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Global Trends in Telemedicine Dr. Mark J. Burby MB BChir

Director, Cisco Healthcare, Asia Pacific

19 October, 2011

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• Telemedicine housekeeping

• Telemedicine modalities

• Applications of telemedicine

• Market overview around the world

• Challenges facing the technology

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• Voice

• Fax

• Email / Messaging

• PACS

• EHR

• Video

• Medical device telemetry

• Web conferencing

• SMS

American Telemedicine Association

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Claims

Agent

Specialist

Hospital A

Hospital B

Payer

Physician’s

Office

Patient’s

Home

Allow radiologists and

physicians to collaborate

in real-time through

unified communications

and image sharing

Reduce costs, and

collaborate more

effectively, and provide

better access to care

through telemedicine

Enable video communication

for caregivers to provide

language interpretation

services, education, poison

control help and psychiatric

services remotely

Provide better and more cost-

effective care through

collaboration

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DATA

VOICE

VIDEO

SECURITY

Electronic Health

Records (EHR)

Remote Patient

Monitoring Disease State

Tele-health Digital Image

Transfer (PACS)

Tele-health Remote Video Consultation

50

Speed

10

(Mb)

1

Fast Faster Real-Time

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Publication Date: 28 July 2011/ID Number: G00214814 Page 15 of 58

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Figure 1. Hype Cycle for Telemedicine, 2011

Source: Gartner (July 2011)

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Publication Date: 28 July 2011/ID Number: G00214814 Page 17 of 58

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Figure 2. Priority Matrix for Telemedicine, 2011

Source: Gartner (July 2011)

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• US$900m in 2007(Datamonitor)

• 2012-2013 Projections

The Wall Street Journal projects telemedicine to be a $6 billion industry by 2012.

DataMonitor projects telemedicine to be an $8 billion industry for 2012.

TechNavio Insights projects telemedicine to be a $17.8 billion industry by 2012.

Schooley Mitchell Consultants projects telemedicine to be a $4.4 billion industry by 2013 (home based).

• Over 200 telemedicine networks in US connecting over 2,000 medical institutions.

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• Telesurgery/Robots In Touch Health (medical robots)

Intuitive Surgical (surgical robots) da Vinci

• Telemonitioring - Home Based Products

Honeywell

Bosch

Intel

AT&T

• Teleconsulting AMD Global Telemedicine

Polycom

Cisco/Tandberg

• Teleradiology – PACS Systems

Siemens

GE

Kodak

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Telesurgery 2% Telemonitoring

13%

Teleradiology 67%

Teleconsulting 18%

Source: TechNavio Insights

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• Delivery of medical care to any patient located in a remote location.

• Shortage of physicians, telemedicine provides ability to care for more patients at a distance.

• Improvement of the quality and access to care to remote and medically under-served areas.

• Financial considerations – possible savings in transportation cost savings for patient and physician.

Telemedicine has the opportunity be more

disruptive by challenging conventional

workflow and care delivery models

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• Pre-configured telemedicine solutions including integrated cart solutions and integrated telemedicine case solutions.

Telemedicine Carts

Health Pod/Stations

Portable Cases

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This fully integrated telemedicine cart allows care providers to:

• Capture images, video, vital signs and data

• Capture information from external imaging devices

• Forward patient cases and attached images and information to other professionals or specialists at remote locations for review and consultation

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Portable Cases

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Main Hospitals to Rural Hospitals including eICU’s and ER’s to monitor or triage patients

Main or Rural Hospitals to Clinic(s)

Schools- Elementary to College level, Mobile Vans

Travel – Commercial and Private Ships & Airlines

Military and Prisons based programs.

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• Teleneurology

• Teleopthalmology

• Telepsychiatry

• Telepediatrics

• Teleobstetrics

• Teleultrasound

• Telemammograph

• Teleradiology

• Telerehabiliation

• Teledermatology

• Telecardiology

• Telesurgery

• Teletrauma/TeleEmergency

• Telespeech

• Telementoring

• Teleeducation

• Telehospice

• Teleforensics

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Expert Gateway – translation services

Healthcare Interpreter Network

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―81% of nurses report they would save 30 to 60 minutes with instant access to experts.‖ —Forrester Research, 2006

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R-Bay Architecture, courtesy C Wanscher / J Rasmussen, MedCom Denmark

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The future of Telemedicine technologies are influenced by telecommunication and technology advancements

Future of telemedicine technologies…

Are influenced by:

1.Telecommunications advancements

2.Technology advancements

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The da Vinci consists of 3 main parts:

A. Surgeon’s console

B. Video tower

C. 3 robotic arms

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CALIFORNIA DEPARTMENT OF CORRECTIONS

• California Department of Corrections has a 170,000 population of adult prisoners in 33 institutions.

• Most prisons are located in rural areas where specialists are in short supply.

• State documents say the first telemedicine project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.

• The director of clinical operations for California Prison Health Care Services says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year.

Telemedicine Applications

Correctional Health

CALIFORNIA DEPARTMENT OF CORRECTIONS

California Department of Corrections has a 170,000 population of adult prisoners in 33 institutions.

Most prisons are located in rural areas where specialists are in short supply.

State documents say the first telemedicine project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.

The director of clinical operations for California Prison Health Care Services says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year.

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Internet-based REACH system for Telestroke at the Medical College of Georgia, USA

Internet- based REACH system for Telestroke at

the MCG, Georgia, USA

(Remote Education of Acute Ischemic Stroke)

Dr. Hess a neurologist exams a CT of the brain

via videoconferencing and teleradiology application.

REACH System Model

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Greenland significantly reduced the number of unnecessary transports through telemedicine system implemented in 2008

GREENLAND’S NATIONAL MANGEMENT OF HEALTH

Problem: How can we reduce number of patients that are MedEvaced

while still providing timely and expert medical care to the entire

population of our island?

Solution: In 2008, Greenland began the process of implementing a

Telemedicine Encounter Management System

(TEMSTM). This system greatly reduced the

number of unnecessary transports and gave

the people of Greenland unprecedented

access to quality healthcare.

Telemedicine ApplicationsRural Health

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US Military and VA use telemedicine to deliver care to soldiers in the field and a disparate veteran population

Telemedicine ApplicationsVeteran’s Administration

Some Veterans live many miles from a VA Medical Center, making visits to doctors or clinicians an all-day event. Others - those in chronic conditions - require constant monitoring but opt to stay at home rather than in the hospital.

In either case, telemedicine provides greater access to healthcare through the use of telecommunications and videoconferencing.

A nurse assists a Veteran with medical exam equipment while a physician tunes in

via video to offer her expertise.

Telemedicine ApplicationsMilitary

In military settings, telemedicine is being widely used to identify injury and illness and aid in the treatment, rehabilitation, and recovery of combat-wounded soldiers.

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Infrastructure improvements and developments in video codec bring the possibilities of telemedicine with the convenience of mobility

Telemedicine ApplicationsMobile Health

Mobile health is aimed at expanding access to health care. A mobile clinic can travel to patients.

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• Better compliancy

• Post-acute discharge monitoring

• Reduction in post-operative complications

• Improved self-care management of chronic disease

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• Reimbursement

• Cross-state/region licensure

• Care management programs

• Physician training and acceptance

• Patient privacy rules

• Bandwidth / infrastructure

• Interfacing to applications

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• Small scale studies have shown clear cost savings…large scale studies are beginning to come through

• Correct implementation appears to be the most important step in achieving success (rather than technology)

• Characteristic demand for variety and customisation makes it difficult to acquire consistent cost savings data

• Cost savings data is a typical step toward development of a satisfactory reimbursement model

• Local and state government agencies often pick up the slack where federal agencies fall short

Source: Frost & Sullivan

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2002 2003 2004 2005 2006

Lack of Security

Slow connections

Lack of interoperability

Interference between devices

Inability to achieve workflow integration

Difficult to use

Source: Medical Records Institute’s Ninth Annual Survey of Trends and Usage 2007

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Health plans and Government Payers

Healthcare Providers

Employers Technology & MDCs

Change enablers

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• Telemedicine is being applied today across the world in a wide variety of modalities and specialities

• More work needs to be done to demonstrate cost effectiveness and develop effective reimbursement models

• Barriers are being lowered as technology, infrastructure improves

• Some telemedicine applications will become mainstream soon, others will take time to develop – chance for differentiation

• Need for large scale studies to demonstrate benefits

• Reduction in capital and operational costs are starting and will continue to greatly improve RoI etc.

Thank you.