Transcript Expanding Telemedicine to Medical Homes for

Expanding Telemedicine to Medical Homes for Comprehensive Care Delivery for Persons with
Hemostatic disorders: A pilot study of the American Thrombosis and Hemostasis Network
(ATHN)/National Hemophilia Program Coordinating Center (NHPCC)
Abstr. No. ISTH15ABS-2041
Vitamin K Antagonist II
Roshni Kulkarni* 1, Rebecca A. Malouin1, Colleen Vallad-Hix2, Laura Carlson1, Marcia Bird1, Diane Aschman3, Ann Forsberg3, Zachary Trost1, Robert Greenhoe2
1Michigan
State University, East Lansing MI, 2Portage Health Pediatrics, Upper Great Lakes Family Health Center , Hancock, 3American Thrombosis and Hemostasis Network, Illinois,
INTRODUCTION &OBJECTIVES
Results: Demographics and types of disorders
• Telemedicine (TM) is the delivery of health services through
HIPAA secure synchronous videoconferencing to patients in
remote sites with limited access to specialist services.
• Telemedicine can also be used to delivery cost effective
diagnostic and comprehensive services for management and
monitoring of patients with hemostatic disorders.
• Our goals were to provide increase access to family-centered and
culturally competent specialty care and to
• Increase the number of patients with bleeding/blood disorders that
are timely and accurately diagnosed and referred for specialty
care
Objectives
• To assess feasibility of telemedicine between specialists and
medical home for children with hemostatic disorders
• To assess the cost of telemedicine visits versus traditional
visits from the societal perspective
• To assess the acceptability by patients, families, primary care
physicians, primary care staff, specialist physicians, and
specialist staff
• To assess resource, referral, support assistance and patient
confidentiality of medical and mental health services
Telemedicine Clinics: Houghton MI
Time period
June 2014- May 2015
No. of patients
Telemedicine
visits
Age range
No. of Clinics
13
15
2 weeks -17 years
1 per month
No of patients
seen/clinic
Videoconferenci
ng system
Challenges
• Patient no shows
• Technology challenges:
• Portage network
upgraded, firewalls
blocking telemedicine
• New laptop computers
not set up with email to
send telemedicine link
• Clinic cancellations – due
to meetings or lack of
patients
• Inability to do platelet
function testing (platelet
aggregation) and
specialized coagulation
tests in Upper Peninsula
www.POSTERPRESENTATIONS.com
Epistaxis/possible Ehlers
Danlos
5/2
Von Willebrand disease
(VWD)
2
Cervical lymphadenopathy
Spherocytosis
Iron deficiency anemia/
hemoglobinopathy
(Thalassemia)
1
1
1
Vidyo
Family members
tested/counseled
Family
Parents and sibs and
uncle
Family
Family
1
Patient and Father
3/1
Mother and siblings
1
Sickle cell trait
Parents
Results: Costs
• TM site was the Medical Home/primary care physician (PCP)
pediatrician’s office at the Upper Great Lakes Family Health Center
in Hancock/Houghton, MI, located ~500 miles from Michigan State
University Center for Bleeding and Clotting Disorders (MSUCBCD)
• Types of comprehensive team services provided were recorded.
• Personnel, equipment type and as well as the cost savings of travel
by the care team were recorded. Cost savings were analyzed.
• Synchronous HIPAA regulated bidirectional videoconferencing
technologies, Vidyo TM (web based), was utilized in all phases
• Written photo releases with permission to utilize them for education
were obtained
TEMPLATE AND PRINTING BY:
No
Hereditary Hemorrhagic
Telangiectasia
Menorrhagia, anemia,
abnormal coagulation
profile, thrombophilia
1-3
METHODS
Clinic Location
Types of Disorders
Acceptability and Lessons Learned
Demographic
Parameters
Portage Clinic
Patient Costs
Patient to attend clinic at MSUDriving costs
(Driving, meals and lodging)
Time lost from work, round trip (RT)
hours @ $33/hr wage
Average distance that 33.4 (2.4 -42.3 ) miles
patients travelled
Distance patients lived 30-50 miles : 4 Visits
from local center. N13 10-15 miles : 4 Visits
patients with 15 visits <10 miles : 7 Visits
Distance for Patients
to MSU (RT)
960 -1000 miles RT
(460-504 miles OW)
Commercial airline
ticket cost
$1142 to $1184
Driving time
9 hrs OW or 18 hrs RT
Time lost from work
20 hrs ( 9 hrs travel
time OW)
Patient
seen at
HTC
Total Costs with driving
MSU,
If patient flies ( $1184 airline costs +
East
travel time = 16 hours @$33/hr =
Lansing
528
Meals and Lodging $175 /night
Total Costs with flying
Physician cost saving $3850
Patient
seen
locally at
Portage
clinic
Portage
Clinic
$615
20 hours
x$33=$660
$1275
$1712
$175
$1887
Patient to attend clinic at local facility
$18.7
(Driving)
Time lost from work (RT) @$33/hour 3 hrs x$33=
wage
$99
Total costs attending local
clinic
$117
Outreach Nurse/ Coordinator Roles
Outreach Nurse Role::Gathered referral information, including labs & pertinent history and labs from outreach location;
Reviewed patient information with hematologist, ordered necessary testing desired prior to visit
During Telemedicine visit: Provided nursing assessments and family education
Post TM clinic follow up:
Coordinated patient and family testing, medications, education, implementation of plan of care
Documented patient care and data entry to ensure that both clinics have visit documentation. Updated contact information
Coordinator Role:
Coordinated with Portage, MSU staff, and physicians, and IT department regarding dates and times for monthly telemedicine
clinics. Assisted with grants and site visits
• Families and clinic staff found telemedicine to be an acceptable form a
care, especially as it is becoming common among other specialties in
rural areas
• In most cases families preferred telemedicine as their trusted healthcare
provider was close by and they did not need to travel
• Lessons learned from staff
• Staff were accustomed to protocols and desired a telemedicine
protocol for hematology consults
• Tools to provide families with information about what to expect from
the consult would be helpful
• Planned visits are necessary due to scheduling in a busy pediatric
practices
• Lesson learned from patients
• Written information about the purpose of and expectations during and
following the telemedicine consults are needed
• Having the primary care physician in the room to explain what the
hematologist is recommending might be helpful
• Having many team members on the video on consultant side is
confusing - fewer is preferred
Social Work (SW) Role and Perspectives
• Facilitated services such as education programs, mental health
support programs among patients, family members, MSUCBCD and
PCP
• Provided bleeding disorder education in specialty care, insurance
and patient assistance programs to PCP and staff
• Built a rapport with patient and family members and assured all
participants of confidentiality, which was integral to success
• Researched and offered alternatives for parent/child, in-home, early
intervention, special education and social work services not
available to patients in rural area
• Assisted families in overcoming barriers due to low economic
status, unemployment, learning disabilities and transportation
through CBCD, local resources and Helping Hands
• Provided post-telemedicine contacts for on-going HTC
communication and referrals to bleeding disorder state and national
recreational, educational activities and support services
CONCLUSIONS
• TM allows care delivery by specialists for diagnosis and monitoring and
follow up of remote patients. Critical social worker and nursing
evaluation and interventions can be accomplished via TM.
• Successful care delivery is possible at Medical Home using telemedicine
• There is significant cost and time savings for the patients, physician and
health care facilities.
• Besides patient satisfaction and education of patients and providers, TM
allows state of the art specialized care to be provided to remote patients.
References
Whitten P et al. Applied Clinical Informatics 2010;1:132.
Grosse SD et al. Medical Care. 2009;47:594
Study supported by ATHN NHPCC grant; Project Number: ATHN2014NHPCC-1; Funding source: HRSA#UC8MC2409 through ATHN