G. Doolittle MD, D Cook PhD, M Schlyer RN, S Clay RN and R Henderson ARNP

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Oncology Care via Telemedicine

• G. Doolittle MD, D Cook PhD, M Schlyer RN, S
  Clay RN and R Henderson ARNP
• University of Kansas Medical Center, Kansas
  City, KS Hays Medical Center, Hays KS Horton
  Center for Health and Wellness, Horton KS

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University of Kansas Medical Center
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Tele-oncology in Kansas

• Why?
• Clinical Practice
• Support Services
• Lessons Learned
• benefits to community
• satisfaction
• cost studies

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Oncology Care for Rural Kansans

• Few oncologists in the state
• Population predominantly located in urban areas
• Northwestern portion of the state medically
  underserved
• Cancer patients must travel long distances
• Smaller communities lack patient/financial base
  to support an oncologist

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Oncology Care for Rural Kansans

• Oncology Care for Rural Kansans
• University - based outreach program
• Three communities Hays, Parsons, Pittsburg
• Physicians conducted fly-in clinics monthly
• Advantages - patients received care close to
  home
• local support of primary
  practitioner
• Disadvantages - travel time for oncologist
• pulled oncologist from
  medical center
• - Kansas WEATHER

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Tele-oncology Practice

• Established six years ago
• Outreach sites Hays, Horton
• Telemedicine Sites Liberal, Beloit, Caldwell,
  Parsons
• Service mix
• thrice weekly telemedicine clinics
• outreach clinics--monthly
• Goals
• use telemedicine to enhance outreach practice
• practice oncology via telemedicine

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2000 Kansas Tele-Oncology Sites
Beloit
Horton
Hays
KUMC
Parsons
Liberal
Caldwell
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Tele-oncology Practice

• TEAM
• Local primary care practitioner
• Local medical and radiation oncologists
• Oncology-trained nurses
• Technician
• KUMC
• Consultant Oncologist
• TeleMedicine Services scheduler, tech
• Oncology-trained nurse practitioner

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Tele-Oncology Practice

• Patient referred by a local practitioner
• Consult is scheduled
• patient
• on-site health care provider
• consultant
• technicians
• Medical information sent prior to clinic

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Tele-oncology Practice

• Consent
• Introduction to the system
• History
• Physical exam - proxy examiner
• Review radiographs/lab
• Discussion diagnosis/treatment

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Tele-oncology Practice

• 678 clinic visits since 1993
• Hematologic / oncologic diagnoses
• No discrepancies noted between telemedicine and
  on-site evaluations
• Consultation
• new patient
• follow-up visits
• second opinion

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Tele-oncology Practice Diagnosis at a
distance
HEMATOLOGIC amyloidosis coagulopathy cold
agglutinin disease erythrocytosis essential
thrombocytosis hemochromatosis hyperbilirubinemia
hypercoaguable state hypercoagulation
syndrome Langerhans histiocytosis leukocytosis le
ukopenia lymphadenopathy macrocytosis monoclonal
gammopathy
MALIGNANCIES ONCOLOGIC breast cancer lung
cancer melanoma ovarian cancer sweat gland
cancer prostate cancer HEMATOLOGIC acute
myelogenous leukemia chronic lymphocytic
leukemia chronic myelogenous leukemia prolymphocyt
ic leukemia multiple myeloma non-hodgkins
lymphoma
myelodysplasia pancytopenia p. vera porphyria sple
nomegaly thrombocytopenia thrombocytosis
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Tele-oncology Practice

• Patient Demographics
• Total 167 Patients
• age range 10.2 - 96.4 years
• average age 66.7 years
• catchment area
• Hays area 113
• Horton 44
• Additional sites 10

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Tele-Oncology Practice

• Referring Practitioners
• Hays 41
• Horton 6
• Other 4
• Average time for visits
• New31 min.
• F/ U visit19 min.

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Support Services For Tele-oncology

• Cancer Pain Management
• Tele-psychiatry
• Cancer Support Groups
• TeleHospice Project
• Educational Series patients, nurses, physicians

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Tele-oncology Practice

• Lessons Learned
• communication
• reimbursement for services
• gathering patient data
• data management
• expense
• patient travel time/ acceptance

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Benefits of Tele-oncology

• Medical community
• access to hematologist/oncologist
• Patients
• receive care close to home
• minimize travel expenses
• Local revenue generated
• physician billing
• hospitalizations
• outpatient diagnostic evaluations

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Tele-oncology Research

• Studies
• efficacy
• acceptance
• cost effectiveness
• clinical utility
• organizational

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Efficacy Study for Tele-oncologyin analysis

• Patient Population
• Patients accrued the first Monday of each month
• All patients requesting a second opinion were
  recruited to the study
• Diagnostic Categories
• Design
• On site evaluations
• Community Oncology
• Outreach clinic
• Telemedicine Evaluation

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Cost Study for Tele-oncology

• Costs of providing telemedicine services
  considering three practice scenarios
• Telemedicing
• Traditional
• Outreach, fly-in clinic
• One year study period
• Two sites KUMC and Hays Medical Center
• Expenses tabulated for
• Equipment/ transmission
• Personnel

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Costs for a tele-oncology practice

• Cost per visit
• Traditional
• 149
• Telemedicine
• 812
• What about at maximum efficiency?
• Outreach
• 897

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Acceptance of Tele-oncology

• Objective to assess satisfaction level of rural
  cancer patients who received care via
  telemedicine
• 37 patients surveyed first year of the
  tele-oncology practice
• 12 item survey instrument assessing satisfaction
• Seven pt scale one-strongly agree
• seven-strongly disagree

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Patient Acceptance with Tele-oncology

• I felt I could talk about anything with the
  consultant
• The consultant cared about me as a person
• The consultant knew what he/she was doing
• Telemedicine makes it easier to get medical care
  
• The care I received from this telemedicine
  consultation was as good as a regular in-person
  visit

• 5.8
• 6.1
• 5.9
• 5.4
• 5.9

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Tele-Oncology Patient Perceptions

• Interviews 22 patients
• Thematic Content Analysis
• All expressed satisfaction with Consultations
• 41 concerned about proxy examiner
• 50 percent of respondents
• Want to see oncologist in person
• Seen as a monitoring service

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Questions?