Columbia University Medical Center

Doctors Reinvent The Housecall – $28 Million Telemedicine Project

$28 MILLION TELEMEDICINE DEMONSTRATION PROJECT LARGEST EVER FUNDED BY THE FEDERAL GOVERNMENT’S DEPARTMENT OF
HEALTH & HUMAN SERVICES

New York, NY – March 18, 2000 — Columbia University College of Physicians & Surgeons (P&S) at Columbia Presbyterian Medical Center (CPMC) and SUNY Upstate Medical University have received a $28 million grant from the Health Care Financing Administration (HCFA) to bring health care into the homes of underserved rural and inner-city residents with diabetes — the largest telemedicine effort ever funded by the federal government’s Department of Health and Human Services. Columbia and SUNY Upstate join five other sites in the effort, called Informatics for Diabetes Education and Telemedicine (IDEATel), which will serve as a test bed for the national use of Internet technology to increase access to health care for all Americans. The demonstration project will be a model to develop more effective treatments for other diseases such as depression, obesity, asthma and heart failure.

Traditionally, Americans living in rural and impoverished inner-city areas have low levels of primary care and high levels of isolation from consistent specialized high-quality medical care. Led by Steven Shea, M.D., Hamilton Southworth Professor of Medicine in Public Health at Columbia University P&S and director of the division of general medicine at Columbia Presbyterian Medical Center of New York-Presbyterian Hospital, the diabetes telemedicine program is a collaborative effort among the Joslin Diabetes Center of SUNY Upstate Medical University, the American Diabetes Association, Harlem Hospital Center, the Harlem Renaissance Network, Arnot Ogden Hospital in Elmira, Olean General Hospital in Olean, Good Samaritan Hospital in Watertown, the Hebrew Home for the Aged at Riverdale, and HCFA.

“While much has been made of the digital divide between rich and poor, rural and urban, I believe this technology will bring better, faster health care to all, ” says U.S. Representative Charles B. Rangel of Manhattan. U.S. Representative Amory Houghton of Upstate New York adds, “Telemedicine can reach beyond the limits to health care in rural New York to ensure quality care in any environment.” The IDEATel project will establish Web-based computing and telecommunications networks in both urban and rural economically disadvantaged areas within New York State.

“The promise of telemedicine is that it will improve health and access to care for all Americans. This study, pathbreaking in its use of medical informatics, will provide the data to understand the impact of telemedicine on the cost and quality of care,” says Dr. George Rupp, president of Columbia University. “Columbia is proud to lead this effort, the largest telemedicine grant ever funded by the federal government’s Department of Health and Human Services.”

“Governor Pataki has made a strong commitment to ensuring that New York State fosters innovative and high-tech industries such as telemedicine, and we are pleased that Columbia University’s Center for Advanced Technology, one of our Centers for Advanced Technology, played a role in this project,” says Russell W. Bessette, M.D., executive director of the New York State Office of Science, Technology and Academic Research. “Telemedicine is an exciting, new field that can create unlimited opportunity for patients and physicians and will reinvent the ‘housecall’.”

In New York State approximately 1.6 million people suffer from diabetes. Complications from diabetes cost the U.S. economy $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can expand the reach of that treatment.

The four-year grant will enable researchers to study the efficacy of telemedicine in improving patient quality-of-life and reducing overall health care cost. Columbia’s Department of Medical Informatics pioneered the use of the Web in providing clinical care. Two million patient records are computerized at CPMC and are available for secure access online by more than 4,000 clinicians. SUNY Upstate’s Joslin Center is preeminent in providing state-of-the-art diabetes care in urban and rural settings, and Columbia’s Naomi Berrie Diabetes Center is one of New York City’s leading centers for diabetes care and research.

“In a doctor’s office, care of diabetes takes place for a few minutes every few months. But in a patient’s home, diabetes care occurs every day. Telemedicine will give people the tools they need to take control of their diabetes. We will be reaching into patients’ homes and empowering them
to take better care of themselves through monitoring, access to information, and education,” says Dr. Shea. “This ‘house call’ of the future will allow patients and clinicians to reach out across any distance for care.”

Initially, 1,500 patients from Northern Manhattan (Washington Heights, Inwood, and North and Central Harlem) and rural areas of Central and Upstate New York will be enrolled in the project. Computers with devices to read blood sugar, take pictures of skin and feet, and check blood pressure will be placed in half of these patients’ homes and the other half, the control group, will continue with the care they usually receive from their providers. The American Diabetes Association also has designed a special “trusted” website — no marketing or advertising — for participants in the telemedicine project that offers comprehensive and reliable information on diabetes management in both English and Spanish and at levels that all users can understand.

“Diabetes, more than most other chronic diseases, requires daily self-management. One cannot take a vacation from diabetes,” says Ruth Weinstock, M.D., Ph.D., professor of medicine, medical director, Joslin Diabetes Center at SUNY Upstate, chief, endocrinology, diabetes and metabolism at SUNY Upstate, and co-principal investigator on the project. “Education, frequent monitoring and medication adjustments in the home setting should help patients achieve better glucose and blood pressure control, thereby preventing or slowing the progression of diabetes’ dreaded complications, such as eye disease, nerve and kidney damage, heart attacks and strokes.”

Participants will receive Internet service, training in equipment use, and maintenance support. Patients will check their blood sugar, blood pressure and other factors that affect diabetes. They will be able to view their own medical information, learn more about diabetes and receive recommendations and instructions on how to manage their disease. Decision support systems will play a crucial role, as an automated care guideline system will analyze each patient’s data. If information recorded on the computer varies from predetermined values, an automated alert will be sent to the physician or nurse. The system also will provide suggestions and reminders to patients about what steps they need to take to maintain good health.

“We will use the power of the Web to treat people with diabetes with more success than ever before,” says David Liss, executive director of Columbia’s Center for Advanced Technology (CAT). The CAT coordinated the participation of companies including American Telecare, which is providing the special home-based units, and Bell Atlantic, which will serve as the telecommunications carrier.

“New York’s 31st District is the home of fiber optics and other advanced technology. This type of system would allow the technology to make a significant difference in peoples’ lives and physical well-being,” says Congressman Houghton. “It is difficult for diabetes patients residing in rural New York State to gain access to hospital care. This project would provide patients with the essential daily monitoring they need.”

“Congratulations to Columbia and its partners for an excellent proposal to help our state’s low-income residents with diabetes with the latest in high technology health care,” says Congressman Rangel. “I am pleased that Columbia’s work has been recognized. It will provide lessons to the entire nation on how to better treat patients.”

TELEMEDICINE FACTS
Approximately 30% of all healthcare spending is utilized by 0.5% of all claimants for reimbursement.1 Telemedicine can target that 0.5% and provide cost-saving, health-saving early treatment.

Early intervention and intensive treatment of chronic diseases will alleviate significant human suffering and save large amounts of money. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can reach a significant percentage of affected Americans.2

Clinical guidelines based on data that can be captured by home health instruments are available for treating diabetes, making the disease particularly well suited for telemedicine.

Americans living in rural and poor inner-city areas have less access to specialty medical care and receive a disproportionate level of primary care by visiting hospital emergency rooms.3 Telemedicine can reach these people quickly, with cost-effective, quality care.

Managed care is increasingly replacing the fee-for-service model in many of the nation’s health care markets, including New York. Telecommunications technology will allow managed care organizations to maintain quality of service while reducing certain costs associated with serving people who are chronically ill. Telemedicine may be especially cost-effective in a capitated reimbursement model.

1 Diabetes Care 1994 Aug; 17(8):909-17
2 Garfield, Richard & Abramson, David M. “Washington Heights/Inwood: The Health of a Community,” pps. 45-46, The Health of the Public Program at Columbia University, New York City, 1994
3 National Institutes of Health; Washington, D.C.

DIABETES FACTS

Diabetes affects 5.9% of the U.S. population, estimated to be 15.7 million Americans.4

Approximately half of all diabetes occurs in people older than 55.4

Nearly 18.4% of the U.S. population aged 65 and older (6.3 million people) has diabetes.4

An estimated 580,000 New Yorkers have been diagnosed with diabetes (4.2% of the state population), and it is estimated that almost an equal number are undiagnosed.5

An estimated 10% of African-Americans in the U.S.– 2.3 million people – have diabetes.4

Diabetes causes many serious complications, including blindness and heart disease. Complications from diabetes cost the U.S. economy $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities.6

4 American Diabetes Association
5 Diabetes Control Program, NYS Dept. of Health (based on 1993-5 data)
6 CHAMP Database

QUESTIONS & ANSWERS

What is the Informatics for Diabetes Education and Telemedicine (IDEATel) project?
Using a $28 million grant from the Health Care Financing Administration (HCFA), the IDEATel project will bring health care into the homes of underserved rural and inner-city residents with diabetes — the largest telemedicine effort ever funded by the federal government. The IDEATel project will establish Web-based computing and telecommunications networks in both urban and rural economically disadvantaged areas within New York State.

Why is this project important?
There are millions of people with diabetes in the U.S. Many of these people have complications that could be prevented, including blindness, kidney failure and heart attacks. We hope that with the electronic house call, we can help people take better care of their diabetes and prevent these complications.

Telemedicine will give people the tools they need to take control of their diabetes. IDEATel will reach into patients’ homes and empower them to take better care of themselves through monitoring, access to information, and education. This ‘house call’ of the future will allow patients and clinicians to reach out across any distance for care. This project will provide patients with the essential daily monitoring they need.

IDEATel will serve as a test bed for the national use of Internet technology to increase access to health care for all Americans. The demonstration project will be a model to develop more effective treatments for other diseases such as depression, obesity, asthma and heart failure.

The project will also seek to establish the healthcare and cost-effectiveness of telemedicine, so that HCFA can set standards for reimbursement of telehealth services.

What is the role and need for telemedicine in New York State?
Americans living in rural and poor inner-city areas have less access to specialty medical care and receive a disproportionate level of primary care by visiting hospital emergency rooms. Telemedicine can reach these people quickly, with cost-effective, quality care.

Managed care is increasingly replacing the fee-for-service model in many of the nation’s health care markets, including New York. Telecommunications technology will allow managed care organizations to maintain quality of service while reducing certain costs associated with serving people who are chronically ill. Telemedicine may be especially cost-effective in a capitated reimbursement model.

Who will benefit from this project? How will they benefit?
Initially, 1,500 patients from Northern Manhattan (Washington Heights, Inwood, and North and Central Harlem) and rural areas of Central and Upstate New York will be enrolled in the project. Computers with devices to read blood sugar, take pictures of skin and feet, and check blood pressure will be placed in half of these patients’ homes. Participants will receive Internet service, training in equipment use, and maintenance support. Patients will check their blood sugar, blood pressure and other factors that affect diabetes. They will be able to view their own medical information, learn more about diabetes and receive recommendations and instructions on how to manage their disease. An automated care guideline system will also analyze the patient’s data. If information recorded on the computer varies from predetermined values, an automated alert will be sent to the physician or nurse. The system will also provide suggestions and reminders to patients about what steps they need to take to maintain good health.
What organizations are involved in this project?
The diabetes telemedicine program is a collaborative effort led by Columbia University that includes New York Presbyterian Hospital, the Joslin Diabetes Center of SUNY Upstate Medical University, the American Diabetes Association (ADA), Harlem Hospital Center, the Harlem Renaissance Network, Arnot Ogden Hospital in Elmira, Olean General Hospital in Olean, Good Samaritan Hospital in Watertown, the Hebrew Home for the Aged at Riverdale, and HCFA.

Why is this project focusing on diabetes?
Clinical guidelines based on data that can be captured by home health instruments are available for treating diabetes, making the disease particularly well suited for telemedicine. Diabetes, more than most other chronic diseases, requires daily self-management. In a doctor’s office, care of diabetes takes place for a few minutes every few months. But in a patient’s home, diabetes care occurs every day. Telemedicine will give people the tools they need to take control of their diabetes. Diabetes is common, costly and complex. If we can show that telemedicine is cost-effective in the care of diabetes, it will be an important demonstration of the wider potential of this technology.

What is the impact of diabetes on the economy?
Diabetes causes many serious complications, including blindness and heart disease. Complications from diabetes cost the U.S. economy $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities.

Early intervention and intensive treatment of chronic diseases will alleviate significant human suffering and save large amounts of money. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can reach a significant percentage of affected Americans.

How does this demonstration project differ from other funded telemedicine projects?
This project relies on the medical informatics expertise developed at Columbia University, the nation’s premier center for informatics. Rather than rely on video conferencing, the project integrates Columbia’s work in Web-based medical records to provide a solution that uses the Web and is cognizant of the full healthcare needs of each patient.

How does this project differ from commercial services now available?
Current commercial products or services are proprietary in nature. That means that the equipment or software of one company does not operate with the products of another company. This project uses technology that will work in any manufacturer’s environment. Columbia has broad experience in automatically taking patient information from the Web and applying medical logic modules to analyze the meaning of the data. Information that is not significant is stored in a database for future reference. Information that requires immediate attention is automatically sent to the right caregiver. Thus, clinician time is used where it is most needed.

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