Redefining the Patient Care Experience

Transcription

1 Redefining the Patient Care Experience The Story of Global Telehealth Program February 29, 2016 Harun Rashid

2 Learning Objectives 1. Explain how telehealth can be used to appropriately bridge specialty care, avoiding unnecessary travel 2. Evaluate barriers and lessons learned allowing for optimal use of telehealth to supplement real-time international patient care 3. Examine how one health system has become self-learning in its use of telehealth leading to multiple healthcare efficiencies and creating a telehealth adoption model for others

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4 UPMC s Telehealth Evolution: Tele-Maternal Fetal Medicine Tele-Surgical Oncology/Breast Visits Tele-Infectious Disease Tele-Preoperative Evaluations Tele-Transplant Behavioral Health Tele-Transplant Nutritional Counseling Tele-Pediatric Tele-Dermatology Tele-Rounding Tele-Colon & Rectal Surgery (Pre & Post Op Visits) International e-icu (PEDS) Tele-Psychiatry 2007 Tele-Stroke Services 2012 Teleconsult Center launched UPMC Health Plan Employer On-site Svc. Tele-Physical Medicine & Rehabilitation On-line Virtual Visits 2015 Expansion of On-line Virtual Visits Consult center expansion Chronic Care Remote Monitoring 4

5 5 UPMC Telehealth - Growth

6 UPMC Telehealth Volume Change across Business Units FY 12 - FY 14 Volumes By Business Unit CHP CPS HP WPIC HS INT'L Sum of FY12 Volume Sum of FY13 Volume Sum of FY14 Volume

7 Top 20 Service Lines of FY16 YTD Through November Psychiatr y Anywher e Care: Convenie nce of Care Anywher e Care Visits (HP Members ) Employer On-Site Clinics Maternal Fetal Medicine Patholog y (KingMed - Internatio nal) Stroke CHP Cardiac Dermatol ICU ogy (Internati onal) CHP Cardiac Infectious Rheumat ICU Diseases ology (Domesti c) Remote TeleNew Monitorin born g -HH Endocrin e Surgery Series HP- Remote Monitorin g *AnywhereCare includes all UPMC AnywhereCare volumes, with AnywhereCare Visits (HP Members) being just the HP subset of volumes. Endocrin ology Diabetes Manage ment Heart Failure Wound Care Patholog y

8 UPMC Telehealth Fiscal Year over Year Summary *(FY15 Data is projected) $3,000, UPMC Telehealth Financial Impact (FY12 to FY15) $2,500, $2,000, $1,500, $1,992,844 17% $1,518,654 $2,417,542 9% $2,636,160 $1,000, $500, $- FY12 FY13 FY14 FY15 Insurance Payment $48, $96, $166, $292, Contractual $1,469, $1,896, $2,251, $2,343, Total $1,518, $1,992, $2,417, $2,636, UPMC Telehealth Program- Copyright 2015 NOT FOR DISTRIBUTION 8

9 Bridge specialty care, avoid unnecessary travel, reduce wait times, achieve great customer satisfaction..

10 UPMC Inpatient & Outpatient Telemedicine Services Outpatient Services Psychiatry Dermatology Preoperati ve Evaluation Center Mammogra ms Transplant Behavior Health 10 Inpatient Services Genetic Counseling (Breast Oncology) Maternal Fetal Medicine Surgical Oncology (Breast Consults) Transplan t Nutrition

11 Additional Telehealth Programs: Tele- SNF New Models Remote Monitoring International Reduce avoidable Hospitalizations ED transfers Increase efficiency Lower costs Increase quality Decrease Acute care costs Decrease Readmissions Enhance population health Tele-Surgical Mentoring Tele-ICU Tele-Pediatric Consults Tele-Pediatric ICU Services Enhancing High Quality Care Coordination 11

12 Remote Monitoring Algorithms/ Peripherals/Hub Cloud/Lifestyle Management Call Center/ Clinical Decision Support Pathways/Visiting Nurses/ Peripherals/Hub 2-way Communication Low High Out of the Box Passive/ Wearable Patient Self Capture/ Bluetooth (glucose, weight) Low Bandwidth (Phone) High Bandwidth (Video) In-patient (Pathways) (Visiting Nurse) 1 2

13 UPMC Teleconsult Centers New Models of Care Delivery Teleconsult Centers established across three rural locations to expand virtual, multi-specialty care to patients within their communities Integrating new technologies to achieve the goals of Triple Aim- Expanding patient access to high quality clinical care at a lower cost Improved Care Coordination Eliminating duplicate tests and unnecessary procedures Access to specialists Reduced travel time and cost Bringing timely treatments closer to home Over 1,476 TeleSpecialist visits completed High Patient Satisfaction- Average Scores- 4.8 out of 5 Physician access to medical history Improved quality of care High Provider Satisfaction 13

14 UPMC Teleconsult Center Overview Overall Survey Outcomes Cardiac Electrophysiology Colorectal Surgery (Pre and Post-operative consults) Dermatology Diabetes Management Endocrine Surgery Genetic Counseling Heart Failure Infectious Disease Inflammatory Bowel Disease Maternal Fetal Medicine MFM: Diabetes Education Management (Type I & II and Gestational) Neurology: Movement Disorders Neurology: Multiple Sclerosis 31 Telemedicine Specialty Service Lines Oncology: Breast Consultations Pediatrics Allergy and Asthma Pediatrics Gastroenterology Pediatrics Nutrition Plastics: Head and Neck Reconstruction Oncology Plastics: Breast Reconstruction Oncology Plastics: Hand Surgery Plastics: Post Weight Loss Pulmonary Reproductive Endocrinology and Infertility Rheumatology Sleep Disorder Evaluations (Restless Leg Syndrome) Vascular ,476 Completed Patient Visits Overall Patient Satisfaction Survey Outcomes 4.8 All Specialties Telemedicine Providers Rating Neurology: Follow-up Stroke Neurosurgery: Cranial Nerve and General Neurosurgery Neurosurgery: Neuro-Oncology 14 Voice Therapy Wound Evaluations

15 Total Number of Completed MFM Visits Snapshot of Tele-MFM Services: Northwest Bedford Hermitage Telemedicine 4 % Patients Who Would Have Forgone Care Northwest 30% Hermitage 35% TOTAL 990 Completed Patient Visits Total Trip Distance (Miles) Cost of Travel Expenses Time Spent Traveling Round Trip 411 (Dollars) (Hours) Total Saved: 183,561 $103,183 3,144 Average Saved: $ Ancillary MFM Services Completed at all Hospitals Total Charged Amount November 2012-December 2014 Number of Services Completed Total Charge Amount Location Northwest Teleconsult Center 599 $54, Bedford Teleconsult Center 30 $2, Hermitage Teleconsult Center 67 $8, Grand Total 688 $65,

16 UPMC Tele-Dermatology Inpatient Locations: UPMC Northwest UPMC Mercy UPMC McKeesport UPMC East UPMC Passavant Outpatient Locations: General Internal Medicine Oakland Office St. Margaret Family Health Centers Lawrenceville Bloomfield New Kensington Primary Health Network Titusville Family Practice Northwest Teleconsult Center Bedford Teleconsult Center 16

17 UPMC AnywhereCare Adult Symptoms Treated: Back pain Birth control Bronchitis Burn Cold Cold and flu Cough Diarrhea symptoms Flu Genital herpes Pink eye Pneumonia Poison ivy Rash Red eye Scabies Seasonal Shingles Sinus/cold Sinus infection allergies symptoms Sore throat Strep throat Urinary symptoms Vaginal irritation/discharge Pediatric Symptoms Treated: cold cough pink eye 17

18 UPMC AnywhereCare Visit Summary: AnywhereCare Convenience (24/7/365 On-Demand, Virtual Visits ) AnywhereCare Continuity (Established PCP evisit) UPMC AnywhereCare Cumulative Visit Report 11/04/13 01/31/15 Total Visits Submitted Total Adult Visits Submitted Total Pediatric Visits Submitted Clinically Inappropriate (NONEVISIT) Total Visits Completed 3,511 3, , Total 3,947 3, ,248 18

19 Complex offering - Telestroke Only 2-8% of stroke patients receive IV tpa Many hospitals don t have stroke protocols and have never treated a patient with tpa 64% of hospitals in US did not give IV tpa * Lack of available stroke specialist in rural hospitals major impediment to emergent treatment * Kleindorfer et al Stroke 2009

20 Teleneurology v. Telephone Telemedicine Telephone History First hand From local provider Exam First hand From local provider Consent Hub doctor Local team Triage for transfer Reliable Questionable Clinical trials Yes No

21 Telestroke Consult CT Call from ED IP over Internet Remote control of PTZ camera Hx, PE Consent tpa order BP Glucose Plt INR CT

22 Telestroke Consult Audebert et al. Cerebrovasc Dis 2005

23 Mobile Stroke Unit Ambulance Portable CT POC lab Telemedicine Teleradiology Rajan et al.jama Neurol 2014

24 UPMC Stroke Institute: IV tpa - PUH v. OSH transfers IV PUH IV OSH

25 UPMC Telestroke hospitals 10 UPMC, 11 non-upmc tpa treatment rate: 32% Transfers: 23% ME PS JR SM MK WS NW MV BV JM HR CR AR EA UN BR BD MG WM LT Consults tpa -730

26 UPMC International - Telemedicine

27 Global Health Partners CHINA India

28 Current State International Services 28 Tele-Health Consultation Telemedicine Offering Tele-Health Case Review Global Referrals MD to MD 2 nd Opinion Tele-monitoring Virtual Conference MD Training Nursing Training Technical Training (i.e. Ecmo) Academic Collaboration Research Collaboration Other training (i.e. Grand rounds, case review)

29 Tele-Monitoring Bucaramanga, Colombia Pittsburgh to Bucaramanga = 2335 miles

30 Components of Telehealth Program Bidirectional real time video and audio Protocols / order sets (if applicable) In service training (RN) Technical training (i.e. ECMO) Access to Radiology imaging Access to electronic health record Access to other diagnostic results People, Process, Technology

31 Challenges to Tele-medicine IT support Bandwidth Licensing / Credentialing / Liability Physician acceptance Patient acceptance Domestic and Foreign laws Equipment Language Cultural issues Time-zone Wearables Technology

32 Questions Harun Rashid Vice President University of Pittsburgh Medical Center