Telehealth - Virginia Healthcare Leadership Retreat

University of Virginia Health System

August 21, 2015
Karen S. Rheuban M.D.
Director, UVA Center for Telehealth

Definitions:

Telemedicine/Telehealth

  • The remote diagnosis and treatment of patients through the use of telecommunications technologies
  • Live interactive videoconferencing
  • Store and forward
  • Remote patient monitoring
  • m-Health

Services

  • Speciality Care
  • Primary Care
  • DTC
  • Emergency services
  • ICU services
  • Collaborative care models
  • Remote patient monitoring
  • Health professional education
  • Patient education
  • Health workforce training

Value for a broad range of stakeholders

PATIENTS

Improves Access by reducing the burdens of time, distance and cost of travel

Access to Locally Unavailable Specialties

Better outcomes through timely interventions, chronic disease management and self-management tools

HEALTH PROFESSIONALS

Broader Reach by providing consultative services

Increased Capacity through team-based delivery models

Improved Community Provider knowledge

HOSPITAL SYSTEMS

Expands Network capabilities

Decreases Re-admissions through remote patient monitoring tools and population health models of care delivery

Improves Transfer Coordination and triage, keeping patients local when appropriate

COMMUNITIES

Helps to Improve local healthcare facility viability

Supports community workforce capacity

Expands broadband adoption


UVA Center for Telehealth

Overcoming the barriers of distance and time to improve access and quality

Services:

  • Live Interactive Telemedicine
  • Store and Forward Services
  • Remote Patient Monitoring
  • Health Professional & Patient Education
  • Health Workforce Training
  • InternaDonal Program Support
  • Technical Assistance (MATRC)

Volumes:

48,036   Encounters
1,793     Additional patients enrolled in RPM
14.5M   Miles of driving avoided
152        Partner sites across Virginia
63          Clinical Specialties

Program Growth

Program growth data, opens in a new windowView Data

 

 

 

 

 


Participating clinical services

Telemedicine Speciality Services
Cancer Center Language Assistance Pediatrics – Neonatology
Cardiology Mobile Mammography Pediatrics – Orthopedics
Cardiology: Heart Health @ Home (3H) Nephrology Pediatrics – Rheumatology
Children’s Fitness Clinic Neurology – ALS Pediatrics – Transplant
Dentistry Neurology – Child Neurology Pediatric Cardiology – Echo
Dermatology Neurology – General Pediatric Cardiology – EP
Diabetes Education Neurology – Stroke Plastic Surgery
Diabetes Care Neurology – Stroke (SOC) Psychiatry – Adult
Digestive Health Neurosurgery Psychiatry – Child & Family
Emergency Medicine Nutrition Psychiatry – Emergency
Endocrinology Obstetrics – Colposcopy Pulmonology – Cystic Fibrosis
ENT Obstetrics – High Risk Pulmonology – ICU
Faculty & Employee Assistance Obstetrics – Genetic Counseling Special Pathogen Response
Gastroenterology Ophthalmology – Retinopathy Surgery
Genetic Counseling Ostomy Surgery – Trauma
Geriatrics Pain Management Thoracic Cardiovascular Surgery
Gynecology Pediatric – Critical Care Toxicology / Poison Control
Hematology Pediatrics – Developmental Transplant
Hepatology Pediatrics – Endocrinology Urology
Home Monitoring Pediatrics – GI Urology: Bladder Cancer
Infectious Disease Pediatric – Infectious Disease Wound Care

 


Accelerating reach

Continued growth driven by demand

Encounters Data; opens in a new windowView Data

Current Partner Sites

Virginia State Map

Current Partner Sites Data  View Data

62 New Projects in Development


Tracking quality outcomes

Tele-Stroke

  • 537 patients evaluated; Use of TPA in 19.4%

High Risk Obstetrics

  • 586 Unique Patients; 3,377 Clinical Encounters
  • 62% reduction in missed appointments
  • Pre-term deliveries avoided; 38% reduction in NICU Hospital days

Screening for Diabetic Retinopathy

  • 2,166 patients screened since 2011; 40% abnormal diagnosis
  • 80 patients identified and referred for ophthalmic intervention

Remote Patient Monitoring

  • Decreased UVA readmission rates for all payer penalty condition patients by 40%
  • CHF, AMI, COPD, Pneumonia, CABG, TJR, CVA

Tele-Psychiatry

  • 22,351 Tele-Psychiatry Clinical Patient Encounters
  • Adult; Child & Family; Emergency (24 hour On-Call)

Advancing the field

Research collaborations

  • Federally funded health services research initiatives
  • Device development and trials
  • Interdisciplinary workforce development grants
  • VCHI contract: SIM planning grant

State and federal policy development

  • Virginia Medicaid coverage of both urban and rural telemedicine since 2003
  • Virginia 12th state to pass parity reimbursement legislation (now 29 states)
  • Virginia Telehealth Network (501c3)
  • Home of the federally funded Mid Atlantic Telehealth Resource Center (9 states)
  • Virginia Board of Medicine guidance document
  • National Academy of Medicine (IOM) Workshop on Telehealth

Training the next generation of health professionals

  • Cross grounds Student Telemedicine Organization
  • Integration within SOM and SON Curricula both at UVA and in partnership with ODU
  • STAR Telehealth Training - 850 professionals to be trained in FY16

Challenges and Opportunities

Federal

  • Limited Medicare reimbursement ($14 million nationwide in 2014)
  • Statutory challenges within Medicare remain, including in alternative payment models
  • Originating site restrictions (Floyd, Scott, Giles, Buckingham, Washington Counties and the Grand Canyon are “urban”)
  • FCC Rural Healthcare program still remains underutilized
  • Licensure restrictions – FSMB “compact”
  • Veterans Health AdministraDon

State Virginia’s “A” rating by the ATA

  • Strong tradition of support from four consecuDve Virginia Governors
  • VDH, DMAS, VHWDA, DOC, DOE, DHP, DBHDS support
  • Virginia Medicaid is a national CMS pilot for expanded telemedicine to include coverage of dual eligibles for urban telemedicine, store forward and RPM
  • General Assembly and the Joint Commission on Healthcare
  • Virginia Healthcare Foundation, TIC, CIT
  • Close the coverage gap – infrastructure in place
  • Advancing collaborative care delivery models – scope of practice

Non-governmental/Private sector

  • Corporate and private philanthropy
  • State association support
  • Employers
  • Telemedicine businesses in the Commonwealth

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