The Role of Technology in Community Engagement

Tom Nesbitt, MD, MPHExecutive Associate DeanClinical and Administrative AffairsUC Davis Health System

Chancellor’s Fall RetreatSept 17, 2007

Overview of presentation

Rationale for the use of technology in the Health System’s community engagement activities

Define and describe telemedicine Impact of this program on current and

future academic activities One faculty member’s story

Shortages in Rural California

There is a shortage of physicians statewide

Nearly 200 California communities are located in the 109 rural health professional shortage areas

Rural areas often lack access to the full spectrum of health services

Many generalists will not practice in areas without specialty back-up

The University has significant expertise and resources that potentially address some of these issues

California’s Health Care Expertise State-of-the-Art, Yet Unavailable to

Millions

There is an explosion of new knowledge and

information that is ironically creating even greater disparities in

access to state-of-the-art health care

The Role of Technology

Advances in telecommunications and

information technologies can help overcome some

of these disparities by helping to redistribute

knowledge and expertise

Telemedicine

Interactive health care over distance using information or telecommunications technology

Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient

Telemedicine Improves Access to Expertise

UC Davis Telemedicine Services

Pediatric Critical Care Pediatric Sexual Abuse QA OB/GYN Pediatric Cardiology Surgical Oncology Allergy Occupational Medicine Child Development Burn Genetics Transplant Urology Pediatric Rheumatology Pulmonary Plastic Surgery Pediatric PM&R Podiatry Hematology Pediatric Urology Pediatric Gastroenterology Oncology Pediatric Hematology/Oncology

Surgery Cardiology Pediatric Endocrinology Pediatric Nephrology Gastroenterology Infectious Diseases Pediatric Neurology Pain Management Pediatric Genetics Nephrology Psychology Rheumatology Neurology Hepatology Otolaryngology Pediatric Obesity Orthopaedics Nutrition Endrocrinology Psychiatry Dermatology

Other Applications

Real-time emergency care

In-patient ICU and infectious disease consultation

Tele-pharmacy Tele-interpreting Diabetic retinal

screening

Remote Telepharmacy funded by California HealthCare Foundation

Telemedicine Training

Telemedicine Learning Center funded by The California Endowment

Organizations trained by the TLC 569Attendees 1,200Sessions at the UC Davis TLC 35Sessions off-campus 14

Makeup of Attendees:Clinical/Technical staff (59%)MDs (14%)Nursing (16%)Executives (11%)

Other states: AZ, FL, HI, IN, MA, MI, MO, NE, NY, OH, OR, TX, DC, WA

Other countries: Brazil, Mexico, Nigeria, Saipan

Telemedicine Learning Center at UC Davis

April 2007

UC Davis Telemedicine Programs Supported by Foundations in California

Sierra Health Foundation 1990-1992, Access to Prenatal Care in Northern California ($100,000) 1996-1998, Improving Access to Care in Rural Northern California ($500,000)

California HealthCare Foundation 2002-2004, Pediatric Telemedicine Outreach to Rural Underserved Emergency Departments

($290,000) 2005-2006, Pharmacy Consultation for Rural Hospitals ($400,000)

The California Endowment and California Telehealth and e-Health Center 1999- 2006, Telemedicine Learning Center ($2,000,000) 2003-2004, Telehealth via Portable Satellite Terminal: Conquering the Geographic and

Telecommunication Barriers ($250,000) 2004-2005, e-mental Health ($250,000)

William Randolph Hearst Foundation 1999-2005, The Northern California Rural Telemedicine Program for the Acutely Ill and Injured Child

(Rural Child Abuse and Pediatric Emergency Medicine) ($350,000) 2005-2007, Using Telemedicine to Provide Inpatient Pediatric Consultations ($250,000)

Children’s Miracle Network Pediatric Telemedicine for PICU care ($25,000)

Blue Shield of California Foundation 2007-2009, Store & Forward Telepsychiatry: A Cross Cultural Validation Study in Rural California

($500,000)

Robert Wood Johnson Foundation 2000-2004, Palliative Care in Assisted Living ($960,000)

Benefits for Research and Education

Greater than $40 million grants and contracts since 1997 Researchers

40 faculty members 15 have made telemedicine

a substantial part of their research 36 staff members

TM is a component of other UC initiatives Clinical Translational Science Center Betty Irene Moore School of Nursing Center for IT Research in the Interest of Society

Pediatric ER sites funded by California HealthCare Foundation

State Funding for Telehealth Nearly $500M currently

available state-wide $200 million to five

University of California medical schools to leverage telemedicine technology $36 million to UC Davis for

major new facility, statewide leadership role

$10 million for statewide community partners for technology for clinical TM and training medical students

Teleophthalmology with support from The California Endowment

California’s Proposition 1D Passes

“With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California.”

Governor Arnold Schwarzenegger  10/27/2006 UC Davis Pediatric Telehealth Colloquium

UC Davis Pediatric Telehealth Colloquium funded in part by William Randolph Hearst Foundation

A new model of collaboration through partnership in education,

research, and clinical expertise using Advanced Information and telecommunications Technologies

The Future: Rural Centers of Excellence

Education Research

Clinical

RURAL CENTER OF

EXCELLENCE

Summary

California is in the midst of a major transformation in the way that rural health care is delivered and rural physicians are trained

Technology and outreach are key elements in this transformation

Innovative models of community engagement by the University using technology played an essential role in setting the directions for this transformation

TM and the UCD TM network have contributed to other system-wide activities in the Health System