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Direct to Consumer Video Visits
Patient Centered, Clinician Driven
California Telehealth SummitMark Avdalovic MDMay 23, 2019
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UC Davis Health
One of 5 University of California Academic Health CentersComprised of:
– School of Medicine– Betty Irene Moore School of Nursing– Practice Management Board (Faculty Practice Group)– UC Davis Medical Center and Primary Care Network
Research Clinical Education Service
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History of Telehealth at UC Davis
1992: Tele-fetal monitoring
1996 - 2005: Video telemedicine implemented with three sites and three specialties. Steady growth outpatient and inpatient services
2005-2015: Emphasis on statewide efforts
2015- now: Refining our telehealth strategies to fit today’s demand and prepare for the future
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Types of TelehealthINCREASE ACCESS TO
SPECIALISTSREDUCE SPECIALTY
REFERRALS
Patient - Specialist
Live Video
Store and Forward
Live, two-way video between patient with remote PCP and tele-specialist
Transmission of history and images to specialist for diagnosis and treatment
Distance Learning
Videoconference-enabled training of PCPs by specialists
Electronic message exchange, including clinical question and related patient information
e-Consult
Sync
hron
ous
(Liv
e)As
ynch
rono
us
Patient - PCP PCP - Specialist
Remote Patient Monitoring
Direct to Consumer
Live, two-way video between patient and generalist or PCP
IMPROVE PATIENT-CENTERED CARE
Remote monitoring of patient with video and peripheral devices
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UC Davis Telehealth Portfolio
30+ UC Davis
Specialties
Outpatient Specialty
Telehealth
80+ External Sites
Virtual Clinic (Urgent Care)
Contracted Internal
MyChart Video Visits
Epic-integrated
30 UC Davis Providers
eConsults
Epic-integrated
20+UC Davis
Specialties
Patient generated
data
Epic-integrated
devices
Research & Custom Digital
Health
Innovative applications of
emerging technology
10+UC Davis
Specialties
InpatientSpecialty
Telehealth
35+ External Sites
Chronic Disease Management
>200 Peer Reviewed
Publications
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Why Do a Video Visit?
Patient Convenience and Satisfaction–Decreased travel time– Improved access (in particular for specialty care)– Interact directly with their physician
Build on Our strength–Patients consistently rate their interactions with clinician highly-Video Visits are an extension of the office
Improve Quality and Safety Designed and shaped by clinicians Aligned with our long-term health system
goals
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MyChart Video Visits
Live, interactive visits that utilize MyChart (patient side) and Epic Hyperspace and Haiku/Canto (provider side)
Patients get the convenience of a visit from home Program is in alignment with UC Davis Health’s
strategic goal to lead person centered care Video Visit team (Clinician Lead [CHT], Health
System Sponsored, IT supported, Fully vetted by Finance, Legal and Compliance)
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How it Works
1. An appointment is scheduled for a MyChart Video Visit
2. The patient ‘checks in’ to the appointment by launching from within the MyChart App
3. The provider initiates two-way video by launching from within Epic and the Haiku/Canto App
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Patient Securely Connects via MyCharton their Smartphone or Tablet
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Providers connect to video via Haiku or Canto
Providers chart in Epic hyperspace as usual
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Current and Future Users (as of April 18)
Active Partners Surgery(ortho, vascular Bariatric, CT, Surg onc,urologyplastics) Specialty Pharmacy Pulmonary OB/GYN Family Medicine (ACC) Internal Medicine (Midtown) Folsom PCN Cardiology, Heart Failure ENT, Speech Pathology Pediatric Cardiology
Pending Implementation
Internal Medicine (ACC)
NICU Cancer Center,
Thoracic Surgery Neurology Pain Management Psychiatry Cancer Center,
Palliative Care Wound Care
Exploring Options Home Based Care Genetic Medicine Pediatric
Endocrinology Neurosurgery Anesthesiology MIND
**Not an exhaustive list**
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The Ideal Video Visit Patient
Simple straightforward post operative visits Review of recent test results Review response to treatment, medications Evaluation of simple dermatologic complaints
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Billing for MyChart Video Visits
Billing all payers for established patient visits California Law prevents private insurers from
denying payment based on place of service Medicare patients responsible for $50 flat fee Self-pay patients pay $50 flat fee THE HEALTH SYSTEM INCENTIVE
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Approach to Non MyChart Users
Examples:– Patients outside UCD Health System– Teenagers– Platform for a three way video connection
Utilize a ZOOM connection for provider and patient for majority
Vidyo Platform supports three way video connection
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Training Resources
Video Visit Toolkit–TipSheets (patient, clinic staff, and provider)–eLearnings/Videos (patient, clinic staff and provider)
Group and Individual Training At the elbow training Simulation Training MyChart Adoption
– 2 FTE just for MyChart Video Visit support
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Thank You
All the Clinics and Providers MyChart Video Visit Team
– CHT– IT – PMB– Legal and Compliance– Finance– Ambulatory Operations
Contact– Rupinder Colby, MPH ([email protected])– Mark Avdalovic MD ([email protected])