Telemedicine in the Mountains

1
Telemedicine in the Mountains
2
Maggie Jaynes MD

• Department of Pediatrics
• Center of Excellence in Disabilities
• West Virginia University

3
The Need

• Barriers to health care in rural areas
• Poverty
• Lack of public transportation
• Limited education
• Lack of pediatric specialty care

4
Wild WonderfulWest Virginia

• Second most rural state
• Only state that lies completely within the
  Appalachian Region.
• Considered isolated culturally and economically
  because of its terrain.
• Transportation often sited as single most
  critical issue affecting health care access

5
Children and Healthcare in West Virginia

• Highest percentage of children with disabilities
  in the nation
• Children living in poverty - 27 compared to US
  average of 22
• 43 through age 20 are enrolled in Medicaid
  compared to 30 nationally
• 55 of patients seen for epilepsy have Medicaid

6
Telemedicine -Advantages

• Providing specialty care that otherwise may not
  available
• Impact on family cost savings
• Patient/family satisfaction

7
Mountaineer Doctor Television

• Available since 1992
• Diagnostic units link with two larger medical
  centers
• Bridging the gap in specialty care
• Educational activities and consultation via TV to
  isolated primary care centers
• Consultations and CME credit for rural
  practitioners

8
(No Transcript)
9
WHY USE MDTV?

• Provide clinical care that emphasizes
  co-management
• Community based
• Family centered
• Supports Medical Home

10
(No Transcript)
11
HISTORY of the Lewisburg Site

• Patient every few months- now 10 patients monthly
• Originally presented by nurse practitioner- now
  pediatricians in practice use

12
Clinic Visit

• History complete with home chart including growth
  and developmental and all labs
• Other conditions considered
• Local providers may participate
• During the visit, the plan is reviewed with the
  family and client

• Contact with schools and other agencies made by
  primary care physician after visit
• Next visit with MDTV made
• Other referrals made
• Family feels comfortable talking to consultant
  with primary care provider

13
Clinic Visit

• Continuity of care
• All concerns addressed
• Chart updated, no waiting for referral letter

• Network of health care providers developed and
  utilized

14
What Does the Patient and Parent Get?

• No travel
• Car may not be able to travel long distance
• Patents have not traveled in that area or that
  far from home
• Parents may not have to take day off from work
• Child/children may not have to miss school

• Timely appointment
• Provider with the patient during visit
• Scripts and lab orders done after appointment
• May include other members of health team

15
What does the Provider get?

• Makes better referrals
• Stronger advocate for patients and family

• The care is integrated into primary care and not
  fragmented
• Has someone to call during intervals for med
  changes or problems

16
WHY USE MDTV?

• Can be used for educational purposes
• CME available for MDs
• Educational activities for medical students and
  residents who might not otherwise have exposure
  to pediatric specialists
• Educational activities for other health care
  providers

17
WHY USE MDTV ?

• IT JUST MAKES SENSE