Palliative care shortage in the U.S.
“An acute shortage of HPM physicians exists. The current capacity of fellowship programs is insufficient to fill the shortage. Changes in graduate medical education funding and structures are needed to foster the capacity to train sufficient numbers of HPM physicians.”
J Pain Symptom Manage 2010;40:899-911.
Source: ResolutionCare
ResolutionCare is a social enterprise that empowers primary care providers and patients with the confidence and tools to manage symptoms, share decisions, and anchor care coordination in the primary care practice.
Solution: ResolutionCare for End of Life Care
Source: ResolutionCare
●Provides access to specialty palliative care clinical services at home
●Includes a nimble interdisciplinary team
●Leverages innovative use of videoconferencing
●Follows value-based payment models
Resource Sharing A
greement
●Shares the same videoconferencing technology and interdisciplinary team
●Rigorously defined Resource Sharing Agreement
●A licensed affiliate/partner with the University of New Mexico’s Project ECHO model
ResolutionCare PC ResolutionCare Fund
ResolutionCare – Need to Insure Funding
Source: ResolutionCare
Case 5: Challenges of Data-Driven Medicine & Deep Learning
Requires the use of unstructured data, the most common type of medical data– such as radiology images, genome sequences, and pathology
Until now, data-driven approaches performed poorly, compared to humans. For instance, the use of Computer Aided Diagnostics in mammography has largely been a disappointment.
Source: Enlitic
Deep Learning has surpassed human capability in some types of unstructured data interpretation. This is after many decades of research and development into neural networks.
Solution: Deep Learning
Source: Enlitic
Since 2012 deep learning has achieved state of the art on image recognition, language translation, chemoinformatics, speech recognition.
Image Recognition accuracy has improved by nearly 10x, speed has increased by 10,000x.
human
Deep Learning has the ability to transform medicine
Source: Enlitic
Slash physician time
Increase diagnostic accuracy
Handle every kind of affliction, everywhere
Deep Learning advantages in medicine
In this case, IT drives the process rather than serving a supporting roleSource: Enlitic
Common Critical Success Factors
Believable business model to sustain the effort
Funding for initial efforts and sustained operation
Protected intellectual property
Major medical center participation
Dedicated team
Project champion
Heroes of Telemedicine
One common theme for each of these projects is the existence of a champion:
Kenneth M. McConnochie, MD, MPHUniversity of Rochester Medical Centers
Heroes of telemedicine – project champions
Osama Taawfiq MD, PhD, Professor at KUMC
Dr. Michael FratkinPresident & Founder
ResolutionCare
Mark Seraly, MDCMO and FounderIagnosis®/DermatologistOnCall®
Jeremy HowardFounder and CEOenlitic
More than half of all U.S. hospitals currently have a telemedicine program.1
The global telemedicine technologies market, including hardware, software, and services, was valued at $17.8 billion in 2014 and is predicted to grow at a compound annual growth rate of 18.4% from 2014 to 2020.2
There will be about 800,000 online consultations in the U.S. in 2015.3
Telemedicine makes up nearly one-fourth of the health IT market, which was valued at $15.6 billion in 2014 and is expected to increase to nearly $20 billion by 2019 with a compound annual growth rate of 4.8%.4
About 22% of employers with 1,000 or more employees currently offer telemedicine services, and another 37% of employers plan to offer telemedicine services to their employees by the end of this year.5
Recent TM Statistics Show Strong Growth
Telemedicine is Not a New Modality
Other projects providing opportunities and challenges
The Evolution of an Eye Clinic in El Salvador
International Second Opinions
Incorporating wearables and their data
What is the driving project for you?
What steps are you taking to make this successful?
RECAP: We Have Only Seen the Beginning
Footnotes
1. http://www.americantelemed.org/about-telemedicine/faqs#.Vco0MPlViko 2. http://www.researchandmarkets.com/research/qn3csn/global 3. http://medcitynews.com/2015/05/new-ata-president-tuckson-calls-telehealth-mainstream/ 4. http://www.prweb.com/releases/2015/05/prweb12736376.htm 5. http://www.towerswatson.com/en/Press/2014/08/current-telemedicine-technology-could-mean-big-savings