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Anne E. Burdick, MD, MPHProfessor of Dermatology

Associate Dean for TeleHealthMarch 20, 2014

University of Miami TeleHealth Enhancing Healthcare for Floridians UM TeleHealth is a catalyst for

healthcare transformation in Florida.

Access ConvenienceConvenience

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QualityQuality Cost

SynchronousReal-time interactive

AsynchronousStore-and-forward

We use all 3 operational TH modes

SynchronousReal-time interactive

AsynchronousStore-and-forward

We use all 3 operational TH modes

Hybrid

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University of Miami TeleHealth

• 1974: Dr Jay Sanders, prison telemedicine

• 1994: Fellowship at MCG, ATA Board member

•1994: Teledermatology for migrant workers, JAMA

•1996: American Academy of Dermatology Telemedicine Position Statement

• 1999: Founded ATA Teledermatology Special Interest Group Approved 2007

2007

Approved 2007

Endorsed by American Academy of Dermatology

2007

“Based on the history and images provided, my impression is as

follows.”

2008

UM TeleHealth: Our strengths

• Telehealth operations

• Technology & systems engineering

• Telehealth policy

• Industry relationships

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Our challenge: Limited TH reimbursement

• Medicaid: Children’s Medical Services via waiver

• Medicare: Rural, Health Provider Shortage Areas

• No private payers

Our challenge: Limited TH reimbursement

• Medicaid: Children’s Medical Services via waiver

• Medicare: Rural, Health Provider Shortage Areas

• No private payers

Our strategy:

• Contracts

• Grants• Advocate for policy change

Dept of Health Children's Medical Services

• Teledermatology• Telegenetics• Telenutrition• Telepsychiatry

Miami-Dade School Telehealth Initiative

• MD provides Pediatric care to 8 schools

• RN, MA or medical or nursing students present

• Specialty care with UM MDs

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Miami-Dade School Telehealth Initiative

• North Miami Beach schools: elementary, middle and high

• Equipment: HRSA grant

• Health care providers: John T MacDonald grant, Children’s Health Fund, AHEC

• Specialist reimbursement: Verizon Foundation grant

• Dermatology, Nutrition, Psychiatry, Cardiology, Endocrinology

Miami-Dade School Telehealth Expansion

• Centers for Medicare and Medicaid Services grant

• 8th school

• Partnering with Larkin Hospital for telemental health

• Partnering with NOVA University for teledentistry

Eczema herpeticum

Generalized herpes simplex infection + atopic dermatitis

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Eczema herpeticum

Generalized herpes simplex infection + atopic dermatitis

Admitted for IV Acyclovir and antibiotics for 3 days

Other Pediatric TH specialities

UM Pediatric Mobile Van• Sweetwater, Little Haiti, Homestead• Verizon Foundation grant for specialist

reimbursement, 4G network provided

• Nutrition, dermatology, cardiology

Telegenetics

•Statewide Newborn Screening conferences

Telehealth training of health providers

• Dermatology residents• Medical students• ARNP students• DNP students

Core Competencies for residentsAmerican College of Graduate Medical Education

• Interpersonal & Communication Skills

• Systems-Based Practice

• Patient Care

• Practice-Based Learning & Improvement

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Acute teleneurology to hospital emergency departments

• Specialists on Call, Inc.

Discharge planning enhancement

• Patients transfers

• UM Hospital to Miami Jewish Home for the Elderly

• Verizon Foundation grant for a Vgo robot

UM-Aetna Employee TeleHealth

• UM employees

• At a satellite UM clinic, • 10 miles or 45-60 minute drive or

Metrorail ride

• Specialty teleconsultations

• Neurology, dermatology, nutrition, cardiology, pulmonary

Teletrauma: Ryder Jackson Memorial/University of Miami Trauma Center

• Trauma bay resuscitations• ICU bedside rounds• Air ambulance optimization from

Lower Keys Medical Center • Brazil Olympic team, London• US Dept of State contract: 24/7

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Store-and-forward teledermatology

Nashville Area

Oklahoma Area

Albuquerque Area

2010: 75 Indian nations in 29 states

MICMACPleasant Point, ME

Oneida, NY

Catawba, SC

4 yo: 3 days itching, sores hands & stomach4 yo: 3 days itching, sores hands & stomach

………Scabies

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UM – Alaska Teledermatology Service AFHCAN MISSION

To improve access to health care for federal beneficiaries in Alaska through

sustainable telehealth systems

AlaskaFederalHealthCare

AccessNetwork

Alaska’s Health Care Challenges

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• 49% MDs in Alaska are primary care physicians, U.S. average is 28%

• 59% residents live in medically underserved areas

• 48th in “doctors to residents” ratio- 65% are located in Anchorage- Shortages in many specialties

Average Alaska village = 350 Residents

Alaska Native Medical Center

• Tertiary care• Referrals to private medical providers & other

states for complex care• 6 regional hospitals• 4 multi-physician health centers• 25 subregional mid-level care centers• 180 small community primary care centers

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Human assistance and disaster response: TeleHealth in Haiti

• Trauma and critical care

• Teleradiology

• Pediatric subspecialties

Telemedicine for Trauma, Disaster, and Emergency Management Eds: Latifi R, Poropatich R.

Artech House, Boston. 2010

“Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for

Benefit–Cost Analysis”

Dávalos ME, French MT, Burdick AE, Simmons SC Telemedicine and e-Health. 2009, 15: 933-948

2009 Manuscript Award at ATA 2010 Plenary

, Cutis 88, 213: 2011

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UM Cruise Ship Teledermatology

• Provides rapid access to University of Miami dermatologists for crew and occasionally guests on ships all over the world

• Within 72 hours or 24 hours

• Royal Caribbean Cruise Lines since June 2010

• Carnival Cruise Lines since November 2012

Teledermatology at Sea

• Provides dermatology care for an employee population that’s geographically dispersed

• Allows ship’s medical staff to effectively manage their crew’s skin conditions

• Reduces onshore dermatology visits

• Assists in medical evacuation decisions

• Cost avoidance

• UM selected Medweb software

• Cruise IT teams evaluated software

• Username/password assigned to each ship

• Introduced service at RCL/CCL conferences

• Lab and X-Ray capabilities determined

• Additional drugs recommended

• MDs and RNs reviewed UM’s online training

• Test case submitted by each ship before sending consults

Fleetwide Rollout Dermatology at Sea: Special Issues

• Limited drug formulary• Challenging to access shoreside dermatologists • Diverse occupations• Off work or “dry” work difficult, no duplicate crew• Maximum Medical Improvement • Medical isolation • Medical evacuation

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Ship MD UM DermatologyConsultantPhotos

Consult Form

PC

PCInternet UM

ServerS

Workflow Dermatology at Sea: Special Issues

• Limited drug formulary• Challenging to access shoreside dermatologists • Diverse occupations• Off work or “dry” work difficult, no duplicate crew• Maximum Medical Improvement • Medical isolation • Medical evacuation

Stat case: hand dermatitis, violinist

Tinea versicolor

Alopecia areataContact dermatitis

Wart

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Candida intertrigoErysepelis

Bullous cellulitisLeishmaniasis

“3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?”

“3 day painful rash with vesicles, left trunk. On Acyclovir 800mg every 4 hours. Correct?”

Agree with Herpes zoster and treatment

Rare Diseases

Multiple acral reticular histiocytosis

Hidradenitis suppurativa

Relapsing polychondritis

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Oral lesions: Torus palatinus

New England Journal of Medicine, April 11, 2013

<5% consult: referred to dermatologist

Present x 1 monthWart vs. squamous cell cancer vs

keratoacanthoma

Solitary nail pigmentationProbable melanoma

Growing dark dot x 1 yearProbable melanoma

Stat case: Fever + coryza + rash, R/o Measles Stat case: Erythema multiforme major

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UM TeleHealth is a catalyst forhealthcare transformation in

Florida and beyond.

Anne E. Burdick, MD, MPHAssociate Dean for TeleHealth

Professor of Dermatologyaburdick@med.miami.edu

(305) 243-8252telehealth.med.miami.edu

Contact