UCSF

Telehealth“You cannot separate the technology from the process.”

UCSFThree legs of Telehealth

• Live-Video

– Cisco gives us a very strong position

• Store & Forward

– Asynchronous consultations such as

eConsult/eReferral, Tele-Derm and

Tele-Ophthamology

– PACs and EHR integration

• Remote Patient Monitoring

– Enabling the Ubiquitous vs. Episodic care paradigm

UCSFTelehealth’s Organizational Position

• Governance

– The Telehealth Resource Center reports to the

Telehealth Steering Committee

• Strategic tool that allows UCSF to:

– Build an extended referral network

– Export UCSF’s expertise and brand via remote

consultation and education

• Tactical tool that allows UCSF to:

– Collaborate intra-campus/intra-specialty

– Create dispersed yet integrated teams

– Expand our research coverage

UCSFSenator Tom Daschle visits UCSF

• Senator Daschle: “Health care in any society looks like a pyramid. The base of the pyramid comprises basic health care delivery involving wellness and prevention. It is the least costly. As we move up the pyramid, the care becomes more sophisticated and technologically advanced. At the peak are the most costly and technologically advanced applications, such as organ transplants, available in modern medicine today.”

• “Every country begins at the base of the pyramid and works its way up until the money runs out. However, in the U.S., we start at the top of the pyramid and work our way down until the money runs out. This is our fundamental problem.”

Oct 3rd 2012

UCSFUCSF Telehealth develops

The Daschle Cone• Tom Daschle is right however he offers no specific

solution

• So we developed The Daschle Cone to explain how distributed interactions would look both vertically and horizontally

Jeffrey Olgin, Chief of Cardiology, leads a large-scale digital version of the Framingham Heart Study – Health eHeart

UCSF

Local Clinic

Live Homecare

Remote Patient Monitoring

Wellness

Tele

heal

th

mH

ealth

UCSFA patient’s journey through

the Daschle Cone

UCSF

Local Clinics

Live Homecare

Remote Patient Monitoring

Wellness

Pro-Active

In Patient Specialized Care and Education

Tracking conditions

TriageTracking issues

Follow up New NormalConsult

UCSFDr. Mault CMO Qualcomm Life

UCSF

UCSFAgrees with Eric Dishman of Intel

UCSF

UCSF

UCSFHands-on, high touch

UCSF 25X improvement?

UCSFHow Automated Telephony Self-

Management works

UCSF

UCSF This is why ATSM is important

UCSFThe big picture

UCSF Telehealth Focus Areas

• Mission Bay– Intra-campus consultations (MB, M/L, Mt Z.)

– Intra-campus & inter-facility case conferences

• Telehealth Outreach– Inter-facility consultations

• Kaiser: Heart & Lung Transplant

• Pediatrics: CHO, CHCC Madera, Washington, Mad River, Marin General

• Neurology: Contra Costa

• ED: San Joaquin General

UCSF Beware the hype

• “Physicians at UC Davis began practicing telemedicine in 1992” (http://www.ucdmc.ucdavis.edu/ucdavishealth/issues/spring2014/telemedicine-leading-a-revolution.html)

• So why hasn’t UCD blanketed California?

• Factors:– Technology

– Integration

– Adoption

UCSFAdoption

• Dis-rup-tive: – innovative or groundbreaking;

– troublesome, undisciplined, unmanageable, uncontrollable, obstreperous;

• Normalisation Process Theory (Carl R. May PhD)– Four factors of success:

• Local and/or National Policy sponsor

• Structural/Technical integration

• Enrollment of cohesive, cooperative groups

• Integration at the level of professional knowledge and practice, where clinicians are able to accommodate technology through the development of new procedures and protocols