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3/4/2019
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Telemedicine Applications (Part 2):“Advanced” Applications
Ronald S. Weinstein, MDDirector, Arizona Telemedicine Program
Telemedicine & Telehealth Services
1. Gap Services2. Urgent Services3. Mandatory Serivces
4. Mobile Telehealth5. Direct-to-Consumer Telehealth
6. Cloud Computing Applications
3/4/2019
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https://ihealthlabs.com/wireless‐scales/ihealth‐core/
Images intended as examples of technology and not as an endorsement of companies or products.
“Care Beyond Walls and Wires is the best thing ever for me, and the best thing for my
dad.”
Rita Yazzie
Case Study
Mobile Telehealth
3/4/2019
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“Care Beyond Walls and Wires”T-Health Institute, Phoenix
January 24, 2018
Congresswoman Kyrsten Sinema,U.S. Representative, Arizona’s 9th Congressional District
http://patientengagementhit.com/features/how‐mhealth‐technology‐supports‐patient‐engagement‐strategies
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Connected Health/Mobile Health
Telemedicine & Telehealth Services
1. Gap Services2. Urgent Services3. Mandatory Services
4. Mobile Telehealth5. Direct-to-Consumer Telehealth
6. Cloud Computing Applications
3/4/2019
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Tucson Daily StarJanuary 6, 2019
• GET GREAT CARE YOU NEED• Cold & flu symptoms• Allergies• Pink eye• Ear infections• Respiratory infection• Sinus problems• Skin problems• … and more
Tucson Daily StarFebruary 24, 2019
3/4/2019
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Flagstaff, AZTucson, AZ
3/4/2019
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Direct-to-Consumer Telehealth
https://www.youtube.com/watch?v=gnVmHZRSOnQ
United HealthCare Virtual Visits
(Single Click on the link)
Direct-to-Consumer Telemedicine
https://www.youtube.com/watch?v=sBryMAxi5tE
American Well
3/4/2019
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1850
0
500
1,000
2,000
2,500
3,000
3,500
4,000
1,500
1880 1910 1940 1970 2000
Managers
Technicians
Therapists
Aides
LPNs
RNs
Pharmacists
Dentists
NPCs
Physicians
Physicians, Non‐physician Clinicians,and other Health Workers
1850‐2010
Health
Employm
ent per
100,000ofPo
pulation
Adapted from Kendix and Getzen, and the Bureau of Labor Statistics
FlexnerReport
HillBurton
Medicare
1850
0
500
1,000
2,000
2,500
3,000
3,500
4,000
1,500
1880 1910 1940 1970 2000
Managers
Technicians
Therapists
Aides
LPNs
RNs
Pharmacists
Dentists
NPCs
Physicians
Physicians, Non‐physician Clinicians,and other Health Workers
1850‐2010
Health
Employm
ent per
100,000ofPo
pulation
Adapted from Kendix and Getzen, and the Bureau of Labor Statistics
HillBurton
3/4/2019
9
Telemedicine & Telehealth Services
1. Gap Services2. Urgent Services3. Mandatory Services
4. Mobile Telehealth5. Direct-to-Consumer Telehealth
6. Cloud Computing Applications
Telemedicine & Telehealth Services
1. Gap Services2. Urgent Services3. Mandatory Services
4. Mobile Telehealth5. Direct-to-Consumer Telehealth
6. Cloud Computing Applications
3/4/2019
10
Project ECHO Programs(Extension for Community Healthcare Outcomes)
Why Project ECHO?
121,697 square miles
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Arizona TelemedicineProgram
ATP Rheumatology TeleECHO Clinic
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ECHO TeleRheumatology Clinic
ECHO TeleRheumatology Clinic
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Physicians in Bisbee, AZ Attending from a rural hospital conference room
Federal Grants for Telehealth Research
PCORI Program (2010-2017)(Patient-Centered Outcomes Research Institute)
61 Telehealth Grants$221 Million Dollars
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PCORI Programs(Patient-Centered Outcomes Research Institute)
EXAMPLE
“Ostomy Telehealth for Cancer Survivors: A Program of Collaborative Research”
Robert Krouse, M.D., FACS, Principal Investigator
Ostomy Surgery
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Session/Content
• Session 1: Self-management & immediate
concerns
• Nutrition
• Pouching System
• Goals/Resources
• Session 2: Social well-being and body image
• Social/Interpersonal relationship
• Sexuality/Intimacy
• Psychological Health
• Session 3: Caregiver/Support Person only
• Ostomy review
• Concerns regarding ostomates
• Caregiver/Support person well-being
• Session 4: Healthy Lifestyle
• Interpersonal Relationships
• Travel Concerns
• Physical Activity
• Improving Attitudes
• Psychological Health
• Session 5: Booster session for ostomateand support person
• Content Review
• Available Resources
• Goal Progress
Ostomy Self-Management Clinical Research Sites
City of HopeUniversity of Arizona & Arizona Telemedicine Program
Penn Medicine
Yale New Haven
3/4/2019
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Telehealth Resource Center Network
Kris, please add latest National TRC map
Health Resources and Services Administration - HRSA
In-Person Model
Telehealth Model
• “PCORI Peers”
• Personal Engineers
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Cloud Computing -- Staff Meeting for PCORI Grant
© 2018, Arizona Telemedicine Program
Cloud Computing -- Staff Meeting
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Telemedicine & Telehealth Services
1. Gap Services2. Urgent Services3. Mandatory Services4. Mobile Telehealth5. Direct-to-Consumer Telehealth6. Cloud Computing Applications
Service Providers
1. Home-based
2. Virtual medical centers
© 2018, Arizona Telemedicine Program
3/4/2019
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© 2019, Arizona Telemedicine Program
Photo – Ostomate Peer at Home
Mayo Acute Care Telemedicine
• 60 originating sites• Command & Control Center• ~3000 activations per year
• Tele Stroke
• Tele Neonatology
• Tele Emergency Medicine
• Tele Behavioral Health
©2012 MFMER | 3288990-38
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Presented to:Arizona Telemedicine Council
AZ State CapitalPhoenix, AZ
April 19, 2017
Mayo Acute Care Telemedicine
Banner University Medical Center -- Tucson
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-- Emergency Medicine Telehealth Center –-
41
eCareMobile
Correctional Facility
ClinicseED
Stroke Neurologist
Trauma Surgeon
Nephrologist
Psychiatrist
Initiate TX asap
ED
Referring sites
Tele-stroke
Trauma triage
Tele-psychiatry
Specialty call coverage
Intensivist & Hopstialist
ED
Courtesy of Debbie Dahl, EE.Banner Health
electronic Intensive Care Unit
3/4/2019
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iCare BGMC MedSurg LOS
0
1
2
3
4
5
medical surgical
Average LOS (days)
0%
5%
10%
15%
20%
25%
medical surgical
LOS outliers (%)
Pre (2008) Post (2010)
Courtesy of Debbie Dahl, E.E.Banner Health
Mercy Virtual HospitalChesterville, MO - 2017
© 2013, Arizona Telemedicine Program
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Mercy Virtual
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T-Health – PhoenixInstitute for Advanced Telemedicine
& Telehealth
T-Health Amphitheater/Phoenix
“e-Classroom-of-the-Future”
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© 2018, Arizona Telemedicine Program
Phoenix/Tucson
T-Health Amphitheater“e-Classroom-of-the-Future”
Tucson
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http://fortune.com/2016/10/06/kaiser-permanente-virtual-doctor-visits/
Industry Trends?
• Patient-centered health care
• Health care becomes a commodity
• Retail telemedicine becomes a growth industry
• Hospitals outsourcing of professional services
• Dominance of large integrated healthcare organizations
• Interprofessional Education and Collaborative Practice (IPECP) model
• Redesign of health professions’ education
• Fusion of health professions schools and integrated healthcare service organizations
