PRESENTED BY TOM LANDERS, MD & KEVIN ROSS

PRESENTED BY TOM LANDERS, MD & KEVIN ROSS MBA 1 https://help.nmcp.med.navy.mil Jennifer W. Mbuthia, Kerry A. Hudson, MD Medical Director, Health Online Expert Portal MD Director of Fleet Liaison Medical Director, Pacific Asynchronous TeleHealth Allergy/Clinical [email protected] Staff Obstetrician & Gynecologist [email protected] Background Pacific Asynchronous TeleHealth (PATH) System - Established in 2004 at Tripler Army Medical Center - Provider-to-Provider Tele-Consultation - Asynchronous (store & forward), multi-media - Web-based, HIPAA compliant, secure system - Air Evacuation/Patient Movement/Case Management - Supports documentation & workload credit

- Increasing access & quality care 3 Hubs, Sub-Hubs, and Spokes: New Case Alaska Japan KoreaS NH Yokosuka NH Okinawa NMCSD TAMC Guam ISOS Regional Hub Sub-Regional Hub Spoke Hubs to Sub-Hub Alaska Japan KoreaS

NH Yokosuka NH Okinawa NMCSD TAMC Guam ISOS Regional Hub Sub-Regional Hub Spoke Total PATH Cases 9% increase in total case numbers in 2017 4000 3500 3000 Adult Echo Read Only 2500 Patient Movement

Submission 2000 Consult Converted to Patient Movement 1500 1000 Clinical Advice Consult Only 500 0 04 005 006 007 008 009 010 011 012 013 014 015 016 017 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 93% of all Patient Movements started as Clinical Consultations. 47% of all Clinical Consultations became Patient Movement Cases. 7 PATH Metrics Access to Care

Quality of Care Median response time: 12 hrs. 75% of consults addressed within 24 hrs. 1376 consults resulted in Patient Movt >60 Specialties Available Many further divided into sub-specialties Complexity of Cases Number of Specialties Involved in Cases CY17 6.26% 19.51% 1 Specialty 2 Specialties 3 or More Specialties 74.22% PATH Patients by Service Branch CY17 Coast Guard; 0.6%

Army Navy Other; 4.1% Air Force; 28.0% VA; 2.0% Army; 18.7% Marines Air Force Other Navy; 30.3% VA Coast Guard Marines; 16.2% Providers Requesting PATH Consult/Referrals CY17 Surgery; 17.7%

Behavioral Health Behavioral Health; 2.9% Family Medicine Internal Family Medicine; 35.2% Medicine Operational Pediatrics; 16.0% Other Pediatrics Operational; 7.8% Surgery Other; 7.1% Internal Medicine; 13.2% Specialties Requested on PATH in CY17

Patient Movement (NOT Overflights) Advice ONLY Cases Medical Subs Behavioral Health Other; 8.1% Surgery; 19.3% Other; 16.5% Medical Subs; 23.7% Peds Subs Medical Subs; 38.4% Radiology Behavioral Health; 2.6% Peds Subs; 8.7% Radiology; 3.3% Surgery Behavioral Health; 2.5%

Peds Subs; 28.4% Other Surgery; 41.8% Radiology; 6.7% Specialties Requested Requested Specialties Specialty Number 1. Behavioral Health* 352 2. Orthopedics 230 3. Dermatology 173 4. General Surgery 98 5. Neurology* 82 6. Gastroenterology 73 7. OB/GYN 68

8. Cardiology 66 9. Hematology/Oncology 54 10. Urology* 53 11. Endocrinology 47 12. ENT* 48 13. Neurosurgery* 44 14. Sleep Medicine 35 15. Infectious Disease 35 16. Trauma Surgery 29 17. Pulmonary/Critical 27 Care 18. Radiology 27 19. Pediatric 21 Endocrinology 20. Pain Management

20 Requested Specialties Specialty Number 21. Rheumatology 20 22. Physical Therapy 19 23. Pediatric Hematology/ 19 Oncology 24. Nephrology 18 25. Ophthalmology 18 26. Podiatry 18 27. Allergy/Immunology 17 28. Genetics 12 29. Pediatric 11 Gastroenterology 30. Pediatric Nephrology 11

31. Plastic Surgery 9 32. Occupational Medicine 8 33. PM&R 8 34. Pathology 6 35. Pediatric Infectious 6 Disease 36. Vascular Surgery 6 37. Pediatric Cardiology 5 38. Pediatric Rheumatology 5 39. Sports Medicine 5 *Includes combined adult & pediatric sub-specialists Others: Developmental Pediatrics (4), Cardiothoracic Surgery (4), Proctology (4), Nutrition (4), Pediatric Surgery (4), Audiology & Speech (3), Pediatric Pulmonary (3), Pharmacy (3), Concussion Clinic (2), Dentistry (4), Anesthesiology (2), Neonatology (1), and Preventive Medicine(1) 12 Organizations & Referral Volume CY17*

Organization NH Okinawa NH Guam NH Yokosuka Kadena Air Base Misawa Air Base Brian Allgood ACH Yokota Air Base BHC Iwakuni Camp Humphreys Andersen Air Base BHC Sasebo Osan Air Base Camp Zama BHC Atsugi SURFPAC Kunsan Air Base BMC Bush Daegu USAG NH Lemoore Cases 573 474 409 218 216

176 140 130 98 85 72 59 36 36 22 21 19 18 14 Organization Tricare Pacific SUBPAC Camp Casey Fort Greely Joint Base Elmendorf-Richardson BMC Kinser BMC Evans BHC Chinhae BMC Hansen Camp Red Cloud NMC San Diego

Fleet - Pacific Tripler Army Medical Center BHC Diego Garcia BMC Futenma Camp Stanley Camp Hovey AIRPAC Camp Carroll *Does not include Echo Read Only Cases 13 12 11 10 7 7 6 6 5 5 5 4 4 4 4 4

4 3 3 5 PATH Metrics Access to Care Median response time <12 hours 75% of consults addressed within 24 hours Quality of Care 82 Medevacs recommended from advice only consults 57 Subspecialties currently registered as consultants Cost Savings 58 Medevacs Prevented 245 consults prevented network referrals $1,186,000 total cost savings $654,356 Medevacs avoided $531,160 Recaptured care

Subspecialty Recaptured Care Cardiology 18 Dermatology 92 Endocrinology 29 ENT 21 Gastroenterology 18 General Surgery 5 Genetics 6 Hematology 22 Infectious Disease 18 Internal Medicine 4 Nephrology 8 Neurology 11 OB/GYN 5

Oncology 22 Pediatric Subspecialties 26 Psychiatry/Behavior Health 3 Pulmonology 3 Rheumatology 5 Urology 18 Other 20 TOTAL 354 14 FIRST CLICK 15 Three click submit HELP Three Click Submit Second Click

16 Three click submit HELP Three Click Submit Third Click 17 PATH Cases Types Three PATH Cases Types Clinical Cases Provider to NMCSD Subspecialty Provider Patient Movement Cases Provider/MAO to NMCSD Fleet Liaison Request For Information Cases LIMDU, MEDBOARDS, Discharge Summaries, ALTHA notes, etc ED Reports 18 SPOKE

HUB Clinical Case Consult Manager oversight Consulting Provider Ongoing Dialogue e-mail notification Specialty Consultant oversight Patient Movement or RFI* OFMLS Fleet Liaison Benefits: improved efficiency, decreased errors, decreased air evacs * RFI Request for Information

ADVANTAGES No host nation issues Provider-to-Provider discussion Group Discussions 19 CLICK HERE 20 Tom Landers, MD Naval Medical Center San Diego Virtual Health Committee Chair Dermatology [email protected] Kevin D. Ross, MBA Naval Medical Center San Diego, Virtual Asynchronous TeleHealth Project Manager [email protected]

21 QUESTIONS 22