Department of Medicine 2016 Tech Challenge

New Uses of Information Technology to Advance the Missions of the Department of Medicine

Leveraging telehealth for Resident and Fellow Education for homebound patients

Idea Status: 

There is increasing interest in the use of telehealth initiatives nationally.  Simultaneously, Medicare and other payors are increasingly recognizing that home-based care can be effective, cost-saving, and more person and family centered.  To date, opportunities for trainees to learn about home-based care are limited by current funding mechanisms.  For example, the primary care exception that allows residents to see patients in clinic and bill medicare, does not apply to the home setting. 

At UCSF, Primary care residents and fellows have had opportunities to see patients at home on a very limited basis via the UCSF Division of Geriatrics Care at Home Program.  However, this opportunity has been limited by lack of funding for faculty oversight, and most of the visits are done without capability for attendings to precept the visit LIVE.  The use of telehealth for trainee education could help provide funding for faculty oversight while also enriching the trainee experience by being able to have "live" precepting.  If funded, this opportunity could be avaiable starting with Internal Medicine Residents, Geriatrics Fellows, Nurse Practitioner students, and Palliative Care fellows.  If successful, it could also be easily expanded to include other disciplines.  For example, live telehealth consults for homebound patients who cannot otherwise see specialists, for example, orthopaedics.

This idea is innovative, interdisciplinary, feasible and has the potential to add a new dimension to our education mission, our trainees needs, and help provide person and family centered care. 






Absolutely agree and support. While I'm mindful that CMS is likely concerned about abuse of primary care exception, they must also recognize that their Medicare population is growing larger which means a growing population of homebound adults who still need care. We not only need to provide this care but to teach our learners how to provide competent and comprehensive care in the home. By restricting the primary care exception to bricks-and-mortar clinics, CMS is inherently limiting the competence of its future health care workforce. Telehealtlh is an answer to these restrictions. DOM/UC Medical Center can take a forward step by recognizing and developing a reimbursement strategy for tele-precepted home visits. On broader scale, by showing we can effectively train learners and provide care, we can better advocate for CMS to change their rulings. 

Sounds like a win-win.   Trainees see get experience with house calls and faculty/UCSF get funded to do so.   

Great idea that creatively allows faculty with geriatric expertise to precept more trainees during home visits.  This will enhance trainee skills in home care and geriatrics and improve care for homebound older adults.

From the perspective of a trainee, this sounds like a fantastic idea that would facilitate the educational experience of the residents and fellows while remaining relatively burdenless. It would also make more transparent for the patient the whole process of "precepting".

This is a strong proposal.  It would help secure our  institution as leaders in implementing what will soon become a common way to provide healthcare for populations.  It allows for multiple discplines within the health center to "touch" patients in a low-cost, interdisciplinary way.  Nurses, social worker, physicians, and others could be taught to provide care in the home setting, extending the reach beyond the clinic and hospital to provide a safe continuum of care thus preparing UCSF for the emerging ACO market and Medicare Advantage plans.

As a trainee, I am excited about this opportunity to participate in telemedicine to reach home limited patients. We currently do not have any training in telemedicine as a part of our residency and this would be a forward-thinking addition to our program. The opportunity for live preceptorship would be key to the educational value of the home based primary care experience for residents as well, so I'm glad to see that has been included in the proposal.  

Wonderful idea, this would strongly enhance the skills of trainees while improving the productivity of supervising faculty several-fold. Very feasible. It could also be a "foot/tablet in the door" that creates a model for doing more sophisticated, as-needed, in-home consulting to help maintain complex patients at home whenever possible.

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