Redefining the Patient Care Experience – The Story of Global Telehealth Program

February 29, 2016

Harun Rashid

Learning Objectives

1. Understand how telehealth can be used to appropriately bridge specialty care, avoiding unnecessary travel

2. Evaluate barriers and lessons learned allowing for optimal use of telehealth to supplement real-time international patient care

3. Examine how one health system has become self-learning in its use of telehealth leading to multiple healthcare efficiencies and creating a telehealth adoption model for others

UPMC’s Telehealth Evolution:

4

Tele-Stroke Services

Tele-Pediatric

Tele-Dermatology

Tele-Rounding

Tele-Colon & Rectal Surgery (Pre & Post Op Visits)

2012

Teleconsult Center launched

UPMC Health Plan Employer On-site Svc.

Tele-Physical Medicine & Rehabilitation

Tele-Maternal Fetal Medicine

Tele-Surgical Oncology/Breast Visits

Tele-Infectious Disease

Tele-Preoperative Evaluations

Tele-Transplant Behavioral Health

Tele-Transplant Nutritional Counseling

2013-2014

2015

Expansion of On-line

Virtual Visits

Consult center expansion

Chronic Care

Remote Monitoring

On-line Virtual Visits

2007

2008

2011

Tele-Psychiatry

International

e-ICU (PEDS)

2009

5

UPMC Telehealth - Growth

6

CHP CPS HP WPIC HS INT'L

Sum of FY12 Volume 917 0 766 2700 2074 118

Sum of FY13 Volume 971 385 1510 4047 2330 463

Sum of FY14 Volume 1096 609 2203 4029 4127 798

0

500

1000

1500

2000

2500

3000

3500

4000

4500FY 12 - FY 14 Volumes By Business Unit

UPMC Telehealth –Volume Change across Business Units

Psychiatry

Anywhere Care:

Convenience ofCare

Anywhere CareVisits(HP

Members)

EmployerOn-SiteClinics

MaternalFetal

Medicine

Pathology

(KingMed-

International)

Stroke

CHPCardiac

ICU(Internati

onal)

Dermatology

CHPCardiac

ICU(Domesti

c)

InfectiousDiseases

Rheumatology

RemoteMonitorin

g -HH

TeleNewborn

Endocrine Surgery

HP-Remote

Monitoring

Endocrinology

DiabetesManage

ment

HeartFailure

WoundCare

Pathology

Reeks1 1896 1882 1389 547 544 375 339 270 258 250 206 181 153 150 82 82 64 56 46 42

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Top 20 Service Lines of FY16 YTD Through November

*AnywhereCare includes all UPMC AnywhereCare volumes, with AnywhereCare Visits (HP Members) being just the HP subset of volumes.

UPMC Telehealth –Financial Impact (FY12 to FY15)

8

FY12 FY13 FY14 FY15

Insurance Payment $48.976,00 $96.378,00 $166.041,00 $292.290,00

Contractual $1.469.678,00 $1.896.466,00 $2.251.501,00 $2.343.870,00

Total $1.518.654,00 $1.992.844,00 $2.417.542,00 $2.636.160,00

$-

$500.000,00

$1.000.000,00

$1.500.000,00

$2.000.000,00

$2.500.000,00

$3.000.000,00

17%

9%

$1,992,844

$2,417,542 $2,636,160

$1,518,654

UPMC Telehealth Program- Copyright 2015

NOT FOR DISTRIBUTION

UPMC Telehealth Fiscal Year over Year Summary *(FY15 Data is projected)

Bridge specialty care, avoid unnecessary travel, reduce wait times, achieve great customer satisfaction ..

Dermatology Preoperati

ve Evaluation

Center

Transplant – Behavior

Health

Transplant –

Nutrition

Surgical Oncology

(Breast Consults)

Maternal Fetal

Medicine

Genetic Counseling

(Breast Oncology)

Mammograms

Psychiatry

10

UPMC Inpatient & Outpatient Telemedicine Services

Outpatient Services

Inpatient Services

Tele-SNF

Coordination

New Models

Enhancing Care

Remote Monitoring

International

High Quality

Additional Telehealth Programs:

11

• Reduce avoidable

Hospitalizations

• ED transfers

• Increase

efficiency

• Lower costs

• Increase

quality

• Decrease Acute

care costs

• Decrease

Readmissions

• Enhance

population health

• Tele-Surgical

Mentoring

• Tele-ICU

• Tele-Pediatric

Consults

• Tele-Pediatric

ICU Services

Remote Monitoring

Hospital @Home

(Visiting Nurse)

In-patient(Pathways)

Out of the BoxPassive/

Wearable

Patient Self Capture/Bluetooth

(glucose, weight)

2-way Communication

Low Bandwidth(Phone)

High Bandwidth

(Video)

Low High

Pathways/Visiting Nurses/

Peripherals/Hub

Call Center/

Clinical Decision Support

Algorithms/ Peripherals/Hub

Cloud/Lifestyle Management

1

2

Access to specialists

Reduced travel time and cost

Bringing timely treatments

closer to home

Improved quality of care

Physician access to medical

history

Eliminating duplicate tests

and unnecessary procedures

Improved Care Coordination

UPMC Teleconsult Centers – New Models of Care Delivery

13

• Teleconsult Centers established across

three rural locations to expand virtual,

multi-specialty care to patients within

their communities

• Integrating new technologies to achieve

the goals of Triple Aim- “Expanding

patient access to high quality clinical care

at a lower cost”

• Over 1,476 TeleSpecialist visits

completed

• High Patient Satisfaction- Average

Scores- 4.8 out of 5

• High Provider Satisfaction

UPMC Teleconsult Center Overview

14

1,476 Completed

Patient Visits

31 Telemedicine Specialty Service Lines

Cardiac Electrophysiology

Oncology: Breast Consultations

Colorectal Surgery (Pre and Post-operative

consults)

Pediatrics Allergy and Asthma

Dermatology Pediatrics Gastroenterology

Diabetes Management Pediatrics Nutrition

Endocrine Surgery Plastics: Head and Neck Reconstruction

Oncology

Genetic Counseling Plastics: Breast Reconstruction Oncology

Heart Failure Plastics: Hand Surgery

Infectious Disease Plastics: Post Weight Loss

Inflammatory Bowel Disease Pulmonary

Maternal Fetal Medicine Reproductive Endocrinology and

Infertility

MFM: Diabetes Education Management

(Type I & II and Gestational)

Rheumatology

Neurology: Movement Disorders Sleep Disorder Evaluations (Restless Leg

Syndrome)

Neurology: Multiple Sclerosis Vascular

Neurology: Follow-up Stroke Voice Therapy

Neurosurgery: Cranial Nerve and General

Neurosurgery

Wound Evaluations

Neurosurgery: Neuro-Oncology

4.8

0

1

2

3

4

5

All SpecialtiesOver

all

Su

rvey

Ou

tcom

es

…

Telemedicine Providers

Overall Patient Satisfaction

Survey Outcomes

Rating

Snapshot of Tele-MFM Services:

1

5

345

10

56

0

50

100

150

200

250

300

350

400

Northwest Bedford Hermitage

To

tal

Nu

mb

er o

f C

om

ple

ted

MF

M V

isit

s

Telemedicine

4 %

Patients Who Would Have Forgone Care

Northwest 30%

Hermitage 35%

411

Total Trip

Distance

(Miles)

Cost of

Travel

Expenses

(Dollars)

Time Spent

Traveling

Round Trip

(Hours)

Total Saved: 183,561 $103,183 3,144

Average Saved: 446.6 $251.05 7.6

TOTAL

990 Completed Patient Visits

Ancillary MFM Services Completed at all Hospitals

Total Charged Amount

November 2012-December 2014

Location

Number of

Services

Completed

Total Charge

Amount

Northwest Teleconsult

Center 599 $54,718.76

Bedford Teleconsult

Center 30 $2,727.25

Hermitage Teleconsult

Center 67 $8,494.75

Grand Total 688 $65,940.75

UPMC Tele-Dermatology

16

Inpatient Locations: Outpatient Locations:

UPMC Northwest

UPMC Mercy

UPMC McKeesport

UPMC East

UPMC Passavant

General Internal

Medicine – Oakland Office

St. Margaret Family

Health Centers

– Lawrenceville

– Bloomfield

– New Kensington

Primary Health Network

– Titusville Family

Practice

Northwest Teleconsult

Center

Bedford Teleconsult

Center

UPMC AnywhereCare – www.upmcanywherecare.com

17

Adult Symptoms Treated:

Back pain Birth control Bronchitis Burn

Cold Cold and flu

symptoms

Cough Diarrhea

Flu Genital herpes Pink eye Pneumonia

Poison ivy Rash Red eye Scabies

Seasonal

allergies

Shingles Sinus/cold

symptoms

Sinus infection

Sore throat Strep throat Urinary

symptoms

Vaginal

irritation/discharge

Pediatric Symptoms Treated:

cold cough pink eye

UPMC AnywhereCare Cumulative Visit Report 11/04/13 – 01/31/15

Total Visits

Submitted

Total Adult

Visits

Submitted

Total

Pediatric

Visits

Submitted

Clinically

Inappropriate

(NONEVISIT)

Total Visits

Completed

AnywhereCare Convenience

(24/7/365 On-Demand,

Virtual Visits )

3,511 3,473 38 647 2,533

AnywhereCare Continuity

(Established PCP eVisit) 436 431 5 41 363

Total 3,947 3,904 43 688 3,248

UPMC AnywhereCare Visit Summary:

18

Complex offering - Telestroke

• Only 2-8% of stroke patients receive IV tPA

• Many hospitals don’t have stroke protocols and have never treated a patient with tPA

• 64% of hospitals in US did not give IV tPA *

• Lack of available stroke specialist in rural hospitals major impediment to emergent treatment

* Kleindorfer et al Stroke 2009

Teleneurology v. Telephone Telemedicine Telephone

History First hand From local provider

Exam First hand From local provider

Consent Hub doctor Local team

Triage for transfer Reliable Questionable

Clinical trials Yes No

Telestroke Consult

IP over Internet Remote control of

PTZ camera – Hx, PE

BP

Glucose

Plt

INR

CT

CT

Consent

tPA order

Call from

ED

Telestroke Consult

Audebert et al. Cerebrovasc Dis 2005

Mobile Stroke Unit

• Ambulance

• Portable CT

• POC lab

• Telemedicine

• Teleradiology

Rajan et al.JAMA Neurol 2014

0

20

40

60

80

100

120

140

160

180

200

IV PUH IV OSH

UPMC Stroke Institute:

IV tPA - PUH v. OSH transfers

0

50

100

150

200

250

300

350

400

ME PS JR SM MK WS NW MV BV JM HR CR AR EA UN BR BD MG WM LT

Consults - 2247 tPA -730

UPMC Telestroke

• 21 hospitals – 10 UPMC, 11 non-UPMC

• tPA treatment rate: 32%

• Transfers: 23%

UPMC International - Telemedicine

Global Health Partners

CHINA

India

• Tele-Health Consultation

• Telemedicine Offering –

– Tele-Health Case Review – Global Referrals

– MD to MD 2nd Opinion

– Tele-monitoring

– Virtual Conference

– MD Training

– Nursing Training

– Technical Training (i.e. Ecmo)

– Academic Collaboration

– Research Collaboration

– Other training

• (i.e. Grand rounds, case review)

Current State – International Services

28

Tele-Monitoring – Bucaramanga, Colombia

Pittsburgh to Bucaramanga = 2335 miles

Components of Telehealth Program

• Bidirectional real time video and audio

• Protocols / order sets (if applicable)

• In service training (RN)

• Technical training (i.e. ECMO)

• Access to Radiology imaging

• Access to electronic health record

• Access to other diagnostic results

• People, Process, Technology

Challenges to Tele-medicine

• IT support

• Bandwidth

• Licensing / Credentialing / Liability

• Physician acceptance

• Patient acceptance

• Domestic and Foreign laws

• Equipment

• Language

• Cultural issues

• Time-zone

• Wearables Technology

Questions

• Harun Rashid

• Vice President

• University of Pittsburgh Medical Center

• Harun.rashid@upmc.edu

• 412-692-8001