1. Anne E. Burdick, MD, MPH
Professor of Dermatology
Associate Dean for TeleHealth
March 20, 2014
University of Miami TeleHealth
Enhancing Healthcare for Floridians

2. I have no conflicts of interest
to disclose.

3. ?

4. UM TeleHealth is a catalyst for
healthcare transformation in Florida.

5. Access

6. Convenience

7. Quality

8. Cost

9. Synchronous
Real-time interactive
Asynchronous
Store-and-forward
We use 3 operational telehealth systems

10. Synchronous
Real-time interactive
Asynchronous
Store-and-forward
We use 3 operational telehealth systems
Hybrid

11. University of Miami TeleHealth
•1974: Dr. Jay Sanders, telemedicine in Miami jails
•1994: Fellowship at MCG, ATA Board member
•1994: Teledermatology for migrant workers, JAMA
•1996: Developed American Academy of Dermatology
Telemedicine Position Statement
•1999: Founded ATA Teledermatology Interest Group

12. Approved 2007
2007

13. Approved 2007
2007
“Based on the history
and images provided,
my impression is as
follows.”

14. Approved 2007
Endorsed by American Academy of Dermatology
2007
“Based on the history
and images provided,
my impression is as
follows.”
2008

15. “Economic Evaluation of Telemedicine:
Review of the Literature and Research
Guidelines for Benefit–Cost Analysis”
Dávalos ME, French MT, Burdick AE, Simmons SC
Telemedicine and e-Health 15: 933-948, 2009.
2009 Manuscript of the Year Award

16. Our challenge in Florida:
Limited telehealth reimbursement
• Medicaid: only Children’s Medical Services, waiver
• Medicare: Rural and Health Provider Shortage Areas
• No private payers

17. Our strategy:
• Contracts
• Grants
• Advocate for policy change

18. Dept of Health Children's Medical Services
• Teledermatology
• Telegenetics
• Telenutrition
• Telepsychiatry

19. Miami-Dade School Telehealth Initiative
• 7 North Miami Beach schools:
• Elementary, middle and high schools
• Staff in school clinics supported by Children’s Health Fund,
John T. MacDonald Foundation, AHEC
• Equipment from a HRSA grant
• UM specialists reimbursed by Verizon Foundation grant
• Dermatology by hybrid telemedicine
• Endocrinology, nutrition and psychiatry by VTC

20. Miami-Dade School Telehealth Initiative
• UM doctor provides primary care
onsite and to schools by VTC
• RNs, MAs or medical/nursing
students present patients
• UM specialists: scheduled clinics
• Nutrition: onsite + VTC, groups

21. Miami-Dade School Telehealth Initiative
Expansion
• Awarded an Innovation Grant from Centers for
Medicare and Medicaid Services
• Booker T. Washington High School added
• New services and partners:
• Larkin Hospital for telemental health
• NOVA SE University for teledentistry

23. Eczema herpeticum
Generalized herpes simplex
infection + atopic dermatitis

24. Eczema herpeticum
Generalized herpes simplex
infection + atopic dermatitis
Sent to ER for hospitalization
with IV acyclovir and antibiotics

25. Eczema herpeticum
Generalized herpes simplex
infection + atopic dermatitis
Sent to ER for hospitalization
with IV acyclovir and antibiotics

26. UM pediatric mobile van teleconsultations
• Route: Little Haiti, Sweetwater, Homestead
• Verizon Foundation grant for specialist
reimbursement and 4G network provided
• Nutrition, dermatology, cardiology by VTC

27. Training in telehealth
• Dermatology residents
• Genetics fellows
• Medical students
• ARNP and DNP nursing students

28. UM TeleHealth: Educating residents in
the “Core Competencies” required by
American College of Graduate Medical Education
• Interpersonal and communication skills
• Systems-based practice
• Patient care
• Practice-based learning and improvement

29. Acute teleneurology to hospital
emergency departments
• Specialists on Call, Inc.

30. Discharge planning enhancement
• Patients transfers from UM Hospital to Miami Jewish Home
for the Elderly
• Verizon Foundation grant for a Vgo robot
• Interactions between nurses, doctors and patients
• Goal: to decrease readmissions

31. UM Employee TeleHealth
• Employees at a UM satellite
clinic 10 miles away
• 45-60 minute by car or Metrorail
• VTC specialty teleconsults with
faculty at the medical campus
• Neurology, dermatology,
nutrition, cardiology

32. Teletrauma: Ryder Jackson
Memorial/University of Miami Trauma Center
• Trauma bay resuscitations
• ICU rounds, InTouch robot
• Air ambulance optimization from
Lower Keys Medical Center

33. Teletrauma: Ryder Jackson
Memorial/University of Miami Trauma Center
• Brazil Olympic team, London
• U.S. State Department contract for 24/7
teleconsults for personnel in Iraq + Afghanistan
• 16 specialties:
• Trauma and orthopedics
• Anesthesia, cardiology, dentistry, dermatology,
ENT, gynecology, internal medicine, nephrology,
ophthalmology, psychiatry, pulmonology,
radiology, urology

34. Human assistance and disaster response:
UM TeleHealth in Haiti
Aerial view of University of Miami Hospital, Port-au-Prince, Haiti.Arrow A is the location of the
operating room in the posterior part of the first tent.
Jaffer A K et al. Ann Intern Med doi:10.1059/0003-4819-153-
4-201008170-00266
©2010 by American College of Physicians
• Trauma and critical care
• Teleradiology
• Pediatric subspecialties

35. Telemedicine for Trauma, Disaster, and
Emergency Management Eds: Latifi R, Poropatich R.
Artech House, Boston. 2010

36. Cutis 88, 213: 2011

37. Store-and-forward Teledermatology

38. Nashville Area
Oklahoma Area
Albuquerque Area
MICMAC
Pleasant Point, ME
Oneida, NY
Catawba, SC

39. 4 yo: 3 days itching, sores hands & stomach

40. 4 yo: 3 days itching, sores hands & stomach
………Scabies

41. UM – Alaska store-forward Teledermatology
Alaska’s healthcare challenge:
• 49% MDs are primary care physicians, U.S. average is 28%
• 59% residents live in medically underserved areas
• 48th in doctor : resident ratio
• 65% MDs are in Anchorage
• Shortages in many specialties

42. UM – Alaska store-forward Teledermatology
Alaska’s healthcare challenge:
• 49% MDs are primary care physicians, U.S. average is 28%
• 59% residents live in medically underserved areas
• 48th in doctor : resident ratio
• 65% MDs are in Anchorage
• Shortages in many specialties
UM Teledermatology service, started 12/13
• ARNP at Alaska Native Medical Center, Anchorage
• Reviews referrals from 180 community primary care
centers in the Alaska Federal Health Care Access Network
• Sends selected teledermatology cases to UM

43. UM Cruise Ship Teledermatology
• Provides rapid access to University of Miami dermatologists
for crew and occasionally guests on ships all over the world
• Within 72 hours or 24 hours
• Royal Caribbean Cruise Lines since June 2010
• Carnival Cruise Lines since November 2012

44. Teledermatology at Sea
• Provides dermatology care for an employee population
that’s geographically dispersed
• Allows ship’s medical staff to effectively manage their
crew’s skin conditions
• Reduces onshore dermatology visits
• Assists in medical evacuation decisions
• Cost avoidance

45. • UM selected Medweb software
• Cruise IT teams evaluated software
• Username/password assigned to each ship
• Introduced service at RCL/CCL conferences
• Lab and X-Ray capabilities determined
• Additional drugs recommended
• MDs and RNs reviewed UM’s online training
• Test case submitted by each ship before sending consults
Fleetwide Rollout

46. Ship MD UM Dermatology
ConsultantPhotos
Consult Form
PC
PC
Internet
UM
Server
S
Workflow

47. Dermatology at Sea: Special Issues
• Limited drug formulary
• Challenging to access shoreside dermatologists
• Diverse occupations
• Off work or “dry” work difficult, no redundant crew
• Maximum Medical Improvement
• Medical isolation
• Medical evacuation

48. Tinea versicolor
Alopecia areataContact dermatitis
Wart

49. Candida intertrigoErysepelis
Bullous cellulitisLeishmaniasis

50. “3 day painful rash with vesicles, left trunk. On Acyclovir
800mg every 4 hours. Correct?”

51. “3 day painful rash with vesicles, left trunk. On Acyclovir
800mg every 4 hours. Correct?”
Agree with Herpes zoster
and treatment

52. Rare Diseases
Multiple acral reticular histiocytosis
Hidradenitis suppurativa
Relapsing
polychondritis

53. Oral lesions: Torus palatinus
New England Journal of
Medicine, April 11, 2013

54. <5% Consults are referred to a dermatologist
Present x 1 month
Wart vs. squamous cell cancer vs
keratoacanthoma
New pigmentation of a single nail
Probable melanoma
Growing dark dot x 1 year
Probable melanoma

55. STAT case: Hand dermatitis, violinist

56. STAT case: Fever + coryza + rash, R/o Measles

57. STAT case: Erythema multiforme major

58. UM TeleHealth is enhancing
healthcare in Florida and beyond.

60. Anne E. Burdick, MD, MPH
Associate Dean for TeleHealth
Professor of Dermatology
aburdick@med.miami.edu
(305) 243-8252
telehealth.med.miami.edu
Thank you