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Integrating Telemedicine into

Fellowship ProgramsJennifer Shih, MD, FAAP

Assistant Professor Emory University

Medical Director Allergy and Immunology Clinics

Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep

Department of Pediatrics and Medicine

Atlanta, GA

Presenter Disclosures

Advisory Board Takeda

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Objectives

• The learner will be able to define telemedicine

and the different types.

• The learner will be able to describe a

telemedicine visit.

• The learner will be able to describe how

telemedicine can be incorporated into their

trainees’ education.

Why telemedicine for trainees?

“Trainees will receive comprehensive education

in a complete curriculum encompassing clinical

allergy, clinical immunology, basic allergy and

immunology sciences, research design and

methodology, professionalism, ethics and

quality improvement”

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Why telemedicine for trainees?

• “Trainees will receive comprehensive education in a complete curriculum encompassing clinical allergy, clinical immunology, basic allergy and immunology sciences, research design and methodology, professionalism, ethics and quality improvement”

• Prepare them for all aspect of medical care in their career

• Maintain relevance for our field

• Diversify patient populations for training (rural, urban, school, nursing home)

Specialists whose practices are using telemedicine the

least to interact with patients are:

• Allergists/immunologists—6.1 percent.

• Gastroenterologists—7.9 percent.

• Ob-gyns—9.3 percent.

Jan 2019

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U.S. Market Size (ATA)

>50%More than half of U.S. hospitals now

use telemedicine applications

230telemedicine networks

>3,800U.S. service sites

Over 1 Million Americans are currently using remote

cardiac monitors

Growth of Telemedicine Globally

$55.1 billion

2021 Market Size --BCC Research, 2013

$23.8 billion

2016 Market Size

B1

Slide 10

B1 Reference for this slide:

http://www.bccresearch.com/market-research/healthcare/telemedicine-technologies-global-markets-hlc014e.html

Lew, 4/18/2014

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How Prevalent is Telemedicine?

90% of healthcare executives

say their organizations are

developing or already have a

telehealth application.

MedCity News

48 states require payers to cover telehealth

Center for Connected Health Policy

Patient Perspective

65% of patients with a primary care provider would

be willing to see them through a telehealth visit.

Healthcare IT News

50 million Americans would be willing to switch their

family practice provider to have access to a video visit.

Healthcare IT News

Majority of consumers are comfortable having their private patient records in

the cloud.Cisco

~ 60% of patients aged >65 willing to manage a chronic condition with a telehealth

visit.Healthcare IT News

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Telemedicine

• “Distance healing“

• Derived from a Greek word "Tele" meaning

"distance" and a Latin word "mederi"

meaning "to heal“

Telemedicine:

the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

Telehealth:

refers to a broader scope of remote healthcare services than telemedicine; telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

Mhealth:

mobile-based or mobile-enhanced solutions that deliver health.

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Telemedicine

Asynchronous Synchronous

Non-Facilitated

Facilitated

Asynchronous (Store and Forward)• Acquire medical data (medical images, etc) �

transmit data to doctor at a convenient time for assessment OFFLINE (not in real time)

• Does not require presence of both parties at the same time

• Dermatology, pathology and teleradiology (store-and-forward images)

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Synchronous (Real time)

• As simple as a telephone call

or as complex as robotic

surgery.

• Requires the presence of both

parties at the same time.

• Video-conferencing equipment

• Peripheral devices can be

attached to computers or the

video-conferencing equipment

to aid in an interactive

examination.

Sitecall.com

Non-Facilitated (Direct to Consumer)

• Synchronous, involving real-time two way

video conferencing

• Generally initiated on demand by the patient

• Audio-only encounters

• May not involve a physical exam

• Direct payment, insurance not involved

Healthcareitnews.com

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Facilitated

• Synchronous, involving real-time two way video conferencing

• Scheduled visits with a facilitator at the originating site

• Designated sites may be required such as with CMS

• Physical exam required

• Bill to insurance with EM code plus modifier/site

Southwesttrc.org

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How to integrate telemedicine into

your program?

• Outpatient clinic

– Schedule for the fellow

• Integrated throughout the day

• Designated day

– New vs Established

– Immunology vs Allergy

– IT, OIT, biologic checks

• 10yo severe persistent asthmatic

• Intubated 3 times

• Risk of death

• Poorly controlled asthma

• Poor compliance

• Misses severe asthma clinic appointments

• Insurance=Medacaid

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4.5 hours

https://www.omicsgroup.org/articles-admin/disease-images/egg-allergy-58113.jpg

Originating Site

Where the patient is located

Distant Site

Where the remote

provider is located

The Visit

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https://www.omicsgroup.org/articles-admin/disease-images/egg-allergy-58113.jpg

Originating Site

Where the patient is located

Distant Site

Where the remote

provider is located

The Visit

• Improved Access

• Improved Control

• Improved Compliance

• Improved once a month

telemedicine clinic visits

• Decreased exacerbations

• Plays basketball

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Wi-Fi Smart Scale Otoscope Blood Pressure Monitor

Bluetooth Stethoscope

Blood Glucose Meter

Digital Thermometer

Peripherals

EKG

Dermatoscope Spirometer Camera

UltrasoundBody Fat Analyzer

How to integrate telemedicine into

your program?

• Inpatient Consults

– New vs follow up

– MD to MD or patient to MD on call

– Webside vs bedside manner

– Consent placed in patient hospital chart

– Who is the facilitator if needed

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Penicillin Testing

-JACI in Practice, online access May 2018

-46 PST-negative patients, 33 were transitioned to a B-lactam

-> $30,000 was saved throughout the study period.

How to integrate telemedicine into

your program?

• Education and Long Distance Learning

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Visits at CHOA/Emory

The nation will be short 130,000 MD’s by 2025

-Association of American Medical Colleges

With ~5000 allergists

telemedicine offers the

opportunity to provide

scalable, high quality care

for patients(AI workfoce report)

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Checklist

• Team- administration, nurse, MA, IT

• Orientation

• Consents

• Documentation

• Webside vs Bedside manner

• Billing

• Tip Sheets for trouble shooting

Security

• HIPAA compliant

• BAA

• Fully encrypted data transmission

• Peer-to-peer secure network connections

• No storage of video

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Key points

• Patients want

convenience

• Telemedicine is here

• There is great potential

for our field

• Ultimately preparing our

trainees for the big real

world.

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Telemedicine Toolkit:

Center for connected health policy

(https://www.cchpca.org/telehealth-

policy/current-state-laws-and-reimbursement-

policies) interactive map of policies by state

Thank you!

Jetsons, season 1 ep 10, 1962

http://www.americantelemed.org/homehttp://www.americantelemed.org/home

https://evisit.com/state-telemedicine-policy/

https://www.cchpca.org/telehealth-policy/current-state-laws-and-reimbursement-policies?jurisdiction=All&category=128&topic=All

Jennifer.a.shih@emory.edu

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