Teledentstiry Training

University of Nebraska Medical Center

TeledentistryTeledentistry

Kimberly McFarland, DDS, MHSA

Calvin Hughes

Ashley Merritt

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University of Nebraska Medical Center

Telehealth

The use of telecommunication technologiesto provide health care services and accessto medical information for health careprofessionals and consumers.

Mosby’s Medical Dictionary, 8th edition. 2009, Elsevier

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University of Nebraska Medical Center

Telehealth Services

•Direct patient care

•Health care providercontinuing education

•Consumer medical andhealth information

•Health care research

•Management andadministration services

•Home health care orremote patient monitoring

•Specialistreferral/consultation

•Supervision of direct careservices

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Telehealth Technologies

Live or Real Time - a videoconference inwhich the provider and patient are atdifferent locations, but are able to see,hear and communicate with one another.

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University of Nebraska Medical Center

Telehealth Technologies

Remote Patient Monitoring

•Sensors capture and transmit biometric data

•Serve to educate, build compliance and whennecessary, provide timely intervention andcare

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Telehealth Technologies

Store and Forward – data is captured andstored in one location than forwarded ortransferred to another location

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Telehealth

According to a recent survey, nearly three-quarters of U.S. consumers say they woulduse telehealth.

Health Data Management, July 23, 2009

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University of Nebraska Medical Center

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Telemedicine

The use of medical informationexchanged from one site to another viaelectronic communications to improvepatients’ health status.

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American Telemedicine Association 2012 www.americantelemed.org

University of Nebraska Medical Center

Teledentistry

Clinical consultation services including theuse of digital radiography for the efficientexchange of diagnostic information acrossdental clinic locations.

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Teledentistry Consultation

Click here to view an example consultation.

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Clinical Sites with TeledentistryVideoconferencing Equipment

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Teledentistry Equipment

•Telehealth Cart

•Extraoral camera

•Intraoral camera

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University of Nebraska Medical Center

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Telehealth Cart Features

•Far End: Video from the other end of a videoconference

•Near End: Video coming from the main cameraon the cart

•Content: Patient info or video being shown

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Far End

Near End

Content

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Telehealth Cart Features

Input panels let you attach video sourceslike cameras and computers

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Telehealth Cameras

Additional cameras providediagnostic images

1.Extraoral

2.Intraoral

Extraoral

Intraoral

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University of Nebraska Medical Center

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Extraoral Camera

To use the extraoral camera, you willfirst need to assemble thepower supply and plug intoa power source

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University of Nebraska Medical Center

Extraoral Camera

•Plug the s-video cable intocart’s side auxiliary panel

•Take note of video input number

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Extraoral Camera

Select the video input numberfrom the front panel

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Extraoral Camera

•Adjust the focus: I = Close Up,II = Medium Range, III = FarRange/Full Room View

•Turn on Light

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Camera FocusTwist to focus from Near to Far

Light On/Off

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Extraoral Camera

•When ready freeze the imagefor the other side to view

•Allow 5 seconds for the full image qualityto be viewable at the far end

•Confirm the image is viewable

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Image Freeze

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Intraoral Camera

•Can be used to take close up photosinside the mouth

•Touch sensitive image freeze/capturebutton

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Image Freeze/Capture

Focus RingTwist to Adjust

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Intraoral Camera

Using the secondary freeze/capturebutton helps keep the camera steady

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Secondary Freeze/Capture

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Intraoral Camera

•Requires the use of a computer or laptop

•You will need to have image capturesoftware installed (e.g., MiPacs orTigerView)

•Share computer’s screen by connecting aVGA or DVI cable from laptop to cart

VGA

DVI

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Intraoral Camera

•Plug the DVI or VGA cable intoauxiliary input panel on rear of cart

•To use a VGA cable you will need aVGA to DVI adaptor

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DVI Cable

VGA with DVI Adaptor

University of Nebraska Medical Center

Intraoral Camera

•Use the presentation button to shareyour screen

•Wait for 5 seconds for the image tofully transfer to the far end

•Confirm that the image is viewable

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Presentation Button

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Networking Overview

•Network: More than one device connectedthrough a means of communication.

•IP Address: A unique number used toidentify devices on a network.

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Internet

IP Address

192.198.51.50

Network

IP Address

132.145.23.46

University of Nebraska Medical Center

Tele-health Network

Nebraska Statewide Telehealth Network

An interactive video and data network thatprovides integration among the hospitals, publichealth departments, public health laboratoriesand other entities across the state of Nebraska.

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Clinical Sites with TeledentistryVideoconferencing Equipment

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University of Nebraska Medical Center

Scheduling a TeledentistryConsultation if ON TD Network

1.Call Ashley Merritt at 402-472-1116 and wewill schedule the consultation

2.You will call into the network at theappointed time and select the conferencefrom a menu of conferences

3.Fill out (3) copies of aMedia Authorization

4.Fill out (3) copies of aConsultation Consent

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University of Nebraska Medical Center

Scheduling a TeledentistryConsultation if NOT on TD Network

1.Call Ashley Merritt at 402-472-1116and we will schedule the consultationand we will call you at the appointedtime

2.Fill out (3) copies of amedia authorization

3.Fill out (3) copies of aconsultation consent

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University of Nebraska Medical Center

Media Authorizations& Consultation Consent

•Prior to conducting a teledentistry consutlation,a signed media authorization form and consentis required.

•Forms available on the UNMC Teledentistry website:http://www.unmc.edu/dentistry/teledentistry.htm

•Three copies of each form needed for each of thefollowing:

•The patient

•The dental office/clinic

•The College of Dentistry

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Placing a Call

Click here to watch a movie about placing a call using a Teledentistry Cart

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Barriers to Teledentistry

•Technology

•Reimbursement

•Liability

•HIPPA/Privacy

•Consent

•Record Keeping & Forms

•Legal Issues

•Provider Resistance

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HIPAA Compliant

•Encryption – CODEC units (part of thevideoconferencing equipment) encryptsdata that is transmitted out and un-encrypts data where data is received.

•Dedicated lines or Private Networks (NEStatewide Telehealth Network) are utilized.

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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules

University of Nebraska Medical Center

Teledentistry Reimbursement

•Medicaid pays both the sending andreceiving dentists for their services

•Partial line time is also covered

•May be submitted on the 1999 version2000 ADA Dental Claim Form

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University of Nebraska Medical Center

How to Bill for Teledentistry Services

1.Use the telehealth provider number

2.Bill services per claim instructions in theDental Provider Handbook

3.Note: In Field #49: Place of Treatment,check “OTHER”

4.Bill using the NPI number and zip code + 4and taxonomy

5.For more information please visit:http://dhhs.ne.gov/medicaid/Pages /med_telehealthfaq.aspx

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Field#49

University of Nebraska Medical Center

Teledentistry Reimbursement

How to bill for teledentistrytransmission costs

1.Use procedure code T1014 in Field #59.

2.Enter the number of minutes of transmissionin Qty. (Transmission less than 5 minutes isnot reimbursed.)

3.For more information please visit:http://dhhs.ne.gov/medicaid/Pages /med_telehealthfaq.aspx

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Field#49

Field#59

University of Nebraska Medical Center

Benefits of Teledentistry

•Improves access

•Reduces provider shortages

•Reduces geographic barriers to care

•Improves patient wait times

•Improves patient travel times

•Saves patients time off work

•Saves patients money

•More cost effective as a provider (thanhiring a dentist to go into the field)

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University of Nebraska Medical Center

Teledentistry

For additional information regardingteledentistry and how to successfullyconduct a teledentistry consultation,please see:

http://www.unmc.edu/dentistry/teledentistry.htm

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Future of Dentistry

•Distant expertise provided locally

•Interprofessional interaction/treatment

•Virtual dental clinics/visits

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