Advances in Telehealth on to the Future

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Advances in Telehealth- on to the Future

• Ronald Merrell, MD, FACS
• Professor of Surgery Virginia Commonwealth
  University
• Richmond, Virginia USA

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Richmond Virginia
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Drivers in Health Reform

• Mobility
• Access
• Demographic of Aging
• Costs
• Technology

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Health Care as a Place

• The hospital as locus for heavy technology
• The Record Room for medical documents
• The File Room for radiology studies
• The clinic and emergency department for incident
  care

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Mobility is the tradition Not a
revolution. Mobility represents a return to
traditions
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Health Care in an Electronic Continuum

• Digital data, digital records, digital decision
  support
• Lightweight mobile intermittent technology for
  diagnostics and intervention
• Continuous disease management
• Longitudinal care
• Home Health Care
• Telemedicine

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What Technology do we have? Is it really
useful?
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Projected presence and robotic assistance
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Mobility in Healthcare

• Mobile patient
• Mobile disease manager
• Mobile technology
• Mobile First Responder
• Mobile learner and consultant

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Mobile Patient
Through all ages and activities medicine can be
an electronic presence and advocate
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Subsaharan Africa

• 24 disease burden, 3 health workers, 1 health
  expenditures
• Uganda47 years, fertility 7, health expenditure
  12 per cap, GDP 330per cap, MD 118,000
• 31 states lt10 MD/100,000 25 states lt10 per cap
  health expenditure.

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MDs per 100,000 population

• Italy 606
• US 549
• China 164
• South Africa 69
• 31 states in subsaharan Africa lt 10!

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Comparative expenditures for health per capita
per year in dollars

• US 5000
• South Africa 122
• Kenya 10
• Nigeria 5
• Burundi 0.5

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Internet Service Costs (basic)

• US 15/month
• South Africa 33/month
• Tanzania 117/month
• Africa as whole 55/month
• Annual Internet cost/year for Africa is 4 times
  the GDP per capita.

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Bandwidth Costs, 2007

• FiOS (Fiber phone) 30 Mbps
• FiOS 15Mbps
• FiOS 5 Mbps
• Cable 8Mbps
• Cable 6 Mbps
• Digital Subscriber Line (DSL) copper wire phone
  line 780KBpS to 3 Mbps
• Wireless 400 Kbps -1.5 Mbps
• Dial-up Modem 56 Kbps

• 180/200 itune album 15sec
• 50/58 29sec
• 40/48 1min, 26 sec
• 53/58 54 sec
• 34/58 1 min, 11 sec
• 15-40 2 min, 23 sec
• 30-80 4 min, 45 sec
• 10-15 2 hr, 7 min

Richmond Times Dispatch July 9, 2007
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The Anticipated Demand of an Aging Population

• Over 65 years in US rises from 10 to now to 20
  in 2030
• 1946-1960 the baby boom
• Life expectancy doubled in 20th century
• 5 year survival does not fall below 5 years until
  age 90
• The fastest growing portion of the US population
  is age over 85

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Anticipated needs of the aging population

• Old people are sick
• At age 65 average one chronic disease
• Average number of prescription drugs at age 65 is
  5
• Over 65 43/1000 in hospital average of 5.6 days
  each year.
• The cost for medical care for older Americans 3-5
  times that of young people

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BEEP, BEEP, BEEP
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IPv6 Technical Implications

• NAT (Network Address Translation) not necessary
• 128 character address, enough addresses for every
  device and person on earth
• IPsec embedded in the protocol
• Fewer header data problems because of such a long
  address
• Flow Control field in the header can classify
  traffic to advantage real time and lesser
  priority for e-mail and store and forward.
• Mobility
• Security
• Capacity
• Reliability

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Kenya
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Kenya
Mobile Disease Management

• Power
• Sensors
• Telecommunications
• Information Management
• Assisted Autonomy

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Simulated Medical Event above Arctic Circle Mars
Society Mobile consultant and distant emergency
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Wireless Interface Consultant in Richmond
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Integration of Fixed and Mobile Telemedicine

• Remote Environments
• Mobile capabilities
• Pre-op / post-op screening
• Low Bandwidth
• EMR
• Validation

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Fixed Telemedicine
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Remote data collection and diagnostics
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Mobile Surgery Unit in Ecuador
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Image capture for teleconsultation from
Ecuador to Richmond
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Tsunky Nua in Puerto Morona, Ecuador
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Romania VR Coach
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Outcomes for benchmarking

• Number of medical crises averted
• Improved disease management by hard data
  including diastolic blood pressure, HgbA1C,
  Cardiac events
• Reduced face to face medical encounters
• Duration of independent living, Retention of
  autonomy
• Duration of rehabilitation and functional outcome
• COSTS!!!! It simply cannot cost more than the
  traditional care model of incident and
  intervention

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Outcomes Currently Available for Consideration

• Reduced emergency visits for a variety of disease
  states including congestive heart failure,
  asthma, hypertension
• Shorter hospital stays with early transition to
  home
• Fewer clinical visits
• Fewer in person home visits
• Improved diastolic pressure patterns, HgbA1C,
  quality of life
• Reduced costs of chronic disease management

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TelemedicineWhereverWheneverWhatever