TelemedicineDelivery of Care Through Technology

2014 SSCET & UNO Engineering Forum

Kim Landry, M.D., FACEP, FAAEMPresident/CEO Excalibur Telemedical Services

Chief Medical Officer, Lifeguard Ambulance Service, LLC.

Brett Jovanovich, MSHAPresident, Lifeguard Ambulance Service, LLC.

What is Telemedicine?

How does it work?

Examples

MDMD &

Patient

MD Patient

MDExtender

&Patient

1. MD examines patient directly through extender

2. MD Specialist can assist the patient’s primary MD during a virtual visit at the bedside/office

3. MD and patient discuss issues virtually face to face with little to no exam taking place. i.e.Skype

Examples

Extender&

Patient

MD

Extender

Extender Patient

MD

Extender Patient

4. Patient sends digital data to central receiving center. Data is processed and forwarded to patient’s MD

5. Medical assistant helps obtain data from patient and sends to central office for processing

6. Call center triages calls and offers medical advice

Nursing Home Awith UTI

High School ClinicSevere Asthma

Pt at homew/cellulitis

Pt at homeAllergic Reaction

Motor vehicle Accidenton scene "wants to be

checked"

Nursing Home BFall w/skin tear

Elderly Pt w/CHF recently discharged from Hosp

requested post D/C eval

Nursing Home-CPt w/N/V/D/Weakness

Excalibur Model Diagram(Emergency Physician-EMS Telemedical Services)

EMSZZZZZZZ

Diabetic w/low BSand altered LOC

Recent D/C fromHosp w/pneumonia

requested forpost D/C eval

Prisonerwith N/V/D

Abdm Cramps

65 yr rooferworking in heat

feeling ill

Recent D/C fromHosp w/MI

requested for post D/C eval

Follow Up or Referral

Priamry Care MDMedical SpecialistLocal ClinicHealth DeptHospital ServicesTelemedical revisit+/- Psych facilitySocial Services

55 yr old w/severe lowback pains/p lifting

Office BasedEmergency PhysiciansTelemedicine Group

EMSXXXXX

EMSYYYYY

EMSLeon County

EMSColumbia

County

EMSSanta Rosa

County

45 yr old w/burn left arm

and leg42 yr oldw/ left flank pain

16 yr football playervomiting/sweating

tachycaridia, near syncope during practice

Assisted Living Facility

74yr old w/acute painfulblistered rash

across right back and chest

t

Mobile Healthcare Connections

• Leveraging existing technologies• Cellular• Data

• Encryption and Security

How can we deliver quality healthcare through telemedicine? • Telemedicine equipment should:• Allow for an exam that is equal to or better than a face to face exam

Images taken with AMD 2500 Exam Camera and Digital Otoscope

12 lead EKG

Exactly what data and tests are available via telemedicine?

• General Exam Camera• Skin lesions• Eyes• Throat

• Otoscope• Ophthalmoscope• Stethoscope (breath, heart, and bowel sounds)

Exactly what data and tests are available via telemedicine?• 12 lead EKG• Ultrasound• X-ray• POC Lab test (Chemistries, H/H, Dip Urine, Rapid Strep, RSV)• Vital signs (BP, Pulse, Resp Rate, Temp, Pulse-oximetry, weight)• Spirometer

Conclusion

• What is the goal of telemedicine?:• Increases access to healthcare• Improves health outcomes• Reduces healthcare and other cost• Assist in addressing shortages of healthcare providers• Supports clinical education programs

Conclusion

• Technology today permits an equal or better exam than face to face• Allows for more efficient delivery of quality healthcare

• A very positive experience for patients:• No more hours in waiting rooms waiting to be seen • Not having to fight traffic, parking, weather to get to a doctor when your sick• Getting the care you need, when you need it

– YOUR time is valuable, and so is your health