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Telehealth expanding access to care | Irina Gelman | TEDxFMCC


our talk begins in Johnstown New York

our talk begins in Johnstown New York where I have relocated to with my

where I have relocated to with my

where I have relocated to with my husband about three years ago at the

husband about three years ago at the

husband about three years ago at the time we had about two and a half

time we had about two and a half

time we had about two and a half children and as a general irresponsible

children and as a general irresponsible

children and as a general irresponsible mildly pregnant individual my first

mildly pregnant individual my first

mildly pregnant individual my first inclination was to contact the local

inclination was to contact the local

inclination was to contact the local medical practice in order to find a

medical practice in order to find a

medical practice in order to find a family doctor and pediatrician at our

family doctor and pediatrician at our

family doctor and pediatrician at our new county of residence much to my

new county of residence much to my

new county of residence much to my surprise every doctor was not accepting

surprise every doctor was not accepting

surprise every doctor was not accepting new patients and that happened to be the

new patients and that happened to be the

new patients and that happened to be the common response until I was finally able

common response until I was finally able

common response until I was finally able to find an appointment months away this

to find an appointment months away this

to find an appointment months away this is the family my husband our two lovely

is the family my husband our two lovely

is the family my husband our two lovely daughters and baby Michael much like any

daughters and baby Michael much like any

daughters and baby Michael much like any other family in Fulton County

other family in Fulton County

other family in Fulton County the fact is residents in rural areas

the fact is residents in rural areas

the fact is residents in rural areas have a decreased access to care

have a decreased access to care

have a decreased access to care resulting in poor health outcomes

resulting in poor health outcomes

resulting in poor health outcomes what is our area all about statistically

what is our area all about statistically

what is our area all about statistically we have over 1,200 businesses one

we have over 1,200 businesses one

we have over 1,200 businesses one Airport our population vacillates at

Airport our population vacillates at

Airport our population vacillates at around 55,000 with half residing in

around 55,000 with half residing in

around 55,000 with half residing in rural and the rest in cities in town

rural and the rest in cities in town

rural and the rest in cities in town 15.9%

15.9%

15.9% are 65 and over with 21.2%

are 65 and over with 21.2%

are 65 and over with 21.2% being 17 and younger poverty rates and

being 17 and younger poverty rates and

being 17 and younger poverty rates and level of educational attainment strongly

level of educational attainment strongly

level of educational attainment strongly influence community health our County is

influence community health our County is

influence community health our County is disproportionately affected by poverty

disproportionately affected by poverty

disproportionately affected by poverty 16.2% reside under the federal poverty

16.2% reside under the federal poverty

16.2% reside under the federal poverty level as compared to 11.8% in upstate

level as compared to 11.8% in upstate

level as compared to 11.8% in upstate New York and 15.6 percent New York

New York and 15.6 percent New York

New York and 15.6 percent New York statewide 18.6% live in single-parent

statewide 18.6% live in single-parent

statewide 18.6% live in single-parent households as compared to 16.6% in

households as compared to 16.6% in

households as compared to 16.6% in upstate New York and 19.8% New York

upstate New York and 19.8% New York

upstate New York and 19.8% New York statewide 21.9% received Medicaid and

statewide 21.9% received Medicaid and

statewide 21.9% received Medicaid and forty seven point six percent of

forty seven point six percent of

forty seven point six percent of children were eligible for free or

children were eligible for free or

children were eligible for free or reduced lunch

reduced lunch

reduced lunch our health care landscape we have one

our health care landscape we have one

our health care landscape we have one hospital one urgent care center

hospital one urgent care center

hospital one urgent care center 13 primary care clinics 92 primary care

13 primary care clinics 92 primary care

13 primary care clinics 92 primary care physicians 19th registered physician

physicians 19th registered physician

physicians 19th registered physician assistants and 20 nurse practitioners

assistants and 20 nurse practitioners

assistants and 20 nurse practitioners there are 155 registered physicians in

there are 155 registered physicians in

there are 155 registered physicians in Fulton County as compared to 215 in the

Fulton County as compared to 215 in the

Fulton County as compared to 215 in the rest of that are under Perl Health

rest of that are under Perl Health

rest of that are under Perl Health Network and 285 New York statewide

Network and 285 New York statewide

Network and 285 New York statewide health outcomes and these are out of 62

health outcomes and these are out of 62

health outcomes and these are out of 62 counties in New York State overall

counties in New York State overall

counties in New York State overall health

health

health 47 length of life 48 quality of life 49

47 length of life 48 quality of life 49

47 length of life 48 quality of life 49 health factors 56 health behaviors 50

health factors 56 health behaviors 50

health factors 56 health behaviors 50 clinical care 53 social-economic 58 and

clinical care 53 social-economic 58 and

clinical care 53 social-economic 58 and physical environment 32 we do enjoy our

physical environment 32 we do enjoy our

physical environment 32 we do enjoy our great outdoors and the many lakes that

great outdoors and the many lakes that

great outdoors and the many lakes that we have here in many respects were much

we have here in many respects were much

we have here in many respects were much like any other rural county in the

like any other rural county in the

like any other rural county in the country working for the local public

country working for the local public

country working for the local public health department we thought what can we

health department we thought what can we

health department we thought what can we do telehealth initiatives may provide a

do telehealth initiatives may provide a

do telehealth initiatives may provide a viable solution to the increased need

viable solution to the increased need

viable solution to the increased need for remote access to care telehealth

for remote access to care telehealth

for remote access to care telehealth being the overall concept of

being the overall concept of

being the overall concept of telemedicine and telemetry components

telemedicine and telemetry components

telemedicine and telemetry components encompassing remote consultations with

encompassing remote consultations with

encompassing remote consultations with doctors as well as vital statistic

doctors as well as vital statistic

doctors as well as vital statistic equipment the benefit of telehealth

equipment the benefit of telehealth

equipment the benefit of telehealth includes evidence-based costs and time

includes evidence-based costs and time

includes evidence-based costs and time effectiveness and may have a major

effectiveness and may have a major

effectiveness and may have a major impact on overall health outcomes

impact on overall health outcomes

impact on overall health outcomes believe it or not today we are on the

believe it or not today we are on the

believe it or not today we are on the cusp of healthcare innovation the

cusp of healthcare innovation the

cusp of healthcare innovation the location of this talk to Fulton

location of this talk to Fulton

location of this talk to Fulton Montgomery Community College happens to

Montgomery Community College happens to

Montgomery Community College happens to be the epicenter of our pilot telehealth

be the epicenter of our pilot telehealth

be the epicenter of our pilot telehealth initiative in collaboration with our

initiative in collaboration with our

initiative in collaboration with our community stakeholders and with the

community stakeholders and with the

community stakeholders and with the approval of our County Board of

approval of our County Board of

approval of our County Board of Supervisors we have received funding

Supervisors we have received funding

Supervisors we have received funding from the Medicaid restructuring

from the Medicaid restructuring

from the Medicaid restructuring initiative in order to set up telehealth

initiative in order to set up telehealth

initiative in order to set up telehealth stations at the Fulton Montgomery

stations at the Fulton Montgomery

stations at the Fulton Montgomery Community College Office for the aging

Community College Office for the aging

Community College Office for the aging in News and the local Fulton County

in News and the local Fulton County

in News and the local Fulton County Public Health Department as a matter of

Public Health Department as a matter of

Public Health Department as a matter of fact our first health station is right

fact our first health station is right

fact our first health station is right across this wall here

across this wall here

across this wall here basically we’re taking over closets all

basically we’re taking over closets all

basically we’re taking over closets all across the county because there are no

across the county because there are no

across the county because there are no windows and privacy is a major

windows and privacy is a major

windows and privacy is a major consideration and incurred that

consideration and incurred that

consideration and incurred that hipaa-compliant platform will be

hipaa-compliant platform will be

hipaa-compliant platform will be utilized to connect our county residents

utilized to connect our county residents

utilized to connect our county residents in real time not as store-and-forward

in real time not as store-and-forward

in real time not as store-and-forward technology to a doctor at that Nathan

technology to a doctor at that Nathan

technology to a doctor at that Nathan what our and st. Mary’s hospitals or any

what our and st. Mary’s hospitals or any

what our and st. Mary’s hospitals or any other provider of their choice the

other provider of their choice the

other provider of their choice the server will be housed with the Fulton

server will be housed with the Fulton

server will be housed with the Fulton County IT department for neutrality

County IT department for neutrality

County IT department for neutrality getting back to what the statistics

getting back to what the statistics

getting back to what the statistics dictate the leading causes of death in

dictate the leading causes of death in

dictate the leading causes of death in Fulton County are heart disease cancer

Fulton County are heart disease cancer

Fulton County are heart disease cancer chronic lower respiratory disease stroke

chronic lower respiratory disease stroke

chronic lower respiratory disease stroke and unintentional injury often alcohol

and unintentional injury often alcohol

and unintentional injury often alcohol and substance abuse related premature

and substance abuse related premature

and substance abuse related premature deaths are due to cancer heart disease

deaths are due to cancer heart disease

deaths are due to cancer heart disease chronic lower respiratory disease

chronic lower respiratory disease

chronic lower respiratory disease unintentional injury and stroke in that

unintentional injury and stroke in that

unintentional injury and stroke in that order obesity and smoking rates in

order obesity and smoking rates in

order obesity and smoking rates in Fulton County are high contributing to

Fulton County are high contributing to

Fulton County are high contributing to increased incidence of hypertension

increased incidence of hypertension

increased incidence of hypertension cardiovascular disease cancer and Stroke

cardiovascular disease cancer and Stroke

cardiovascular disease cancer and Stroke 30 point nine percent of adults in

30 point nine percent of adults in

30 point nine percent of adults in Fulton County are obese as compared to

Fulton County are obese as compared to

Fulton County are obese as compared to 27 percent in upstate New York as well

27 percent in upstate New York as well

27 percent in upstate New York as well as nineteen point five percent of public

as nineteen point five percent of public

as nineteen point five percent of public school children as compared to 16 point

school children as compared to 16 point

school children as compared to 16 point seven percent of their upstate New York

seven percent of their upstate New York

seven percent of their upstate New York counterparts the smoking rate of Fulton

counterparts the smoking rate of Fulton

counterparts the smoking rate of Fulton County adults has continued to rise from

County adults has continued to rise from

County adults has continued to rise from 25 percent in 2013 to the 29 percent of

25 percent in 2013 to the 29 percent of

25 percent in 2013 to the 29 percent of adults that you see depicted here as

adults that you see depicted here as

adults that you see depicted here as compared to seventeen point three

compared to seventeen point three

compared to seventeen point three percent in the rest of upstate New York

percent in the rest of upstate New York

percent in the rest of upstate New York resulting in increased hospitalizations

resulting in increased hospitalizations

resulting in increased hospitalizations edie visits due to asthma COPD and other

edie visits due to asthma COPD and other

edie visits due to asthma COPD and other respiratory conditions cancer continues

respiratory conditions cancer continues

respiratory conditions cancer continues to be a local public health priority

to be a local public health priority

to be a local public health priority with ovarian colorectal and prostate

with ovarian colorectal and prostate

with ovarian colorectal and prostate topping the charts according to the US

topping the charts according to the US

topping the charts according to the US Department of Health and Human Services

Department of Health and Human Services

Department of Health and Human Services Fulton County’s considered to be a

Fulton County’s considered to be a

Fulton County’s considered to be a health professional shortage area for

health professional shortage area for

health professional shortage area for primary care mental health and dental

primary care mental health and dental

primary care mental health and dental care

care

care there is hope according to a recent

there is hope according to a recent

there is hope according to a recent survey approximately 70 to 75 percent of

survey approximately 70 to 75 percent of

survey approximately 70 to 75 percent of residents of Fulton County have a

residents of Fulton County have a

residents of Fulton County have a smartphone a larger percentage use other

smartphone a larger percentage use other

smartphone a larger percentage use other technology such as a laptop tablet or

technology such as a laptop tablet or

technology such as a laptop tablet or personal computer let us pause here and

personal computer let us pause here and

personal computer let us pause here and think about that for a moment that

think about that for a moment that

think about that for a moment that statistic is astonishing think of its

statistic is astonishing think of its

statistic is astonishing think of its implications this common thread that

implications this common thread that

implications this common thread that unites many indicators and most

unites many indicators and most

unites many indicators and most demographics may potentially have a

demographics may potentially have a

demographics may potentially have a positive impact on our health outcomes

positive impact on our health outcomes

positive impact on our health outcomes for the remaining residents that are now

for the remaining residents that are now

for the remaining residents that are now unable to do so in lieu of socio

unable to do so in lieu of socio

unable to do so in lieu of socio economic educational connectivity or

economic educational connectivity or

economic educational connectivity or other barriers we are hoping to set up

other barriers we are hoping to set up

other barriers we are hoping to set up health stations across the county to

health stations across the county to

health stations across the county to improve remote access to care for all

improve remote access to care for all

improve remote access to care for all residents what we are hoping to achieve

residents what we are hoping to achieve

residents what we are hoping to achieve here in Fulton County New York falls

here in Fulton County New York falls

here in Fulton County New York falls under the spectrum of true prevention

under the spectrum of true prevention

under the spectrum of true prevention health education and improved access

health education and improved access

health education and improved access that may positively impact our health

that may positively impact our health

that may positively impact our health outcomes this is quintessential

outcomes this is quintessential

outcomes this is quintessential population health this initiative has

population health this initiative has

population health this initiative has the potential to impact all residents of

the potential to impact all residents of

the potential to impact all residents of Fulton County New York and is at the

Fulton County New York and is at the

Fulton County New York and is at the forefront of health care innovation here

forefront of health care innovation here

forefront of health care innovation here you may say well telehealth initiatives

you may say well telehealth initiatives

you may say well telehealth initiatives are not new there are plenty of

are not new there are plenty of

are not new there are plenty of evidence-based publications with regard

evidence-based publications with regard

evidence-based publications with regard to their utility and efficacy all over

to their utility and efficacy all over

to their utility and efficacy all over so what is the innovation to that I

so what is the innovation to that I

so what is the innovation to that I would respond this is a viable

would respond this is a viable

would respond this is a viable sustainable initiative that has the

sustainable initiative that has the

sustainable initiative that has the potential to improve remote access to

potential to improve remote access to

potential to improve remote access to care and have a profound impact on

care and have a profound impact on

care and have a profound impact on health outcomes while reducing the

health outcomes while reducing the

health outcomes while reducing the burden of chronic disease that within

burden of chronic disease that within

burden of chronic disease that within the confines of our given infrastructure

the confines of our given infrastructure

the confines of our given infrastructure our local Public Health Department may

our local Public Health Department may

our local Public Health Department may leverage existing resources and act as a

leverage existing resources and act as a

leverage existing resources and act as a lynchpin to facilitate the connections

lynchpin to facilitate the connections

lynchpin to facilitate the connections between stakeholders culminating in

between stakeholders culminating in

between stakeholders culminating in improved care ideally Fulton County

improved care ideally Fulton County

improved care ideally Fulton County residents will utilize their own

residents will utilize their own

residents will utilize their own smartphones or other technology devices

smartphones or other technology devices

smartphones or other technology devices in their homes and throughout the

in their homes and throughout the

in their homes and throughout the community health stations will be

community health stations will be

community health stations will be available as a supplement

available as a supplement

available as a supplement alternate means of access are not

alternate means of access are not

alternate means of access are not available connecting to a local health

available connecting to a local health

available connecting to a local health care provider ensures continuity of care

care provider ensures continuity of care

care provider ensures continuity of care from remote access to in-person visits

from remote access to in-person visits

from remote access to in-person visits while optimizing the local provider

while optimizing the local provider

while optimizing the local provider panel and reducing burden on physicians

panel and reducing burden on physicians

panel and reducing burden on physicians the budget for this project is minimal

the budget for this project is minimal

the budget for this project is minimal as compared to other health initiatives

as compared to other health initiatives

as compared to other health initiatives while the correlating impact is vast the

while the correlating impact is vast the

while the correlating impact is vast the funding is provided by the regional and

funding is provided by the regional and

funding is provided by the regional and medicaid restructuring plans as well as

medicaid restructuring plans as well as

medicaid restructuring plans as well as other grant monies geared towards

other grant monies geared towards

other grant monies geared towards towards health improvement and

towards health improvement and

towards health improvement and population health Fulton County New York

population health Fulton County New York

population health Fulton County New York is the fifth most populous region in the

is the fifth most populous region in the

is the fifth most populous region in the Adirondack oral health network as you

Adirondack oral health network as you

Adirondack oral health network as you now know it is a rural area with

now know it is a rural area with

now know it is a rural area with restricted access to care due to a

restricted access to care due to a

restricted access to care due to a limited provider panel remote location

limited provider panel remote location

limited provider panel remote location and over overall low population density

and over overall low population density

and over overall low population density the future according to Clem bezel chair

the future according to Clem bezel chair

the future according to Clem bezel chair and futurist of the institute for

and futurist of the institute for

and futurist of the institute for alternative futures in his brilliant

alternative futures in his brilliant

alternative futures in his brilliant vision for public health 2030 for a nice

vision for public health 2030 for a nice

vision for public health 2030 for a nice h/o scenario for community driven health

h/o scenario for community driven health

h/o scenario for community driven health and equity that includes a positive

and equity that includes a positive

and equity that includes a positive public health movement communities

public health movement communities

public health movement communities promoting population health widespread

promoting population health widespread

promoting population health widespread health consciousness and a value shift

health consciousness and a value shift

health consciousness and a value shift to equity

to equity

to equity he’s even included telemedicine my

he’s even included telemedicine my

he’s even included telemedicine my personal favorite he highlights the

personal favorite he highlights the

personal favorite he highlights the necessity for political leaders to

necessity for political leaders to

necessity for political leaders to include public health on their agenda

include public health on their agenda

include public health on their agenda the population health initiative

the population health initiative

the population health initiative discussed today is viable capable of

discussed today is viable capable of

discussed today is viable capable of being sustained long-term and provides a

being sustained long-term and provides a

being sustained long-term and provides a positive health impact in this region

positive health impact in this region

positive health impact in this region healthy people 2020 is committed to the

healthy people 2020 is committed to the

healthy people 2020 is committed to the vision of a society in which all people

vision of a society in which all people

vision of a society in which all people live long healthy lives and the outlined

live long healthy lives and the outlined

live long healthy lives and the outlined initiative may take us one step closer

initiative may take us one step closer

initiative may take us one step closer to making this a reality I will leave

to making this a reality I will leave

to making this a reality I will leave you with one final thought prevention

you with one final thought prevention

you with one final thought prevention education and access equals population

education and access equals population

education and access equals population health thank you

health thank you

health thank you [Applause]

”

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