3/2/2014
1
Anne E. Burdick, MD, MPHProfessor of Dermatology
Associate Dean for TeleHealthMarch 20, 2014
University of Miami TeleHealth Enhancing Healthcare for Floridians UM TeleHealth is a catalyst for
healthcare transformation in Florida.
Access ConvenienceConvenience
3/2/2014
2
QualityQuality Cost
SynchronousReal-time interactive
AsynchronousStore-and-forward
We use all 3 operational TH modes
SynchronousReal-time interactive
AsynchronousStore-and-forward
We use all 3 operational TH modes
Hybrid
3/2/2014
3
University of Miami TeleHealth
• 1974: Dr Jay Sanders, prison telemedicine
• 1994: Fellowship at MCG, ATA Board member
•1994: Teledermatology for migrant workers, JAMA
•1996: American Academy of Dermatology Telemedicine Position Statement
• 1999: Founded ATA Teledermatology Special Interest Group Approved 2007
2007
Approved 2007
Endorsed by American Academy of Dermatology
2007
“Based on the history and images provided, my impression is as
follows.”
2008
UM TeleHealth: Our strengths
• Telehealth operations
• Technology & systems engineering
• Telehealth policy
• Industry relationships
3/2/2014
4
Our challenge: Limited TH reimbursement
• Medicaid: Children’s Medical Services via waiver
• Medicare: Rural, Health Provider Shortage Areas
• No private payers
Our challenge: Limited TH reimbursement
• Medicaid: Children’s Medical Services via waiver
• Medicare: Rural, Health Provider Shortage Areas
• No private payers
Our strategy:
• Contracts
• Grants• Advocate for policy change
Dept of Health Children's Medical Services
• Teledermatology• Telegenetics• Telenutrition• Telepsychiatry
Miami-Dade School Telehealth Initiative
• MD provides Pediatric care to 8 schools
• RN, MA or medical or nursing students present
• Specialty care with UM MDs
3/2/2014
5
Miami-Dade School Telehealth Initiative
• North Miami Beach schools: elementary, middle and high
• Equipment: HRSA grant
• Health care providers: John T MacDonald grant, Children’s Health Fund, AHEC
• Specialist reimbursement: Verizon Foundation grant
• Dermatology, Nutrition, Psychiatry, Cardiology, Endocrinology
Miami-Dade School Telehealth Expansion
• Centers for Medicare and Medicaid Services grant
• 8th school
• Partnering with Larkin Hospital for telemental health
• Partnering with NOVA University for teledentistry
Eczema herpeticum
Generalized herpes simplex infection + atopic dermatitis
3/2/2014
6
Eczema herpeticum
Generalized herpes simplex infection + atopic dermatitis
Admitted for IV Acyclovir and antibiotics for 3 days
Other Pediatric TH specialities
UM Pediatric Mobile Van• Sweetwater, Little Haiti, Homestead• Verizon Foundation grant for specialist
reimbursement, 4G network provided
• Nutrition, dermatology, cardiology
Telegenetics
•Statewide Newborn Screening conferences
Telehealth training of health providers
• Dermatology residents• Medical students• ARNP students• DNP students
Core Competencies for residentsAmerican College of Graduate Medical Education
• Interpersonal & Communication Skills
• Systems-Based Practice
• Patient Care
• Practice-Based Learning & Improvement
3/2/2014
7
Acute teleneurology to hospital emergency departments
• Specialists on Call, Inc.
Discharge planning enhancement
• Patients transfers
• UM Hospital to Miami Jewish Home for the Elderly
• Verizon Foundation grant for a Vgo robot
UM-Aetna Employee TeleHealth
• UM employees
• At a satellite UM clinic, • 10 miles or 45-60 minute drive or
Metrorail ride
• Specialty teleconsultations
• Neurology, dermatology, nutrition, cardiology, pulmonary
Teletrauma: Ryder Jackson Memorial/University of Miami Trauma Center
• Trauma bay resuscitations• ICU bedside rounds• Air ambulance optimization from
Lower Keys Medical Center • Brazil Olympic team, London• US Dept of State contract: 24/7
3/2/2014
8
Store-and-forward teledermatology
Nashville Area
Oklahoma Area
Albuquerque Area
2010: 75 Indian nations in 29 states
MICMACPleasant Point, ME
Oneida, NY
Catawba, SC
4 yo: 3 days itching, sores hands & stomach4 yo: 3 days itching, sores hands & stomach
………Scabies
3/2/2014
9
UM – Alaska Teledermatology Service AFHCAN MISSION
To improve access to health care for federal beneficiaries in Alaska through
sustainable telehealth systems
AlaskaFederalHealthCare
AccessNetwork
Alaska’s Health Care Challenges
35
• 49% MDs in Alaska are primary care physicians, U.S. average is 28%
• 59% residents live in medically underserved areas
• 48th in “doctors to residents” ratio- 65% are located in Anchorage- Shortages in many specialties
Average Alaska village = 350 Residents
Alaska Native Medical Center
• Tertiary care• Referrals to private medical providers & other
states for complex care• 6 regional hospitals• 4 multi-physician health centers• 25 subregional mid-level care centers• 180 small community primary care centers
36
3/2/2014
10
Human assistance and disaster response: TeleHealth in Haiti
• Trauma and critical care
• Teleradiology
• Pediatric subspecialties
Telemedicine for Trauma, Disaster, and Emergency Management Eds: Latifi R, Poropatich R.
Artech House, Boston. 2010
“Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for
Benefit–Cost Analysis”
Dávalos ME, French MT, Burdick AE, Simmons SC Telemedicine and e-Health. 2009, 15: 933-948
2009 Manuscript Award at ATA 2010 Plenary
, Cutis 88, 213: 2011
3/2/2014
11
UM Cruise Ship Teledermatology
• Provides rapid access to University of Miami dermatologists for crew and occasionally guests on ships all over the world
• Within 72 hours or 24 hours
• Royal Caribbean Cruise Lines since June 2010
• Carnival Cruise Lines since November 2012
Teledermatology at Sea
• Provides dermatology care for an employee population that’s geographically dispersed
• Allows ship’s medical staff to effectively manage their crew’s skin conditions
• Reduces onshore dermatology visits
• Assists in medical evacuation decisions
• Cost avoidance
• UM selected Medweb software
• Cruise IT teams evaluated software
• Username/password assigned to each ship
• Introduced service at RCL/CCL conferences
• Lab and X-Ray capabilities determined
• Additional drugs recommended
• MDs and RNs reviewed UM’s online training
• Test case submitted by each ship before sending consults
Fleetwide Rollout Dermatology at Sea: Special Issues
• Limited drug formulary• Challenging to access shoreside dermatologists • Diverse occupations• Off work or “dry” work difficult, no duplicate crew• Maximum Medical Improvement • Medical isolation • Medical evacuation
3/2/2014
12
Ship MD UM DermatologyConsultantPhotos
Consult Form
PC
PCInternet UM
ServerS
Workflow Dermatology at Sea: Special Issues
• Limited drug formulary• Challenging to access shoreside dermatologists • Diverse occupations• Off work or “dry” work difficult, no duplicate crew• Maximum Medical Improvement • Medical isolation • Medical evacuation
Stat case: hand dermatitis, violinist
Tinea versicolor
Alopecia areataContact dermatitis
Wart
3/2/2014
13
Candida intertrigoErysepelis
Bullous cellulitisLeishmaniasis
“3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?”
“3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?”
Agree with Herpes zoster and treatment
Rare Diseases
Multiple acral reticular histiocytosis
Hidradenitis suppurativa
Relapsing polychondritis
3/2/2014
14
Oral lesions: Torus palatinus
New England Journal of Medicine, April 11, 2013
<5% consult: referred to dermatologist
Present x 1 monthWart vs. squamous cell cancer vs
keratoacanthoma
Solitary nail pigmentationProbable melanoma
Growing dark dot x 1 yearProbable melanoma
Stat case: Fever + coryza + rash, R/o Measles Stat case: Erythema multiforme major
3/2/2014
15
UM TeleHealth is a catalyst forhealthcare transformation in
Florida and beyond.
Anne E. Burdick, MD, MPHAssociate Dean for TeleHealth
Professor of [email protected]
(305) 243-8252telehealth.med.miami.edu
Contact