Neurodevelopmental Examination Using … Michael P. McCue, PhD2,3Departments of 1Health Information Management and R ehabilitation Science and Technology and Rehabilitation Engineering

Neurodevelopmental Examination Using Telemedicine: Clinical experience at KKI STAR Presentation Dr. Deepa Menon, MBBS,MD ([email protected] ) JULY 15th, 2015

mailto:[email protected]

www.kennedykrieger.org

Telemedicine

• Practice of Medicine from a distance, in which

intervention and treatment decisions and

recommendations are based on clinical data,

documents(images) and information transmitted

through telecommunication systems. This excludes

audio only, email and facsimile transmissions. • (MD Board of Physicians COMAR 10.23.05)


Definition of Telemedicine


Why does it matter?


Telemedicine in Special Populations

• Telemedicine for people with developmental

disabilities and children with neurological disorders

– Literature is scarce – Neurology and Developmental

Medicine Lags Behind

• Stroke

• Epilepsy

– UK Assistive Technology Program

– Speech and Language Pathology


Challenges & Opportunities

• Increasing numbers

• Delayed diagnosis

• Access to services

• Reimbursement

• Workforce shortages

• Training issues

• Home as originating site

• Available technology

• Security/filming

• Costs of technology

• Few studies/little data

• Store and forward

questions

• Contracts

TELEPRACTICE IN ASD

http://online.liebertpub.com/doi/full/10.1089/tmj.2009.9965





An Integrated Telehealth System for Remote Administration of an Adult Autism Assessment . Bambang Parmanto, PhD,1,2 I. Wayan Pulantara, MS,1,2Jamie L. Schutte, MS,2,3 Andi Saptono, PhD,1,2

and Michael P. McCue, PhD2,3Departments of 1Health Information Management and R ehabilitation Science and Technology and Rehabilitation Engineering Research Centeron Telerehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania

10


Needs Assessment

• CYSHCN: ( birth-21 years) : MD prevalence 15.7% ( National 15.1%)

• 28% of children 4mos-5 yr are at a risk for DD but only 22.3% received services

• ASD: MD prevalence 1 in 64 ( 1 in 68 nationally) (ADDM, 2012)

• Wide disparity between access to services:

• --central MD concentration of services

• --Poverty ( Balt City 34%; Eastern Shore23-29%; Western MD 24%)

• Ethnic diversity + poverty (AA 17%; Hispanic 13%)

• (MD Commission on Autism report , Sept 2012)


Here and Now Article


Key Needs identified

• 1) Access ( Barriers: geography; finances;

transportation; language ; cultural factors; manpower

shortage)

• 2) Quality ( lack of measures of quality; EB practice)

• 3) Lack of Collaborations and Partnerships ( Public-

Private; Professionals- families)

• 4) Training and Professional Development

• 5) Funding ( Systems; insurance for ABA etc.)

• 6) Transitions (Housing; employment; services) • ( MD Autism Commission Report , 2012.)


Goals of Telemedicine Project

• Telemedicine can be additive to current diagnostic services and Therapeutic interventions that is provided at KKI and can serve to address the needs identified and also serve to improve patient health care outcomes and quality of life.

• We hope to identify and drive best practices and potential use cases for telemedicine use to improve and increase therapeutic support for CYSHCN, cost effectively and for better therapeutic outcomes.

• Improve care of CYSHCN within their medical homes and communities.


AGH-KKI Developmental medicine telemedicine clinic

15


Maryland Counties

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Telemedicine suite


AGH and KKI Telemedicine clinic

• Located at 716 North Broadway on the 4th floor.

• Professionally designed and installed Video & Web conferencing capable system that has been configured

for small, executive-format interactions between KKI Medical staff and external healthcare partnership

organizations.

• Equipped with a LifeSize Room/Express 220 Optical PTZ camera & mic pod that connects to a 40 inch

Sharp Aquos LCD TV with speakers.

• The system has a Video furniture Collaboration table that can accommodate 2 staff members at a time for

optimal camera position & quality, an additional 40 inch Sharp Aquos LCD TV with speakers for sharing

content simultaneously while displaying video on the other monitor.

• And a Logitech B901 HD Webcam has been included in the system for connectivity with platforms such as:

Adobe Connect Pro, WebX & GoToMeeting. (Initial cost of Install: Total: $10,224.00)

• The installation a of Studio Style Lighting System (Total: $5,793.00) - that includes Brightline Corner

Angle, Bidirectional & Studioline lamp fixtures and a custom controller.

• -Painting of the backdrop wall to promote proper skin tone and depth of field for interview sessions.

• -Title Generator system for overlaying the KennedyKrieger Logo and staff info on the video feed to external

sites (to be completed in 2014 – cost not known at this time).

• -Removal of the LifeSize ICON small format videoconferencing system, and replacement with LifeSize

Room 220 System (8-point multi-conference capability) for better connectivity options. { Partially completed,

will be complete by 2/19: Add $12,837.00 for the Room 220 – Deduct $2,625.00 for the ICON}

• (Information provided by Greg Miller

and Anthony Scimonelli)


Telemedicine suite

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Telemedicine on the Eastern Shore

• Delmarvanow.com: Telemedicine program connects doctors in Baltimore with child patients in Berlin

• An article highlights the partnership between Atlantic General Hospital and Kennedy Krieger to help serve children with special needs on the Eastern Shore through telemedicine. Read more at: http://www.delmarvanow.com/videonetwork/3239523801001/AGH-Telemedicine-Program http://www.wboc.com/category/174346/main-wboc-video-player?clipId=9874832&topVideoCatNo=109353&autoStart=true

http://www.delmarvanow.com/videonetwork/3239523801001/AGH-Telemedicine-Program (2








http://www.wboc.com/category/174346/main-wboc-video-player?clipId=9874832&topVideoCatNo=109353&autoStart=true










NDD Evaluation

21


Evaluation Experience.

• First KKI Telemedicine clinic with AGH was on 12/13/2013.

• Held every 2nd and 4th Friday of the month for 6 mos( Pilot) .

• 2 patients scheduled for 90 mins each. One monthly whole day clinics where 4 new pts and 2 follow up patient scheduled

• Access granted to AGH EMR system.

• Currently both providers have been present for all the visits.

• Have been able to do developmental screening using CAT/CLAMS; Gessel Figures; Block design , WRAT-4 etc.

• Providers will figure out what other tests can be reliably done via telemedicine. ( Standardize)

• Have trained the Telemedicine RN at AGH , Dornese Whittington who facilitates testing.

• In the process of gathering info about local resources.


Analysis of Telemedicine – Dec 2009


Analysis of Telemedicine – 2009 2009


Current clinical experience_ Outcomes

• Outcomes- wait times,

demographics, drawing

area,patient

satisfaction, community

relations

• We are monitoring

_Parent satisfaction;

_Referring physician

satisfaction ;

_KKI consultant

satisfaction.


Current Clinical information.

• Between Dec 2013 and Sept 2014 we saw 41 patients in total

• Show rate 37/40 (92%)

• 9 girls and 28 males

• Ages: 18 mos to 15 yrs

• Most common diagnosis:

ADHD= 14 and Disruptive behavior disorder =14

ASD=10

Mixed Receptive Expressive language delay = 9

Anxiety=4

DCD and Sensory issues=1

Specific learning issues=6

Others( Microcephaly=1; Dysmorphic features=1; feeding issues=1; sleep issues=1)


Clinic Demographics

Number of patients Percent

Initial 32 78.05%

Follow Up 5 12.20%

No Show/Cancel 4 9.76%

Total 41 100.00%

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Referral/Followup pattern

Follow-up method Number of patients Percent

No further follow-up 6 14%

Via telemedicine only 8 19.51%

Via telemedicine plus clinic

visit

8 19.51%

Via clinic visit 15 36.59%

28


Patient/ Provider Satisfaction

29

New Diagnosis (%) New t/t or testing (%)

Patient Questionnaire

Quarter 1 27% 56%

Quarter 2 43% 100%

Quarter 3 50% 86%

Quarter 4

Physician Questionnaire

Quarter 1 20% 40%

Quarter 2 57% 43%

Quarter 3 57% 100%

Quarter 4


Service Utilization

30

0% 20% 40% 60% 80% 100%

Quarter1

Quarter2

Quarter3

Did not answer

Decline service

Local provider

Would trvel to KKI


Common Outcomes Outcomes


Lessons Learned

• Good resource for Neurological and NDD

consultation

• Good patient satisfaction

• Good show rate

• Increased collaboration with PCP and community

providers

• Ability to steer referrals as needed and cutting down

on unnecessary consultations at main hospital

• Avenue for education of paraclinical

32


Lessons learned

• Need Good IT staff at both sites.

• Can have technical glitches .

• Telemedicine compatability

• More standardized methods of doing ASD evaluation

and Neuro evaluation

33

Documents

Neurodevelopmental Examination Using … Michael P. McCue, PhD2,3Departments of 1Health Information Management and R ehabilitation Science and Technology and Rehabilitation Engineering