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Integrating Telemedicine into
Fellowship ProgramsJennifer Shih, MD, FAAP
Assistant Professor Emory University
Medical Director Allergy and Immunology Clinics
Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep
Department of Pediatrics and Medicine
Atlanta, GA
Presenter Disclosures
Advisory Board Takeda
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Objectives
• The learner will be able to define telemedicine
and the different types.
• The learner will be able to describe a
telemedicine visit.
• The learner will be able to describe how
telemedicine can be incorporated into their
trainees’ education.
Why telemedicine for trainees?
“Trainees will receive comprehensive education
in a complete curriculum encompassing clinical
allergy, clinical immunology, basic allergy and
immunology sciences, research design and
methodology, professionalism, ethics and
quality improvement”
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Why telemedicine for trainees?
• “Trainees will receive comprehensive education in a complete curriculum encompassing clinical allergy, clinical immunology, basic allergy and immunology sciences, research design and methodology, professionalism, ethics and quality improvement”
• Prepare them for all aspect of medical care in their career
• Maintain relevance for our field
• Diversify patient populations for training (rural, urban, school, nursing home)
Specialists whose practices are using telemedicine the
least to interact with patients are:
• Allergists/immunologists—6.1 percent.
• Gastroenterologists—7.9 percent.
• Ob-gyns—9.3 percent.
Jan 2019
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U.S. Market Size (ATA)
>50%More than half of U.S. hospitals now
use telemedicine applications
230telemedicine networks
>3,800U.S. service sites
Over 1 Million Americans are currently using remote
cardiac monitors
Growth of Telemedicine Globally
$55.1 billion
2021 Market Size --BCC Research, 2013
$23.8 billion
2016 Market Size
B1
Slide 10
B1 Reference for this slide:
http://www.bccresearch.com/market-research/healthcare/telemedicine-technologies-global-markets-hlc014e.html
Lew, 4/18/2014
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How Prevalent is Telemedicine?
90% of healthcare executives
say their organizations are
developing or already have a
telehealth application.
MedCity News
48 states require payers to cover telehealth
Center for Connected Health Policy
Patient Perspective
65% of patients with a primary care provider would
be willing to see them through a telehealth visit.
Healthcare IT News
50 million Americans would be willing to switch their
family practice provider to have access to a video visit.
Healthcare IT News
Majority of consumers are comfortable having their private patient records in
the cloud.Cisco
~ 60% of patients aged >65 willing to manage a chronic condition with a telehealth
visit.Healthcare IT News
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Telemedicine
• “Distance healing“
• Derived from a Greek word "Tele" meaning
"distance" and a Latin word "mederi"
meaning "to heal“
Telemedicine:
the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.
Telehealth:
refers to a broader scope of remote healthcare services than telemedicine; telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Mhealth:
mobile-based or mobile-enhanced solutions that deliver health.
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Telemedicine
Asynchronous Synchronous
Non-Facilitated
Facilitated
Asynchronous (Store and Forward)• Acquire medical data (medical images, etc) �
transmit data to doctor at a convenient time for assessment OFFLINE (not in real time)
• Does not require presence of both parties at the same time
• Dermatology, pathology and teleradiology (store-and-forward images)
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Synchronous (Real time)
• As simple as a telephone call
or as complex as robotic
surgery.
• Requires the presence of both
parties at the same time.
• Video-conferencing equipment
• Peripheral devices can be
attached to computers or the
video-conferencing equipment
to aid in an interactive
examination.
Sitecall.com
Non-Facilitated (Direct to Consumer)
• Synchronous, involving real-time two way
video conferencing
• Generally initiated on demand by the patient
• Audio-only encounters
• May not involve a physical exam
• Direct payment, insurance not involved
Healthcareitnews.com
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Facilitated
• Synchronous, involving real-time two way video conferencing
• Scheduled visits with a facilitator at the originating site
• Designated sites may be required such as with CMS
• Physical exam required
• Bill to insurance with EM code plus modifier/site
Southwesttrc.org
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How to integrate telemedicine into
your program?
• Outpatient clinic
– Schedule for the fellow
• Integrated throughout the day
• Designated day
– New vs Established
– Immunology vs Allergy
– IT, OIT, biologic checks
• 10yo severe persistent asthmatic
• Intubated 3 times
• Risk of death
• Poorly controlled asthma
• Poor compliance
• Misses severe asthma clinic appointments
• Insurance=Medacaid
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4.5 hours
https://www.omicsgroup.org/articles-admin/disease-images/egg-allergy-58113.jpg
Originating Site
Where the patient is located
Distant Site
Where the remote
provider is located
The Visit
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https://www.omicsgroup.org/articles-admin/disease-images/egg-allergy-58113.jpg
Originating Site
Where the patient is located
Distant Site
Where the remote
provider is located
The Visit
• Improved Access
• Improved Control
• Improved Compliance
• Improved once a month
telemedicine clinic visits
• Decreased exacerbations
• Plays basketball
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Wi-Fi Smart Scale Otoscope Blood Pressure Monitor
Bluetooth Stethoscope
Blood Glucose Meter
Digital Thermometer
Peripherals
EKG
Dermatoscope Spirometer Camera
UltrasoundBody Fat Analyzer
How to integrate telemedicine into
your program?
• Inpatient Consults
– New vs follow up
– MD to MD or patient to MD on call
– Webside vs bedside manner
– Consent placed in patient hospital chart
– Who is the facilitator if needed
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Penicillin Testing
-JACI in Practice, online access May 2018
-46 PST-negative patients, 33 were transitioned to a B-lactam
-> $30,000 was saved throughout the study period.
How to integrate telemedicine into
your program?
• Education and Long Distance Learning
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Visits at CHOA/Emory
The nation will be short 130,000 MD’s by 2025
-Association of American Medical Colleges
With ~5000 allergists
telemedicine offers the
opportunity to provide
scalable, high quality care
for patients(AI workfoce report)
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Checklist
• Team- administration, nurse, MA, IT
• Orientation
• Consents
• Documentation
• Webside vs Bedside manner
• Billing
• Tip Sheets for trouble shooting
Security
• HIPAA compliant
• BAA
• Fully encrypted data transmission
• Peer-to-peer secure network connections
• No storage of video
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Key points
• Patients want
convenience
• Telemedicine is here
• There is great potential
for our field
• Ultimately preparing our
trainees for the big real
world.
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Telemedicine Toolkit:
Center for connected health policy
(https://www.cchpca.org/telehealth-
policy/current-state-laws-and-reimbursement-
policies) interactive map of policies by state
Thank you!
Jetsons, season 1 ep 10, 1962
http://www.americantelemed.org/homehttp://www.americantelemed.org/home
https://evisit.com/state-telemedicine-policy/
https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies?jurisdiction=All&category=128&topic=All
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