Otn.teledermSF - e-Health Conference

Report
Reducing dermatology wait times
to less than 5 days with Store
Forward…Otn.teledermSF®
eHealth
May 27, 2013
Objectives
Who is OTN
What is Store Forward
Impact on wait times
Utilization
Why is it working?
User feedback
Where are we going from here?
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About OTN
Veni – We came
Vidi – We saw
Video – We Video’d
Vaco…Store Forward
OTN is a not-for-profit organization funded by the Government of Ontario
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®
What is Otn.teledermSF ?
SF means Store Forward…move the
information, not the patient
Whereas videoconferencing is real-time
(synchronous), store forward is asynchronous
The information is stored and then forwarded for
action by the consultant at a later time
Otn.teledermSF® is a OTN program that
incorporates technology, workflow logic to allow
the secure flow of information between referring
doctors and dermatologists
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How does it work?
The referring doctor, or their
delegate, takes a digital photo of
the patient’s skin lesion
Photo and pertinent
patient information
is sent to the
dermatologist
through OTN’s
secure
software/servers
Referring doc
implements
treatment with
patient
Dermatologist returns a
diagnosis and suggested
treatment plan to the referrer
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What is the need?
Access: 180 dermatologists in Ontario
Wait times: The further from a major centre the
longer the wait times (anecdotal):
For example:
–
–
–
–
45 minutes from Toronto 3-4 months
1.5 hours from Toronto 6 months
4 hours from Toronto 8-12 months
Even reports of 18+ months in some parts of northern
Ontario
Time to treatment reduces costs
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How the program was developed
Literature supports effectiveness of Store Forward
– Patient satisfaction is equivalent to face-to-face
– A study of nearly 1,500 shows improved clinical outcomes,
with better diagnosis and disease management.
– Teledermatology, when applied to all dermatology
referrals, has a probability of being cost saving to society.
Pilot 2009-2010
Operationalized 2011
Remuneration for derms
(Remuneration for referrers not until April 2012)
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Growth
# of consults answered per month
600
500
400
300
FY 2011-2012
FY 2012-2013
200
100
0
Month
Currently, in FY 2013/14, 600+ consults/month…and growing
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Growth Rate
6000
5000
4000
3000
2000
5,101
1,240
1000
0
2011-2012 TOTAL
Over 300% from FY2011/12
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2012-2013 TOTAL
User stats
18 Ontario-based dermatologists
700+ referring physicians
1000+ “delegate” referring users (NPs, Nurses, etc.)
225+ Primary Care referring sites (FHTs, FHOs,
CHCs, etc.)
The list of dermatologists and referring users grows
every week.
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How is Otn.teledermSF affecting wait times?
On average wait times are less than 5 days
Current trending: Less than 3 days
Dermatologists are telling us they are not near
capacity
Will add more derms as required
Derms welcome to join any time (referrers too!)
Otn.teledermSF is freeing up time for f-2-f
appointments
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What dermatologists are saying
“[Telederm] can free up some time in my clinic so
the quick patients can be done through
telemedicine.”
“I do find that I can better screen subjects to see
who needs to be brought in sooner, or who needs
a referral to surgery sooner rather than later. I saw
a woman with melanoma a couple of weeks ago
through Telederm and referred her directly to
Plastics - it was excised in a week. Wouldn't have
happened on real clinic referral time.”
Dr. Melinda Gooderham, Dermatologist
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Talk about setting expectations….
Recall that wait times for a face-to-face
appointment can be more than 12 months
“…and I have to say that I’ve been
waiting a long time to get responses
back from the consultants. I know I
used to get responses back as
quickly as a couple of hours and now
for some, 3-5 days.”
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Why is it working so well?
spent
day today relaxing
5“Iday
turn the
around
poolside
Ease
of usewith my laptop and was able
to catch
up on a few
cases
myof
For
dermatologists,
removes
thewhile
shackles
regular
office hours*
kids swam.
I find the flexibility of
OHIP
(for derms)
doingbillable
the cases
on my own time is
OHIP billable for referrers
convenient.”
Delegate model allows for distributed workflow
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Like using you iPad as a cutting board…
Work flow at some referring clinics: hybrid of
Otn.teledermSF and paper
Delegate handles Otn.teledermSF
Consult notes are printed and handed to the
physician
Perhaps complete
physician adoption
requires full
integration with
EMR
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Adoption Strategies
Referring:
Delegate model
Any camera
Standardized photo kit
No
iPhones
for you!
Dermatologists:
Dermatologists encourage adoption with their usual
referrers
General:
Supports: training, work flow, RMs, Service Desk
Continuous quality improvements
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Benefits for dermatologists
OHIP Billable
Flexibility to provide diagnosis and treatment
when and where convenient
Efficient & effective way to treat patients leading to
decreased wait times
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Benefits for referrers
Consults provided within 5 days on average
OHIP billable as an eReferral
Reduces “n” trials of “X” treatments
Timely referrals leading to improved patient
outcomes
Increased collaboration with specialist = increased
capacity
Potential to reduce costs through efficient referral
process (vs. f2f)
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Other User Benefits
OTN develops relationship with
dermatologists – no need to search for
available derms
Pan-provincial initiative
Collaboration with OneID
OTN Service desk
OTN RMs
Advocacy
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What referring docs are saying
I find Telederm incredibly useful, I have
sent 3-4 patients so far and I received
speedy advice within 2 days. It is an
amazing service. I am very happy being
able to use it.
Thanks for your help
Dr. Lili Mileva
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What referring users are saying
We had less than 24 hour turn around with 2 of our uploaded files and they were to Dr. G.
[Our] doctors had a faxed copy of consultation report in less than 24 hours. That's
amazing!
I set this up approximately 3 months ago and the MD's at my clinic are really impressed
with the efficient manner in which the referrals are received and processed. The MD's are
also satisfied with the recommendations from the specialists. I would highly recommend
this program; it meets the needs of many clients. Regular wait times for a Dermatologist
can be 8 mo to 1yr. We facilitate their assessment in less than a month. Fantastic!!!
I have found the OTN TeleDerm process to be a very quick and easy way of obtaining a
specialist's opinion for our patients. The average response time is about 2 days, which is
remarkable! The patients are very happy to have a diagnosis so quickly. In most of the
cases the specialist recommended medication and it was beneficial to the patient to be
able to start on the treatment in a timely fashion.
I got my first SF referral answered in less than 24 hrs!! It’s amazing.
I personally have had two consults now with Dr. W and have been thrilled with the
results. One actually came back the same day I sent it. She lays out the differential
diagnoses, advises if biopsy necessary to determine correct diagnosis, and then provides
outline of therapeutic plan for each possible outcome. Clear as can be, and so helpful.
Patients are thrilled.
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What dermatologists are saying
I must say that I enjoy doing these store
forward consultations. I find that the focus
is somewhat different than in-office
consultations. I tend to give more useful
basic information to the PCP, knowing that
this physician will be taking active care of
the patient in most cases, especially when
located some distance from major centres.
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eConsult fees
Referring docs can bill the referral as an eConsult
E-Consultation (Physician to Physician):
– This is a service where the referring Physician, in light of
his/her professional knowledge of the patient, requests the
opinion of another Physician. The “consultant Physician”
is able to offer competent advice to provide an accurate
opinion. Both the request and the opinion are sent
electronically through the use of a secure server.
Billing Code:
– K738 Physician to Physician e-consultation (Referring
Physician)
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Challenges to the program
In polite conversation topics to avoid:
1. Religion
2. Politics
3. Sex
4. OHIP fees
Consult fees were $72 up to March 31st 2013
As of April 1st 2013 fees moved to $44
MoHLTC and OMA have been apprised of the
concerns expressed over the reduced fees
eReferral cannot be billed same day
Counter productive to the efficiency of Store
Forward
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Potential Expansion
TeleWound care TelePsychiatry
(in pilot now)
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(pilot starting
summer 2013)
TeleDentistry
(exploration)
What are the steps to get
Otn.teledermSF?
Contact OTN ([email protected])
OTN will contact you
You will receive a password
The password gives you access to the online training
materials/videos as well as to Otn.teledermSF itself
Once training is completed (about 45 minutes) you can
start referring patients right away
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It takes a village…
Manish Rughani
– Supervisor & Systems Administrator, Technical
Operations
Sev Derghazarian
– Telehealth Hardware/Software System Support
Specialist & Systems, Technical Operations
Joy Harris
– Provisioning Group, New Site
Matt Sherman
– Business Analyst, Service Optimization
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Thank you!
Contact information
Stewart Stein
Manager Store Forward
Email: [email protected] (preferred)
Phone: 416-446-4110 x4118
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APPENDIX
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Costs
No annual fees
No set-up fees
No licensing costs
OTN is a not-for-profit funded by the
Government of Ontario
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The Ontario Telemedicine Network
An independent not-for-profit corporation funded
by the Government of Ontario
Members include 1,000 health care and
education organizations
Delivery partners include:
– e-Health Ontario
– Keewaytinook Okamakanak
Telemedicine
– Canada Health Infoway
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OTN: Available Everywhere
One of the world’s
largest & most
active TM networks
Programs &
services delivered
collaboratively at
more than 1,600
sites (>3,000
systems) across
Ontario
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Studies
Teledermatology Patient Satisfaction in the Pacific Northwest - Martha T. Hsueh, R.N., Kristin
Eastman, M.D., Lynne V. McFarland, Ph.D., Gregory J. Raugi, M.D., Ph.D., and Gayle E. Reiber,
M.P.H., Ph.D.
A cost minimisation analysis in teledermatology: model-based approach - Nina Eminović1*,
Marcel G Dijkgraaf2, Rosanne M Berghout1, Astrid H Prins3, Patrick JE Bindels4, Nicolette F de
Keizer1
Netherlands study shows dermatologists using telemedicine to provide efficient care at
lower costs - van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L.
Teledermatology Operational Considerations, Challenges,and Benefits: The Referring
Providers’ Perspective - April W. Armstrong, M.D., M.P.H.,1 Mei W. Kwong, J.D.,2, Elizabeth P.
Chase, M.D.,1 Lynda Ledo, B.S.,1, Thomas S. Nesbitt, M.D., M.P.H.,3, and Sandra Louise Shewry,
M.P.H., M.S.W.2
Telemedicine boosting dermatology care - CAROLYNE KRUPA http://www.ama-assn.org/amednews/2012/01/30/prsc0131.htm
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