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University of Nebraska Medical Center
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TeledentistryTeledentistry
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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University of Nebraska Medical Center
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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University of Nebraska Medical Center
Telehealth Technologies
Store and Forward – data is captured andstored in one location than forwarded ortransferred to another location
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University of Nebraska Medical Center
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
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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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University of Nebraska Medical Center
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Clinical Sites with TeledentistryVideoconferencing Equipment
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University of Nebraska Medical Center
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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University of Nebraska Medical Center
Telehealth Cart Features
Input panels let you attach video sourceslike cameras and computers
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University of Nebraska Medical Center
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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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University of Nebraska Medical Center
Extraoral Camera
Select the video input numberfrom the front panel
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University of Nebraska Medical Center
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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University of Nebraska Medical Center
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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University of Nebraska Medical Center
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University of Nebraska Medical Center
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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University of Nebraska Medical Center
Intraoral Camera
Using the secondary freeze/capturebutton helps keep the camera steady
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Secondary Freeze/Capture
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University of Nebraska Medical Center
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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University of Nebraska Medical Center
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
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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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University of Nebraska Medical Center
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
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University of Nebraska Medical Center
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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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University of Nebraska Medical Center
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University of Nebraska Medical Center
Barriers to Teledentistry
Technology
Reimbursement
Liability
HIPPA/Privacy
Consent
Record Keeping & Forms
Legal Issues
Provider Resistance
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University of Nebraska Medical Center
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 
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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
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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
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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:
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University of Nebraska Medical Center
Future of Dentistry
Distant expertise provided locally
Interprofessional interaction/treatment
Virtual dental clinics/visits
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University of Nebraska Medical Center
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