1. Impacting Lives through Applied
Technology
March 20, 2013
A Brave New World for
Telehealth and HIT
Dale C. Alverson, MD, FAAP
Medical Director, Center for Telehealth and Cybermedicine
Research, University of New Mexico
CMIO, LCF Research
Albuquerque, New Mexico
Past President, American Telemedicine Association

2. Objectives:
To understand the current and future
potential for Telehealth and Health
Information Technologies; regionally,
nationally, and globally
To understand how Telehealth and
Health Information Exchange (HIE) can
be blended and complimentary as a
part of healthcare transformation.

3. Health Care Reform/PPACA Emerging Enabling Information
Communication Technologies
Economic Downturn
Need for more Access to Care
An Aging Population/Baby Boomers
Critical Shortage of Healthcare Providers
EHR Adoption/HIE
Meaningful Use
ICD10
PCMH
ACOs
A Time for Telemedicine & HIT

4. Major Public Health Issues Impacting our Rural
Communities and their Economic Development
Gaps in Access to Health Services
in Rural New Mexico
 Hepatitis C
 Behavioral Health
 Diabetes
 Asthma
 Cancer
 Oral Health
 Cardiac and
Stroke Care

5. Telehealth and
Health Information Technologies
are Part of the Solution in Closing the Gaps

6. How is Telehealth used?
 Clinical: Consultation, Direct patient Care, Case
Reviews
 Educational: Providers, Students, and Patients
 Research: Community-based Participatory, Outcomes
driven
 Administrative: Strategic planning, Operations
 Health Information Exchange
 Enhanced Disaster Response

7. Telehealth Networks
Rural/Remote Health Providers Can Access Expert Medical
Opinions, Knowledge, Education via Telehealth
Rural
or Remote Specialty
Location Telehealth
Network Medical Center
Audio
Patient High-Resolution Images & Video
Student
Medical
Local Health Consultation Specialist
Provider Direct Patient Care
Case Reviews
Education
Training
Health Information Exchange
Community-Based Research

8. “Back to
the Future”

9. Case Reviews or Consultation

11. ECHO: Treatment Outcomes
Outcome ECHO UNMH P-value
N=261 N=146
Minority 68% 49% P<0.01
SVR (Cure) Genotype 1/4 50% 46% NS
SVR (Cure) Genotype 2/3 70% 71% NS
SVR=sustained viral response
NEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, et.al.

12. Direct Patient Care
Maternal Fetal Medicine-High Risk Pregnancy

13. “Store and Forward”
 Capturing an image and storing it to then be forwarded for
review by a medical specialists
 Examples include teleradiology, telepathology and
teledermatology, tele-ophthalmology (retinal scans)
 “Telemedicine” or HIE?/Large Data Files Need Broadband
Teleradiology and Image Transfer Web-Based Portals

14. Video Phone or “VOIP” with video
Family Visitation

15. School Based Health Centers

16. Telehealth assistants at the school
or child care center provide the link
to examine the eyes, ears, throat,
lungs and skin.
Videoconferencing provides the
“face to face” interaction.
Getting providers to think of their
desktop computer as an exam
room is the trick.
16

17. Trauma Triage
44% Transfer
Avoidance
27% Management
Recommendation
Changes
Moya M, Valdez
J, Yonas
H, Alverson DC.
The Impact of a
Telehealth Web-
based Solution on
and Consultation.
Telemedicine and
eHealth, 2010;
16:945-949

18. IRA HAYES Project – PTSD/TBI

19. Telehealth
Toolkit
SaaS (SIP)
Videophone (H.324)
Skype
Software IP Based (H.323)
Desktop IP Based (H.323)
Small Conference Room IP Based (H.323)

20. Hand Held Devices- “mHealth”
iPhone
Droid
iPhone
BlackBerry Treo/Palm
Smart Phones

22. Remote Monitoring
The “Smart Band-Aid”

23. Center for Telehealth and Cybermedicine Research
The Center for Telehealth
at UNM Health Sciences Center:
•Developing New Programs
•Technical, Operational, Busines
s, and Evaluation Planning

24. The New Mexico Telehealth
Alliance
Telehealth Alliance
“Networks of Networks” Providers
Consumers
 Represents a consortium of
public and private health care Telehealth
stakeholders: “Neutral Expertise
Territory” (501c3)
Communication
Networks
 Reflects the diversity of our
health care delivery system in Social Networks
New Mexico
 Enables collaboration

25. New Mexico Telehealth Act
Passed and Signed into Law 2004
http://legis.state.nm.us
Introduced by Rep. Danice Picraux (D)
Supported by Sen. Susan Wilson-Beffort (R)
HOUSE BILL 581
46TH LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION 2004
Authorization Bill for Telehealth:
•Covers interactive video and “Store and Forward”
technologies
•Any Licensed Health Professional authorized to use
•Covers any Originating Site Where Patient Located,
including place of residence
•Authorizes/Encourages Use of and Reimbursement for
Telehealth
(NM Medicaid has announced policies to reimburse for
telehealth services)

26. New NM Legislation:
SB 69/HB 171
Insurance Coverage for Telemedicine Services
 An act relating to health care coverage; enacting sections of the
health care purchasing act, the New Mexico insurance code, the
health maintenance organization law and the nonprofit health care
plan law to require coverage for telemedicine services; providing for
utilization review and appeal rights for denials of telemedicine
coverage.
 "Group health coverage, including any form of self-insurance,
offered, issued or renewed under the Health Care Purchasing Act
shall include coverage of telemedicine Services. Coverage for
health care services provided through telemedicine shall be
determined in a manner consistent with coverage for health care
services provided through in-person consultation."

27. SWTAG is a “Network of Networks”

28. The 4 “C’s”
Cooperation
Coordination
Collaboration
Communication

31. http://www.americantelemed.org

32. American Telemedicine Association (ATA)
and Telemedicine
Hitting the Target: “The Triple AIMS”
Improve
Access
ATA
and ATA
Improve
Telemedicine Health
Reduce
Costs

33. Health Information Exchange (HIE)
Engagement and Encouraging Adoption
• An HIE Solution brings health information systems
together across regions and states in order to
provide access to a patient’s information in one
centralized record.
• Multiple healthcare providers with access to the
same record of clinical information will make
healthcare delivery more robust and efficient with
improved continuity, better outcomes, and reduced
cost. There are significant benefits to patients,
healthcare providers, payers and employers. 33

34. Core HIE Functions
Provides access to a current patient
summary from a variety of sources (From
Where and When):
 Problem List/Diagnosis
 Medications
 Immunizations
 Allergies
 Procedures
 Lab Data
 Radiology Data
 Encounter Summaries

35. Why the HIE is Accessed?
When and why a Provider needs to access the
HIE:
 New patient, not seen before
 Infrequent patient
 Patient known to have received care elsewhere
 Complex patient
 Tracking of patient
 Patient ER visits and
hospital stays
 EHR is unavailable
 Remote Access
35

36. Value/Benefits of HIE
• Access to each patient’s health information from a variety
of healthcare provider sources
• Improved situational awareness regarding patient’s
health and use of health systems, better coordination of
care
• Better triage and evaluation capability: Dx/Problem
list, prior procedures, Rx/Medications, Allergies, tests;
lab/x-ray, progress note and summaries
• Improved efficiency in making diagnosis and
management plans
• Decrease unnecessary duplication of tests
• Readmission avoidance
• Other Benefits : Data Analytics, Public
Health, PCMH, ACO

37. Cloud Based

38. Solution: Core HIE – High Level
Physicians
Privacy Officers
HTTPS
HIE Platform
Web-based access to the
longitudinal patient record
• Demographics
Health Information • Labs, Rads
Hospital with Exchange (HIE) • Encounters
EMR • Allergies
• Diagnosis
• Transcribed documents
• Medications
• Problems
• Procedures
HL7/CCD, XDS, SSO • Immunizations
Direct Secure Messaging
Clinic with
Patient Privacy & Consent
EMR
Notifications &
Seamless integration with EHRs Subscriptions
• User Subscribed Notifications
• Send to My EHR Secure
Inbox
• Portal embedded within EHR
E-Mail
Other HIEs
Mobile

39. Example Integration (Epic)

40. Example Integration (Cerner)

41. The HIE in New Mexico
SS
Raton
A
Farmington Taos
Navaj VA
o Clayton
Clayton
Los
Las
Nation Alamo
Vegas
s
Santa Fe
Cuba
Tucumca
Gallup Grants ri
Albuquerque Santa Amarillo
Anna
Socorr
Los Established HIE
Lunas
o Clovis connectivity
Magdalena Belen
Portales
Lubboc
k Future HIE connectivity
Ruidoso
(random sample of sites)
T or C Roswell Lovington
Silver Alamogordo Hobbs
City
Las Carlsbad
Cruces
Demin
g
El Paso
HITREC sites
(random sample of sites)
41

42. International Telemedicine and eHealth:
Transforming Systems of Care in the Global
Community
Reasons to do International Telehealth
Most health issues are global!

44. H1N1

45. H5N1

46. Distributed Medical
Intelligence
• Knowledge Sharing
Networks/Just in
Time/On Demand
• Best Practices
• Evidence based
46

47. International
Union
Against TB

48. La Lancha Medica
en la Amazonia

49. 49

50. 50

52. Exchange of Students and Faculty

54. Opportunities
Blending HIE with “Telehealth”
Integration with Mobile Devices
Facilitation of research, data analytics,
quality reporting, and other aggregate uses
Hitting the Triple Aims
Becoming a Standard of Care
Fostering Champions
Developing a National and International
Network of Networks

55. Navigating the Perfect Storm with
Telemedicine & HIT
Use a broad spectrum of information communication technologies
Effective distribution of limited resources and expertise
Increasing Access to care
Bringing care to the patient; Aging in place
Decreasing unnecessary variations in care; evidence-based best practices
Improving continuity and coordination of care;The Patient Centered Medical Home
Avoiding unnecessary hospitalizations, duplication of tests, & decreasing errors
Improving health outcomes
Reducing costs; avoiding more costly care and complications, decreasing travel

57. Questions?
http://hsc.unm.edu/som/telehealth
http://www.lcfresearch.org/