Telemedicine In Mendocino County

Telemedicine in Mendocino County Meeting the needs of our residents in a difficult environment Mark Turner, I.T. Director Ukiah Valley Medical Center Frank R. Howard Memorial Hospital

Challenging Times •

We have not produced enough physicians to serve the population we have in this country. This is only going to get worse because we are not producing enough physicians to meet the needs of the population we have today or the baby boomers of tomorrow." Peter Fine, President and CEO of Banner Health in Phoenix

•

Rural areas will logically be the hardest hit. Fewer med school graduates start off in rural communities due to loan debt and lower projected earnings.

•

Mendocino county, with higher-than-average home prices and high governmental case mix faces an even tougher challenge. This isn’t our future, but our reality.

1

Bad Timing •

One out of three practicing physicians in the United States is over the age of 55, and are expected to retire in the next 10 or 15 years.

•

Meanwhile, U.S. medical schools have not provided for the loss of 33 percent of the nation's physician work force.

• •

A number of studies have estimated that by 2020 the United States will be short anywhere from 24,000 to 200,000 physicians. Evidence suggests that younger physicians are not willing to put their lives on hold and work 80-hour weeks that include weekends, nights and emergency department on-call duty like their predecessors, which means it may take two younger physicians to cover the work of one retiring physician.

A National Shortage of Physicians "We are in the trenches on this, seeing it every day. Six or seven years ago we would call Mayo or Johns Hopkins and they would say, 'We've got more CVs than we can shake a stick at.' They call us now and say, 'We are in desperate need of doctors.' That is like saying the Yankees can't get anyone to play with them. When that happens, I know we have a shortage.” Kurt Mosley, VP of Business Development Merritt Hawkins & Associates.

2

Overview of Mendocino County Medicine •

Three hospitals serving a population of approximately 89,000 with 300 physicians over an area of 3,878 square miles.

•

Growing deficiencies in some medical specialties.

•

Diminishing pool of on-call physicians.

•

A care system challenged by geography and a relatively weak economy.

•

Tough to attract new physicians due to low reimbursement and high property costs.

•

And it’s in California, the most regulated healthcare system in the country

Mendocino is the best place to live… ..but not the best place to have a stroke. •

Every 53 seconds in America, someone has a stroke, interrupting blood flow to the brain.

•

Chances of recovery are significantly improved if treatment begins within three hours of stroke onset .

•

Only 30% of stroke victims arrive at the hospital in time to be considered candidates for an effective type of clot-busting therapy called thrombrolysis.

•

Only about 20% receive the therapy, often because physicians are unsure if the patient is an appropriate candidate for the treatment.

•

To deem a patient appropriate requires the intervention physician with a neurological background.

3

Number of full-time Neurologists in Mendocino County:

Filling in the gaps • If we can’t bring the physicians to us, we need to

develop ways of getting the patients to them. • The residents of Mendocino County should have

access to life-saving medical procedures in the time of need if at all possible. • Now is the time to strategically position ourselves to

meet the challenges of further challenges in physician availability. • Now is the time to build a strong support model for the

residents of our county.

4

Areas of Deficiency in Our County • Neurology • Cardiology • Pediatric Specialties • Psychiatry • Orthopedics

Medical specialties conducive to Telemedicine: •

neurology

•

obstetrics

•

cardiology

•

gynecology

•

internal medicine

•

psychiatry

•

pediatrics

•

speech-language pathology

•

family practice

•

pharmacy

•

rehabilitation

5

What would such a program look like? • Units in every facility that can connect to regional

centers containing specialists. • Solid relationships and expectations with the medical

centers we would connect to in the time of need. • Proven technology that we can trust to work when

needed. • The necessary bandwidth to facilitate

teleconferencing, medical device feeds, and teleradiology.

Connectivity to Life-Saving Resources

Broadband Broadband UC Davis

Oakland Children’s UCSF Stanford

6

A potential case study-A successful outcome •

77 year-old woman notices numbness on her left side while cleaning her apartment, After finishing cleaning, she calls her daughter, concerned.

•

Daughter calls ambulance and leaves for the hospital.

•

Ambulance arrives at residence, stabilizes the patient and transports to hospital.

•

Upon arrival, ER physician notices slight facial drooping on left side. Orders stat CT scan. It has now been 90 minutes since the incident.

•

CT Scan is performed, ER physician contacts UCSF to request review by neurologist.

•

Neurologist reviews the scan. Decides that stroke protocol should be started. Orders ER Physician to begin TPA (clot buster). It has now been 2 hours, 15 minutes since the first symptom. Patient will return home in 4 days.

Keys to a successful outcome • Patient didn’t wait to see if symptoms would pass. • Accurate diagnosis and referral by ER physician. • CT done in timely manner • A referral to qualified specialist made possible by both

infrastructure and established practice: It was possible, it was planned, therefore it was performed perfectly.

7

We already have success stories: •

Howard Hospital able to save the life of a pediatric diabetic. ER physician able to consult with Pediatric surgeon at UC Davis who walked him through the placement of a line that ultimately saved the child’s life.

•

Stroke protocol has been enacted 3 times at UVMC through the use of telemedicine robot—used to view the CT by using the camera of the robot to view the film.

•

Patients routinely being treated by intensivist at both HMH and UVMC, keeping them close to home and family. Family involvement can be the key to a positive outcome.

What already exists

Units that connect to Intensivist and to UCDavis Medical Center

8

Collateral Benefits of Telemedicine: • Use telemedicine to reach the remote areas of

Mendocino County

• Electronically crossing the coastal range—

better communication between local hospitals.

• Disaster Communication • Staff Education • Patient Education

What would it take to effectively reach out with telemedicine? • Participation from area hospitals and clinics • Aggressive pursuit in areas of funding • Well-defined expectations of the outcome • A well-ran, long-term project. • A successful execution with accountable, measurable

results.

9

Obstacles and Challenges: •

Bandwidth: the greatest need….the smallest pipe. ƒ

Ironically, from the standpoint of telemedicine, rural communities have the greatest need for larger bandwidth.

ƒ

Unfortunately, such connectivity is either unavailable or prohibitively expensive.

•

Telemedicine is an emerging, loosely defined offering with sketchy reimbursement.

•

Currently, telemedicine exists in Mendocino County; but not to the level where it is of the biggest benefit.

•

There will come a time when such connections will be critical to the continuum of care.

Existing/Emerging Broadband Technologies • DS3 • Opt EMan • GigaMAN • SONET Ring • Local Ethernet • ISP-Centric Broadband • Fiber Technologies

Each technology has advantages and disadvantages. Some being data rate/reliability, some being price.

10

Conclusions: • Connecting to specialties is both part of our present,

and our future. • The time to begin building this infrastructure is now.

This will build our foundation for the future, and help Mendocino County Residents today.

11