Lawrence Wechsler, M.D.

Vice President for Telemedicine, UPMC Physician Services Division

Professor and Chair, Department of NeurologyUniversity of Pittsburgh Medical School

Telehealth: Transformational opportunities for academic medical centers in workforce, clinical care, teaching, research, innovation and public service

• $9 billion in revenue • 20 hospitals operating over 4,200

beds; 187,000 admissions per year• 4.5 million outpatient admissions;

750,000 emergency visits per year• 1.5 million UPMC Health Plan

members • More than 400 outpatient locations• 54,000 employees; 2,700 employed

physicians• $1.3 billion invested in IT over past 5

years

UPMC Background

• Addresses an unmet clinical need

• Enhances physician productivity

• Extend high quality care to regions/communities in need

Telehealth: Why do we need it?

Regional Hospital Affiliations

120 MILES

60 MILES

I 79I 79

I 76

I 90

I 70I 70/I 76

I 70

30 MILES

I 80

I 80

WASHINGTONALLEGANYGARRETT

ALLEGHENY

MERCER

CRAWFORD

VENANGO

FAYETTE

BEDFORD

SOMERSET

LAWRENCE

WESTMORELAND

GREENE

WARREN

JEFFERSON

CLEARFIELD

BLAIRHUNTINGDON

CAMERON

ERIE

BUTLER

ARMSTRONG

ELK

CLARION

INDIANA

CENTRE

MCKEAN

PRESTONMONONGALIA

BR

OO

KE

OHIO

HA

NC

OC

KMARSHALL

MORGAN

JEFFERSON

MAHONING

COLUMBIANAPennsylvaniaPennsylvaniaPennsylvaniaPennsylvaniaPennsylvaniaPennsylvaniaPennsylvaniaPennsylvaniaPennsylvania

MarylandMarylandMarylandMarylandMarylandMarylandMarylandMarylandMarylandWest VirginiaWest VirginiaWest VirginiaWest VirginiaWest VirginiaWest VirginiaWest VirginiaWest VirginiaWest Virginia

OhioOhioOhioOhioOhioOhioOhioOhioOhio

Mercy Jeannette

Southwest Regional

Sharon

Grove City Med Ctr

Uniontown

Somerset

Med Ctr Beaver

Ellwood City

WestmorelandConemaugh LeeConemaugh MainLatrobe

FrickMon Valley Windber

Brookville

Bon SecoursAltoona

St VincentMillcreek

Elk

Titusville

Hamot

UPMC Bedford

UPMC Passavant CranberryBEAVER

CAMBRIA

FOREST

POTTER

WASHINGTON

MARIONWETZEL

ASHTABULA

TRUMBULL

Butler

Dubois

Washington

Highlands

Meadville

Armstrong

Bradford

Clarion

ClearfieldJameson - NorthPunxsutawney

Warren

Canonsburg

Mt. Nittany

Charles Cole

Corry

Indiana

J C Blair

Kane

Meyersdale

Miners

Nason

Jameson - South

Tyrone

UPMC Northwest

UPMC Horizon - Shenango

UPMC Horizon - Greenville

I 79

US 22/30

I 279I 79

PA 60

I 76

PA 2

8

ALLEGHENY COUNTY

Forbes

Alle-Kiski

UPMC Mercy

Ohio Valley West Penn

Suburban

AGH

St Clair

Jefferson

Sewickley Valley

Magee-Womens Hospital of UPMC

CHP

UPMC PresbyterianUPMC Shadyside

UPMC St. Margaret

UPMC McKeesport

UPMC Passavant

UPMC PSD Telemedicine Locations

Competitor Hospitals

13 UPMC Hospitals

• EHR• HIE• ED staffing• Hospitalists• Revenue cycle• Administrative

support• Telemedicine

UPMC PSD Telemedicine Activities

• Telestroke• Teledermatology• Teleconsults• Telewound care• TeleICU• Teleophthalmology• Telecardiology• Pre and post-surgical

care

• Telepsychiatry• Telepathology• Teleradiology• TeleMFM• TeleEndocrine• TeleTrauma• TelePediatrics• eVisits

16 Service Lines19 Facilities in WPA3 International Sites

• Unmet need for stroke expertise at small rural hospitals

• 2-8% of stroke patients treated with IV tPA

• 64% of hospitals did not treat with tPA over 2 years *

Telestroke

Audebert et al. Cerebrovasc Dis 2005

* Kleindorfer et al. Stroke 2009

UPMC Stroke Institute:IV tPA - PUH v. Outside Hospital Transfers

0

20

40

60

80

100

120

140

160

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

# Pts

IV PUH IV OSH

Passavant St. Margarets McKeesport Northwest Horizon – Greenville Horizon – Shenango Bedford Cranberry Magee Mercy

Mon Valley Jefferson Meritus - MD Washington Hosp Jameson Heritage Valley - Beaver

UPMC Stroke Institute Telemedicine Sites 2011

UPMC Non - UPMC

0

20

40

60

80

100

120

140

160

180

200

PAS MCK SMH MER JEFFWASH NW MVH CRN HOR BRD BED MGE

Consults -1005 tPA -275

Telestroke By Hospital

Consults by Hospital 2007-2011

Telestroke Metrics and Outcomes

Results – (N=239)

90 day Outcomes - (N=183)

0 20 40 60 80 100 120 140 160

Sx Hem

OTT < 90 Min

OTT < 2 Hrs

Door to Rx

Onset to Rx

Median NIHSS

0 10 20 30 40 50 60

Sx Hem

Asx Hem

mRS 0-2

mRS 0-1

Mean NIHSS

UPMC NINDS

11

141 min

83 min

38%

9%

3%

1214

41%39%

45%48%

10%5%

2%6%

Telestroke v. Stroke Center tPA Patients 90 day Outcomes

90-Day Clinical Outcomes

8.9

17.1

14.3

21.1

14.3

4

8.9

11.8

14.3

7.9

8.9

6.6

30.4

31.6

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

STROKE CENTER(N=56)

TELESTROKE (N=76)

90 Day Modified Rankin Scores

mRS 0 mRS 1 mRS 2 mRS 3 mRS 4 mRS 5 mRS 6

Zaidi et al. Stroke 2011

TPA Use Before and After Telestroke: All UPMC Hospitals

2.9%

5.5%5.4%

7.2%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

% strokes Rx with tPA % strokes within 3 hrs

Before

After

1235 Pts Before 2175 Pts After

Elements of Telestroke Program

• Bidirectional real time video and audio

• Protocols / order sets• In service training• Stroke team• Community education• EMS awareness

• Grants• Government• Insurance reimbursement• Contractual arrangements• Subsidies from insurers or

hospitals• Self-pay

How Do We Pay for Telehealth?

Telemedicine Platform – UPMC and ALU