A Novel Solution: Integration of Telecardiology into Primary Care Setting

The Agenda
• Problem
• Solution
• Takeaways
• Questions

Telehealth & Emerging Technology

Professor Michael Kurliand
University of San Diego
Mojdeh Amini
May 2020

TELECARDIOLOGY


Cardiovascular Diseases
(CVD)

Mortality
• Every 37 secs, one dies = CVD
• 647,000 Americans die from heart diseases

Cost
• $219 billion/year

Barriers and Challenges

• Socio-economic
Zip Codes Analysis

• Access to cardiologist
Demand-Supply work force
Annual shortage increases about 18% e by 2025
• Primary Care Physician (PCP)
Trajectory of Illness
Trajectory of Heart Failure

• Prevention

Reducing Readmissions via

• Clinics
• Emergency Department (ER)
• Office Visit

Reducing Physical Referrals to

• Secondary Care
• ER
• Cost
 DUO Electrocardiogram +
Hand-Held Echocardiography
Telecardiology + PCP Digital Stethoscope

From Bench To Practice

• Guidelines
• Second Opinion
Benefits
• Improving Access
• Patient + PCP + Cardiologist
• Reducing Referrals
Arrhythmias + Heart Attack
Door-to –Stents
• Cost=Hardware $1,495
=Training $ 11,034
Outcomes:
• Reducing mortality + cost
• Improving satisfactions
Takeaways
Workflow
• Critical Thinking
• Analysis
• Gaps
• Solution

• HIPAA compliance
(Health Insurance Portability
and Accountability Act )

• Culture of Telehealth

• Eliminating Steps

• Outcomes
 Current State Future State
Current State Future State
The Project Telephone In person
RN completed EMR
RNsigns
vital completed
+ ECGEMR
+
Telephone
Virtual Check in
RN completed EMR
RNsigns
vital completed
+ ECGEMR+
Telephone
encounter In person
check in Telephone
encounter
Highlights encounter
generated check in
vital and
assessment signsreviewed
+ ECG +by
encounter
generated
Virtual Check in vital signs +and
assessment ECG +
assessment PCPand reviewed by assessment
reviewed by PCPand
generated generated
PCP reviewed by PCP

Telecardiology into PCP NO

NO Emergency ED Information
Yes
Yes
In person
In person
cardiologist
cardiologist
Emergency consultation
referral? ED Information
Transferred consultation Yes Telecardiology
referral? Transferred referral? No
referral? Yes Telecardiology
Consultation? No
Consultation?

Yes
No
Yes
No

Reduce Office cardiologist

Office cardiologist
consultation Call 911 and referral
Discharge + F/U
Discharge + F/U
No

• Admission
Virtual Co-visit
consultation toCall
ED 911 and referral
Cardiologist Virtual Co-visit Cath Lab No
to ED Cardiologist PCP and Cath Lab Discharge +
PCP and Cardiac Discharge +
Cardiologist Cardiac F/U
Cardiologist intervention? F/U

• Referral
Check Out intervention?
Check Out

Discharge + F/U Yes

• Reduce Mortality Discharge + F/U E/R + Cath/ Lab Cardiac Yes

E/Rintervention?
+ Cath/ Lab Cardiac
intervention? Intervention Check Out

• Cost Effective
Intervention
+ Cardiac Rehab Check Out
+ Cardiac Rehab
Yes
Yes
No
Check Out Intervention No
Check Out Intervention
+ Cardiac Rehab Discharge + summary
+ Cardiac Rehab Discharge + summary
sent to PCP
sent to PCP

Discharge + summary
Discharge + summary
sent to PCP
sent to PCP
Key Check out
Key
RN=Registered Nurse Check out
RN=Registered
ECG= Nurse
Electrocardiogram
ECG=
PCP= Electrocardiogram
Primary Care Provider
PCP= Primary
Cath/Lab= Care Provider
Catheterization Check Out
Cath/Lab= Catheterization
Laboratory Check Out
LaboratoryUp
F/U=Follow
F/U=Follow Up
D/C=Discharge
D/C=Discharge
The Project Budgeting
CostCostofofTeleCardio
TeleCardioConsultaion
ConsultaionperperPatient
Patient Hour
Hour CostCostperperHour
Hour Total
TotalCostCost
• Average Cost of ER Visit + Cost
CostofofTeleCardio
TeleCardio 0.250.25 $80$80 $20$20
Chest pain $1000 PCPPCP 0.20.2 $95$95 $19$19
• Average cost of ER TeleCardio
TeleCardioConsultaion
Consultaion 0.150.15 $200
$200 $30.00$30.00
admission for heart attack RNRNCertified
Certified 0.30.3 $60$60 $18$18
approximately $760,000

• Cost of Telecardiology Total

TotalCostCostofofCounsultaion
Counsultaion $87$87
consultation is $87
 Questions?
References
Bhatt, A. B.; Winchester, D. E. (2020). The Intersection of
Telemedicine and Cardiovascular Patient Care:
Implementing a Practical and Effective Program. Retrieved
from
Thank You!
https://www.acc.org/education-and-meetings/meetings/mee
ting- mamini@sabdieo.edu

Elflein, J. (2019, August 13). U.S.: Active doctors’ number

by specialty 2019. Retrieved from
https://www.statista.com/statistics/209424/us-number-of-ac
tive-physicians-by-specialty-area/

Kim, I., Youn, J., Kobashigawa, J. (2018, July). The Past,

Present and Future of Heart Transplantation. Retrieved
from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031715/

Statista. (2019). The Statistics Portal. Retrieved from

https://www.statista.com/search/?q=cardiovascular
Appendix 1

The Past Medical History

1880’s- Stethoscope

• Faster
• Easy to Use
• Less Costly

https://commons.wikimedia.org/wiki/File%3ALaennec_-_Th%C3%A9obald_Chartran.jpg
Appendix 2

The Past Medical History

1900s – EKG

Key Features

•Instant EKG analysis

•Lead I, Lead II or chest Lead

•30 seconds to 15 minutes Willem Einthoven

recording duration