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Redefining the Patient Care Experience – The Story of Global Telehealth Program
February 29, 2016
Harun Rashid
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
UPMC’s Telehealth Evolution:
4
Tele-Stroke Services
Tele-Pediatric
Tele-Dermatology
Tele-Rounding
Tele-Colon & Rectal Surgery (Pre & Post Op Visits)
2012
Teleconsult Center launched
UPMC Health Plan Employer On-site Svc.
Tele-Physical Medicine & Rehabilitation
Tele-Maternal Fetal Medicine
Tele-Surgical Oncology/Breast Visits
Tele-Infectious Disease
Tele-Preoperative Evaluations
Tele-Transplant Behavioral Health
Tele-Transplant Nutritional Counseling
2013-2014
2015
Expansion of On-line
Virtual Visits
Consult center expansion
Chronic Care
Remote Monitoring
On-line Virtual Visits
2007
2008
2011
Tele-Psychiatry
International
e-ICU (PEDS)
2009
5
UPMC Telehealth - Growth
6
CHP CPS HP WPIC HS INT'L
Sum of FY12 Volume 917 0 766 2700 2074 118
Sum of FY13 Volume 971 385 1510 4047 2330 463
Sum of FY14 Volume 1096 609 2203 4029 4127 798
0
500
1000
1500
2000
2500
3000
3500
4000
4500FY 12 - FY 14 Volumes By Business Unit
UPMC Telehealth –Volume Change across Business Units
Psychiatry
Anywhere Care:
Convenience ofCare
Anywhere CareVisits(HP
Members)
EmployerOn-SiteClinics
MaternalFetal
Medicine
Pathology
(KingMed-
International)
Stroke
CHPCardiac
ICU(Internati
onal)
Dermatology
CHPCardiac
ICU(Domesti
c)
InfectiousDiseases
Rheumatology
RemoteMonitorin
g -HH
TeleNewborn
Endocrine Surgery
HP-Remote
Monitoring
Endocrinology
DiabetesManage
ment
HeartFailure
WoundCare
Pathology
Series1 1896 1882 1389 547 544 375 339 270 258 250 206 181 153 150 82 82 64 56 46 42
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Top 20 Service Lines of FY16 YTD Through November
*AnywhereCare includes all UPMC AnywhereCare volumes, with AnywhereCare Visits (HP Members) being just the HP subset of volumes.
UPMC Telehealth –Financial Impact (FY12 to FY15)
8
FY12 FY13 FY14 FY15
Insurance Payment $48,976.00 $96,378.00 $166,041.00 $292,290.00
Contractual $1,469,678.00 $1,896,466.00 $2,251,501.00 $2,343,870.00
Total $1,518,654.00 $1,992,844.00 $2,417,542.00 $2,636,160.00
$-
$500,000.00
$1,000,000.00
$1,500,000.00
$2,000,000.00
$2,500,000.00
$3,000,000.00
17%
9%
$1,992,844
$2,417,542 $2,636,160
$1,518,654
UPMC Telehealth Program- Copyright 2015
NOT FOR DISTRIBUTION
UPMC Telehealth Fiscal Year over Year Summary *(FY15 Data is projected)
Bridge specialty care, avoid unnecessary travel, reduce wait times, achieve great customer satisfaction ..
Dermatology Preoperati
ve Evaluation
Center
Transplant – Behavior
Health
Transplant –
Nutrition
Surgical Oncology
(Breast Consults)
Maternal Fetal
Medicine
Genetic Counseling
(Breast Oncology)
Mammograms
Psychiatry
10
UPMC Inpatient & Outpatient Telemedicine Services
Outpatient Services
Inpatient Services
Tele-SNF
Coordination
New Models
Enhancing Care
Remote Monitoring
International
High Quality
Additional Telehealth Programs:
11
• 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
Remote Monitoring
Hospital @Home
(Visiting Nurse)
In-patient(Pathways)
Out of the BoxPassive/
Wearable
Patient Self Capture/Bluetooth
(glucose, weight)
2-way Communication
Low Bandwidth(Phone)
High Bandwidth
(Video)
Low High
Pathways/Visiting Nurses/
Peripherals/Hub
Call Center/
Clinical Decision Support
Algorithms/ Peripherals/Hub
Cloud/Lifestyle Management
1
2
Access to specialists
Reduced travel time and cost
Bringing timely treatments
closer to home
Improved quality of care
Physician access to medical
history
Eliminating duplicate tests
and unnecessary procedures
Improved Care Coordination
UPMC Teleconsult Centers – New Models of Care Delivery
13
• 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”
• Over 1,476 TeleSpecialist visits
completed
• High Patient Satisfaction- Average
Scores- 4.8 out of 5
• High Provider Satisfaction
UPMC Teleconsult Center Overview
14
1,476 Completed
Patient Visits
31 Telemedicine Specialty Service Lines
Cardiac Electrophysiology
Oncology: Breast Consultations
Colorectal Surgery (Pre and Post-operative
consults)
Pediatrics Allergy and Asthma
Dermatology Pediatrics Gastroenterology
Diabetes Management Pediatrics Nutrition
Endocrine Surgery Plastics: Head and Neck Reconstruction
Oncology
Genetic Counseling Plastics: Breast Reconstruction Oncology
Heart Failure Plastics: Hand Surgery
Infectious Disease Plastics: Post Weight Loss
Inflammatory Bowel Disease Pulmonary
Maternal Fetal Medicine Reproductive Endocrinology and
Infertility
MFM: Diabetes Education Management
(Type I & II and Gestational)
Rheumatology
Neurology: Movement Disorders Sleep Disorder Evaluations (Restless Leg
Syndrome)
Neurology: Multiple Sclerosis Vascular
Neurology: Follow-up Stroke Voice Therapy
Neurosurgery: Cranial Nerve and General
Neurosurgery
Wound Evaluations
Neurosurgery: Neuro-Oncology
4.8
0
1
2
3
4
5
All SpecialtiesOver
all
Su
rvey
Ou
tcom
es
…
Telemedicine Providers
Overall Patient Satisfaction
Survey Outcomes
Rating
Snapshot of Tele-MFM Services:
1
5
345
10
56
0
50
100
150
200
250
300
350
400
Northwest Bedford Hermitage
To
tal
Nu
mb
er o
f C
om
ple
ted
MF
M V
isit
s
Telemedicine
4 %
Patients Who Would Have Forgone Care
Northwest 30%
Hermitage 35%
411
Total Trip
Distance
(Miles)
Cost of
Travel
Expenses
(Dollars)
Time Spent
Traveling
Round Trip
(Hours)
Total Saved: 183,561 $103,183 3,144
Average Saved: 446.6 $251.05 7.6
TOTAL
990 Completed Patient Visits
Ancillary MFM Services Completed at all Hospitals
Total Charged Amount
November 2012-December 2014
Location
Number of
Services
Completed
Total Charge
Amount
Northwest Teleconsult
Center 599 $54,718.76
Bedford Teleconsult
Center 30 $2,727.25
Hermitage Teleconsult
Center 67 $8,494.75
Grand Total 688 $65,940.75
UPMC Tele-Dermatology
16
Inpatient Locations: Outpatient Locations:
UPMC Northwest
UPMC Mercy
UPMC McKeesport
UPMC East
UPMC Passavant
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
UPMC AnywhereCare – www.upmcanywherecare.com
17
Adult Symptoms Treated:
Back pain Birth control Bronchitis Burn
Cold Cold and flu
symptoms
Cough Diarrhea
Flu Genital herpes Pink eye Pneumonia
Poison ivy Rash Red eye Scabies
Seasonal
allergies
Shingles Sinus/cold
symptoms
Sinus infection
Sore throat Strep throat Urinary
symptoms
Vaginal
irritation/discharge
Pediatric Symptoms Treated:
cold cough pink eye
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
AnywhereCare Convenience
(24/7/365 On-Demand,
Virtual Visits )
3,511 3,473 38 647 2,533
AnywhereCare Continuity
(Established PCP eVisit) 436 431 5 41 363
Total 3,947 3,904 43 688 3,248
UPMC AnywhereCare Visit Summary:
18
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
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
Telestroke Consult
IP over Internet Remote control of
PTZ camera – Hx, PE
BP
Glucose
Plt
INR
CT
CT
Consent
tPA order
Call from
ED
Telestroke Consult
Audebert et al. Cerebrovasc Dis 2005
Mobile Stroke Unit
• Ambulance
• Portable CT
• POC lab
• Telemedicine
• Teleradiology
Rajan et al.JAMA Neurol 2014
0
20
40
60
80
100
120
140
160
180
200
IV PUH IV OSH
UPMC Stroke Institute:
IV tPA - PUH v. OSH transfers
0
50
100
150
200
250
300
350
400
ME PS JR SM MK WS NW MV BV JM HR CR AR EA UN BR BD MG WM LT
Consults - 2247 tPA -730
UPMC Telestroke
• 21 hospitals – 10 UPMC, 11 non-UPMC
• tPA treatment rate: 32%
• Transfers: 23%
UPMC International - Telemedicine
Global Health Partners
CHINA
India
• Tele-Health Consultation
• Telemedicine Offering –
– Tele-Health Case Review – Global Referrals
– MD to MD 2nd 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)
Current State – International Services
28
Tele-Monitoring – Bucaramanga, Colombia
Pittsburgh to Bucaramanga = 2335 miles
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
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
Questions
• Harun Rashid
• Vice President
• University of Pittsburgh Medical Center
• 412-692-8001