Washington, DC. Telemedicine and E-Health for Acute Care and Chronic Illness Management Seong K. Mun, PhD

Transcription

1 Washington, DC Telemedicine and E-Health for Acute Care and Chronic Illness Management Seong K. Mun, PhD 1

2 ISIS Center Technology Development Systems Integration Clinical Economics Research Policy Support Deployment and Operations 2

3 ISIS Center Refugee Health Global MRI Network: NGI Congestive Heart Failure: Home Diabetes Management at Home Diplomatic Telemedicine in Africa Telemedicine Demo in Russia Disaster Relief in Kenya Medical Education in Latin America: ACTS Renal Dialysis Center and Home Dialysis Rural Health: Kidney Stone Disease Post Spine Surgery Follow Up Telepathology, Tele-echocadiology Teleradiology: DEPRAD, Bosnia, Hungary, Germany PACS: Filmless Digital Hospital 3

4 ISIS Center Refugee Health Global MRI Network: NGI Congestive Heart Failure: Home Diabetes Management at Home Diplomatic Telemedicine in Africa Telemedicine Demo in Russia Disaster Relief in Kenya Medical Education in Latin America: ACTS Renal Dialysis Center and Home Dialysis Rural Health: Kidney Stone Disease Post Surgery Follow Up Support Telepathology, Tele-echocadiology Teleradiology: DEPRAD, Bosnia, Hungary, Germany PACS: Filmless Digital Hospital 4

5 BOSNIA Telemedicine Deployment Operation Prime Time Interactive Video Telemedicine Deployable Teleradiology December

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9 Expansion to Kuwait Engineering Technical Support Clinical Support Continental United States Bosnia Hungary Germany Kuwait US Air Force 9

10 Global Configuration State Department Disaster Assistance (Experimental) Washington, DC State Department Germany Walter Reed Army Medical Center Georgetown University Nairobi 10

11 State Department Network US Embassies in Africa Kenya Uganda Cameroon US Embassies in Americas Haiti Santo Domingo South Florida Regional Office 11

12 Integrated Common Workstation: Digital Imaging Systems CR, MR, CT, DR and Other Via DICOM Video Film Digitizer Information And Data Systems Document Scanner Stethascopes Headset Digital Video Camera Various Scopes 12

13 Examples Is telemedicine acceptable to physicians? Physician Focused Evaluation Clinical Acceptance Technology Validation

14 Urgent Care - ER Telemedicine Support Film Scanner ISDN Line 5 miles Urgent Care Clinic General Practitioner Technology: Excellent Utilization: Poor Lack of Operational Scenario Lack of Relationship Organizational or Professional Georgetown University Washington, DC ER Specialist 14

15 Kidney Stone Disease Telemedicine Consultation Existing Relationship Martinsburg City Hospital West Virginia Film Scanner Georgetown University Washington, DC ISDN Line 100 miles Urologists and Patients Kidney Stone Specialist One Year Trial Satisfactory Technology Reductions of Travels Improved Care Patient Satisfaction Physician Education 15

16 Spine Surgery Telemedicine Same Physician Scanned Digital Images Interactive Video Digital Still Photo Audio ISDN Line 250 miles Columbia University Medical Center New York City Georgetown University Washington, DC Dr.Riedle s Home in Virginia 16

17 General Assessment Acceptable Technology: High Bandwidth Demanding Logistics, TV Production High Costs: Tech, Ops, Staffing Technology Insertion Requires Appropriate Operational and Business Environment What can we do with cheaper capability? ( Tech, Ops, Staffing, Over all) 17

18 Acute Vs. Chronic Illness 25% - 30% Cost Diagnosis Demanding Treatment Focused Goal: Cure Defined Endpoint High Bandwidth: Fast Physician Driven 75%-70% Cost Diagnosis Known Treatment Known Goal: Manage & Prev. Manage the Illness Low Bandwidth: Slow Patient Orientation 18

19 Diabetes Statistics 15.7 million people in United States Total (direct and indirect) cost: $98 billion Early detection and proper treatment of diabetes can: prevent up to 90% of incidents of blindness reduce amputations by more than 50% reduce kidney disease and dialysis by over 50% 19

20 Preliminary Research Diabetes Control and Complications Trial patients with insulin-dependent DM reduced their risk of developing, or worsening, retinopathy, nephropathy, neuropathy by 50 75% when treated intensively United Kingdom Prospective Diabetes Study tight glycemic control & aggressive blood pressure management reduced the risk of complications 20

21 How Does Work? Glucose Meter Portable device Insulin Type and dosage. Stores 250 readings Data port Strip for blood droplet Data not used by physicians 21

22 Question? Can we use the glucometer data to improve the care of diabetic patients? 1. Collect and analyze using Internet 2. Present the results to patients and physicians 3. Allow diabetes personal medical record 4. Allow easier way to communicate 5. Promote healthier life style 22

23 Analysis Results Instructions Data, Questions Patient at Home or Work Physician at GUMC Weekly Down Load for Scheduled Interaction Automated Interaction 23

24 MyCareTeam Improves diabetes management by patients and practitioners Provides access to one s healthcare team between regularly scheduled clinic visits Encourages self-management and education of one s illness Promotes behavior modification towards improved compliance 24

25 MyCareTeam Functionality Daily blood glucose data Log book Graphs and charts Medications Insulin, oral meds, pump prescriptions Other medications Blood pressure readings Exercise logs Quarterly HbA1C and other laboratory results HbA1C: gold standard for long term outcome 25

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30 MyCareTeam Trial Specific Aims Achieve and maintain HbA1c of 7% Achieve and maintain mean BP of 130/85 Receive annual dilated eye exams Reduce hospitalizations & ER visits Reduce unscheduled outpatient care visits 30

31 MyCareTeam Trial Patient selection criteria HbA1c > 8.5 on 2 occasions w/in 12 months Diagnosed with Type 1 or 2 longer than 1 year Age > 18 years old Patient exclusion criteria Inability to read a CRT screen Unstable or active heart disease 31

32 Study Population 16 patients ranging in ages female and 6 male 7 patients with type 1 DM, 9 with type 2 3 month follow-up: 8 patients 32

33 Preliminary Results 75% of patients had a reduction in HbA1c Weight change over 3 months: 2 patient s increased significantly (>15 lbs) 2 patient s decreased slightly (3-8 lbs) 4 patient s increased slightly (1 7 lbs) Compliance with sending data 12 send data regularly 3 not connected / never sent data 1 sends data sporadically 33

34 Current Trials Georgetown Patients Veterans Medical Center in Boston Windber Medical Center in Pennsylvania Bethesda Navy Medical Center 7 American Indian Tribal Communities 34

35 Home Monitoring of CHF To develop a cost-effective care management program for Congestive Heart Failure Patients To demonstrate a 6%-7% reduction in overall cost. CMS currently spends $34,000 per year per patient Washington area Appraoch: Reduction of Hospitalization 35

36 Home Monitoring In-home monitors: weight, blood pressure, pulse, and oxygen saturation (pulse oximeter) Computer flags abnormal results for care manager to intervene, by phone or home visit. Internet-based tracking of all episodes of care 36

37 Technology Monitoring Center Daily Prompt Followed by Phone Call 37

38 Patient Enrollment 500 patients over a 3-4 year period Currently at 150 patients Daily Monitoring Certain Medication Benefits Home visiting nurses 50 patients per nurse Preliminary results very encouraging 38

39 Health Care Models H e a l t h CHF Diabetes Case Wellness Management Illness Management Age: Life Span 39

40 Lessons Health System s Apathy No reimbursement for physicians No business model to promote health No intellectual challenge Suspicious of intent of the project Do not want to be burdened by more papers 40

41 Medical System not Health System Developed to respond to acute care needs for cure of disease Poorly organized to manage long term chronic illness What is a patient to do? 41

42 Role of Technology Set of tools to be used Who should use it? What is the cost of it s use? Whose cost is it? How can a stand alone technology be integrated into routine healthcare system? There are many disconnects. 42

43 Consequence of Information Technology Intended vs. Un-intended Bureaucracy to Ad-hoc-cracy New Communication Pattern More Power to End Users More Responsibilities to the End Users Externalizing Labor Costs 43

44 Lessons from Industrial Models Craft Production Mass Production Managed Health Care Payer Centered Electronic Production Self Service Home Shopping Distributed Care Patient Centered Or Patient Burdened? Traditional Health Care Doctor Centered 44

45 In Closing Healthcare is a highly complex business of multiple competing processes Stand alone technology will not be useful Technology insertion requires proper business model Who will pay for the use of technology? 45

46 Role of Technology Quality Access Cost 46

47 Balancing and Competing Where does your technology fit? Charge More Spend Less Providers Physicians Hospitals Suppliers Patients More Benefits Payers Insurance Government Patients Pay Less 47

48 Thank you.

49 Balancing and Competing Where does your technology fit? Charge More Spend Less Providers Physicians Hospitals Suppliers Patients More Benefits Payers Patients Insurance Governments Pay Less 49