1115 Sable GOVAE Mon

International Telemedicine: Developing a Model for a Global Pediatric Practice : 

International Telemedicine: Developing a Model for a Global Pediatric Practice Molly Reyna, BA, Oussama El-Baba, MHA, Gerard Martin, MD, Philip Hopkins, Craig Sable, MD Children’s National Medical Center, Washington, DC

International Health Partnership Models for Patient Care : 

International Health Partnership Models for Patient Care Patients travel to United States Medical teams travel internationally Consultation Patient Care Education Advance state of care Physicians provide consultation for international physicians after record review

Goals of International Outreach : 

Goals of International Outreach Improve health care Increase educational opportunities Didactic Hands on patient care Build sustainable business model Patient care Education

Our Experience : 

Our Experience Over view of international program at Children’s National Medical Center Utilization of telemedicine to complement and enhance our international program

International Referrals to DC: 2006 : 

International Referrals to DC: 2006 Service Line Cardiovascular surgery – 46 Cardiology – 17 Orthopedic surgery – 7 Gastroenterology – 4 General surgery – 4 Pediatric medicine – 2 Urology – 2 Oncology – 1 Physical medicine – 1 Neurosurgery – 1 Otolaryngology – 1 Country Kuwait – 43 Saudi Arabia – 11 Uganda – 8 United Arab Emirates – 6 Qatar – 4 Brazil – 3 Netherlands – 1 Barbados – 1 Greece – 1 Chile – 1 Afghanistan – 1 Honduras – 1 Argentina – 1

Countries Visited: 2006 : 

Countries Visited: 2006 Middle East Saudi Arabia Kuwait United Arab Emirates Qatar Europe Belarus Ukraine Russia Africa Uganda Morocco Latin America Dominican Republic Asia China Sri Lanka

Financial Impact: Direct Patient Care : 

Financial Impact: Direct Patient Care Inpatient admissions N = 67 Hospital charges: $6,280,000 Outpatient encounters N = 286 Hospital charges: $372,000 Same day surgery/cardiac catheterization N = 12 Hospital charges: $195,000 Total charges (hospital and professional) $9,020,000

Telemedicine/Distance Education : 

Telemedicine/Distance Education Telemedicine Germany Saudi Arabia Iraq Morocco Qatar Distance Education: Live Lectures Bosnia Iraq Morocco Ukraine Potential sites for 2007 – 08 Egypt Eritrea Uganda Kuwait United Arab Emirates Belarus

Telemedicine : 

Telemedicine Specialties Cardiology Nephrology Pulmonary medicine Infectious disease Gastroenterology Emergency medicine Models Electronic data transfer Live case presentation Discussion of transferred data

Cardiology Case Study 1 : 

Cardiology Case Study 1 24 hour old baby born at Landstuhl Regional Army Medical Center in Germany Trisomy 21/mild cyanosis Referring army cardiologist suspected coarctation of the aorta Initial plan Start prostaglandin E Arrange for medical transport to Washington, DC Plan for expedited discharge of father from Army

Cardiology Case Study 1 : 

Cardiology Case Study 1 Referral call received at 9 AM EDT (3 PM GMT +1) Three way telemedicine call to view live echocardiogram established within 1 hour Physician home (IP to hospital/bridged via Gateway to Germany) Our hospital in DC (ISDN – 384 kbps to Germany) Patient and physician in Germany Telemedicine diagnoses Patent ductus arteriosus/normal transitional circulation No coarctation of aorta Recommendations/outcome Oxygen therapy for 24 hours Normal newborn care Repeat echocardiogram (also by telemedicine) at DOL #3 was normal No disruption of service for father

Cardiology Case Study 2 : 

Cardiology Case Study 2 1 month old blue baby in Saudi Arabia CNMC cardiologist in Saudi Arabia with local physicians: 6 AM EDT (2 PM GMT + 3) Live videoconference (ISDN – 384 kbps): 8 AM EDT Cardiologist and cardiac surgeon in Washington reviewed and discussed case with Saudi team Outcome Complex congenital heart disease Surgical plan agreed upon Patient transferred to Washington for surgery

Nephrology Case Study : 

Nephrology Case Study 5 year old boy in Iraq with severe hypertension, headaches, stroke, and hyperpigmented lesions Data sent in advance via email (PowerPoint) and reviewed by nephrologist Live case discussion (IP – 256 kbps) Satellite from Baghdad to New York IP from New York to Washington Recommendations Medication Renal artery angioplasty

Telemedicine Business Model : 

Telemedicine Business Model Sustainability is critical Direct reimbursement/contractual agreement Telemedicine installation/maintenance Lectures Patient consultation Direct revenue from test interpretation Customization from menu of services Downstream revenue Grant/external funding Support poorer countries with revenue from wealthier countries

Outcome measures : 

Outcome measures Patient care outcomes: Direct patient care statistics: mortality, morbidity, length of stay Public health initiatives Physician satisfaction Academic productivity Public relations/media coverage Financial

Challenges : 

Challenges Language barriers Time zone difference Computer technology compatibility IT staff communication Band width availability Medical practice variability Ongoing funding Sustainability Travel time/insurance/safety

Lessons Learned : 

Lessons Learned Strong incentive to move forward with international telemedicine Good business in wealthy countries Can fill critical need in poor countries Need to be very cognizant of each country’s needs, resources, customs, and politics Relationship building is vital Multiple visits necessary for success Ongoing communication with technical, medical, administrative and political staff Involvement of embassy’s on both ends is very helpful

Next Steps : 

Next Steps Continue to build international program Open up CNMC office in United Arab Emirates Partner with adult hospitals Schedule routine international visits Expand telemedicine reach Build networks in existing countries Look for new partners Advance the concept of combined international programs/telemedicine service line