Abstract
Concurrent Sessions Abstracts
Clinical Services
Presentation #: CS1-01
REFERENCES:
1. Lindsay JA, Kauth MR, Hudson S, Martin LA, Ramsey DJ, Daily L, Rader J. (2015). Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder. Telemed J E Health, 21(6), 467-472.
2. Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. (2015). Teleconsultation and training of VHA providers on transgender care: Implementation of a multisite hub system. Telemed J E Health, 21(12), 1012-1018.
3. Acierno R, Gros DF, Ruggiero K.J, Hernandez-Tejada BM, et al. (2016). Behavioral activation and therapeutic exposure for posttraumatic stress disorder: a noninferiority trial of treatment delivered in person versus home-based telehealth. Depression and anxiety.
Presentation #: CS1-02
Presentation #: CS1-03
First, we review the definitions of and concepts behind big data, automation, and deep learning. Second, we introduce how these concepts are being applied to teleophthalmology. Third, we discuss how the lessons learned can be extrapolated to applications in other medical specialties.
Teleophthalmology offers a unique opportunity to implement digital concepts in healthcare, due to (1) the very high prevalence of ocular diseases such as diabetic retinopathy, macular degeneration, and glaucoma that can be evaluated with store-and-forward telemedicine; and (2) the worldwide shortage of eye care professionals in both first world and developing countries.
We present Care1, one of the largest teleophthalmology programs in the world. Based in Western Canada, dozens of healthcare providers are connected to deliver over 10,000 patient interactions every year. Canada has a unique need for teleophthalmology due to an alarming shortage of eye care professionals, and a population that is spread out over a very large geographic expanse.
In order to deliver the highest level of care to very large numbers of patients, telemedicine is combined with software to maximize the time efficiency for healthcare professionals, allowing each single provider to deliver care to many more patients.
Existing scientific literature on the software-led provision of medical care has performance rates that are not high enough to be universally accepted by most healthcare professionals. The primary reasons for this include the overly strict application of automated medical algorithms on one end of the spectrum, and the overgeneralized application of machine learning and neural networks at the other end.
We demonstrate outstanding acceptance rates among healthcare professionals in the software-led provision of eye care, by utilizing a hybrid concept of both extremes, “Medically Architected Deep Learning”. Automation is applied to frameworks of diagnosis and treatment, for which there should be no variation. Deep learning and neural networks are then applied to individual facets within the automated framework, allowing artificial intelligence to superimpose the more subjective and provider dependent aspects of medical care. The result is software that is able to make profound diagnostic and treatment recommendations that have very high rates of alignment with clinical decisions made by healthcare professionals. Healthcare professionals benefit from improved efficiency, as it allows them to deliver much greater quality of care to a much larger number of patients. Clinical impact is exponential when these software benefits are applied to telemedicine networks.
The unique nature of ocular disease means that teleophthalmology is the ideal launching point into healthcare, for the most exciting and important technological concepts of the digital age.
Presentation #: CS2-01
Presentation #: CS2-02
1. Understand provider perceptions and use of telemedicine for newborn resuscitation (termed teleneonatology).
2. Identify potential barriers to implementation and use of teleneonatology services.
3. Recognize local initiatives that optimize inclusion of teleneonatology into the local practice.
Track: Clinical Services
Presentation #: CS3-01
In Southern Illinois, very few hospital organizations deliver babies and when those organizations do, very few actually are capable of caring for a high risk newborn. Even in delivery, more often than not, no advanced practice clinician is available to help assist with the neonate if there are problems at the time of delivery. There are approximately 165,000 births in Illinois, with 8.3 percent being low birth weight (<2,500 grams) and 2 percent being very low birth weight (<1,500 grams). Ten percent of births are preterm (<37 weeks) and 31 percent of births either are scheduled or result in emergency cesarean section. Forty percent of births are to mothers who are unmarried and 15 percent of births are to mothers who did not graduate high school, increasing the likelihood of poor socio-economic and health status and less than optimum prenatal care. Fifteen thousand births were to mothers under the age of 20 and another 35,000 between the ages of 20 and 24. Six thousand births are twin births and 250 or more births per year are three or more babies. The infant mortality rate is 6.8 percent, higher than the U.S. infant mortality rate of 6.1, and ranking the state 27th in the world. This presentation focuses on an approach to providing TeleNICU services between a private practice.
Neonatology group and rural facilities who are Level I or Level II Nurseries. The development of the program will be covered which will explain the initial planning phase, development of a TeleNICU agreement, identification of appropriate nursery locations of telehealth equipment, the options for selecting and using telehealth equipment, what patient peripherals must be in place to conduct a full physical exam of the newborn, training of NICU nursing staff, clinical protocol development and other critical elements to implementing the program. Of specific interest to the learner will be a review of easy and practical methods for sharing health information and images when necessary, how to get documentation back to the referring NICU without complicated EHR interfaces, and selection of cost effective technologies that are easily integrated into the NICU environment. Outcome metrics will be shown including the number of newborn evaluations conducted, time from referral to evaluation (minutes), the number of transfers avoided and the cost/revenue implications of such, and the costs and risk/complications avoided when transfers are expedited. In addition, other pediatric subspecialties will be introduced that complement the work done by the Neonatology team. Participants in birthing hospitals and those with a higher than normal emergency department birth rate will benefit from learning how to implement a cost effective TeleNICU program that maximizes return on investment for families, birthing hospitals, and neonatology groups.
Presentation #: CS3-02
The increasing prevalence of ASD (CDC, 2012) brings more demand for diagnostic and early intervention services. Research suggests early diagnosis and subsequent early intervention services play a significant role in facilitating optimal outcomes for children with developmental delays and disabilities (Carter et al., 2011; Dawson et al., 2012; Rogers et al., 2012). Despite significant needs for diagnostic and behavioral services, access can be challenging; many children, particularly those from underrepresented groups, are still not diagnosed until after 48-months (CDC, 2012). Similarly, early intervention providers with ASD and applied behavior analysis (ABA) expertise are difficult to access in many communities (Mello et al., in press) due to shortages of providers, cost of services, and ability to travel to access services. Recently, behavioral assessments as well as caregiver and provider training for treating individuals with developmental delays and disabilities has been conducted via telemedicine (Marturana & Woods, 2012; Wacker at al., 2013).
Following evaluation, families and their Early Intervention Providers engage in 6 intervention sessions guided by a Behavioral Specialist, focusing on the application of ABA to address a specific area of need as identified by the family (i.e., challenging behavior reduction, increased functional communication). Early Intervention Providers were engaged in an effort to build capacity of state-funded providers to support families of children with ASD. The intervention sessions includes a combination of in person and remote Behavioral Specialist support.
REFERENCES
1. Carter AS, Messinger DS, Stone WL, et al. (2011) A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry 52(7), 741-752.
2. Mello MP, Goldman S, Urbano RC, Hodapp RM. (in press). Services for children with autism spectrum disorder: Comparing rural and non-rural communities. Education and Training in Autism and Developmental Disabilities.
3. Marturana ER, Woods JJ. (2012). Technology-supported performance-based feedback for early intervention home visiting. Topics in Early Childhood Special Education, 32(1), 14-23.
Presentation #: CS4-01
After attending this session, participants will be able to:
1) Describe different technology-enabled interventions that may help caregivers.
2) Describe how different technology-enabled interventions can be used to improve quality of life and outcomes of caregivers of older veterans.
3) Enumerate factors that impact acceptance and adoption of technologies in the home environment.
4) Reiterate potential logistical issues in the implementation and evaluation of technology based interventions for caregiving dyads.
5) Discuss lessons learned and the research, policy, and clinical implications of using technology-enabled interventions in caring for older adults.
Presentation #: CS5-01
The University of Mississippi Medical Center's Center for Telehealth launched The Mississippi Diabetes Telehealth Network in August 2014 to pilot an advanced healthcare model on patients with uncontrolled diabetes living in the Mississippi Delta. At the Center for Telehealth, our active multidisciplinary team works together to provide individual disease management plans for patients which would not otherwise have access to this type of care without telehealth. By providing access to our telehealth network, this program is helping improve care coordination and strengthening connections between clinicians and patients beyond the walls of a hospital in a way which is reducing the use of higher acuity clinical settings, such as the ER.
Presentation #: CS5-02
Track: Clinical Services
Presentation #: CS6-01
1) Describe the importance of formal telestroke training for neurovascular fellows in the setting of growing gaps in acute ischemic stroke coverage, and in spite of lack of well-characterized educational approaches.
2) Compare tissue plasminogen activator treatment metrics between neurovascular fellows and neurovascular attendings for acute ischemic stroke patients, using the time between when a telestroke consultant is paged and the time of tissue plasminogen activator administration (page-to-needle time) as an objective measure of proficiency in telestroke management of acute ischemic stroke.
3) Recognize trends in page-to-needle time with increasing number of telestroke consultations for both neurovascular fellows and neurovascular attendings.
REFERENCES
1. Jagolino AL, Jia J, Gildersleeve K, et al. A call for formal telemedicine training during stroke fellowship. Neurology. 2016;86:1-7.
2. Jagolino A, Gildersleeve K, Indupuru HK, et al. Tissue Plasminogen Activator is Safe When Administered by Neurovascular Fellows Via Telemedicine. Stroke. 2015;46:ATP196. (Abstract)
Presentation #: CS6-02
1. Present potential benefits of neurological telecare.
2. Describe short fallings of current knowledge.
3. Determine patient cost savings and health outcomes.
4. Explain potential gains to rural area hospitals.
REFERENCES
1. Bladin CF, Cadilhac DA. Effect of telestroke on emergent stroke care and stroke outcomes. Stroke 45.6 (2014): 1876-1880.
2. Kalanithi L, et al. Better Health, Less Spending Delivery Innovation for Ischemic Cerebrovascular Disease. Stroke 45.10 (2014): 3105-3111.
3. Chiang H-Y. Dementia risk and medical cost assessment model for patients with stroke. (2016).
Track: Clinical Services
Presentation #: CS7-01
Teledermatology is quickly gaining popularity among both patients and providers in this era of connectivity, convenience, and cost-consciousness. While there is robust evidence to support consultative teledermatology's significant impact on patient access and comparable diagnostic and therapeutic concordance, there is less evidence on the quality of teledermatology care provided outside of the research setting. Because of the increasing interest in teledermatology and its likely integration into the future of value-based medicine, the American Academy of Dermatology has developed a practice toolkit to better educate its residents and its practicing members on how to use teledermatology to better care for their patients and communities. The educational resources include a position statement, an online curriculum, practice management resources, and quality assurance and improvement programs. The position statement includes technical, administrative and clinical criteria. The online curriculum includes modules on modality, practice models, medicolegal considerations, health policy, best practices, ethics, and potential pitfalls. The quality assurance and improvement program includes recommendations and projects to optimize patient outcomes and promote safe, coordinated care.
Presentation #: CS7-02
The newly updated ATA teledermatology guidelines will be briefly reviewed. Contrasting content from other US organizations will be discussed, including the American Academy of Dermatology, the American Medical Association, and the Federation of State Medical Boards.
REFERENCES
1. ATA 2016 Practice Guidelines for Teledermatology
2. Ethical Guidelines for Telemedicine Providers
3. American Academy of Dermatology Position Statement on Teledermatology
Presentation #: CS8-01
1. Discuss the unique needs of sexual assault patients and how telemedicine can increase provider competence and confidence in forensic examinations through access to expert Sexual Assault Nurse Examiners.
2. Describe reported experiences of TeleSANEs and Remote Site Clinicians regarding the impact of the National TeleNursing Center on the quality of sexual assault forensic examinations and patient care.
3. Discuss challenges faced in the development of the National TeleNursing Center, solutions employed and resources that can be used to inform practice replication.
This panel will review the successes and challenges of this project to date. The NTC program team's presentation will review the development of the NTC model describe the telenursing methodology, and highlight progress in providing effective services and challenges related to sustainability. The presentation from the program evaluation team from the University of Illinois at Urbana-Champaign and the University of New Hampshire will discuss findings on impact and sustainability from data gathered from program staff, teleSANEs and site clinicians receiving telenursing consultation. Participants will learn how this novel use of telemedicine holds promise for improving outcomes for sexual assault survivors, increasing community responsiveness and identifying possible avenues for replication.
Clinical Services
Presentation #: CS10-01
Medicare, Medicaid, and private health plan payment for telehealth or virtual care is often misunderstood by telehealth providers. This presentation takes a simple, straight-forward approach to helping the participant understand how to determine whether or not services are covered via telehealth by CMS. The RUCA calculator for rurality is covered with specific examples shown. CMS CPT codes and explanations of how these codes are used/modified/updated is explained to the session participants, as well as how to apply MSA and urban rules. Medicaid is often trickier as each state applies its own set of rulemaking to paying for services delivered via telehealth. The difference between CMS Medicare and state-based Medicaid payment is discussed. Specific state examples are covered to ensure that participants understand how to interpret 'good' and 'vague' Medicaid language. Parity laws are discussed as these rules apply to private payers, Medicaid and Medicare. Participants will have ample time to ask questions about specific examples. With so many new comers to Telehealth, understanding government payers is a topic that never grows old. With annual changes to Medicare reimbursement, and the growing number of states that are instituting or amending Medicaid rules, even experienced telehealth programs have a need to understand the new rules. The session will cover the new 2017 requirements for CMS, Medicaid (some state examples) and movement of state's Office of Insurance Commissioners and NCQA to using telehealth in calculations of network adequacy. The two new bundled payment systems that include the use of telehealth in the home will also be highlighted. Chronic care management codes and telehealth is still greatly misunderstood and examples of how to use and bill these codes will be reviewed. This session provides a comprehensive overview of government and private payer reimbursement and gives the participant additional resources to use after the session is complete.
Presentation #: CS11-01
REFERENCES
1. Bhaskaranand M, Ramachandra C, Bhat S, Cuadros J, Nittala MG, Sadda S, Solanki K. Automated Diabetic Retinopathy Screening and Monitoring Using Retinal Fundus Image Analysis. J Diabetes Sci Technol. 2016 Feb 16;10(2):254-61.
2. Litvin TV, Weissenberg CR, Daskivich LP, Zhou Q, Bresnick GH, Cuadros JA. Improving Accuracy of Grading and Referral of Diabetic Macular Edema Using Location and Extent of Hard Exudates in Retinal Photography. J Diabetes Sci Technol. 2015 Nov 17;10(2):262-70.
3. Cuadros JA. Telemedicine-based diabetic retinopathy screening programs: an evaluation of utility and cost-effectiveness. Smart Homecare Technology and TeleHealth. 2015 Apr (3):119-127.
Presentation #: CS11-02
The Joslin Vision Network (JVN) Pediatric Diabetes Eye Care Program is an ATA category 3 ocular telehealth program for evaluation and management of diabetic retinopathy (DR). It is offered at the endocrine department of an inner city pediatric hospital since November 2006 via a partnership with M.M.G. Foundation in Venezuela and the Beetham Eye Institute at Joslin Diabetes Center (JDC) in Boston, Massachusetts, USA. The program, conceived as an education initiative aiming at long-term prevention of vision loss from diabetic eye disease, involves capturing nonmydriatic, stereoscopic, digital retinal images, automated refraction to evaluate refractive error; and patient history to identify medical risk factors for retinopathy progression in a pediatric diabetes population. All pediatric diabetes patients receiving care at the center are offered JVN at no cost. The program uses “store and forward” technology and all images are evaluated at a centralized reading center at JDC. The presence and severity of DR, macular edema, and nondiabetes findings are documented and risk factors for DR are reviewed. A semi-automated treatment algorithm developed by JDC guides the development of a treatment plan and a bilingual (English/Spanish) patient report that includes detailed information about the level of DR, risk for progression (based on the individualized patient risk factors), follow-up interval, and evidence based treatment plan.
The program has faced significant challenges that include technical issues related to internet connectivity and speed, limited availability of nonmydriatic cameras, limited access to laboratory testing and supplies, limited availability of ophthalmologists specialized in diabetic eye disease and patient related barriers to care (cost of transportation, limited access to diabetes supplies). Despite the challenges, the program completed 2,129 studies in ten years of operation, providing care for 662 pediatric and 100 adult persons. At the initial visit, the mean age of the pediatric patient was 10.8 ±3.7 years, mean age of diabetes onset 8.5±3.8 years, and mean diabetes duration 2.4±3.2 years; 53.7% were female and 96.3% used insulin. This telemedicine visit was the first retinal evaluation for 45.4% of the pediatric patients with type 1 diabetes (data available through February 2015). The mean age of the adult patients was 39.4 ±15.2 years, mean age of diabetes onset 28.6±19.1 years, and mean diabetes duration 10.8±8.9 years; 63.% were female and 67.3% used insulin. At their initial evaluation, any DR was present in 4.5% of pediatric patients and 32% of adult patients, and vision threatening DR (defined as moderate or more advanced nonproliferative DR) was present in 0.6% and 13%, respectively. Prior research performed in different populations and settings has demonstrated that visual impairment among persons with diabetes is substantially lower in populations that have access to systematic ocular telemedicine programs. The goal is to expand the program to additional locations, offering more individuals access to high quality eye care through telemedicine in Venezuela.
REFERENCES
1. American Telemedicine Association. Telehealth Practice Recommendations for Diabetic Retinopathy.
2. American Diabetes Association. Standards of Medical Care in Diabetes - 2016. Diabetes Care 2016;39(Suppl. 1)
3. Silva PS, Aiello LP. Telemedicine and eye examinations for diabetic retinopathy: a time to maximize real-world outcomes. JAMA Ophthalmology. 2015;133(5):525-526.
Presentation #: CS11-03
REFERENCES
1. Silva PS, Aiello LP. Telemedicine and eye examinations for diabetic retinopathy: a time to maximize real-world outcomes. JAMA Ophthalmol. 5/1/2015 2015;133(5):525-526.
2. Silva PS, Cavallerano JD, Aiello LM, Aiello LP. Telemedicine and diabetic retinopathy: moving beyond retinal screening. Arch Ophthalmol. 2/2011 2011;129(2):236-242.
3. Silva PS, Horton MB, Clary D, et al. Identification of Diabetic Retinopathy and Ungradable Image Rate with Ultrawide Field Imaging in a National Teleophthalmology Program. Ophthalmology. Mar 1 2016.
Direct to Consumer
Presentation #: DTC1-01
1. What barriers and challenges exist from established telemedicine programs and providers beyond a program's first use cases;
2. The importance of quality and safety for DTC; and
3. How to engage providers and build a robust DTC program within their health system
Direct to Consumer
Presentation #: DTC2-01
Presentation #: DTC2-02
This is a description of the process that we have undertaken at The University of Utah Health Care system to implement our Virtual Visit Direct To Consumer (VV/DTC) product. There are multiple paths to choose from when selecting a product that will meet the needs of the patient as well as the needs of the health system as a whole. We, at the U, have explored several different ideas and ways to implement the VV/DTC product. Our first options are the classic build vs. buy options that are available to anyone when selecting a system. This presentation goes through the evaluation of basic needs for a system or wants for a system and how to adjudicate those and select the right system for the right audience and usage.
REFERENCES
1. Maclean N. (1993). - Young Men and Fire. - Chicago, Illinois: University of Chicago Press
2. Kotter JP. (1996). Leading Change. Harvard Business School Press.
3. Kotter JP. (2006). Our Iceberg is Melting.
Track: Direct to Consumer
Presentation #: DTC3-01
Presentation #: DTC3-02
Presentation #: DTC3-03
Track: Direct to Consumer
Presentation #: DTC4-01
This paper presents the positive outcomes of the confluence of three sciences, Emergency Medicine, Social Marketing, and m-Health.
An estimated 125m patients visit the Emergency Rooms (ER) of hospitals in USA every year. The ERs in the rest of the world are also over crowded. This leads to reduced patient safety, burnout of clinical staff, and waste of financial resources. Any intervention that can lead to preventing emergencies is in the interest of the patient, staff, and economy.
Social Marketing is the science of voluntary behavior change that helps people adopt, reject, or modify behavior for their own and communities well-being. An estimated half of all deaths are premature as they are caused by preventable behaviors.
With more people having access to mobile phone than toilets, it is time to fully realize the potential of this technology for development. Even the most basic phone (non-smart phone) can send and receive SMS and voice calls.
This paper presents the experience of using SMS technology for behavior change of patients who had recently visited Pediatric ER of government hospital in Pakistan. The ChildLife Foundation, a private nonprofit organization, manages three Pediatric ERs at government hospitals in Pakistan under a Public-Private-Partnership agreement with the government. These hospitals are free of cost and are frequented by the poor. ChildLife Foundation treats half a million children in these ERs every year - free of cost.
Pakistan with a population of 200 million has the world's third highest under five mortality. Almost one in 10 ten children don't live to see their fifth birthday. This can be changed drastically by proven strategies such as breast feeding, weaning foods, oral rehydration therapy (ORS), immunization, hand washing, etc.
ChildLife Foundation had a unique advantage to encourage behavior change. With half a million patients passing through its ER every year, ChildLife had crucial information about these patients such as their mobile number, child's age, name of primary care giver, location, diagnosis, etc. This enabled ChildLife to customize the SMS according to the need of the patient e.g. a parent bringing their child for diarrhea would receive message about ORS or immunization messages were sent based on age of the child. Moreover, these messages were also customized to address the primary care giver by name. This personalization of SMS helps to differentiate the message from spam.
The biggest advantage was the timing. As ChildLife knew when the parents visited their children, they could establish contact with parents soon after the visit to ER. It was this 'while the iron is hot' factor that mattered most as parents were still recovering from the trauma of taking their child to ER.
Randomized Control Trials (RCTs) measured the impact of messages while altering their frequency. The impact of behavior change was significant proving that 'right message at right time' works.
This low cost intervention has huge scope for replication at ERs all over the world resulting in reduction of morbidity and mortality as well as efficient use of human and financial resources.
REFERENCES
1. Strauss RW, Mayer TA. (2014). Emergency Department Management. McGrawHill.
2. Cheng H, Kotler P, Lee N. (2011). Social Marketing in Public Health: Global Trends and Success Stories. Jones and Bartlett Publishers.
3. Fogg BJ, Adler R. Texting 4 Health: A Simple, Powerful Way to Improve Lives. Stanford, CA: Captology Media, 2009. Print.
Presentation #: DTC4-02
Track: Direct to Consumer
Presentation #: DTC5-01
To meet the demands of a growing population, Sharp Rees-Stealy's Population Health's case management department, partnered with a mobile technology company to develop and implement a texting mobile coaching program. Utilizing current capabilities, real time, anytime, anywhere access to care is now delivered to patients newly discharged from the hospital and those living with diabetes. This high impact, low cost strategy, has not only increased our capacity to engage and support patients, evidenced by inbound patient messaging of 4000/month, but has produced quality outcomes as demonstrated by a lowered readmission rate of 12.6%, as well as a decrease in HgA1C by program users.
Scheduled evidenced-based messages are designed to assist individuals in following their discharge instructions, identify early warning signs of potential issues and promote behavioral change. The program also provides reminders, support and tools for patient activation and the management of chronic conditions such as diabetes. Simple behavioral-centric messages engage patients in taking control of their recovery by focusing on their physical and emotional well-being. The program also helps the patient reconcile and manage their medication regime, coordinate follow-up care and builds healthy habits to help patients adapt successfully to the changes in lifestyle and self-care behaviors foundational for health management. Providing case management support, along with interactive communication, triggered by patient's questions, concerns, real time, anytime, anywhere access to care is delivered utilizing current staffing capabilities. This initiative enables staff, in this current healthcare environment, to provide coordinated care to a potentially unlimited number of patients, promoting patient engagement and collaborative relationships between the patient, provider and nurse case manager for patient centered care and shared decision making. The added channel of support has increased staff's ability to reach over 30% more patients with daily outreach and on demand support. It has also extended patient dialog with easy and timely access to care, transforming the way case management services can be delivered within the industry.
REFERENCES
1.
Presentation #: DTC5-02
Amidst an ever-changing clinical and political landscape, the reformation of healthcare policy and the expansion of Medicaid and the Affordable Care Act, has resulted in over 49% of Americans receiving benefits under government programs. Despite these recent gains, data analytics, both macro and micro in nature, have revealed that greater access to coverage is not synonymous with greater access to healthcare. In an effort to bridge that divide, Molina Healthcare of Washington (MHW) has partnered with Carena Medical Providers, a Seattle-based telemedicine provider organization, to launch a virtual urgent care program that concurrently provides a high-touch member experience, with 24/7 access to high quality, cost effective patient care. MHW is the first Managed Care Organization in Washington to provide statewide virtual urgent care at no cost to its over 650,000 Medicaid members.
MHWs Virtual Care program focuses on the immediate treatment and management of non-emergent conditions, many of which needlessly result in ED and inpatient visits, due to barriers of access and awareness. By using evidence-based telemedicine practices, Molina Virtual Care redirects our members to the appropriate primary care settings, and further supports the primary care team with case management and care coordination resources; identifies missing preventive and HEDIS-based services and coordinates follow-up care through shared documentation.
The challenge of meeting the complexity of Medicaid populations requires a coordination of services and collaboration between providers and health plan, and a focus on such primary considerations as:
• The increasing overutilization of Emergency Departments for primary care
• Strategies to extend scarce primary and specialty care resources
• Increasing the availability of care management services for high risk members
• Ability to contact members who are in transition or homeless
• Dispelling the myths of low technological sophistication and adoption among Medicaid Beneficiaries
• Overcoming cultural barriers to deliver needed services and improving population health
The purpose of this proposed session is to present MHW's application of telemedicine as a successful use case, and to highlight the broader lessons learned in the areas of member communication and engagement strategies including social media, provider engagement, clinical service accuracy, and cost effectiveness.
The session will also address ongoing challenges experienced by MHW, including rural access and provider contracting in the new world of payment parity, and to solicit feedback and encouraging dialogue across our healthcare peers, en route to fostering solutions within a constructive and collaborative forum.
REFERENCES
1. National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary Tables.” 1. National Center for Health Statistics (2011): 8.
2. Gindi RM, Cohen RA, Kirzinger WK. Emergency Room Use Among Adults Aged 18?”64: Early Release of Estimates From the National Health Interview Survey, January? “June 2011. Division of Health Interview Statistics, National Center for Health Statistics (2012): n. pag.
3. Smith A. U.S. Smartphone Use in 2015. Pew Research Center Internet Science Tech RSS. N.p., 1 Apr. 2015. Web. 22 Sept. 2016.
Presentation #: DTC5-03
This roundtable discussion will promote an interactive conversation with health systems and direct-to-consumer vendors on how to create a hybrid m-Health delivery model combining the clinical expertise of the health system and technical expertise of the vendor to meet the needs of multiple stakeholders. Stakeholders include medical provider groups, health plans, IT, quality, compliance and health system leadership. Avera's 20 years of experience in business to business telemedicine services helped lay the foundation for a successful partnership in the direct-to-consumer space with a focus on antibiotic stewardship, ATA accreditation, launch of kiosks into the retail space and multiple use cases offering innovative approaches for expanded access and improvement in patient compliance. Innovation strategies were initiated by several health system service lines including coordinated care, employee assistance, behavioral health, obstetrics, and primary care reaching into the college, employer and retail space. As health systems begin to balance value and volume, telemedicine is at the forefront of most discussions. According to a Health Affairs Policy Brief on August 15, 2016, Telehealth has the potential to resolve a number of issues in the U.S. health care system. Some estimate that the combination of store-and-forward, real-time communication, and remote patient monitoring usage in emergency departments, prisons, nursing home facilities, and physician offices could save the United States $4.28 billion on health care spending per year. (1) Attendees for this interactive roundtable discussion all face the challenge of finding new ways to deliver care, save money, improve quality, increase access, and keep up with competition and consumer demand. Additionally, this discussion will focus on provider satisfaction, engagement and compensation as a key component to the success of any telemedicine program.
REFERENCES
1. Yang T. (2016, Aug) “Health Policy Brief: Telehealth Parity Laws,” Health Affairs, August 15, 2016. Retrieved September 18, 2016 at
Direct to Consumer
Presentation #: DTC6-01
Cleveland Clinic has developed a collaborative partnership with the Online Care Group, a nationally expansive physician practice. Understanding that this group provides wraparound coverage and support to enhance the Cleveland Clinic's on-demand Express Care online platform, it is essential that all clinicians provide high quality, safe care. This session highlights the collaborative partnership and quality initiatives for telehealth.
Telehealth has grown exponentially over the last few year providing millions of consumers virtual visits (Tahir, 2015). A key driver in expansion has been the movement towards value-based care. Stand-alone virtual visit companies are growing, boast millions in revenue and investments, advocating that virtual visits expand access and are more cost effective than traditional in person care. Similarly, hospital systems are jumping on the bandwagon providing telehealth services in urgent and emergent care, specialty areas and chronic care management. Major concerns regarding telehealth expansion have been voiced by professional organizations such as the American Medical Association (AMA) and American Academy of Pediatrics (AAP) although supportive of telehealth, voice concerns of inappropriate and unnecessary use of healthcare and healthcare dollars, lack of evidence supporting telehealth quality and clinical outcomes, and technology challenges (AAP, 2015). Organizations such as the American Telemedicine Association (ATA) have taken steps to address these concerns, yet many of these challenges remain minimally addressed or unaddressed.
In 2015, the Cleveland Clinic launched Express Care online for on-demand urgent care visits. Identifying the need for convenient, off-hours provider coverage, they partnered with the Online Care Group from American Well while building the internal infrastructure and capacity to independently support the new service. Off-hours telephone coverage and triage by an external group is not uncommon in healthcare but is different with on-demand urgent care coverage since actual treatment is provided. Subsequently, there was an identified need to collaboratively develop guidelines and protocols which would be shared for telehealth. Standardized national guidelines and protocols do not exist but are needed to ensure safe, quality care for patients seeking telehealth for on-demand urgent care.
REFERENCES
1. Dorsey ER, Topol EJ. N Engl J Med 2016; 375:154-161July 14, 2016
2. The Use of Telemedicine to Address Access and Physician Workforce Shortages COMMITTEE ON PEDIATRIC WORKFORCE Pediatrics Jun 2015, peds.2015-1253
3.
Presentation #: DTC6-02
Thousands of patients are being seen virtually for urgent care problems. Programs have little research data and no telemedicine-specific, evidence-based guidelines to rely on when it comes to assessing the clinical quality of these visits. Southwest Medical, A Part of OptumCare has had an urgent care virtual clinic since 2014. Its current quality assurance program is a good starting point for discussion. Through sharing information and thoughts at this session, innovative ideas and collaborative plans for improving quality assessment will arise!
REFERENCES
1. Tan L. Urgent care telehealth case reviews. Abstracts from The American Telemedicine Association 2016 Annual Meeting and Trade Show. Telemedicine and e-Health. Apr 2016: A6-7.
2. Tan L, Mason N, and Gonzaga W. J. Virtual visits for upper respiratory tract infections in adults associated with positive outcome in a cox model. Telemedicine and e-Health. June 2016, ahead of print. doi:10.1089/tmj.2016.0018. Online Ahead of Print: June 28, 2016.
Presentation #: DTC6-03
Facing enormous costs from their nearly 660,000 members, some of whom were unnecessarily utilizing high-cost venues (including the ED, urgent care, and nurse advice lines) when they needed medical attention quickly, Kaiser Permanente Colorado, a leader in value-based care, sought a virtual care solution that could instantly address their patients' needs.
KP Colorado partnered with CirrusMD to launch the Chat with a Doc program in November 2016. The solution, which is available to KP Colorado members, with no co-pay, through their patient portal allows members to instantly connect with a KP doctor via a chat platform similar to instant message. Chat with a Doc has been very well received as, with only limited marketing, the doctors staffing the platform handle upwards of 110 encounters per day. Projections for the second half of 2017 are for the service to grow to over 200 medical encounters per day, including specialized pediatric, Ob/Gyn, and pharmacy chat channels. Additional non-medical services will also be brought into chat functionality, including billing/benefits, scheduling and general member services inquiries.
While many healthcare organizations are looking for ways to put barriers between a patient and doctor, because the cost of the physician is perceived as being too high, KP Colorado opted to have Chat with a Doc staffed by Family Medicine and Emergency Medicine physicians.
In its first few months, KP Colorado physicians have effectively diagnosed and treated a wide array of conditions with Chat with a Doc. Seventy-nine percent of chat encounters are handled with advice only or a prescription, 18 percent are referred for appointments in the KP system and one percent are referred to the ED. Patient satisfaction and likelihood to recommend are extremely high, outperforming other care channels in KP Colorado because the solution improves overall patient engagement by providing a responsive service for patients to access care and answers to their questions.
During the presentation, patient enrollment demographics and physician staffing processes for Chat with a Doc will be reviewed. Data was gathered on the maximum capacity of physicians for simultaneous asynchronous interactions. Additionally, KPCO was able to gauge member interest in virtual care preference for many of its members. Many of the inquiries weren't medical in nature, which highlighted opportunities for improved communication with members. Service adoption and care metrics for this unique virtual care solution will be described, as well as future service line and platform development plans. Finally, Dr. Ari Melmed will review the results of patient surveys and the impact of those testimonials for the largest integrated delivery network in Colorado.
Learning Objectives:
Describe access to care benefits of an asynchronous virtual care program.
Quantify adoption rates in this unique text-based application of telehealth.
Contrast patient satisfaction data before and after implementation of the Chat with a Doc Program.
Direct to Consumer
Presentation #: DTC7-01
When an individual is in crisis they deserve the best care— fast. One innovative mobile crisis team has figured out how to connect individuals in crisis and crisis response team members with a remote telepsychiatry provider who is able to rapidly meet the person where they are— all through telehealth.
This case study presentation details the nation's first mobile crisis program to utilize telepsychiatry and will cover insights into what worked, what didn't, getting community buy-in, vetting providers and expertise on how it all works together.
In 2014 Access Services, a nonprofit organization that specializes in improving quality of life for people with special needs, paired with a national telepsychiatry provider organization, InSight Telepsychiatry, to launch the 24/7 Adult Mobile Crisis Program and 24/7 Children's Crisis Program. They trained crisis support professionals to bring laptops equipped to connect with a telepsychiatrist into the homes of callers experiencing psychiatric crises.
This case study will discuss the collaboration between these stakeholders to develop a system of care that allows consumers in crisis to remain in their homes and their communities when dealing with new or ongoing psychiatric emergencies. It will review the implementation steps the partners went through to develop and roll out a successful program including designing workflows, selecting providers, overcoming regulatory hurdles, informing insurance payers, choosing their technology and educating their teams.
Though challenging to implement, the benefits of this unique program are numerous. With access to behavioral health providers through telepsychiatry, the mobile crisis team is empowered to more effectively manage crisis situations where individuals are experiencing difficult episodes. Utilizing telepsychiatry in a mobile crisis program allows individuals to be served by a psychiatrist in their home, reducing the need for traveling to an emergency department. Through videoconferencing, the program's psychiatric provider consults with the on-hand crisis support professionals or directly evaluates the individual in crisis. The psychiatric provider also has the ability to potentially prescribe appropriate bridge prescriptions until the consumer is connected with ongoing behavioral health services. Mobile crisis intervention paired with telepsychiatry can reduce the time consumers spend awaiting care and lessen the strain on the psychiatric resources of area hospitals. This unique program helps resolve immediate crises without unnecessary and costly hospitalization and reduces the risk for self-harm or harm to others.
Ultimately, this model of mobile crisis intervention is a recovery-oriented program focused on offering consumers choice in their care. By allowing in-home intervention and reducing hospitalization, telepsychiatry allows consumers to remain in charge of their own lives, even during tough times.
Led by the InSight Account Executive who worked closely with the Access Services team to develop the program and the Adult Mobile Crisis Program Director at Access Services, this interdisciplinary case study presentation will discuss lessons learned from both parties, how the program was implemented and how the program is being utilized today.
Presentation #: DTC7-02
It is a challenging time for many outpatient and community behavioral health clinics. With a provider shortage, an increase in consumer demand, rising competition and an ever-changing heath care landscape its more difficult than ever to stay ahead of the curb.
One outpatient mental health organization in New Jersey decided to tackle these challenges with telehealth. In March 2015, the Center for Family Guidance (CFG) implemented a unique program which allows both their providers and their consumers to access their metal health care sessions from home through telehealth.
The program utilizes telehealth in two ways. First, a group of CFG's current providers have been set up with access to a secure, web-based telehealth platform and are able to offer night and weekend appointments to new and existing consumers through this medium. Using a remote VPN, the providers document their session CFG's regular EMR and the sessions are billed through insurance using the telehealth GT modifier.
In the first months of the program, consumers have liked the convenience of telehealth appointments and appreciate CFG's extended telehealth hours that make it easier to fit mental health care into their busy schedules. The participating providers also love the convenience of telehealth and the option to add more variety (and more billable hours) into their practice. Providers note that doing telehealth sessions with individuals who are in their home environments can also give unique clinical clues about their lifestyle, cleanliness and coping mechanisms.
The second telehealth aspect of the program comes in with referrals. When an individual is unable to make it to an in-person appointment or if the CFG outpatient clinic does not have the in-person resources they need, CFG's intake coordinator, when appropriate, makes a warm handoff to the care navigation team at CFG's telehealth partner- Inpathy. In place of a community-based referral, these individuals instead book a telehealth appointment with one of Inpathy's telemental health providers. This process has come in handy particularly when an individual is looking for a specific specialty or area of expertise that is out of CFG's realm, or for when CFG's waitlist for appointments with their child and adolescent psychiatrists can take months. Inpathy's telemental health providers often have appointments available within 24-72 hours of a request.
Though developing the program and driving utilization took time, the use of telemental health continues to grow at CFG.
This case study presentation will look at the design, implementation and ongoing lessons of this innovative program. It will discuss the challenges, advantages and important buy-in elements for the providers, consumers, administrators and intake coordinators involved. The presentation will cover the selection and training process for participating providers and the intake workflows used to determine if individuals are suited for and interested in telebehavioral health. Data on one-time and repeat consumer utilization as well as referrals will be reviewed. Additionally, the presenter will discuss how the program incorporated quality assurance elements and the tracking of ongoing metrics into their workflows and program evaluation.
Telebehavioral health expands the ability of existing providers to see more people at more flexible times and this makes for happy providers and consumers. For consumers, this flexibility allows them to receive services on their own time. For providers, this flexibility means that they are able to work extended hours and make a supplemental income. As the pool of behavioral health providers, especially psychiatrists, is shrinking, more and more people are in need of care. Direct-to-consumer telebehavioral health can be a tool for keeping up with consumer need. CFG has also recognized that telehealth is also a great way to meet consumer demand as individuals' interest in on-demand services and telehealth expand. Interest in CFG's telebehavioral health program has also come from individuals who have trouble finding time for commutes, those who dislike waiting rooms, or those have trouble leaving their homes.
This discussion-based case study presentation will detail the implementation and growth of this model program from the perspective of CFG's clinical director and the executive director of Inpathy, its telebehavioral health partner.
Track: Direct to Consumer
Presentation #: DTC8-01
1. Identify the most frequent electronic visit (e-visit) requests made to a new program implemented at an academic medical center.
2. Analyze the care provided via e-visits.
3. Describe the patient experience associated with e-visits.
Presentation #: DTC8-02
Healthcare on Wheels (HCOW) is a very unique application of a direct to consumer application being utilized to bring access to care for residents of rural Alabama. HCOW is a public health related facility with the purpose to provide primary care services, health literacy and linkages to community resources in underserved areas and amongst the vulnerable groups in remote areas on Alabama. Healthcare on Wheels is one of the most innovated mobile clinics. People in hard to reach areas no longer have to wait for the doctor visit. They can get care right away and only steps from their home. HCOW is a mobile clinic equipped with two telemedicine exam rooms and connects back to Bryan Whitfield Memorial Hospital using the direct to consumer application Video Medicine.
Currently, the van travels daily into one of six counties in the Delta region of Alabama offering care to residents in need. The van addresses four specific goals based on community needs: 1.) Reduce the disease and economic burden of chronic disease, 2.) Improve the quality of life for persons who have or are at risk of developing chronic disease, 3.) Increase outreach and linkage to other healthcare resources, 4.) Provide undergraduate nursing students rural clinical experience that will prepare them for post degree careers in primary care in rural health care setting.
By using Video Medicine, the van is able to access providers through the web, portable telemedicine kit, tablet and/or smart phone. The Video Medicine platform allows for HIPAA connections in low bandwidth area based on the unique separate video and sound based platform. Additionally, the platform allows for the use of peripheral devices such as an all in one camera, ECG, ultrasound and stethoscope allowing for a complete evaluation and treatment of the patient. Medical professionals on the van utilize the electronic health record (EHR) within the application, which seamlessly integrates with the EHR at Bryan Whitfield Memorial Hospital. Because of Video Medicine's unparalleled platform, the patients are scheduled follow up appointments and receive reminders on their phone and email of the vans return to ensure continuity of care. Healthcare on Wheels is truly a unique program; bringing the use of a direct to consumer application to bettering the healthcare outcomes for residents in their community.
Presentation #: DTC8-03
In 2015, Blue Cross Blue Shield of Minnesota (Blue Cross) announced a partnership with Doctor On Demand to provide telemedicine to its health plan members. Blue Cross is the largest Minnesota-based health plan, covering 2.6 million members in the state and nationally. This presentation will discuss how insurers and providers can collaborate to implement and scale a telemedicine program, using real results from a partnership that successfully engaged its members. The presentation will highlight three key components to deploying and scaling a successful telemedicine operation: high clinical standards, a world-class customer experience, and a proactive engagement plan.
The telemedicine provider also has a role to play, in offering an intuitive, user-friendly application; real-time video interaction; a customer support team that quickly addresses patients' questions; low wait times; and seamless, customized integration into employers' benefits plans. Both insurers and providers can improve their customer experience by conducting intensive user testing and seeking continuous feedback.
Creating a telemedicine program that works requires mastering not just the direct customer touchpoints, but also the behind-the-scenes work that makes the customer experience smooth and worthwhile. This is how to create real results. Per 100,000 employees, Doctor On Demand saves an estimated $2 million and 30,600 hours of productivity each year. But these statistics are a fraction compared to telemedicine's full potential.
Presentation #: DTC9-01
Providing access to health providers online has proven to be popular to payers and consumers alike. As this service has grown it has also changed with large providers entering the market, adding specialty services and potentially incorporating to vital sign devices. CEO's of several leading companies in this space will provide their forecasts and predictions of the major trends and what these services will look like in 3 – 5 years.
Track: Direct to Consumer
Presentation #: DTC10-01
1. To describe an evolution from pediatric care only to family health care by leveraging technology.
2. To discuss the implementation of two Direct to Consumer applications to extend care to families where the live, work and play.
3. To discuss the barriers and pain points in transitioning from traditional healthcare to virtual and on-demand healthcare.
Family Health Virtual Visit provides electronic access to a health care provider through state-of-the-art, HIPAA-compliant technology at a local pharmacy kiosk, and via smartphone, tablet or computer for each visit thereafter. The program currently serves health system employees and convenient on-campus locations, providers in the clinically integrated network leverage the platform for their own patients and local pharmacies.
This panel will provide an overview of the consumer strategy of an evolving healthcare system, implementation lessons learned from an operational and marketing perspective and evaluation metrics to determine return on investment through new market capture, continuity of care, and patient/family retention.
Track: Direct to Consumer
Presentation #: DTC11
1. Upon completion of this session, participants will be able to understand how strategic partnerships and a digital marketing strategy can help health systems drive virtual care utilization.
2. Upon completion of this session, participants will be able to understand best practices to implement a virtual care digital marketing strategy within a health system.
3. Upon completion of this session, participants will be able to understand why it is crucial to meet consumers at their mobile devices in the current on-demand landscape.
Mobile devices have become a key entry point into the online world. Consumers turn to their devices for everyday needs like banking, ordering an Uber, finding directions and shopping online. Why should seeing a doctor be any different?
The rise of mHealth and the widespread use of mobile devices makes it easier and faster to access a variety of healthcare options. A recent survey by Pew Research Center found that 62 percent of smartphone owners have used their phone in the past year to look up information about a health condition. Due to rising healthcare benefit costs, 90 percent of employers are planning to make telehealth services available to their employees next year. As consumers look for an affordable and convenient care option, it is up to health systems to market their virtual care clinics as an integrated and a cost-effective way to receive quality care.
In this session, attendees will learn how to choose the right digital channels along with supplemental traditional channels as part of a marketing campaign to successfully launch a virtual clinic. Presenters will discuss how an integrated virtual clinic model allows health systems to enter into the competitive telemedicine market. They will also present best practices for implementing a digital marketing strategy to drive awareness, patient acquisition and utilization in a consumer-driven healthcare market.
Those attending the session will hear expert insight from Craig Brace, director of marketing and communications at Hospital Sisters Health System, about the system's experience in partnering with Carena to relaunch its virtual clinic, which resulted in the system growing virtual visits up to 50 percent month-over-month.
Direct to Consumer
Presentation #: DTC12-01
REFERENCES
1. Gagnon S, Chartier L. (2012). Health 3.0?”The patient-clinician “Arabic spring” in healthcare. Health, 4(2), 39-45.
2. Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LMS. (2015). The e-health enhanced chronic care model: A theory derivation approach. Journal of Medical Internet Research, 17(4), e86.
3. LeRouge C, Van Slyke C, Seale D, Wright K. (2014). Baby boomers' adoption of consumer health technologies: Survey on Readiness and Barriers. Journal of Medical Internet Research, 16(9), e200.
Presentation #: DTC12-02
1. Describe the potential of digital health interventions for older populations.
2. Analyze the results of two successful interventions: An adherence to medication app, designed for patients with several comorbidities, and used by them for extended periods of time, and an app for adherence to medication and to blood pressure measurement.
3. Learn and implement effective ways in which to achieve satisfaction, engagement and behavior change in elderly and tablet-naïve patients using a digital intervention.
REFERENCES
1. Becker S, Brandl C, Meister S, Nagel E, Miron-Shatz T, Mitchell A, Kribben A, Albrecht U-V, Mertens A. Demographic and health related data of users of a mobile application to support drug adherence is associated with usage duration and intensity. PloS one 10(1) (2015): e0116980.
2. Mertens A, Brandl C, Miron-Shatz T, Schlick C, Neumann T, Kribben A, Meister S, et al. “A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation: A crossover design study comparing documentation via iPad with paper-based control. Medicine 95(36) (2016): e4446.
3. Becker S, Miron-Shatz T, Schumacher N, Krocza J, Diamantidis C, Albrecht E. “m-Health 2.0: Experiences, possibilities, and perspectives. JMIR M-health Uhealth. 2014; 2(2): e24. doi: 10.2196/mhealth. 3328.”
Presentation #: DTC12-03
In short, attendees will get the first look at data from over 8,000 interactions with pet parents beginning in January of 2015. The session will briefly outline the journey to bring telemedicine to the companion animal space, including barriers, opportunities and enormous market opportunity. Secondly, because our veterinary expert team was able to track the behaviors and issues confronting over 600,000 pet parents, whiskerDocs has studied the issues pet parents face, the decisions they need to make and the impact to their pets' health and wellness made by having expert veterinary guidance at their fingertips when it's needed most. Our findings include channel preferences (chat, email, phone, mobile), most common health concerns that prompt action, pet parent perception of actions they need to take, and barriers to taking appropriate steps. Finally, we'll look at what our experiences have taught us so far about what pet parents are needing from this industry and the enormous potential for solution providers. Attendees will also get a quick look at the rapid fire release of mobile pet solutions directed at the consumer.
REFERENCES
1. State regulatory organizations, including State of Minnesota Veterinary Practice Guidelines
Operations and Implementation
Presentation #: OI1-01
1) The attendees will learn about telemedicine in support of disaster response.
2) The attendees will learn about the challenges of developing a multinational telemedicine system for disaster response.
Disasters, whether natural or manmade are unpredictable. While there may be some forewarning like a hurricane, response is often suboptimal. There is a need for an integrated and structured action for all three defined phases of disaster management (pre-, during, and post-) that must be addressed to ameliorate the impact on life and the necessary steps for recovery. One simple observation puts telemedicine under the spotlight: while the population of the planet has doubled in the last 50 years and medical personnel has become a scarce capacity, computing power has doubled about every two years for the past 50 years, according to Moore's Law. Over the past several decades, telemedicine has been integrated in some form of disaster response.
Operations and Implementation
Presentation #: OI2-01
1) Describe the needs, opportunities and challenges of FQHC
2) Compare and Contrast the similarities and differences in working with FQHC in rural and urban settings
3) Analyze meaningful metrics in FQHC and Academic Medical center collaborations.
Both Universities have projects providing telehealth services with Federally Qualified Health Centers. This panel discussion will provide insights into collaboration opportunities with FQHCs. The panel will include a FQHC expert describing the needs, opportunities and challenges of FQHCs. Adding University prospective, the panel will provide insights into the similarities and differences in working with FQHC in rural and urban settings. Finally we will analyze meaningful metrics in FQHC and Academic Medical center collaborations.
The CareFirst Foundation recently funded a telemedicine project between GWU and Unity Health Care, a FQHC in Washington, DC. The project seeks to improve access to specialty care for patients seen at Unity Health Care's Anacostia Health Center. GW is providing specialty services of a nephrologist, cardiologist, and endocrinologist, via real time audio and video enhanced by a MA clinical presenter. The primary outcome measure is the number of completed referrals over total referrals, in effect a measure of the no show rate. By conducting specialist appointments via telemedicine and eliminating referral-related barriers to care, no-show rates are expected to decrease and the rate of completed referrals is expected to increase.
UVA has had collaborations for over 22 years with more than 15 FQHCs across the Commonwealth. These partners look to UVA to provide specialty services that are otherwise unavailable in their communities. As a result, the UVA Center for Telehealth has developed telemedicine services in speciality care including tele-psychiatry, dermatology, high risk obstetrics, and evolving clinics such as tele-sleep, tele-cytoscopy, developmental pediatrics and diabetic retinopathy screening. The collaboration between rural FQHCs and UVA has led to reducations in miles traveled, improved show rates, and decreased readmissions.
Operations & Implementation
Presentation #: OI3-01
1) Describe how CVN is implementing telemental health solutions to bridge mental health care delivery gaps for veterans and their families.
2) Understand how the national roll-out has been structured to deliver care from clinic to clinic and clinic to home.
3) Identify successes and lessons learned to date.
The CVN mission is to improve the quality of life for veterans and their families by ensuring that every veteran and their family members are able to obtain access to high-quality, effective mental health care. This mission is being met through a national network of Steven A. Cohen Military Family Clinics that are resourced to provide free, personalized, and evidence-based mental health care along with access to comprehensive case management support.
The CVN Telehealth Program leverages telemental health in the form of live interactive videoconferencing to improve access and quality of mental health care for CVN patients. This presentation will discuss how CVN is integrating telemental health services into each clinic to offer a balance of face-to-face and telemental health services as appropriate to the communities, settings and population that they are working with. Services are provided from clinic to clinic and from clinic to home settings.
We will discuss the overall CVN telemental health integration process. This will include an overview of expectations that each clinic offer telemental health services, the needs assessment process, the development of clinic implementation plan, service initiation, and full operating capacity. We will provide an overview of outcomes data to include utilization, satisfaction, and improved overall health status. We will also discuss the success and lessons learned of implementing a broad telemental health program across a national network of related, yet independent and non-institutional mental health clinics.
Track: Operations and Implementation
Presentation #: OI4-1
There are an estimated 1.3 million people in Ontario, Canada with type 2 diabetes, with an annual health spend greater than $5.5 billion. Recent studies suggest mobile health solutions and telemedicine models result in significant improvements in diabetes management and patient care, ultimately resulting in improved clinical outcomes.
To explore the potential for technology to facilitate new models of patient care in diabetes, the Ontario Telemedicine Network, along with technology, clinical, and research partners, has launched a project to evaluate the use of mobile health technology for patients with type 2 diabetes. The project involves 300 patients and their clinicians from the Diabetes Education Centres and Complex Care Diabetes Centres of three care delivery organizations.
Patients are provided with a digital health solution consisting of a smartphone preconfigured with a self-management application. The solution provides diabetes-related education to the patient, helps the patient and provider identify blood glucose and medication adherence trends, uses algorithms driven by the patient's treatment plan, and delivers personalized guidance to the patient as needed.
In addition to supporting patients to better self-manage their condition, the solution can deliver analyzed between-visit patient self-management and metabolic data to the care provider on request, while also enabling cross-team communication and care management. It also enhances patient-provider communication and supports timely therapy changes.
Maximizing benefits to both patients and providers requires the effective integration of the solution into clinical practice. Project partners collaborated to develop a clinical model for patient identification and enrollment, app activation and configuration, and ongoing patient and health team engagement. To help promote adoption of the proposed model and implementation of best practices among providers and patients, guidelines to support the optimal use of the mobile application were developed.
By understanding the clinical model, the researchers were able to design for evaluation of the project in a real-world implementation. The pragmatic research approach is a) evaluating how the digital health tool is implemented in practice, (b) exploring patients' and providers' perspectives of the usability and acceptability of the tool, and (c) examining the key issues associated with scaling this type of mobile application across Ontario.
This presentation will focus on the strategies needed to effectively integrate a mobile health solution into a clinical practice. This includes activities designed to foster buy-in and engage patients who integrate self-management into their day-to-day activities, as well as inform providers who transform their practice and use patient-generated data to optimize treatment plans. Lessons learned and interim evaluation findings will be shared for the project, which runs until June 2017.
Presentation #: OI4-2
Within publicly funded Canadian healthcare there are defined pockets of clinical expertise aligned with affiliated academic healthcare centres across the country. These geographic and clinical locations are often inaccessible to patients and families who live in rural and remote locations. Provincial and territorial jurisdictional and licensure boundaries create barriers in accessing services when the required clinical expertise does not exist within your area while “not all provinces pay for the same list of medical services and health-related benefits”. Tele-Link Mental Health at the Hospital for Sick Children (Sickkids) in Toronto Canada has moved to a model of care for one of its Telemedicine services that incorporates Public and Private Partnerships (P3) to reduce these barriers and allow patients to access services via technology regardless of their location within the country.
Tele-Link Mental Health has partnered with The Royal Bank of Canada and Cisco Canada to provide Psychiatric services to rural and remote indigenous populations spanning 2 provinces and 1 territory. Funding was provided to cover the clinical and technology required in providing capacity enhancement, education and direct clinical care to populations who have historically been excluded from these services. By funding direct clinical care from a national perspective Tele-Link has eliminated interprovincial billing requirements that are often partially or not successful at all, leaving the provider organizations unable to cover costs or ensure sustainability. In some instances such as “Quebec, which does not have a reciprocal agreement with any other province; you are required to pay for services up front and apply for a reimbursement”.
Through technology and bandwidth donations, rural and remote nursing stations now provide telemedicine locally in areas historically forced to med-vac all patients to larger southern healthcare facilities.
REFERENCES
1) Taylor P. (2013). Gaps in health care coverage when moving between provinces: Retrieved from: Healthy Debate, Personal Health Advocator:
2) Travel Insurance.com (2011). Travel and Your Provincial Health Plan. Retrieved 09 19, 2016 from
Presentation #: OI4-3
Access to healthcare services, especially for individuals with stigmatizing conditions like behavioral health problems, HIV and other STDs, and other public health concerns, remains a significant problem in the US, especially in frontier and rural areas. Approaches to bridging this access gap have emerged as a result of advances in technology and increased availability of and access to the Internet. Using technology-based interventions to deliver prevention, treatment, and recovery support services for individuals participating in risky behaviors impacts how health care professionals deliver services and what constitutes typical standards of care. While these growing trends towards using technology-based interventions helps expand access and enhance care, it also raises specific practice concerns that administrators and practitioners need to take into consideration. This presentation will highlight: technology-based interventions; concerns and advantages to using technology-based interventions at the staff and organization levels; an agency-focused decision matrix; an introduction to methods and resources to help agencies move forward with implementing technology-based interventions to enhance and expand access to services for patients; the use of social networking websites by practitioners and patients; and social media policy dos and don'ts from a practitioner and organization perspective. Individuals residing in frontier/rural areas may have similar prevalence rates of drug/alcohol dependence as their urban colleagues but their mortality rates and risks for suicide are higher and in general their alcohol/drug problems more severe. The most significant issue facing individuals with substance use disorders (SUD) in frontier/rural areas is access to treatment/recovery services. Although the medical and behavioral health professions have started using telehealth technologies to deliver services to individuals with limited access to services, SUD treatment and recovery providers lag behind when it comes to using telehealth technologies for service delivery. For example, a 2009 study by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) revealed that addiction treatment providers in fewer than 16 states reported offering services using telehealth. A literature review found numerous articles for psychiatrists, psychologists, and social workers on using telehealth technologies, but only a few were found that reference using telehealth to deliver SUD treatment and recovery services and no articles were specifically written on telehealth for the addiction counseling profession. Given the importance and potential benefits of providing SUD treatment and recovery services using telehealth technologies, it is essential that administrators and clinicians be able to access accurate information about implementation in order to make informed decisions. This presentation will introduce individuals working in the SUD treatment and recovery field to the benefits and risks to using technology-based interventions, including privacy and security considerations.
REFERENCES
1) Blue R, Strech G. Rural and frontier culture: Challenges and opportunities for implementing systems of care. [cited 2012 June]; Available from:
2) American Telemedicine Association. 2012; Available from:
3) Chiauzzi E, Gammon J. Recovery 2.0: Substance abuse treatment in a technological world. 2012.
Operations and Implementation
Presentation #: OI5-01
Remote monitoring provides a convenient option to promote care at home while maintaining a connection between patient and provider to address ongoing medical issues. Remote monitoring programs support both short- and long-term health management goals for primary and specialty care. The ability to capture digital health information in near real time increases the capacity for early intervention and rapid response.
Mayo Clinic is an integrated group practice spanning 5 states and with over 5 million outpatient visits annually. Patient care provided at Mayo Clinic is supported by medical education and research. In early 2015, remote monitoring existed in isolated projects within the institution; these services were fragmented and not standardized nor scalable. Additionally, the services were narrowly focused on specific conditions using hybrid systems directed by specific clinical subspecialties. Most of these services lacked interfaces, or a secure technology infrastructure that would support integration and interoperability.
The Center for Connected Care has created a standardized, scalable remote monitoring program that can be ordered by the patient's Mayo Clinic provider through the EHR. The fact that all physicians are employed by the enterprise and the team-based approach to care, further supports the scalability of the program. This presentation will outline the steps that were taken to design and implement this program.
Market research and benchmarking was completed including a comprehensive literature review and site visits to facilities with existing remote monitoring programs. Multiple peer reviewed studies have shown a reduction in the cost of healthcare utilization among patients with chronic conditions.
A multidisciplinary team was created to develop and support the program. Remote monitoring equipment vendors were evaluated through a request for information process and one vendor was selected to provide the technology and aid in the development of the program.
The Mayo Clinic vision for the remote monitoring is a centralized monitoring model to support its population health practice. This model has helped to control costs and ensure scalability of the program. An important step in creating a centralized monitoring model was program adoption by the clinical practice. A robust patient intake process was created with clinician input to streamline processes that leveraged the capabilities of the EHR. In addition, subject matter experts from the specialty practices were leveraged to develop the clinical components of the program. The future goal for the program is to expand from chronic care management into other market segments.
The program is evolving, metrics have been identified and reports created which are being closely monitored, informing program decisions. Specific metrics are: patient adherence, healthcare utilization, and patient and provider satisfaction. A 32% reduction in hospitalizations has been reported and a decrease in the number of face to face outpatient visits has been observed. Analysis of the return on investment for this program was shared with the Center for Connected Care leadership. The program will expand as condition specific workflows and education plans are created with key clinical practice stakeholders. Referral sources for identifying these patients are being defined and expanded.
REFERENCES
1) Structured telephone support or non-invasive telemonitoring for patients with heart failure, Cochrane Database of Systemic Reviews, 2015
2) Remote Monitoring Programs for Heart Failure Patients. The Advisory Board Company. 2015
3) Mobile Technology and Remote Patient Monitoring: No More Secrets. Kenneth A. Kleinberg. The Advisory Board Company. 2015
Presentation #: OI5-02
As the industry continues to shift towards value-based care, virtual care or telehealth has become an effective strategy to improve access to care and reduce cost across the continuum. Named one of the “100 Most Wired” health systems in the United States by Hospitals & Health Networks, Henry Ford Health System is committed to innovation in how we communicate and connect with our patients, our colleagues, and our community. The Henry Ford Health System's Virtual Care mission is to improve the healthcare experience by leveraging virtual care and technology to increase access, reduce costs, improve workflows, increase quality, improve customer convenience and enhance existing portals. Virtual Care applications include doctor consultations, diagnosis and treatment, education, and ongoing health monitoring. Henry Ford Health System has developed a virtual care strategy and processes to support and implement these various applications across the continuum of care including remote monitoring, e-visits, Clinic to Clinic telemedicine appointments, eConsults, virtual consults, MyChart Post Op Follow Ups, and MyChart Video Visits. Our strategy included an in depth needs assessment and standardization across the health system and medical group. Some operational and process components include an organizational structure, standard project work plan, intake request application, equipment kit, EMR build criteria, metrics, and review process.
In the beginning stages, we worked with early adopters to streamline implementation. We have completed various virtual pilot programs including video dermatology and psychiatric consultations within the hospital setting, video outpatient international travel medicine, dermatology, and psychiatric visits, video outpatient vascular procedure assessments, and asynchronous primary care and post-surgical follow up visits. These pilots produced over 100 virtual visits/consults in 2015 with positive results, and over 900 visits/consults in the first half of 2016. Henry Ford also admitted more than 1,600 new patients to their e-Home Care program (remote tele-monitoring at home) with 200 patients active daily.
Henry Ford has developed standards and operating procedures to make the implementation of virtual care programs seamless and easy for the stakeholders. Over the next few years, Henry Ford will be focusing on driving adoption and scale, allowing us to extend our resources and service to a larger patient population, expanding possibilities, connecting people, with care that's All For You.
Presentation #: OI5-03
Gundersen Health System is a comprehensive healthcare network including one of the nation's largest multi-specialty group medical practices, teaching hospital, regional community clinics, affiliate hospitals and clinics, behavioral health services, vision centers, pharmacies, and air and ground transport services. We serve a Tri-State region, serving a population of 600,000 patients. Our telemedicine clinical services have grown to over 100 providers, in 28 specialty areas. This presentation will focus on the growth of this program from infancy to its current state.
Through the years a strong infrastructure of technology, providers and staff has been built. Statistics that are monitored include the number of appointments, the number of specialists, specialties, regional sites and locations. Our telemedicine program is an essential component to our strengthening commitment to 'Care Close to Home'.
Throughout the presentation the presenters will provide tips, resources and guidelines in the areas of:
• Engaging Leadership,
• Recruitment of Providers,
• Technology Licensing,
• Contracting,
• Credentialing, and
• Patient Experience Surveys
This presentation is intended for entry level audiences looking to learn more about implementation of a telemedicine program. Following the presentations attendees will understand the critical steps needed to implement a telemedicine program in their institution. Hear about the lessons learned during the early days and growth of a program and how to overcome challenges in each of the listed points.
REFERENCES
1.
2. Department of Health and Human Services, Centers for Medicare & Medicaid Services December 2015
3. Center for Medicaid, CHIP, and Survey & Certification/Survey & Certification Group
Operations and Implementation
Presentation #: OI6-01
Presentation #: OI6-02
Expansion of maternal and newborn healthcare services via telehealth is supported by executive, operational, technology teams and Women and Newborn Clinical Program. Inpatient Neonatology and Lactation Services, and outpatient Genetic Counseling are fully operational, with key performance measures defined for each program. Additional programs are in early implementation phase including a program for parents to view their newborns in critical care units, a dedicated 24/7 newborn support center and expansion of outpatient services. These telehealth programs augment and complement existing programs to enhance maternal and newborn services throughout Utah and surrounding states. Telehealth Services at Intermountain Healthcare supports a myriad of programs with Women and Newborn programs representative of an area where access to care can be very limited. Early telehealth software and hardware solutions were designed for adult critical care, stroke and crisis care services. Additional hardware design focused on supporting our smallest patients. Purposeful customization of equipment and telehealth platforms result in new challenges and unique opportunities to continually innovate. The purpose of this presentation is to provide an overview and comparison of program design, implementation, and operational barriers as well as keys to success. Using ARHQ's literature map to contextualize and evaluate these programs, opportunities for future research will be identified.
REFERENCES
1. Totten AM, Womack DM, Eden KB, et al. Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews [Internet]. Technical Briefs, No. 26. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jun.
Presentation #: OI6-03
1. To carry out a detailed need assessment study interacting with all stakeholders to customize a cost effective turnkey solution for providing remote health care, end-to-end, on a program management approach, with measurable milestones, in a first of its kind Public Private Partnership mode.
2. To identity key health issues and identify an appropriate, dependable, need based technology withstanding landslides and sub-zero temperatures.
3. To effect a major cultural transformation by recruiting staff from a secluded community and training them in a state of the art, quaternary JCI accredited institution. Urban teleconsultants also had to be sensitized, for remote community interaction.
4. To deploy a Program Management approach including budgeting, defined Service Level Agreements (SLA) for all major activities, training and retraining, capacity building, CME programs, weekly and monthly project reporting, efficient community engagement and optimized capacity utilization with regular monitoring.
REFERENCES
1.
2. Telehealth in the Himalayas: Operational and Clinical Challenges: A Preliminary Report K. Ganapathy et al P 324 − 332 Global Telemedicine and eHealth Updates: Knowledge Resources Vol. 9, 2016 Editors Malina Jordanova and Frank Lievens ISfTeH International Society for Telemedicine & eHealth
3. Teleconsultation in Himalayas
Track: Operations and Implementation
Abstract moved to page A-8
Presentation #: OI7-02
This presentation focuses on the strategies utilized to streamline medical staff credentialing within a large telemedicine network. Through the use of credentialing by proxy and targeted communications aimed at improving the utilization and effectiveness of credentialing by proxy, the Medical University of South Carolina (MUSC) has successfully reduced the burden that this process has on its programs. The presenters will discuss specific credentialing or administrative barriers and how to address them. Additionally, MUSC is part of a collaboration with other telehealth hubs and organizations to move towards a centralized credentialing model for the whole state. This innovative credentialing model could have a large positive impact on the efficient utilization of telehealth in South Carolina.
Presentation #: OI7-03
Provider training is key to any telehealth program's success. However, one approach to training does not work with all providers. In this session we will discuss one organization's approach to training across inpatient, outpatient, and home scenarios. Real world examples, and lessons learned will be provided for case based learning.
Provider training needs to be a multi-faceted approach, but should include a hand on component. As we moved to system wide utilization, we developed key objectives within our organization that would be consistent across training. We knew that approaches to that training needed to meet many different user needs, experience levels, and time constraints. We developed a curriculum for training that could be adapted for individual, small group, as well as large faculty group trainings and set our minimum objectives. Training included hands on training and document review. This far we have completed training with 426 providers over the last 18 months. We solicited feedback via survey after the in person training (23% response rate) and saw 93% of those that completed the survey were satisfied with the quality of the training program. Additionally, 89% of those surveyed agreed or strongly agreed with the statement that they could apply what they learned to their job.
Our training resources needed to include a variety of methods for providers to reinforce what they had learned. We incorporated the use of telemedicine into the existing and ongoing simulation training for our inpatient users. Equipment was installed in our simulation center to mirror what was available in the unit and used for in situ simulations. We learned key lessons from this simulation related to placement of people, equipment, and role definition that allowed us to modify our work flow. We continue to have telemedicine as a key part of the debrief from each in situ simulation in that unit. Additionally we have written job aids with heavy images for reinforcement and refresh of learning. These are available online, at the point of care deliver, and available in hard copy at training. We also created short video job aids that allow users to identify key problem areas for themselves, and watch a video segment specific to that issue. Finally, we created telemedicine encounters within our EMR playground to allow for illustration and training on some of the nuances of documentation.
Finally, required refresh training for key staff is essential to our approach. For our inpatient bedside staff, who serve as presenters, we require a mock consult completion meeting nine key objectives to be done twice a year. Our clinical managers on the inpatient team need to not only complete the two mock consults annually, but also participate in additional training that includes common user error issues and demonstrate their ability to train a new or uncomfortable staff on basics. Mock sessions have also been implemented in several of our outpatient and home based programs as well. Case based learning will also be presented to highlight lessons learned in developing a robust telehealth provider training program.
Presentation #: WP-01
1. Identify key issues to start up a pediatric telemedicine program
2. Identify collaborators and advisors to improve your telemedicine service
3. Network with leaders of the pediatric special interest group
Workshop Presentation
Presentation #: WP-02
1. Upon completion, participants will be able to describe the key elements of a well-written telemedicine research or white paper.
2. Upon completion, participants will be able to compare and contrast the characteristics of a “good” paper with those of a “bad” one.
3. Upon completion, participants will be able to demonstrate how an unsatisfactory paper can be converted into one that is acceptable for publication.
Last year's workshop was the most successful to date: There were between 40-50 attendees and comments included: “Fantastic session, very helpful to those new to writing. I have been to similar presentations before at other conferences, this one was best” and “Wow! Huge talent with great, great input on this subject! The offer for mentoring is an awesome opportunity as well.” We expect the 2017 workshop to be even better!
Track: Operations and Implementation
Presentation #: OI8-01
1. Recognize the power and efficiency of leveraging internal enterprise clinicians across multiple facilities.
2. Examine the use of external clinician to support existing gaps in coverage.
3. Understand the benefits to a standardize workflow regardless of specialties.
As healthcare provider organizations (HPOs) integrate telehealth into their care delivery processes, they have a growing need to simplify their telehealth infrastructure to deliver reliable care and achieve better outcomes at lower cost.
This panel session will present lessons learned from a hospital-based telehealth program that enables HPOs to have the flexibility to leverage the capacity of their existing staff and to supplement, when and where needed, by competitively contracting for additional professional services. The example used will be a large HPO in the for profit sector that established an enterprise telehealth program along with its own spoke (referral) and hub (consultant) technology infrastructure to meet its current needs and future planned telehealth innovations.
Panel members will discuss the integrated business design, operations, and technical aspects, highlighting the benefits over prior siloed telehealth project architectures. These include challenges encountered and remediations implemented in the planning, execution, and operation of the program as well as the data collection strategies used to generate and collect metrics used for quality assurance activities and to establish and validate the program ROI.
The telehealth technology infrastructure supports a referral site having access to a variety of specialists by connecting from the systematized endpoints (carts) to multiple consulting hubs, both inside and outside the enterprise. The telehealth software creates a standardized template at the referral (originating) site for a consistent user experience and data capture for ongoing performance reporting, minimizing retraining and maximizing their productivity, while providing the flexibility to adjust to service-line specific documentation, imaging, and workflow requirements. It also includes integration of clinical documentation with multiple EHRs across the enterprise; a vendor-neutral framework for devices and video services, seamless access to PACS and other images and videos from the referral site; multipoint video encounters; and use of multiple peripheral medical devices. This type of framework allows planning and prioritization of new markets and specialties.
Track: Operations and Implementation
Presentation #: OI9-01
As the telehealth industry continues to explode, the role of women leading complex healthcare organizations and helping to shape this multi-billion-dollar industry is becoming increasingly important. Join us for a provocative discussion on how these leaders successfully navigate both the industry and their organizations in an effort to transform how healthcare is being delivered. This is the first-ever event for women telehealth executives – and was created to inspire and connect women working in healthcare. Its unique insights are designed to help women gain valuable leadership strategies. When one woman helps another, amazing things can happen. Join us in developing the future for women in telehealth.
Track: Operations and Implementation
Presentation #: OI10-01
As healthcare providers continue to increasingly depend on telemedicine to deliver care to a broader population and to reduce the overall cost of its delivery, legal and regulatory questions remain. Devices and mobile medical applications that enable the delivery of telemedicine services are subject to a complex web of regulations by multiple federal agencies, including the Food and Drug Administration (FDA), the Federal Communications Commission (FCC), and the Federal Trade Commission (FTC). Of all of these agencies, the FDA has been particularly active in its promulgation of policies for this slice of the industry - most recently issuing draft guidance in August 2016 on device modification policy. But the challenge for manufacturers of mobile medical apps and devices remains – understanding how to navigate the process of categorizing your device and state its “intended use” to the agency. This session will help attendees understand how to approach this process, the remaining questions/gaps in the FDA guidance and how to manage them, and importance of recognizing the FDA as a partner throughout the lifecycle of the devices it regulates.
Presentation #: OI10-02
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is rolling out. The law impacts how providers are paid under Medicare. Will it push providers to use telehealth technology to achieve value-based care? Will it give Telemedicine providers a better view of the patient with its emphasis on interoperability, information exchange and security?
This presentation clarifies how MACRA affects the telemedicine provider from the perspective of privacy and security including HIPAA and HITECH. CMS will spell out the details and is expected to “include telehealth services in the definition of patient-facing encounters.” This is good news for Telemedicine because Medicare intends to evaluate technology based on its usefulness to clinicians and patients.
Cybersecurity technologies and regulations are often not perceived as very useful and sometimes just “get in the way.” As a result, Telemedicine providers might find a workaround to a security control that slows down work-flow. Healthcare professionals are not hackers or slackers - they just want to get their work done. Walk into a clinic or practice and you'll find a deluge of obstacles thrown at them on a daily basis. A healthcare professional's first priority is to take care of patients.
For a long time, security controls often did not integrate well with clinical workflow or usability. Security experts are in the business of keeping the bad guys out. They also are pretty good at uncovering who, what, when and where a security incident occurs. The reality has been that system and security engineers may not always have always done the best job communicating with Telemedicine professionals.
We will discuss how Telemedicine and Cybersecurity can work both better and smarter. We challenge the emphasis on record-keeping for compliance purposes and promote Cybersecurity in terms of practical value for both Telemedicine professionals and their patients. Cybersecurity must integrate well with Telemedicine's day-to-day processes and training. We will explore emerging Cybersecurity technology that Telemedicine can use to be more efficient and integrate better with work-flow. Privacy and security information should be readily accessible in an intuitive manner. Training and security questions and answers should be relevant, frequent and short so that it becomes part of Telemedicine's culture. Built-in shortcuts and search engines can help answer privacy and security questions quickly and keep documentation work to a minimum. We will consider how “cloud-based” Cybersecurity compares to traditional stand-alone software - its benefits and disadvantages.
As healthcare reaches beyond EMR record keeping, the focus shifts to preparing for Telemedicine's virtual visits. Privacy and security methodology must support the Telemedicine provider's launch of its patient awareness campaign. We will discuss how to leverage Security Risk Assessments (SRA), Incident Responses, security education and security controls for continuous quality improvement of patient experience and outcomes.
Value-based care represents a distinct contrast to the fee-for-service model. MACRA's message for Telemedicine and Cybersecurity is to integrate well so that everyone - including patients - can make better decisions.
REFERENCES
1. The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS);
2. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015;
3. Healthcare Information and Management Systems Society (HIMS;
Track: Operations and Implementation
Presentation #: OI11-01
1. Upon completion, participants will be able to discuss best practices around clinical service delivery and core workflow elements(activation, staffing, etc.).
2. Upon completion, participants will be able to identify critical operational infrastructure and programming elements needed to develop and sustain highly specialized emergency telemedicine services.
3. Upon completion, discuss unique attributes of products and technology solutions to support highly reliable emergency telemedicine services.
Teleneonatology is one of the emergency telemedicine services offered by Mayo Clinic. The successful implementation and growth of teleneonatology was built on a strong partnership between the Center for Connected Care and the Division of Neonatology. The Center for Connected Care serves as centralized administrative operations while the Division of Neonatology manages the clinical operations needed to provide the service. The deep collaboration between the Division of Neonatology and the Center for Connected Care has proven effective in ensuring the sustainability of teleneonatology.
Successful clinical delivery of teleneonatology requires 1) rapid and reliable activation of the service, 2) a physician champion and engaged neonatology and leadership staff, 3) relationship building with the local health system sites, and 4) continuous process improvement to meet the needs of the customer. The clinical workflow should include a formalized activation process that has a reliable turnaround time of less than five minutes and involves the institutional transport team and bed control. Engagement of neonatology staff with support of departmental and institutional leadership is critical to supporting the program, including scalable staffing models and resource requirements. It is crucial to establish and manage relationships between the consulting service and the recipient hospitals. This often requires understanding the needs, processes, and culture of the local hospital. Through continuous process improvement and feedback from local providers, neonatologists can provide the highest quality telemedicine consult. High satisfaction with the clinical service is marked by clear communication, manageable recommendations, and collaborative teamwork when guiding care during high-risk newborn resuscitations.
Expanded knowledge of the telemedicine space is necessary to ensure programs are maintained and compliant. The Center for Connected Care was created as the centralized organization to oversee telemedicine product management, operations, and technology at Mayo Clinic. It serves as the foundational infrastructure to enable emergency telemedicine services. Connected Care administrative operations include facilitating licensing and credentialing requirements, supporting the creation of teleneonatology policies and procedures, developing and reporting program metrics, and guiding teams through implementation of emergency telemedicine products and services.
Emergency telemedicine services, including teleneonatology, depend on highly reliable technology components. The program requires that the telemedicine technology has a 100% uptime to ensure systems are readily available for medical emergencies. To support this level of reliability, the infrastructure must include rigorous product selection processes, technical analysis and multi-tiered support models in which system performance and monitoring can be established. Teleneonatology also has unique attributes that require the technology to function in small patient care spaces. It must also have high fidelity audio to allow for seamless communication during high-risk newborn resuscitations, and video must be of the highest quality to allow remote guided care of the smallest newborns.
Track: Operations and Implementation
Presentation #: OI12-01
1. Develop a person centered model of care that can effect behavior change by improving engagement through nurse coaching and mHealth technologies.
2. Describe the impact active stakeholder participation can have on successful development and implementation of a person centered intervention program.
3. Describe the role technology may have on sustaining an individuals' commitment in improving their health.
Lessons learned in developing an innovative platform and integrating a sensor-driven patient generated health data into the electronic health record for clinical practice, and experience from deployment and troubleshooting technology challenges will be discussed.
Track: Transformation
Presentation #: TI-01
1. Identify key Federal legislative, policy and regulatory barriers facing connected care technologies like telehealth and remote patient monitoring.
2. Overview of federal legislative, policy and regulatory developments and opportunities specific to telehealth and remote patient monitoring.
3. Determine the advocacy priorities for telehealth and remote patient monitoring in 2017 and beyond.
Track: Transformation
Presentation #: T2-01
As the 5th leading cause of death and the leading cause of disability in the United States, stroke costs an estimated $33 billion/year with direct costs projected to triple by 2030. Cost-effective stroke care requires timely intervention for acute onset and long-term strategies post-discharge to decrease morbidity and mortality. Current stroke care is poorly coordinated, including conflicting geographic care locations and changing providers designed to foster confusion. Telemedicine combined with evidence-based, integrated care across the continuum can reduce stroke costs and ensure quality. Bundled payment models that reimburse based on expected costs per episode could enable clinical innovation by aligning financial incentives with high quality care in acute and post-stroke settings.
1. Describe an innovative stroke care model that integrates a comprehensive telehealth system.
2. Describe advantages of integrating telehealth into stroke care.
3. Discuss bundled payment strategies development and methods for cost analyses, including TDABC methodology.
Track: Transformation
Presentation #: T3-01
1. Explain the critical role of an overarching strategy and how it drives telemedicine through leadership.
2. Describe recent case studies and key insights that will further illustrate the power of telemedicine.
3. Identify the key considerations around the launch, scaling and ongoing evaluation of telemedicine models.
Track: Transformation
Presentation #: T4-01
1. Upon completion, participants will be able to identify the three key policy barriers to telehealth implementation
2. Upon completion, participants will be able to identify at least three areas in which further research on telehealth is needed
3. Upon completion, participants will be able to develop action steps to help promote telehealth adoption in their healthcare market.
In September 2016, three ATA members presented the research and policy framework in a challenge workshop at Concordium 2016, an AcademyHealth meeting, and engaged in an interactive discussion with the audience about myths and misperceptions about telehealth. The discussion led to insights about how to promote culture change and increase adoption of telehealth as an extension and enhancement of current healthcare delivery that increases patient satisfaction, improves access and quality, and can improve efficiencies and reduce costs. The discussion also covered the role of evidence, either through quality improvement or other demonstration projects and funded studies, in making business and clinical decisions about establishing and expanding telehealth services.
Based on this feedback, the framework seems to have potential to help educate policy-makers, payers, and health systems about the value of telehealth and to frame discussions about implementation barriers, including risk management, technology costs, and organizational culture. By standardizing language for telehealth modalities and services, the framework could help to increase familiarity with the field among purchasers, leading to increased adoption and information-sharing about promising practices. However, questions remain about how to disseminate and use the framework to help coordinate policy, research, and implementation efforts in the field.
We propose to conduct a panel discussion that brings together these ATA, AcademyHealth, PIAA, and KPIHP partners in an open discussion at ATA 2017. Our intended purpose is to accelerate the development of a collaborative, multi-sector effort that will lead to culture change, an increase in telehealth adoption, and additional support for more systematic research implementation strategies, quality improvement, and patient engagement. After presenting the framework we have developed, each of our panel members will briefly discuss how integrated systems are currently documenting telehealth successes and promoting telehealth services within different markets. Then we will engage in a moderated Q and A with the audience about how ATA might engage with other partners to help move forward on a coordinated policy and research agenda for the field.
Track: Transformation
Presentation #: T5-01
1. Define the concept of Store & Forward
2. Demonstrate how telepsychiatry can transform healthcare programs
3. Describe how an addiction treatment program can be coordinated through telepsychiatry services
Track: Transformation
Presentation #: T6-01
Sharp Healthcare has a number of innovative uses of Telehealth that increase access for patients, adds efficiency for caregivers, and provides exceptional services in a variety of areas, truly making the program “beyond the walls”. Our foundation medical group, Sharp Rees-Stealy, primary care, pediatric physicians and other providers are using the Telehealth Service to see their own patients for a number of follow-up and return visits. Our Neonatologists use the system to allow sub-specialists at regional specialty centers to assist in neonatal diagnoses and treatments. They also are able to consult on babies born in our system that may need NICU services. The NICU staff will also be utilizing USB and Bluetooth enabled devices such as stethoscopes to assist in diagnosis. Our behavioral health providers are often called upon to consult with or clear patients seen in our Emergency departments. Able to see the patients quickly, beds can be safely turned over with more efficiency. Finally, the internationally recognized Sharp Global Patient Services is using the system to connect passengers and crew on cruise, container and cargo ships with physicians both primary care and specialty. Use of this service can decrease unnecessary trips to area Emergency Departments and delight passengers, who do not need to miss days of their cruise waiting to be seen. Our presentation will cover these areas and more. We'll also discuss how we've been able to work across the organization and with our vendor to rapidly bring up areas and provide governance.
Presentation #: T6-02
OTN (Ontario Telemedicine Network) is one of the largest integrated and collaborative telemedicine networks in the world. This presentation is a case study of the evolution of OTN over the past decade, from rural and removes video conferencing to an interoperable online platform providing a wide variety of telemedicine products and services.
The presentation will describe the operational, technical, clinical workflows and financial considerations in this transformational journey.
With advancement in technology and with Telemedicine becoming a mainstream clinical interaction, this session will be relevant to the audience interested in understanding how telemedicine has evolved over the past decade. In addition, insight will be provided into future trends in the virtual healthcare market place.
REFERENCES
1. Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network Laurel D. O'Gorman, MA, John C. Hogenbirk, MSc, and Wayne Warry, PhD Center for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada.
Presentation #: T6-03
While most health services and some specialty health services are provided within federal institutions, the majority of specialist consultations take place outside institutional walls within Regional Health Authority (RHA) facilities. In 2010 the federal offender population in the Atlantic Canada region had increased. Two thirds of this population were in institutions within the geographic area served by Horizon Health Network (HHN), the larger of the two Regional Health Authorities in New Brunswick. This population increase resulted in a rise in the number of offenders visiting HHN facilities, where many of the specialists worked. To put this into perspective, during an 11 month period there were 880 medical escorts of federal offenders from the two minimum security Correctional Service of Canada (CSC) facilities alone. This was an average of 80 escorts per month. An analysis of these escorts determined that 294 of these or one third of these could have been completed using Telehealth technology. A medical escort consists of two guards, at times armed, accompanying an inmate in a modified vehicle to and from the appointment. During this time the offender, depending on security level, may have their hands cuffed and legs shackled at all times. While this can be disruptive to patients in the waiting room area and clinical staff, it is also embarrassing to the offender to the point that some refuse to go to outside medical appointments. It also can pose a falls risk for the offender.
In an effort to improve patient centered care and appointment attendance, HHN and CSC entered into a Memorandum of Understanding (MOU) and launched a strategic Telecorrections Partnership initiative. The clinical focus has been medical services provided by specialists from within Horizon to inmates from both Westmorland Institution and Dorchester Penitentiary. The original clinical areas of focus were plastic surgery, general surgery, and ENT. Expansion to other specialties has since occurred as the opportunities arose to include the establishment of a recurring infectious disease management clinic and a respirology clinic.
Through detailed process and change management Telecorrections has increased staff and patient safety by reducing and/or eliminating the need for inmates to be transferred to a hospital in order to receive specialty care. Security costs associated with medical escorts have been reduced and potential opportunity for elopement associated with these appointments eliminated. One tremendous advantage to embracing Telehealth technology and processes has been the ongoing knowledge transfer which occurs during these assessments for those CSC clinicians involved. Also, vice versa; having the clinicians present during each session has been pivotal in regards to maintaining an open dialogue and general facilitation.
This presentation will describe the process of establishing the partnership as well as clinical outcomes. Challenges experienced both clinically and technically will also be explored as traversal between two separate, private networks remains a necessity. Attention will be given how Telecorrections continues to assist CSC Health Services in providing essential health services to offenders while contributing to public safety.
Track: Transformation
Presentation #: T7-01
It has been well documented ([1], [2]) that about half of overall CMS reimbursement is targeted to caring for a small handful of the sickest patients in the healthcare systems. However, it is less known what these patients look like prior to ‘rising to the top’ of the cost pyramid, and how we can prevent patients from getting there.
The primary objectives of a longitudinal retrospective study conducted by Partners Connected Health and Philips Research/Lifeline were:
1. To evaluate healthcare utilization and expenditure on patients of Partners Healthcare at Home that have been using the Philips Lifeline service.
2. To analyze patients transitions and their cost flow throughout the top-, middle- and bottom-segments of the cost acuity pyramids in the period 2011-2015.
Track: Transformation
Presentation #: T8-01
1. Apply best practices on how to approach commercial health plans to negotiate telehealth coverage under their provider agreements
2. Understand if their home state has a “toothless” telehealth coverage statute, and learn what to do about it
3. Share experiences, raise awareness, and enjoy robust discussion on the inner workings of commercial health plan coverage and contracts
Track: Transformation
Presentation #: T9-01
Reaching out to the population outside of the walls of a hospital, clinic or office has been a goal of healthcare for many years. A growing number of institutions have found ways to use telecommunications technology as part of a game change in service lines and delivery options. This is causing an evolution in care delivery, preventative care strategies, and improved chronic disease management. Three experts will highlight the unique roles and pathways of their respective organizations in growing the use of telemedicine from pilot projects to strategic system-wide transformer. Panelists will share lessons learned including successes and failures to scale telemedicine and the incentives behind their formation.
Track: Transformation
Presentation #: T10-01
It's all about patient choice. The shift from passive customers to savvy healthcare consumers has been predicted for years, but traditional brick-and-mortar care providers such as hospitals and health systems have remained relatively immune. Not anymore. Shifts in the market and advances in technology, among other factors, have given patients the incentives, tools and options to make different decisions about how they receive care.
With the rise of healthcare consumerism, patients are looking not just for quality healthcare—ideally provided by their community's own providers and health system—but also for convenience, value and service. That's where high-value, evidence-based virtual healthcare fits in.
Presenter Kevin Smith, DNP, FNP, FAANP, will explain how health systems can deliver a virtual care experience that keeps patients connected with their own health system versus accessing care via an outsourced direct-to-video telemedicine service. This presentation examines the forces shaping healthcare consumerism and care delivery, with a focus on how health systems can deliver virtual healthcare that supports patient choice by offering affordable, convenient care without sacrificing quality and service.
As a veteran witness to the business impact and trajectory of other disruptive, consumer-focused healthcare models such as retail medicine, Dr. Smith will explain what patients want most in their virtual care, including: anytime, anywhere care and diagnosis; inexpensive access; seamless experience; and confidence and trust in the provider. He will also provide insights into the competitive advantages for health systems achieved by linking high-quality, efficient virtual care offerings with their trusted brick-and-mortar brand.
While virtual healthcare fits well into the new consumer-driven care paradigm, it's important that it be delivered without disrupting the patient's continuity of care. To that end, attendees will learn how virtual care services can be provided that not only maintain-but reinforce-the relationship between the patient and the health system, including electronic health record (EHR) integration and medical home considerations.
The presentation addresses the ripple effect that the rise of consumer-driven healthcare is having on health systems, including the fact that they will need to adapt if they don't want patients to seek care elsewhere. Fortunately, virtual care not only offers a way to meet the consumer demand for convenient, quality care, but it also provides a strong value proposition and ROI fueled by increased clinical efficiency, diminished patient leakage and new patient acquisition. Dr. Smith will explain how health systems that move quickly and nimbly can leverage the opportunity to position themselves as leaders in their respective markets.
REFERENCES
1. COUGHLIN S, WORDHAM J, JONASH B. (2015). RISING CONSUMERISM Winning the hearts and minds of healthcare consumers. Retrieved from
2. PwC. (2015). Top health industry trends and issues 2016: PwC. Retrieved from
3. Cordina J, Kumar R, Moss C. (2015). Debunking common myths about healthcare consumerism | McKinsey & Company. Retrieved from
Presentation #: T10-02
Emerging trends are shifting the focus of Patient Access from a narrow and operational issue, to a broad, value-added capability on the C-Suite agenda.
Improving Patient Access can drive potentially significant benefits to patients, clinicians and health systems including improved quality of care, higher patient and clinician experience scores and increased volumes across the system. Based on our primary research in various markets, health systems can benefit from enhancing Patient Access by:
1) Reducing “true new patient cancellations” (i.e., patients who schedule with our system, cancel/ fail to complete appointments and do not return), which can run into the tens of thousands and cost regional health systems tens of millions of dollars based on our experience.
2) Reducing revenue leakage opportunities, which can run into the hundreds of millions of dollars (even when conservative assumptions are applied)
This session will examine the frameworks, strategies and models to enable seamless Patient Access across modalities and technologies, as well as define the required capabilities for providers to achieve their access goals using digital health and telemedicine.
The presenters will:
• Provide our perspective on the capabilities of systems with leading Patient Access
• Discuss the potential benefits of enhancing Patient Access, including improvements in quality of care and system capacity for taking on risk
• Discuss our approach to identifying where the Patient Access issues are occurring (using internal scheduling and cancellation data, as well as external claims data to identify system leakage/uncaptured revenue)
• Highlight the importance of measuring consumer and provider behaviors, focused on willingness around adopting digital health initiatives
• Demonstrate how building tailored programs with prioritized pilots and service lines can help address access challenges
• Discuss some of the key drivers and challenges providers face when implementing digital health and telemedicine programs based on their experiences from the frontlines and the results of a recent KPMG poll* of healthcare providers
• Discuss improving business cases by evaluating the impact of telemedicine and digital health in the context of enhancing Patient Access
Presentation #: T10-03
Clinicians are often the primary gatekeepers to adoption of new virtual care technologies, and bringing about their widespread use of telemedicine technology is a challenge in many organizations. How can we provide value to the clinician and the patient with telemedicine, in light of the economic realities of current and future reimbursement and compensation models?
Based on a decade of research, pilots and implementation of telemedicine technologies, Mass General Hospital and Partners Healthcare have developed telehealth offerings designed to meet the changing economic landscape and overcome the hurdle of clinician adoption. In particular, asynchronous approaches to patient care offer broad appeal and show rapid adoption, just as they have in human interaction, shopping, relationships, finance and almost every other aspect of our lives. These represent a sea change in delivering care that will be increasingly essential and obvious in the coming years.
We will discuss the changing healthcare economics driving this research and the resulting telehealth solution portfolios designed to meet the needs of clinicians, Population Health Management, value based incentives and increased risk bearing by providers.
REFERENCES
1. Dixon RF, Rao LR. Asynchronous Virtual Visits for the Follow-up of Chronic Conditions: A Telemedicine and e-Health, July, 2014
2. Ganguli I, Wasfy, JH, Ferris TG. What Is the Right Number of Clinic Appointments? Visit Frequency and the Accountable Care Organization JAMA. Published online April 06, 2015. doi:10.1001/jama.2015.3356
3. Dixon RF, Stahl JE. A randomized trial of virtual visits in a general medicine practice. Journal of Telemedicine and Telecare Volume 15 Number 3 2009
Track: Transformation
Presentation #: T12-01
Chronic conditions impact over half of the American population and represent more than 80% of all health care spending in the U.S. each year. Traditional Chronic Condition Management (CCM) programs alone fall short on delivering improved health outcomes and cost savings. The most common chronic conditions include:
• Heart Disease
• Stroke
• Diabetes
• Obesity
• Behavioral/Mental Health
• Cancer
Many chronic conditions can be managed or prevented and could be the key to saving trillions in future health care costs. Through analysis of industry research and interviews with successful CCM programs, SCP gained expertise and developed a tool to aid organizations in understanding the benefits of value over volume. By comparing and drawing conclusions on the value of CCM programs with and without Telehealth, we identified tangible differences in the overall Value on Investment (VOI), rather than traditional Return on Investment (ROI). These differences led to:
• 40%+ reduction in 30-day readmissions for target patient population
• 40%+ reduction in hospitalizations for target patient population
• 50%+ decrease in total cost of care for target patient population
• $3.30 of value for every $1.00 of investment
Similar to an iceberg, much of the value of CCM + Telehealth lies below the surface, out of immediate sight of health care providers and leaders; yet it provides a significant opportunity to improve population health, increase care access and contain costs. Returns on Investment (Fee for Service reimbursement, Copays, PMPM and Coinsurance) are traditionally turned to when organizations create financial models, however, with our changing payment system, this way of thinking about the financial picture of implementing Telehealth is outdated. Elements that translate to Value on Investment (Reduced Readmissions, Improved Patient Satisfaction, Reduced Avoidable ED Visits, Better Managed Provider Time, Increased System Capacity, Reduced Avoidable Days, Increased Service Utilization, Better Medication Management and Better Managed Conditions) are what forward thinking health care leaders are utilizing to more accurately represent the business case for creating Chronic Condition Management Programs with Telehealth.
Realizing value with Telehealth in CCM programs starts with a good business plan and comprehensive financial model. Our CCM benefits estimation tool was developed to:
1. Understand the revenue, avoidable loss and savings opportunities from the deployment of a CCM program.
2. Demonstrate the potential increase in value from the deployment of Telehealth.
REFERENCES
1.
2.
3.
Presentation #: T12-02
Knowledge translation (KT) describes any activity or process that facilitates the transfer of high-quality evidence from research into effective changes in health policy, clinical practice, or products (p.355 1). Knowledge translation is a critical factor in the success of the implementation of telehealth into clinical services. This paper will report on the development of a practical guide for knowledge translation in telehealth called Innovation to Implementation for Telehealth (i2i4Telehealth). The guide was adapted from a similar version produced for dementia and aged care in Australia,1 and the original guide developed by the Mental Health Commission of Canada.2 The guide focuses on the knowledge translation activities required for effective telehealth implementation. It sets the foundation for change by guiding the user to specify the innovation to be implemented, identify the key stakeholders, and set out a plan for communicating and engaging with these stakeholders. The i2i4Telehealth involves a 7-step approach: (1) State purpose of KT plan, (2) Select innovation around which KT plan will be built, (3) Specify people and actions, (4) Identify best agents of change, (5) Design KT plan, (6) Implement KT plan, (7) Evaluate success of KT plan. The guide includes an additional checkpoint after the telehealth innovation has been selected (Step 2) to determine if the telehealth innovation is “KT ready” with respect to the available research evidence, risks and benefits of the innovation, the business model, and the technology infrastructure available. An additional topic on readiness for change at both the organizational and individual level has been developed to inform this guide. This presentation will present an overview of the i2i4Telehealth and give practical examples of how it can be utilized in the implementation of a telehealth service.
REFERENCES
1. Goodenough B, Young M. (2014). Innovation to Implementation ?” Australia: A practical guide to knowledge translation in health care (with examples from aged care and dementia). Dementia Collaborative Research Centres, Australia.
2. Mental Health Commission of Canada (2014). Innovation to Implementation: A practical guide to knowledge translation in health care.
Presentation #: T12-03
With 16 years of experience in video conferencing, including design, build and implementation of many successful programs (and some not so successful programs), I want to help others learn from my success and failures. I want to provide them with food for thought by discussing the elements that are crucial to building a video conferencing network. I will cover the basic overlay of the network needs, considerations, and how to plan for future needs.
The network, though simple, is still the most complex system on the planet. Though there are standards, there are still variances, and new adoptions causing conflicts within your network to only expand as the network grows. These variances then multiply with the implementation of new technologies, applications and programs. These issues only multiply as variances allow connections into other networks. This is where our best friend the firewall comes into play. Just as other walls are built firewalls do not solve all your problems. Now you must safely provide access to other networks while protecting our own.
Another of the many challenges the network teams face is keeping the packet moving with minimal errors; zero preferred. This challenge is compounded when adding video and audio layers to the mix, and more so when leaving the control of your network and connecting to that other network. Where the typical web traffic can lose a packet and retransmit video and audio, in the hospital world, you do not have that ability. That packet, that bit of audio and video are gone. Now the human has to retransmit.
Understanding the video network from the core to the edge is a must for the admins, all layers making the network, not just the OIS model, but where it interacts with the customer. We must design a network to meet the needs of our current customers today, the new customers tomorrow, and their needs today and in three years. All of this, while being compatible with existing technologies. What do they need, what will they need or want, and what solutions can we provide or build for them? While maintaining a sustainable, manageable, and expandable network.
Doing this requires constant research and communication with your customers. Teams must also communicate with your venders and with the manufacturers to ensure they also understand your needs. This helps in many folds. First is budgeting, the worst part. A quick way to lose a program is to break the budget and not show a reasonable ROI. Secondly, working with vendors and manufacturers, you must encourage them to make decisions to promote the growth and success of your programs. It helps to understand your needs, and the direction the technology is going. It's never good to have a young or outdated network.
Track: Value
Presentation #: V1-01
1. Identify how to use telerehabilitation to achieve bundled payment success
2. Determine the clinical workflow implications that might impact your roll-out of a digital solution
3. Identify the areas where a digital intervention might have the most positive results with your total joint population. Identify key human factors to consider when designing a telerehabilitation program.
Anang: Describing an observational case series where patients undergoing joint replacement knee arthroplasty combined with a novel tele-rehabilitation tool that enables home physical therapy exercise programs and virtual tele-visits with a physical therapist in lieu of in-person clinic visits. Eligible patients received physical therapy using the telerehabilitation system in their homes as part of a prehab program up to two weeks prior to their surgery with plans to use it during the rehab program. Those who had uncomplicated PKA/TKA had a pre-specified protocol for HEP loaded into the telerehabilitation program by their clinician. Patients used the tool to complete HEP and participate in video tele-visits from home with a PT at the clinic. Information collected included overall adherence to the home PT exercises. The PT reviewed performance metrics remotely. Additional physical measurements, functional outcomes scores, and usability surveys were recorded via the PT during clinic visits.
Kathleen Sullivan will discuss the results of a case study utilizing a combined synchronous and asynchronous telerehabilitation system with patients having undergone TKA. The study participant was 85 y.o., human factors and telerehabilitation adoption by the participant and training will be discussed along with presentation of clinical results.
Chris Peterson will discuss the key aspects of starting the telerehabilitation study in a healthcare system setting including legal, regulatory, and training considerations as well as the key value programs that telerehabilitation can be incorporated into.
Track: Value
Presentation #: V2-01
1. Recognize the typical telehealth services and frequencies used by Medicaid beneficiaries in a primarily rural state.
2. Analyze the growth of services during the duration of the study. • Apply the newly acquired information and replicate the study in their own state to gain knowledge regarding telehealth usage and trends.
Presentation #: V2-02
1. Describe the development in state-level telehealth parity legislation for privately insured patients.
2. Describe the trends in outpatient utilization for privately insured telehealth services.
3. Examine the change over time in the utilization of outpatient telehealth visits between states enacting parity legislation and those who do not.
REFERENCES
1. American Telemedicine Association (n.d). ATA state telemedicine toolkit. Improving access to covered services for telemedicine. Retrieved from:
2. American Telemedicine Association (2016). 2016 State Telemedicine legislation tracking. Retrieved from:
3. Neufeld JD, Doarn CR, Aly R. (2016). State policies influence Medicare telemedicine utilization. Telemed J E Health, 22(1), 70-74.
Presentation #: V2-03
Track: Value
Presentation #: V3-01
Establishing quantifiable metrics of quality in a technology driven environment remains challenging. Quality approaches often focus on establishing and reporting ratios to assess effectiveness of programs. This session will evaluate current and emerging policy issues arising from the implementation of MACRA and MIPS. Attendees will understand historical challenges associated with measuring the influence of technology based interventions in reported outcomes, including Telehealth, remote patient monitoring, and patient generated health data. A framework will be presented for consideration in future policy making efforts surrounding the implementation of quality measures specific to the technology oriented aspects of clinical practice improvement activities.
REFERENCES
1. CMS Quality Measure Development Plan: Supporting the Transition to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) Center for Clinical Standards and Quality Centers for Medicare & Medicaid Services (CMS)
2. Kvedar J, Coye MJ, Everett W. (2014). Connected health: A review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs, 33(2), 194-9. Retrieved from
3. Schang L, Hynninen Y, Morton A, Salo A. Developing robust composite measures of healthcare quality ?” Ranking intervals and dominance relations for Scottish Health Boards, Social Science & Medicine, Volume 162, August 2016, Pages 59-67, ISSN 0277-9536,
Presentation #: V3-02
Challenged by today's health care environment and the Affordable Care Act (ACA), hospitals are striving to meet the Triple Aim by improving population health, enhancing patient experience and increasing affordability. Access to care is fundamental to each of these domains. Consumer-driven urgent care facilities, such as CVS Minute Clinic, are flourishing based on the premise of convenience and improved access. Telehealth, a technology based tool, also supports convenient, timely access to medical providers. In 2015, the Cleveland Clinic launched Express Care Online using physicians and APN's to provide interstate acute care telemedicine. The use of APN's to provide interstate on demand urgent care is one of the first in the country.
REFERENCES
1.
2. US Department of Health and Human Services (USDHHS), (2015). Health Care. Retrieved from
3. Schlachta-Fairchild L, Varghese S, Deickman A, Castelli, D. (2010). Telehealth and Telenursing are Live: APN Policy and Practice Implications. Journal of Nurse Practitioners. (6)10, 98-106
Presentation #: V3-03
REFERENCES
1. Ward MM, Jaana M, Natafgi N. Systematic review of telemedicine applications in emergency rooms. Int J Med Inform. 2015;84:601-616.
2. Wibbenmeyer L, Kluesner K, Wu H, et al. Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State. J Burn Care Res. 2015.
Track: Value
Presentation #: V4-01
1. Recall the legal, policy, regulatory, payment and, reimbursement models impacting and accelerating the use of telemedicine to reduce potentially avoidable hospitalizations that come from nursing homes.
2. Summarize the most recent research supporting the use of telemedicine to reduce potentially avoidable hospitalizations that come from nursing homes.
3. Demonstrate how telemedicine can help achieve the quadruple aim in nursing homes by reducing potentially avoidable hospitalizations.
Track: Value
Presentation #: V5-01
Previous research has demonstrated that pediatric telemedicine has been cost-saving when delivered in an emergency room setting (1). In our organization, we were determined to evaluate the cost savings, and potential payback period for an investment into telemedicine in an inpatient 42-bed unit. This investment included in-room systems in each of the 42 rooms including codecs with 12x zoom as well as several telemedicine carts and peripherals. The model of care was that unit was staffed by pediatric hospitalists and surgical APRNs 24/7. There is not a pediatric intensive care unit (PICU) on site, so patients requiring that level of care would need to be transferred to the main campus, over 20 miles away. Additionally, specialists in six identified anchor divisions would be on site daily from 8am-5pm for outpatient clinical and available for inpatient consultations. However, consultations in off hours or from some of our other over 30 specialties often is not available onsite. The telemedicine investment allowed for critical care participation in every rapid response team (RRT) and in every code. Additionally, consultation from any medical/surgical specialty can be requested by this inpatient unit, and if not available in person, can be performed via telemedicine. In the first year the unit was open we identified thirty-five cases where a patient had an RRT, was not transferred to PICU, and was able to remain in the inpatient unit. It was estimated that 90% of patients with RRT that were called would have been transferred to PICU if not for critical care consultation. This led to a cost saving estimated at approximately $3000 per patient when cost of transport and difference of cost of 1 ICU bed day was compared with 1 non-ICU bed day. Additionally, our providers delivered 66 formal specialty consultations via telemedicine during that first year. The assumption was that if consulting provider was not available via telemedicine approximately 50% of those cases would have been transferred to facility where specialists were available for consultation. We also accounted for 50% of those where specialist would have traveled to see patient in person. Accounting for transfer cost savings, as well as savings from mileage and non-productive time if physicians traveled we assumed another approximately $55,000. The total cost savings to the organization in year one (with conservative estimates) was $154,500. The payback period is estimated to 3.45 years approximately with all cost savings included if utilization is assumed to be constant to year one with flat census. With anticipated growth, we anticipate payback period to be shorter.
REFERENCES
1. Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments. N. Yang - M. Dharmar - B.-K. Yoo - J. Leigh - N. Kuppermann - P. Romano - T. Nesbitt - J. Marcin - Medical Decision Making - 2015
Presentation #: V5-02
As our nation's population grows older, stroke and its sequelae are increasing. Consider these statistics from the U.S.:
• Every 40 seconds, someone in the United States suffers a stroke
• Strokes are the 5th leading cause of death in the United States
• Strokes are the No. 1 cause of adult disability in the United States
Quantitative neurostereology and stroke neuroimaging research reveals that for every minute during a stroke, a patient loses 1.9 million neurons, 14 billion synapses, and 12 km (7.5 miles) of myelinated fibers. From a practical perspective, for every minute, a patient can be losing pages from the family memory album, losing vocabulary, and losing independence. For every hour of an untreated stroke, a patient loses the brain function equivalent to 3.6 years of normal aging. For a stroke episode of three to six hours, this could mean losing brain function that is typically lost over a period of 10 to 20 years.
Currently, there is an 11-percent shortage of neurologists; this shortage is expected to reach nearly 20 percent by 2025. The uneven geographic spread of neurologists compounds the problem for rural hospitals.
Given these scenarios, teleneurology marks an important evolution in telemedicine. It makes expert care available quickly to even the most remote locations—an important consideration for treating stroke and other neurological emergencies, where every second counts.
A real-world case study on INTEGRIS Bass Baptist Health Center's state-of-the-art teleneurology program will be presented to demonstrate how the facility is realizing a three-fold return on investment:
Financial ROI. A typical stroke DRG (diagnosis-related group) reimbursement is $8,500. If the patient needs tPA treatment and can stay in the local hospital, the DRG reimbursement level is even higher, typically $13,000. This is revenue that hospitals keep when they are equipped to treat patients with stroke and other acute neurological emergencies.
Community ROI. The rural hospitals are often among the largest employers in their hometowns. By helping them find new care models that contribute to their financial survival, telemedicine programs provide a real service. Nurse practitioners and physician assistants, who are taking on a greater share of the primary care delivered in the United States today, get the support they need. And the support for local hospitalists, emergency department physicians, and other primary care providers is invaluable. Local physicians appreciate the access to specialty expertise, and the balance these programs provide their daily-and nightly-work schedule.
Patient ROI. Obviously, patients living in rural communities should not have to continue to suffer geographic penalties for stroke. With teleneurology, this “penalty” is significantly reduced. And when hospitals bring teleneurology or other telemedicine programs to their patients, they are opening the door to 21st century innovations in care—even in the most remote locations.
Other results to be discussed include how teleneurology programs can positively impact clinical metrics such as average response time; average diagnosis and treatment time; time from ED arrival to admission; average length of stay; and door-to-drip time.
Presentation #: V5-03
Numerous studies have suggested a positive benefit of telehealth visits towards saving the health care system on average from $50-$100 per visit. According to one study, traditional office visits cost approximately $135 to $175 per visit for commercial payers. When compared to a telemedicine visit which typically costs $49, the internal savings may be as high as $125. Cleveland Clinic's Employee Health Plan (EHP) started covering acute telehealth services for employees who used Cleveland Clinic's telemedicine platform, Express Care Online. Since implementing this service, the EHP has seen an internal cost savings of approximately $30 per visit.
REFERENCES
1. Yamamoto D. (2014). Alliance for Connected Care. Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Telehealth Services.
2. Mehrotra A, et al. (2015). American Journal of Medical Care. Opportunity Costs of Ambulatory Medical Care in the United States. 21(8):567-574.
Presentation #: V6-01
1. Upon completion participant will be able to understand alternative payment models and MACRA as it applies to telehealth and RPM.
2. Upon completion, participant will have ideas for strategies and consideration related to telehealth reimbursement.
3. Upon completion, participant will have understanding of negotiation and risk mitigation strategies for arrangements related to MACRA and alternative payment models.
• Overview of Alternative Payment Models:
o Description of alternative payment models and potential for telehealth and RPM to demonstrate value.
o How alternative payment models create opportunities for reimbursement, including opportunities to further network adequacy performance in Medicaid for managed care networks.
• Overview of MACRA:
o How CMS plans to implement and measure value-based care.
o How telehealth services are categorized as “patient facing” and tools that apply in meeting practice improvement activities, population health management, patient engagement, and care coordination.
• Practical Solutions:
• How value-based care and payment reform impacts relationships with hospitals and health care professionals, including billing and collection activities.
• What telehealth, RPM and other digital health interventions should consider in light of evolving CMS guidance.
• How proposed modifications to Medicare under MACRA may eventually change provider-based reimbursement.
• What steps you can take to provide flexibility for alternative reimbursement methodologies.
• Risk Mitigation:
• How opportunities for greater integration that MACRA promises may present new risk management issues for hospitals, such as increased tort exposure; and
• How transaction structures may change during the course of a negotiation and proposed alternatives to meet business team objectives for integration and collaboration.
Track: Value
Presentation #: V7-01
1. Describe efforts being made to conduct more rigorous, multi-center research on the effectiveness of telemedicine.
2. Share lessons learned in adapting standardized measures for a diverse group of telemedicine programs.
3. Discuss successful strategies for encouraging appropriate utilization to support a robust sample size.
Since April 2016, these grantees have been gathering information on 49 variables for all of their tele-emergency encounters. These variables include a variety of encounter and clinical data in an attempt to measure the impact of telemedicine on the provision of emergency care. Key areas include information on patient arrival and discharge, the video session details, patient transfers, patient demographics, reason for visit and acuity, payment and payer, and compliance with the evidence base for care of chest pain, heart attack, stroke, and sepsis.
OAT has engaged the Rural Telemedicine Research Center (RTRC) to advance publicly available, high quality, impartial, clinically informed, and policy-relevant telehealth research. As part of that mission, RTRC has been conducting the evaluation of the Evidence-Based Tele-Emergency Network Grant Program to evaluate the utility of telemedicine in improving quality, timeliness, and cost-effectiveness of rural emergency care.
OAT will moderate this panel that includes the principal investigators of the RTRC and two of the grantees submitting data for the evaluation. The discussion will focus on selection of measures for the evaluation, development of the data collection tool, lessons and challenges in data collection, and efforts to boost utilization of telemedicine to gain a robust sample size. Initial findings will also be shared.
Track: Value
Presentation #: V8-01
Remote Patient Monitoring: Impacting the Triple Aim will provide insight and opportunity to healthcare providers that will enhance the service delivery currently provided through traditional means.
The presentation will describe the history of The Evangelical Lutheran Good Samaritan Society's LivingWell@Home service and its team of nurse and data review specialists that focuses on remote patient monitoring. The presentation will explain the lessons learned from research and early deployment of the LivingWell@Home service.
LivingWell@Home is designed to help people live as well and as independently as possible. By tracking vital health information, managing medications, identifying changes in sleep and activity patterns, and detecting falls and sudden illness, LivingWell@Home allows individuals and their caregivers to take proactive steps to maintain and enhance well-being. Remote patient monitoring can help people stay in control of their health by finding potential risks that impact their well-being, while providing peace of mind through early detection and intervention.
One important point that will be highlighted is the pivot and present state of remote patient monitoring. This pivot is now leveraging technology to enhance client/patient outcomes by aligning with the triple aim of better outcomes, better client/patient satisfaction and reduced costs.
A focus will be placed on the Affordable Care Act and the impending shift of healthcare moving toward bundled payments and quality versus the historical fee-for-service environment. Remote patient monitoring can support this change and delay transfers to higher levels of care.
Metrics on industry standards show utilization of telehealth and how it relates to re-hospitalizations both with and without remote patient monitoring. Other metrics demonstrate that remote patient monitoring increases client/patient engagement in their wellness and an overall decrease in emergency room visits and unplanned hospitalizations. Special emphasis will be placed upon predictive analytics and leveraging of such to aid in early intervention before a serious health event occurs.
REFERENCES
1. Comstock J. (2016. Minnesota health system's telehealth program for seniors leads to better outcomes, engagement. MOBIHEALTHNEWS.
2. Giger JT, Pope ND, Vogt HB, Gutierrez C, Newland LA, Lemke J, Lawler MJ. (2014). Remote patient monitoring acceptance trends among older adults residing in a frontier state. Computers in Human Behavior, 44(2015), 174-182.
3. Grant LA, Rockwood T, Stennes L. (2015). Client Satisfaction with Telehealth Services in Home Health Care Agencies. Journal of Telemedicine and Telecare, 0(0), 1-5.
Presentation #: V8-02
REFERENCES
1. Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. (2016). Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health, 58(1):3-10.
2. Berwick DM, Nolan TW, Whittington J. (2008). The triple aim: care, health, and cost. Health Aff (Millwood), 27(3):759-69.
3. Reynolds CA, Maughan ED. (2015). Telehealth in the school setting: an integrative review. J Sch Nurs, 31(1): 44-53.
Presentation #: V8-03
Track: Value
Presentation #: V10-01
REFERENCES
1. Ward MM, Jaana M, Natafgi N. (2015) Systematic review of telemedicine applications in emergency rooms International Journal of Medical Informatics 84(9):601-16.
2.
3. Dorsey ER, Topol EJ. State of Telehealth. N Engl J Med 2016;375:154-61.
Presentation #: V10-02
Tele-ICU Medicine is a disruptive innovation that if used properly can enable a healthcare organization to garner clinical and financial benefits. In this session, Michael Ries, MD, eICU medical director at Advocate Health Care, one of the largest ACOs in the country, will explain how the organization did just that. As Ries will demonstrate, organizations create value by aligning technology with strategy and operations. And if done properly, technology can optimize the work flows that deliver evidence-based practices to all patients, all the time, in the most efficient manner possible. By using case studies and gap analysis, he will demonstrate how tele-ICU technology has allowed Advocate to reduce mortality, adverse events, LOS, direct variable costs, and promote change management in caring for its population of critical care patients.
REFERENCES
1. Critical Care Telemedicine: Evolution and State of the Art; Critical Care Medicine, 2014; 42: 2429 - 2436
2. Evaluating Tele-ICU Cost - An Imperfect Science; Critical Care Medicine, 2016; 44: 441 - 442
3. Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes, JAMA (online); 201; 305: E1 - E9
Presentation #: V10-03
The digital nature of acute care telemedicine provides the opportunity for consistent capture and analysis of processes and outcomes. Without relying on a harried care provider to make a manual note or update a checklist, the digital integration of EMR, bedside, lab, and pharmacy systems with the tele-ICU platform enables robust capture of patient conditions, specific interventions, protocol compliance, and clinical outcomes. In many cases, the implementation of the tele-ICU provides the means to report on and analyze the performance of the ICU for the very first time within the hospital.
With its decision to implement a tele-ICU system beginning in mid-2014, Adventist Health System (AHS) established 3 primary objectives:
1. Provided standardized, critical care excellence 24/7/365
2. Support the onsite providers and clinicians
3. Institute measureable quality and safety improvements aligned with national benchmark standards
Using a 2-year dataset, AHS rigorously evaluated the impact of the tele-ICU overlay. In addition, quarterly reviews examine performance metrics on a more real-time basis. Its measurement and analysis of the results provide the foundation for this useful presentation for those who have or are contemplating tele-ICU or other clinical telemedicine efforts. Participants will understand the measurement process, become familiar with what key metrics can be expected to improve and why, and benefit from insights from hands-on administrators. In addition, there will be specific focus on insights that go beyond the typical mortality and ICU length of stay analyses. For example, the ability to reduce ICU length of stay while at the same time admitting patients that had a higher average acuity will be highlighted, as will the impact of the tele-ICU on the significant reductions in the rate of hospital-associated complications for the most acutely ill patients.
REFERENCES
1. No external references will be used. Internal Adventist Health System and Advanced ICU Care data will be shared, along with APACHE IVa benchmarks and comparisons.
Track: Value
Presentation #: V11-01
Presentation #: V11-02
The data collected during telemedicine consults harbors value that can be leveraged beyond each individual telemedicine encounter. This data can reveal a wide variety of key details when analyzed at the provider, hospital, service line and program levels. Telemedicine consult data can paint a vivid picture of both general trends such as overall consult volume and more specific measures such as an individual provider's response rate. Telemedicine consult data can be used to identify trends, monitor program performance, compare results among participating partners, identify areas for improvement and quantify the value of telemedicine to senior leadership.
Data-driven telemedicine programs are demonstrated to be more effective, successful and sustainable than those lacking clinical and performance metrics. Specific areas where telemedicine data can be leveraged for program improvement include:
Telemedicine consult data may be analyzed to optimize the roles played by key personnel. This can occur in many forms, including feedback on specific encounters, aligning staffing to peak demand, training for EMS, 'report cards' for consulting physicians, and more.
Telemedicine consult data can provide key statistics on rates of different diseases within a population, including age, racial and gender distribution. Similarly, the consult data can be used to identify other relevant patterns within a population, including lifestyle factors such as tobacco use and mode of arrival to the hospital.
Different medical specialties often set treatment standards that can be measured based on telemedicine consult documentation - for instance, the “Golden Hour” of emergency medicine. When it can be demonstrated that telemedicine encounters adhere to these standards, it helps make the case that telemedicine can be as effective as in-person encounters or otherwise worthy of focus/budget. Additionally, key clinical standards such as Door-to-Needle time in stroke care may be deconstructed to see how time is spent in each stage of the care pathway (for instance, the amount of time that passes between a CT scan being ordered and the CT scan being interpreted). Telemedicine consult data also affords an opportunity to identify opportunities for continuing disease-specific education. Telemedicine consult data can also be used for reporting key metrics relevant to different types of medical accreditation.
Telemedicine consult data can go beyond merely reporting utilization rate to provide more meaningful insights into financial viability. Telemedicine usage rates can create a case for the provision of additional telemedicine specialties. For example, a high prevalence of stroke mimics recorded during stroke consults could indicate the need for more robust teleneurology coverage.
REFERENCES
1. This presentation is the result of a four-month research project conducted during 2016 with physicians, telemedicine program directors and coordinators, data analysts and service line executives.
Presentation #: V11-03
In order to fully capture the impact stroke care has on a patient measurable functional outcomes are essential and required. Certified stroke centers assess patient progress and stroke severity utilizing a variety of validated tools such as the NIHSS and mRS. Of importance, complication rate and mortality are also examined. Monitoring and reporting of the aforementioned elements as well as discharge disposition accompanied by pre-event baseline status tell a great deal about the level of impact and success of a program on functional patient outcomes. A telestroke network has the same impact on patient outcomes on a grander scale than a single institution. Research has demonstrated the dramatic impact telestroke has had on acute stroke treatment; namely administration of tissue plasminogen activator. Telestroke networks are regional, statewide and cross state boundaries. The hurdle present at this time is the lack of a national database that captures telestroke network patient outcomes and hence a complete value of a program. The lack of a national database limits benchmarking against other systems limiting ammunition necessary to drive process improvement and establish best practice. As a strong telestroke network, we have created a novel internal database dedicated to capturing functional patient outcomes. The database is structured within Research Electronic Data Capture (REDCap). Stroke coordinators from all associated telestroke facilities are prompted monthly to enter telestroke and non-telestroke patient data relative to their acute treatment and discharge outcomes. The database has allowed for concrete evidence of acute treatment with telemedicine and its impact on patient status. This novel database is especially important within our system of care as all associated community hospitals are independent of the hub. In addition, not all network partners utilize the same registries for data management. The REDCap database allows for a central data depository accessible to all. Capturing outcome measures would otherwise be impossible without the secure database created at the hub level. Stronger evidence is necessary via a national registry and cooperation among telehealth networks. Ideally, a telehealth registry would encompass multiple service lines. At the end of this roundtable discussion, you will be able to describe the relevance of a national database in telehealth.
REFERENCES
1. Heffner DL, Thirumala PD, Pokharna P, Chang Y, Wechsler L. (2015). Outcomes of Spoke-Retained Telestroke Patients Versus Hub-Treated Patients After Intravenous Thrombolysis. Stroke, 46(11), 3161-3167.
2. Bladin CF, Cadilhac DA. (2014). Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes. Stroke, 45(6), 1876-1880.
3. Gregg H. (2014, August 26). 10-year study shows telestroke improves outcomes in rural areas. Retrieved September 22, 2016, from
Track: Value
Presentation #: V12-01
1. How can telemedicine help a provider organization move toward value-based care while managing care quality, cost, and patient satisfaction.
2. What are the challenges in implementing a telemedicine program.
3. How can a telemedicine program improve your bottom line today.
Join us to discuss clinicians' experience leading telemedicine programs across several different healthcare settings including primary care, pediatric care, and emergency departments. The panel will discuss unique challenges for each setting and the commonalities all providers face in meeting the triple aim and the evolving role telemedecine plays.
ePoster Presentations Abstracts
Track: Clinical Services
Presentation #: EP-100
The purpose of this project was to identify common themes in educational deficits among 14 independent Community Partner Hospitals in a telestroke network. An electronic needs assessment was created to measure their self-reflection of stroke knowledge. The goal was to use the data to create a standardized competency tool that the partner hospitals could use to educate their staff. Research Electronic Data Capture (REDcap) was used as the database to administer the needs assessment and collect the responses. Telestroke, as a subspecialty of telemedicine, has many moving parts. The end-users at the partner, or spoke sites, need to be proficient in the following:
1. Standards of care for stroke patients, which includes acute patient management, medications, treatment options, diagnostic tools, requirements for transfers, and certification standards.
2. The audio/visual technology that is required to complete a telestroke consult.
3. The role of being an effective tele-presenter, which requires the healthcare provider at the partner hospital to assist with advanced neurological tele-assessment.
There is no known standard competency model for telestroke programs and it was felt that standardization of the process would save on time, financial resources, and improve the quality of the telestroke consults (satisfaction of both the spoke healthcare provider and the stroke neurologists) at each hospital. The needs assessment consisted of 20 questions using a Likert scale and one open ended question. It was sent to all levels of healthcare providers, such as physicians, nurses, emergency medical technicians/paramedics, emergency room technicians, and any other providers that would come in contact with a stroke patient. The response rate was 10% of the total healthcare providers surveyed. The topics assessment were: telestroke, the telestroke cart, the telestroke cart location, cart functions, NIHSS, tele-presenting to the virtual neurologist, being a team leader, and speaking to patient's family. The needs assessments questions will be shared and the graphical data of the survey will be offered.
REFERENCES
1. Castagnolo C. (2011). The addie model: Why use it? The eLearning Site. Retrieved from
2. French B, et al., (2013). The challenges of implementing a telestroke network: A systematic review and case study. BMC Medical Informatics and Decision Making, 13 (125), 1-9. Retrieved from
3. Galvin P. (2015). Identify learning needs. University of Arizona Continuing Nursing Education. Retrieved from
Presentation #: EP-101
Presentation #: EP-102
Asthma is a common, complex and costly chronic condition in the U.S., resulting in nearly 2 million acute care visits and $56 billion in overall costs each year (Akinbami 2012). Of these patients, 5-20% have poorly controlled asthma accounting for nearly 50% of all asthma-related expenditures (Pakhale 2011). The overall rate of pediatric asthma in Greater Cincinnati is more than twice the national average. In some urban-core Cincinnati neighborhoods, the rate of hospitalization for asthma is 10 times the national rate.
To address the concerning incidence of asthma in Greater Cincinnati, we embarked on an innovative program to develop “asthma-free schools” in neighborhoods where the incidence of asthma is especially high. In partnership with Cincinnati Public Schools, we intend to achieve asthma-free schools through school-based asthma care programs.
This presentation will provide a general overview of program, and will address how to apply telemedicine within the framework of school based asthma care. The presentation will highlight, high-risk asthmatic participants and a number of interventions incorporated into this type of care. Specifically the presentation will address the use of a commercially available inhaler cap monitoring sensor, a mobile software management platform that tracks adherence of all asthma medications, mobile based telehealth medical visits to assess asthma control, and mobile based telehealth adherence problem-solving interventions. Finally, the presentation will address how one institution has begun work to mitigate the concerning incidence of asthma in Greater Cincinnati through the development and understanding of school-based asthma care by defining barriers and identifying outcomes important to key stakeholders, as well as a defined clinical practice algorithm.
REFERENCES
1. Halterman JS, Fagnano M, Montes G, Fisher S, Tremblay P, Tajon R, Sauer J, Butz A. “The school-based preventive asthma care trial: results of a pilot study.” The Journal of pediatrics. 2012 161(6):1109-15. Epub 2012 Jul 10.
2. Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, Wang H, Borrelli B. “Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial.” Archives of pediatrics & adolescent medicine. 2011 Mar; 165(3):262-8.
Presentation #: EP-103
1. Provide better healthcare by overcoming disparities in access to care;
2. Achieve better health for patients by providing timely access to neuro-emergent specialty care;
3. Reduce patient and family impact of unnecessary transfer from rural to tertiary settings; and
4. Increase staff comfort with specialty care management through emergent neurological and neurosurgical telemedicine consultation, education and process support.
REFERENCES
1. Holguin E, Stippler M, Yonas H, Boyd D. Management of acute head trauma in rural locations: University of New Mexico Teleradiology initiative for mild traumatic brain injury. IHS Provider.2011 (5):99-102.
2. Stippler M, Smith C, McLean AR, et al. Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature. Emergency medicine journal: EMJ. Jul 2012; 29(7):528-532.
3. Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M. Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. Neurosurgical Focus. Nov 2010; 29(5):E3.
Track: Clinical Services
Presentation #: EP-120
PIER & SHC Partnership with Guam Public Health using Telemedicine. PIER = Pacific Islands EMSC (Emergency Medical Services for Children) Region. SHC = Shriners Hospitals for Children Honolulu.
Shriners Hospitals for Children and Guam Department of Public Health in partnership with PIER; a regional success story. Collaborative project to improve referral management to Honolulu Health Care Providers. Evaluating the role of EMSC in referral management using Telehealth technologies. In 2015, an agreement was reached between PIER and SHC to support telemedicine usage in the region. Benefits of a video based session prior to a patient's referral off island for care include:
• Reduced parental anxiety
• Provider education
• Increased knowledge by multiple caregivers/family members
• Empowerment of the family
• Reduced unnecessary referrals
• Improved patient education
• Reduced length of stay.
Presentation #: EP-121
Presentation #: EP-122
Implementing a telehealth service requires more work than simply connecting two cameras together. Newborn Medical Director, Dr. Erick Ridout, will discuss the steps to effectively prepare both originating and distant site teams for newborn resuscitations and consults using telehealth technologies. Originating site clinicians must have newborn access to emergency equipment available, requisite skills to perform procedures (e.g., needle thoracentesis) and effective communication protocols using synchronous video technology during newborn resuscitations. Remote sites must have a clear understanding of originating site resources, protocols, and procedures. Starting with onsite walkthroughs at rural hospitals, Dr. Ridout shares procedures that have been developed through 4 years of trial and error implementing and maintaining a robust TeleHealth Newborn Critical Care Service in Southwestern Utah. Building relationships between teams is crucial to effective delivery of emergency newborn care and begins with distant site newborn teams collaborating and training originating site clinicians. Dr. Ridout will present his methods for ongoing team training, the central role of relationship-building with all members of newborn telehealth teams. Communication protocols, establishing roles and responsibilities, and the necessity for ongoing skills assessment will be addressed. The impact of this comprehensive telehealth program to newborn outcomes, including utilization rates, clinical outcomes and prevented transfers will be presented.
Presentation #: EP-123
Track: Direct to Consumer
Presentation #: EP-129
REFERENCES
1. Resneck JS, Abrouk M, Steuer M, Tam, A., Yen, A, Lee, I, Kovarik, CL, Edison, KE. Choice, transparency coordination, and quality among direct-to-consumer websites and apps treating skin disease. JAMA Dermatol published online May 15, 2016.
2. “Practice Guidelines For Teledermatology.” Practice Guidelines for Teledermatology. Web. 27 Sep. 2015.
3. Warshaw E. et al. Teledermatology For Diagnosis and Management of Skin Conditions: A Systematic Review. J Am Acad of Dermatol 2011; 64.4 n. pag. Web.
Presentation #: EP-130
REFERENCES
1. Marcin JP, Nesbitt TS, Kallas HJ, Struve SN, Traugott CA, Dimand RJ. (2004). Use of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California. The Journal of Pediatrics, 144(3), 375-380.
2. Committee on Pediatric Workforce. (2015). The Use of Telemedicine to Address Access and Physician Workforce Shortages. Pediatrics, 13(1), 202-209.
3. Institute of Medicine. (2012). The Role of Telehealth in an Evolving Health Care Environment. Washington, DC: The National Academies Press.
Presentation #: EP-131
REFERENCES
1. Agnisarman SO, Madathil KC, Smith K, Ashok A, Welch B, McElligott JT. (2017). Lessons learned from the usability assessment of home-based telemedicine systems. Applied Ergonomics, 58, 424-434.
2. Narasimha, S., Agnisarman, S. O, Chalil Madathil, K., Welch, B. M., & McElligott, J.T (2016, October). An Investigation of the Usability Issues of Home-based Video Telemedicine Systems with Geriatric Patients. To appear in the Proceedings of the 2016 Human Factors and Ergonomics Society's International Annual Meeting, Washington DC.
3. Chalil Madathil, K. Home-Based Video Telemedicine Systems for Geriatric Population: An Investigation of the Factors that Impact User Acceptance. Presented to the 5th Annual Telehealth Summit, Columbia, SC, October 2016.
Presentation #: EP-132
1) Describe rationale for patient self-monitoring for chronic conditions;
2) Recognize benefits and barriers in use of technology and education for patients age 50+ with chronic conditions; and
3) Understand Central/Eastern KY seniors age 50+ perceived self-efficacy for self-managing chronic conditions through technology.
Track: Operations and Implementation
Presentation #: EP-134
BRICS is an association of five of the largest emerging economies, Brazil, Russia, India, China and South Africa. Formalised in 2006 as BRIC, South Africa joined in 2010. BRICS is home to 43% of the world's population, 37% of world GDP and 17% share of world trade. The agenda of BRICS is wide-reaching. Telemedicine has been identified as an area of co-operation with the opportunity to become a leader in the field.
The BRICS telemedicine experts' group has proposed several goals based on improving universal access to care across the countries through income generating local and international telemedicine. These include the development of ‘complex compatible telemedicine systems’, opening an international BRICS telemedicine educational center, developing uniform standards and specifications for telemedicine, and harmonizing national legislation in this area.
The proposed international telemedicine project is ambitious and deceptively complex. There are 16 official languages in the five countries, with 65 other recognized languages and over 600 regional dialects. English is not necessarily the lingua Franca of the patients or their local or international doctors. There are at least 12 different scripts widely used, like Cyrillic, Hanzi and Devanagi. In what language and script will notes be shared and kept? Russia has a 10 hour difference between east and west. Brasilia is 5 hours behind Cape Town and 11 hours behind Beijing, so time will influence availability of telemedicine services.
Cross border international telemedicine raises legal, clinical, ethical and cultural issues. Currently international, cross border telemedicine is limited to the European Union and countries and institutions with bilateral agreements. Harmonization of legislation makes the assumption that legislation for telemedicine exists. Brazil has a Telemedicine law which allows only for consultation between health practitioners without the patient being present. Russia has only just submitted a Bill to its State Duma. In 2014, the National Health and Family Planning Commission of the People's Republic of China published interpretations and associated guidelines regarding telemedicine services in China and a 2015 document outlining a national telemedicine network raises issues of data security and storage. A draft Telemedicine Bill tabled in 2013 in India was not approved. South Africa has no specific telemedicine regulations but aspects such as privacy, data security and confidentiality are covered by other laws, as is the case in the other countries.
Issues of licensure, responsibility, liability, and continuum of care pertain. Discipline specific clinical guidelines set standards for quality of care. These will need to take into account different treatment and diagnostic algorithms imposed by availability of technology, medications and human resources. Ethical standards, while universal, differ in their implementation and perceived importance, e.g. informed consent. Cultural issues such as patients' beliefs and acceptance of different local forms of medicine like traditional Chinese medicine, ayurveda, medicina indegina, and complementary medicine and their delivery by traditional healers, divinators and herbalists are frequently overlooked.
The BRICS consortium must overcome many identified and unidentified obstacles facing their ambitious project, and political instability in some countries. Achieving this will establish a new model for international telemedicine.
Presentation #: EP-135
Expansion of maternal and newborn healthcare services via telehealth is supported by executive, operational, technology teams and Women and Newborn Clinical Program. Inpatient Neonatology and Lactation Services, and outpatient Genetic Counseling are fully operational, with key performance measures defined for each program. Additional programs are in early implementation phase including a program for parents to view their newborns in critical care units, a dedicated 24/7 newborn support center and expansion of outpatient services. These TeleHealth programs augment and complement existing programs to enhance maternal and newborn services throughout Utah and surrounding states.
TeleHealth Services at Intermountain Healthcare supports a myriad of programs with Women and Newborn programs representative of an area where access to care can be very limited. Early telehealth software and hardware solutions were designed for adult critical care, stroke and crisis care services. Additional hardware design focused on supporting our smallest patients. Purposeful customization of equipment and telehealth platforms result in new challenges and unique opportunities to continually innovate.
The purpose of this presentation is to provide an overview and comparison of program design, implementation, and operational barriers as well as keys to success. Using ARHQ's literature map to contextualize and evaluate these programs, opportunities for future research will be identified.
Presentation #: EP-136
Intermountain Healthcare continues to experience an increasing demand for mental health services throughout the communities we serve. Many of our communities lack the necessary resources to respond in a timely and appropriate manner to the mental health needs of the individuals. This results in delayed assessment of risk and subsequently a delay in treatment. Delay in treatment is a significant risk for persons experiencing suicidal ideation/intention. In 2013, the Intermountain behavioral health and intensive medicine clinical programs in partnership with the Telehealth department began exploring ways to address the needs of patients in crisis in our emergency departments. This was the beginning of our journey to designing and implementing a system wide Telehealth ED crisis care service.
The goals of this presentation are to discuss the following:
1) How we identified Telehealth as an appropriate mechanism for delivering ED crisis care;
2) The key elements to designing a system wide Telehealth service;
3) How to gain support from clinical and business stakeholders;
4) The trials and successes of implementation; and
5) The increasing demands to expand crisis and behavioral health services.
• Over 15% of the patients seen in our emergency departments have a primary or secondary diagnosis related to behavioral health. Some facilities are seeing as high as 30%.
• Facilities and communities struggle to recruit and staff the emergency department with a trained and experienced crisis worker.
• Patients are waiting hours and sometimes days to receive the appropriate care needed.
1. Telehealth provides a transformative and cost effective method to deliver crisis care.
2. Providing access to trained professionals and meeting the unmet needs of our patients.
3. Operational efficiency by having a dedicated crisis team available and eliminating costly on call and downtime hours.
4. Better care coordination and expertise in local resources and inpatient placement processes.
5. Crisis is our core competency and what we deal with on a daily basis.
1. Eleven Intermountain facilities are using these services and 1 outreach partner.
2. Over 600 crisis evaluations have been conducted.
3. Median response times decreased from over 60 minutes to less than 20 minutes.
4. Demand for additional services (inpatient and direct to consumer).
Presentation #: EP-137
Are you challenging federal law? If you or your clinic practice telemedicine and haven't considered the implications of the Ryan Haight Act, you very well might be. In 2008, the Ryan Haight Act was passed to protect consumers from questionable online pharmacy distribution. Though well intended, the Ryan Haight Act inadvertently made many popular models of telemedicine technically illegal.
In 2015, the ATA wrote a letter with recommendations to the DEA advocating for provider-friendly changes to federal controlled substance prescribing rules. The letter included suggestions for how a special registration process could be structured to safely enable the prescribing of certain controlled substances via telepsychiatry. This presentation will review the ATA's recommendations and break down the confusing elements of the Ryan Haight Act into digestible and applicable pieces. The Ryan Haight Act was aptly written to protect individuals from inappropriately prescribed controlled substances, but its current language limits telemedicine, and does not match the way many forms of telemedicine, particularly telepsychiatry, are currently being used in a number of settings.
As it is written, the Ryan Haight Act requires that before a telemedicine encounter can result in the prescribing of a controlled substance, there must be a prior in-person relationship. Otherwise, the consumer must either be located within a DEA registered hospital or clinic or fit into one of six other telemedicine exemptions. Unfortunately, this exemption list does not include a number of locations where telemedicine commonly occurs, including community clinics and correctional facilities, some of the most common applications of telemedicine and telepsychiatry to date.
Another issue with the Ryan Haight Act is that it makes no distinction between classes of controlled substances, and may challenge common applications of controlled substance prescribing like the stimulants often used for child psychiatry.
Though the Ryan Haight Act has been rarely enforced around telemedicine, the rapidly growing telemedicine industry needs regulators to provide clarification and updates to the law so that this form of care can continue to develop and bring much needed access to care to underserved populations.
Interestingly, the text of the Ryan Haight Act of 2008 explicitly recognizes the distinction between valid telemedicine and the sort of internet prescribing practices that the Act intended to target. The Act itself promises to release clarifying language to define and validate appropriate telemedicine prescribing of controlled substances; however that clarifying language has never been released. Thus, the practice of telemedicine industry has grown within a climate of legal ambiguity.
Like many other forms of telemedicine, telepsychiatry must not be abused to provide inappropriate prescriptions, but there is now a very significant body of research, experience and credible guidelines validating that telepsychiatry is an essential tool in the delivery of necessary, timely mental health care. The Ryan Haight Act needs to be modified to accommodate naturally occurring practice shifts, like we are experiencing with the spread of telepsychiatry.
This presentation will be led by a leader in the telemedicine field who has worked closely with the DEA, state medical boards and other telemedicine organizations, including the workgroup that wrote the ATA letter to the DEA, to advocate for appropriate telemedicine and suitable changes to the Ryan Haight Act. Attendees will take away lessons they can use to adhere with the nuances of the Act in their own organization and gain the tools needed for staying up-to-date on the developments of the act to ensure future compliance.
REFERENCES
1. American Telemedicine Association Letter to the DEA, 2015,
Track: Transformation
Presentation #: EP-150
Presentation #: EP-151
REFERENCES
1. Fernández C, Saldana J, Fernández-Navajas J, Sequeira L, Casadesus L. Video conferences through the internet: How to survive in a hostile environment. Sci World J. 2014.
2. Shima Y, Suwa A, Gomi Y, Nogawa H, Nagata H, Tanaka H. Qualitative and quantitative assessment of video transmitted by DVTS (digital video transport system) in surgical telemedicine. J Telemed Telecare. 2007;13(3):148-153.
3. Shimizu S, Kudo K, Antoku Y, Hu M, Okamura K, Nakashima N. Ten-year experience of remote medical education in Asia. Telemed J E Health. 2014;20(11):1021-1026.
Presentation #: EP-152
Imagine if telemedicine technologies could enable the creation of a national corps of volunteer physicians that would bring medical care to our nation's most vulnerable inner city and rural populations. The MAVEN Project - short for Medical Alumni Volunteer Expert Network, mission is to improve access to quality healthcare for underserved populations by linking our corps of expert volunteer physicians to clinics and organizations in need. The MAVEN Project recruits alumni of U.S. accredited medical schools and training programs (especially semi-retired and newly retired physicians) through medical school alumni and other physician organizations to serve the specific needs of vulnerable populations seeking care at health centers. HIPAA-compliant telemedicine technologies overcome geographical barriers by enabling remote video consultation, teaching, and mentoring for health center providers and their patients.
The purpose of this presentation is to share “lessons learned” from 3 MAVEN Project pilots conducted in California and Massachusetts, including the identification of volunteer and clinic criteria essential for successful implementation and the selection of telemedicine platforms.
Presentation #: EP-153
Canadians living in rural and remote communities have increased barriers to healthcare services. Providing universal and accessible healthcare to the people residing in rural and remote settings can be difficult. A distance of 50km or more from tertiary healthcare centers' has been shown to have a negative impact on health outcomes. Patients who require specialist care typically have to travel to urban settings to receive the necessary care, resulting in an increase burden on the patient and can come at a greater cost to the healthcare. This 'distance decay' can result in fewer services being offered, fewer services being available, and fewer services being utilized resulting in altered standards of care. Furthermore, by the time rural or remote patients access care, their condition tends to be more urgent, compared to the acuity levels seen with their urban counterparts. Using remote presence technology is one approach that can improve access to health for people living in rural and remote settings.
An abundance of literature exists demonstrating the feasibility of physicians and specialists providing high quality and cost effective healthcare services to distant sites using remote presence technology. Remote presence technology allows local nurses in rural and remote communities to connect with physicians and specialists in real-time to diagnose and collaboratively manage and treat patients, often reducing the need to transfer the patient out of the community. Patient outcomes are often improved because of the earlier initiation of interventions, and by remaining in the community, it is less disruptive for the patient and their family. The decrease in preventable transfers and hospitalizations has significant savings to the healthcare system.
Largely missing from the literature is the voice of the nurses involved in the care from the peripheral sites. Nurses working in rural and remote communities can experience many benefits from using remote presence technology, including decreased professional isolation; improved communication, trust and relationship with specialists; mentorship; and an increased capacity to manage more challenging care in the community. On the other hand, it is important to note that by treating and managing the patient in the community, the burden of care is transferred to the nurses. This process can dramatically increase the workload of the nurses. It is vital to engage nurses in the planning and implementation of remote presence initiatives, and involve them in research to ensure their experiences are captured and reflected in the literature.
The use of remote presence technology to provide healthcare services could be a key factor for the healthcare system to enhance equitable access to care for populations that traditionally have had many barriers to receive the appropriate healthcare services. The evidence supports that it is safe, effective, and very cost efficient. Policy makers need to be aware of the increased burden this process can have on the nurses from the rural and remote sites. Reinvesting some of the savings back into the community could enhance the local capacity to manage the increased workload and mitigate some of the burden faced by the nurses.
Track: Value
Presentation #: EP-160
Presentation #: EP-161
REFERENCES
1. Avista Adventist Hospital Institutional Review Board, FWA 00011584.
2. ISO 80601-2-61 First edition 2011-04-01 Medical electrical equipment ? Part 2-61: Particular requirements for basic safety and essential performance of pulse oximeter equipment.
Abstract moved to page A-77
Presentation #: EP-163
Utilization management techniques that are based on tightly defined Appropriate Use Criteria are migrating to the ambulatory care setting. To effectively manage cost, there is a need to appropriately control the use of expensive acute resources and increasingly scarce primary care resources. One new and effective way to do that is to implement a more structured and clinically rigorous approach to managing access to utilization of primary care resources.
Nurse triage tools that are built on robust, algorithm-driven utilization management techniques will allow patients to be directed to the appropriate level of care whether it is the ER, an appointment with a primary care provider, or homecare. And patients view nurse triage as an improvement to the care they receive rather than a barrier.
Mayo Clinic is an early adopter of rules-based utilization management tools in their nurse triage call centers. They have built more than 150 algorithms with branching logic that ensures effective use regardless of who the end user is. The algorithms also ensure that each question is presented whereas less structured protocols depend upon the individual nurse's effective use of the checklist or guideline.
These algorithms are packaged within a state-of-the-art front-end tool that is easy-to-use, fast, efficient, and functionally accurate. The tool allows for dynamic questioning and only presents necessary and relevant questions to ask. It is also powerful because the entire encounter is documented, stored and transferred to the EMR without requiring any rework by the nurse. This saves the nurses time and can help provider organizations to effectively manage risk.
The results Mayo Clinic has achieved to this point leveraging algorithm-based utilization management techniques in their nurse triage call center show that it is possible to improve outcomes while reducing cost without sacrificing patient satisfaction. Here is a sampling of the results Mayo Clinic has achieved:
• 10% increase in patient access for those who need appointments
• 45% of patients redirected to a lower level of care than they initially sought (from ED to doctor; doctor to home care; ED to home care)
• 20% of patients redirected from the office or urgent care to homecare
• 97% of patients report increased satisfaction
• lower cost per call on the nurse triage line
• Reducing variation may reduce litigation risk due to symptom triage service consistency
The bottom line is that it is possible to improve access and quality of outcomes while reducing cost using algorithm-based nurse triage solutions.
Track: Clinical Services
Presentation #: EP-124
Traumatic injuries affect all ages, genders, and races, and are responsible for the most deaths in the U.S. among individuals aged 45 years and younger. Over 20% of patients who experience traumatic injury will develop posttraumatic stress disorder (PTSD), depression, and other mental health problems that have serious and long-lasting quality of life and physical health effects. However, most acute care settings in the US do not have the resources in place to identify and address the mental health needs of these patients. This is a costly missed opportunity as emotional health after traumatic injury is associated with productivity and long-term health outcomes, including general health, work status, and overall satisfaction with care.
Hospital discharge after traumatic injury involves a transition of care that is plagued by poor communication, differential access to providers and other resources, and lack of standardization in process. Some models of intervention designed to accelerate emotional recovery have been tested, but are not widely available and generally are resource intensive, costly, and have uncertain scalability and sustainability. We are currently piloting a new service, the Telehealth Resilience and Recovery Program, that we believe has tremendous potential to serve as a national, cost-efficient, scalable, and sustainable model of mental health care after traumatic injury. Our novel, primarily technology-supported model consists of a four-step process: (1) in-hospital education; (2) 30-day mental health phone screening; (3) diagnostic assessment; and (4) delivery of best-practice treatment for PTSD or depression, or referral to address other mental health needs. This service evolved out of a strong partnership at the Medical University of South Carolina between leaders in Psychiatry, Trauma Surgery, Pediatrics, Nursing, and Telehealth. MUSC's Level 1 Trauma Center serves over 2,000 patients with serious traumatic injuries annually.
Since our launch in September 2015, we have identified 852 patients, approached 80% in hospital, and enrolled 53%. Of those enrolled, 40% screened positive for PTSD and/or Depression at 30-day follow-up and 69% of these accepted a referral for mental health care. Of those who accepted this referral, 80% preferred treatment delivered via telehealth, 33% of which were able to participate in telehealth using their own devices. This presentation will describe the feasibility of implementing a novel, technology supported model of care for patients affected by traumatic injury. Future directions for a state-wide dissemination and evaluation will be discussed.
Presentation #: EP-125
Track: Clinical Services
Presentation #: EP-104
REFERENCES
1. Brunetti ND, Scalvini S, Molinari G. (2016). Innovations in telemedicine for cardiovascular care. Expert Review of Cardiovascular Therapies. 7, 1-14.
2. Milano P, Carden DL, Jackman KM, Rongkavilit A, Groves K, Tyndall J, Moll J. (2011). Compliance without patient stress test in low risk patients presenting to the emergency department with chest pain. Critical Pathyways in Cardiology, 10(1), 35-40.
3. Niska R, Bhuiya F, Xu J. (2010). National hospital ambulatory medical care survey 2007 emergency department summary. National Health Statistics Report 26. Retrieved from
Presentation #: EP-105
REFERENCES
1. Raza T, Joshi M, Schapira R, Agha Z. Pulmonary telemedicine- A model to access the subspecialist services in underserved rural areas. International journal of medicine informatics. 2009; 78: 53-59.
2. Agha Z, Schapira R.M, Maker A.H, Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population, Telemed. J. E. Health. 2002; 8: 281?”291
3. Pacht E, Turner J, Gailiun M, et al. Effectiveness of Telemedicine in the Outpatient Pulmonary Clinic Telemedicine Journal. 2009, (4): 287-292
Track: Clinical Services
Presentation #: EP-112
1. Assess the feasibility of a telehealth device with remote audio/video connection for evaluation of children with medical complexity in the home environment.
2. Evaluate the usability of a telehealth device in transmitting real time images (otoscope, oropharyngeal exam, camera), temperature, and sound (stethoscope for heart and breath sounds).
3. Compare the impact of the telehealth device versus traditional telephone assessment on patient management and user satisfaction.
REFERENCES
1. McConnochie KM, Wood NE et al. Acute illness care patterns change with use of telemedicine. Pediatrics Jun 2009, 123 (6) e989-e995; DOI: 10.1542/peds.2008-2698.
2. Burke BL, Hall RW. Telemedicine: Pediatric applications. Pediatrics. 2015 Jul;136(1):e293-308. doi: 10.1542/peds.2015-1517.
3. Casavant DW, McManus DL et al. Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making. Journal of Telemedicine and Telecare 2014, Vol. 20(8) 441?”449.
Presentation #: EP-113
Track: Operations and Implementation
Presentation #: EP-138
Careful attention must be paid to the organizational framework developed and the types of programs built in order to expand telehealth across the entire continuum of care. Necessary key strategies employed by the health system will be discussed, such as building a lean internal system, finding appropriate funding resources, contracting with partner hospitals and selecting the appropriate technology. Maintaining ongoing oversight of telehealth initiatives is essential to a successful program and aids in the elimination of dollars wasted. Discussion around performance metrics will be vital to determining what programs are effective and bring value to the organization long term.
Presentation #: EP-139
REFERENCES
1. Spira JL, Lathan CE, Bleiber J, Tsao JW: The impact of multiple concussions on emotional distress, post-concussive symptoms, and neurocognitive functioning in active duty United States marines independent of combat exposure or emotional distress. J Neurotrauma. 2014 Nov 15;31(22):1823-34.
2. Lathan C, Wallace AS, Shewbridge R, Ng N, Morrison G, Resnick HE: Cognitive Health Assessment and Establishment of a Virtual Cohort of Dementia Caregivers. Dement Geriatr Cogn Dis Extra. 2016 Mar 22;6(1):98-107.
3. Resnick HE, Lathan CE: From battlefield to home: a mobile platform for assessing brain health. doi: 10.21037/mhealth.2016.07.02
Track: Transformation
Presentation #: EP-154
Existing program operations, political agendas, financial constraints and integrated continuous support and quality assurance are crucial to adoption and sustainability of any global telemedicine intervention. We will showcase the MobileODT EVA system deployment for enhanced visual based cervical cancer screening to improve detection accuracy in visual inspection with acetic acid (VIA) programs. VIA is performed in settings in which advanced screening methods are not available and is usually performed by nurses or midwives with minimal training. Due to resource constraints, VIA programs suffer from inadequate clinical supervision resulting in a positive predictive value of only 17%. This misdiagnosis costs under-resourced health systems money in cases of over-diagnosis, and to untimely death in cases of under-diagnosis. Quality assurance is therefore key to ensuring the reduction in cervical cancer deaths. The Enhanced Visual Assessment (EVA) System, developed by MobileODT, has been specifically designed to facilitate QA and the ongoing supervision and training of health providers in LRS through digital cervicography. In digital cervicography (DC), the provider photographs the cervix following VIA using a high-magnification camera and submits it for review to an expert. With the EVA System, QA programs for VIA can be quickly and cost effectively implemented using DC as the modality of comprehensive oversight and continued training of the frontline workforce. The EVA System is compact and composed of three main elements: a handheld medical device with polarized magnification lens and rechargeable light-source (the Scope), a mobile phone based application for patient data capture and image documentation (the App), and an online web-portal for quality control and monitoring and evaluation (the portal). By generating actionable analytics from provider and patient level data collected at the point of care, the EVA system enables program managers and health systems to develop a holistic picture of how the screening program is performing, identify patients that should be brought back into care due to under-diagnosis and identify providers that are underperforming and should receive additional training or supervision. The key to early treatment of cervical cancer is early diagnosis, and a critical component of accurate, early diagnosis is highly trained health providers. In LRS settings, technology such as the EVA System can play a key role in the success of screening programs by providing a platform for ongoing supportive supervision of health providers. By facilitating communication between health providers across settings, technologies such as the EVA System develop a health system partnership on a global scale that makes high-quality cervical cancer screening accessible to women in all settings. While cervical cancer has proven this concept of device/procedure based remote consultation and QA, this model of integrated telemedicine-enabled quality assurance has wide applicability for enhancing care in the primary care setting.
REFERENCES
1. Denny L, et al. “Evaluation of alternative methods of cervical cancer screening for resource-poor settings.” Cancer 89.4 (2000): 826-833.
2. Parham, GP, et al. “eC3 ?” A modern telecommunications matrix for cervical cancer prevention in Zambia.” Journal of lower genital tract disease 14.3 (2010): 167-173
3. Firnhaber C, et al. “Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa.” Journal of lower genital tract disease 19.1 (2015): 7-11.
Presentation #: EP-155
REFERENCES
1. Sood SP (2007). Differences in public and private sector adoption of telemedicine: Indian case study for sectoral adoption. Studies in Health Technology and Informatics, 130:257?”268.
2. Imouokhome FA, Osubor VI. (2012). Mobile-Device-Based Telemedicine for Improved Health-Wealth. African Journal of Computing & ICT Vol 5. No. 5.
3. Iluyemi A. (2009). Telehealth in the Developing World. Edited by Wootton, R., Patil, N.G., Scott, R. E. and Ho, K. Royal Society of Medicine Press Ltd, London.
Track: Value
Presentation #: EP-164
While Telehealth Etiquette can be measured and changed through education, there is additional learning that needs to be done by the students to express themselves verbally and non-verbally with patients. It can be concluded that the transition to a telehealth visit is not intuitive, and the telehealth monitor becomes a block to communication. Students need training specifically focused on telehealth etiquette for the telehealth visits should be no different than traditional “office visits”.
REFERENCES
1. Edirippulige S, Armfield NR. (2016). Education and training to support the use of clinical telehealth: A review of the literature. Journal of Telemedicine and Telecare. 0(0), 1-16.
2. Rienitis, H, Teuss G, Bonney AD. (2016). Teaching telehealth consulting skills. The Clinical Teacher. 13(2), 119-123.
3. Haney T, Kott K, Folwer C. (2015). Telehealth etiquette in home healthcare: The key to a successful visit. Home Healthcare Now. 33(5), 254-259.
Presentation #: EP-165
1. Recognize telemedicine can be utilized to facilitate concussion management in conjunction with athletic trainers and primary care providers.
2. Recognize that telemedicine utilization does not need to involve costly systems and equipment.
3. Recognize health equity is an issue with that goes beyond the rural/urban divide.
REFERENCES
1. American Academy of Neurology, Quality Standards Subcommittee. (2013, June 11). Summary of evidence-based guideline up Evaluation and management of concussion in sports. Report of the Guideline Development Subcommittee of the American Academy of Neurology. (U. D. Agency for Healthcare Research and Quality, Ed.) Retrieved January 15, 2016, from National Guideline Clearinghouse:
2. Dismuke CE, Walker RJ, Egede LE. (2015). Utilization and cost of health services in individuals with Traumatic Brain Injury. Global Journal of Health Science, 7(6), 166?”169.
3. Payne TH, Bates DW, Berner ES, Bernstam EV, Covvey HD, Frisse ME, Graf T. (2012). Healthcare information technology and economics. Journal of American Medical Information Association, 20, 212?”217.
Track: Clinical Services
Presentation #: EP-106
REFERENCES
1. Grady BJ, Lever N, Cunningham D, Stephan S. (2011). Telepsychiatry and school mental health. Child Adolescent Psychiatric Clin N Am. (2011)81-94.
2. Masi R, Cooper J. (2006). Children's mental health: Facts for policymakers. New York, NY: National Center for Children in Poverty, Columbia University Mailman School of Public Health.
3. Shortage of child psychiatrists taking a big toll. The Associated Press: 2006. Available at:
Presentation #: EP-107
1. Participants will learn caregiver's perspective in using m-Health to provide support for the clients.
2. Participants will learn the requirements of the caregiver app identified from caregiver's insight.
3. Participants will learn the result of incorporating the requirements into the design of the caregiver app.
REFERENCES
1. Parmanto B, Pramana G, Yu DX, Fairman AD, Dicianno BE, McCue MP. (2013). iMHere: a novel mHealth system for supporting self-care in management of complex and chronic conditions. JMIR mHealth and uHealth, 1(2), e10.
2. Forducey PG, Glueckauf RL, Bergquist TF, Maheu MM, Yutsis M. (2012). Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting. Psychological services, 9(2), 144.
3. Lim JW, Zebrack B. (2004). Caring for family members with chronic physical illness: a critical review of caregiver literature. Health and quality of life outcomes, 2(1), 1.
Track: Clinical Services
Presentation #: EP-114
The purpose of this evidence-based practice (EBP) change project presentation is to provide mental health providers with valuable insight and feed-forward regarding implementing a sustainable tele- psychotherapy care delivery model.
1. The development and implementation of an evidence-based practice procedure to deliver tele-psychotherapy to mental health patients.
2. The development and implementation of a client screening tool to determine the effectiveness of tele-psychotherapy.
REFERENCES
1. Crawford A, Sunderji N, et al. (2016). Defining competencies for the practice of telepsychiatry through an assessment of resident learning needs. BMC Medical Education, 1628.
2. Perle JG, Nierenberg B. (2013). How psychological telehealth can alleviate society's mental health burden: A literature review. Journal Of Technology In Human Services, 31(1), 22-41 20p.
3. Southard EP, Neufeld JD, Laws S. (2014). Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. Telemed J E Health., 20(7), 664-668.
Presentation #: EP-115
VA Medical Centers (VAMCs) in the Midwest are striving to provide a full range of telehealth services to the Veteran population in specialty care. One of these specialty areas is audiology. Teleaudiology applications change the location where hearing healthcare services are routinely provided and support Veterans' preferences to live in the least restrictive settings possible with the highest quality of accessible care.
Growth of Teleaudiology has been hindered by the “hands-on” approach of audiology in which clinicians believe that it is not possible to evaluate or treat patients without being able to touch them. However, this way of thinking and treatment approach is being challenged and slowly being extinguished through the use of telepresenters and new technologies. Teleaudiology is now being considered as an exciting alternative model of care that can assist patients in gaining their ultimate functional outcome.
In addition, Veterans with disabilities, especially in rural areas, can greatly benefit from the growth of Teleaudiology. Many of these Veterans have mobility issues and/or socioeconomic factors that affect their ability to receive needed care. In addition many live in areas that are void of audiologists. The results are that this population often have decreased access to care and possibly decreased quality of care.
The Midwestern VAMCs are a pioneer of Teleaudiology. For over half a decade, the Midwestern VAMCs have been a national leader in the VA for the number of Veterans served by Teleaudiology. The Teleaudiology program was initiated at the Veterans Hospital in Madison, WI in 2010. The Teleaudiology program has expanded and is conducted at VAMCs in North Chicago; Hines, IL; Iron Mountain, Michigan; and Tomah, WI. The Teleaudiology program has exponentially grown from 40 patients in 2010 to over 3800 patients in 2016.
In the Midwestern VAMCs, Veterans can be referred for initial diagnostic services at face-to-face appointments. For patients who have been identified and are interested in amplification, the initial hearing aid fitting and follow-up services will be completed via a telecommunications link in a synchronous fashion. This includes real-ear probe tube measurements to verify hearing aid gain/output characteristics are consistent with validated prescriptive methods.
A trained audiology assistant serves as the facilitator at each designated outpatient clinic. This individual is responsible for general set-up, ensuring proper probe microphone insertion in the verification process, and serves as a liaison between the patient and audiologist if information or reinforcement is needed.
This presentation will focus on the necessary tools for a successful Teleaudiology program. It will discuss equipment, staff training, risk management, quality management, and data, with a focus on practical applications and best practices.
Track: Clinical Services
Presentation #: EP-126
Presentation #: EP-127
Track: Value
Presentation #: EP-166
In this presentation we will discuss the importance and value of virtual didactic conferencing and continuing medical education. These virtual offerings are undoubtedly a subset of telehealth as it relates to knowledge sharing among physicians. Certainly telehealth services encompass the physician-to-patient relationship and being able to administer expert care at long distances. In fact, this is the fundamental pillar of telehealth as it is our goal to reach rural and/or under-served populations and remove as many barriers to care as possible such as distance and missed work, etc. But, the physician-to-patient model might instead be called “telemedicine” instead of “telehealth”. In trying to transition from a telemedicine thought process to a broader telehealth concept it is vital to include and pursue the same principles that are being encouraged in the healthcare field generally such as elimination of physician silos, a more centralized and coordinated medical home for our patients, and increased communication and collaboration among physicians. It is our opinion that the field of “telemedicine” is in a prime position to participate in, and even lead in these broader endeavors of a more complete system of health management beyond just the doctor-to-patient interaction. We at Children's Mercy Hospital (CMH) have begun these endeavors through several virtual offerings. The first is our weekly “Conferences On-Line Allergy (COLA)” series. COLA is sponsored by the American Academy of Allergy, Asthma and Immunology and it allows a platform for leaders in this field to discuss current best-practices and evidence, and to disseminate this information to other allergy, asthma and immunology (AAI) providers throughout the country. It is also a place where primary care physicians, family practice pediatricians, or anybody else who is interested to learn about how best to manage allergy, asthma, and immunology patients can come to learn. Currently we publish our weekly COLA series on YouTube and ITunes, and these publications enjoy thousands of views per month. This education is of value to physicians and other providers as it serves as a catalyst of improved patient care in and around our community. It is also valuable to the organization through revenue generating CME credits. Whether an institution decides to do the work internally to offer CME credits for these types of virtual didactic conferences or it decides to outsource this function, these conferences are certainly in high demand and fall well within the purview of telemedicine. A second example of CMH's involvement in virtual physician engagement and education is the “Project ECHO - Child and Youth Epilepsy Series” that is sponsored by CMH, and the University of Kansas Medical Center. This series allows neurologists and epileptologists to present the most current evidence of seizure management, testing, diagnosis, etc. Community and family practice physicians can join these online presentations and interact with, and ask questions of the most renowned subject matter experts in the field of epileptology. Virtual education and conferencing allow information and knowledge to be shared efficiently, removing the barrier of distance between experts and those interested in their expertise.
REFERENCES
1. ACAAICOLA. (2016). Retrieved from YouTube:
2. Children's Mercy Hospital/University of Kansas Medical Center. (2016). Child & Youth Epilepsy Series. Project ECHO.
Presentation #: EP-133
The women self-rated their knowledge about menopause on a 1-10 Likert scale; their average knowledge score before participation in the program was 5, after participating in the program their average knowledge score increased to 8. In addition, fifty-six women completed a pre- and post-intervention 18-item true-false menopause knowledge test; 31 (55.4%) had an increase in score, and the average score on the knowledge increased from 81.7% to 87.8%.
When surveyed regarding shared decision making, 34 (60.7%) women reported that they would definitely use it for important health decisions and 19 (33.9%) said they probably would. Fifty-one (91.1%) stated they felt confident in discussing menopause treatments with their providers, thereby initiating the process of shared decision making.
Regarding communication with their providers, 30 (45.5%) women stated that they prepare a list of questions for their doctor; 48 (72.7%) ask questions when they don't understand; and 23 (34.8%) discuss personal problems related to their illness during face-to-face visits.
REFERENCES
1. Why Shared Decision Making? (n.d.). Retrieved September 23, 2016, from
Track: Operations and Implementation
Presentation #: EP-140
The University of Utah Hospitals and Clinics department of Telehealth manages a large portfolio of telemedicine programs. This ranges from research projects on the latest technology in m-Health to standard clinical implementations. In our years of driving these projects to success, and sometimes failure, our team has learned a lot about how to make Telemedicine work and what pitfalls to avoid. This session will go over some of the larger lessons learned and how you can learn from our mistakes (and successes)!
Presentation #: EP-141
This project addressed two problems; the high number of patients that experience a fall while in the hospital and the considerable costs spent to prevent the falls. Preventing falls, which is considered to be a “never event” is a complicated and very difficult task. Our hospital, as many across the US, continually looks for ways to reduce patient falls while remaining fiscally prudent. Our hypothesis was that sitter costs could be significantly reduced without negative impact to patient safety, as defined by fall rates and fall rates with injury, by using a centralized virtual patient monitoring solution with the same selection criteria as the current sitter program. This project was implemented on a 35 bed inpatient rehabilitation unit with a fall rate of 6.29 falls per 1000 patient days and a fall rate with injury of 1.62. Annual cost for physical sitters for this unit was $175,000 prior to the project (7,728 hours). Ninety-day post implementation of a virtual sitter project, with a virtual sitter/patient ratio of 1:12, the fall rate decreased to 4.90 (22% improvement), fall rate with injury decreased to 0.72 (75% improvement), and the cost per patient hour was reduced from $22.47 per patient hour (1:1 sitter) to $1.72 per patient hour using the virtual sitter. The outcomes of this project demonstrate a reduction in cost savings, fall rates and fall rates with injury.
Track: Transformation
Presentation #: EP-156
“Shared Decision Making” (SDM) is arguably the most important feature of a trusted doctor-patient relationship. At its core, great SDM is open and honest communication between patient and care giver. It is education and evidence offered by an informed, empathetic care giver to a patient on diagnosis, prognosis, and treatment options, as well as, information on what the patient can expect and experience depending on the choice the patient makes.
This talk describes a comprehensive and interactive digital health tool kit and solution to provide patients and their families a means to engage in this important shared decision making process with their care givers and care team. The platform provides complete end-to-end virtual and remote care for wellness and care of all types of patients but, it is extraordinarily well adapted for complex and chronic care.
The solution includes a (1) Virtual care and communication platform for either real-time video interactions or 'store and Forward' video messages, (2) “Rich Media” for “behavioral de-escalation”, AND 3) Interactive animated clinical content that will engage, inform and educate patient, family and care givers on end of life (EOL) shared decision making (SDM) process.
Presentation #: EP-157
REFERENCES
1. Bonney A, et. al. The telehealth skills, training, and implantation project: an evaluation protocol. JMIR Res Protoc. 2015 Jan 7;4(1):e2.
2. Adler-Milstein J, Kvedar J, Bates DW. (2014). Telehealth among US hospitals: Several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs (project Hope), 33(2), 207-215.
3. Glover JA, et. al. Connecting to the future: Telepsychiatry in postgraduate medical education. Telemed J E Health. 2013 Jun; 19(6):474-9.
Track: Clinical Services
Presentation #: EP-116
1. Describe the community-based collaborative partnership between the school-based telemedicine program and school nurses;
2. Recognize the need for fully engaging the telepresenter to optimize program success;
3. Discuss the ways school nurses can become more engaged in their role as telepresenter; and
4. Discuss the success of the program through nurse satisfaction and utilization.
Presentation #: EP-117
Texas House Bill 479 requires the Commission on State Emergency Communications (CSEC) and Texas Tech University Health Sciences Center (TTUHSC) to establish a pilot project to implement telemedicine utilization amongst emergency medical services (EMS) providers and area trauma centers. Working with a 10-county region in rural west Texas, the project's main objective is to demonstrate whether telemedicine technology will work in the EMS environments and maintain connectivity with area Trauma Centers in this same region. The goals of the project are to give the physician the ability to observe injuries faster, improve care communications and facilitate triage to the most appropriate treatment facilities. The presentation will describe the project, challenges, barriers, successes and lessons learned.
REFERENCES
1. Trauma system consultation. (2010, May 18-20). State of Texas, Austin, Texas: 2010 American College of Surgeons Committee on Trauma.
2. Verizon 4G/LTE Coverage Map.
3. The history of the R. Adams Cowley shock trauma center”, University of Maryland medical center, (2013, June).
Track: Clinical Services
Presentation #: EP-108
1) Describe the use of a patient-centered process to inform and improve the design and functionality of our type 1 diabetes (T1D) app, MyT1DHero™;
2) Recognize key elements, as expressed by kids with T1D and their parents, of an app that aims to increase positive parent-child communication, motivate the users to engage with the app, and ultimately impact health behavior; and
3) Recommend how a patient-centered app design can be applied across health contexts.
REFERENCES
1) Holtz B, Lauckner C. Diabetes management via mobile phones: a systematic review. Telemedicine and e-Health, 2012. 18(3): p. 175-184.
2) Peters A, Laffel l. Diabetes Care for Emerging Adults: Recommendations for Transition From Pediatric to Adult Diabetes Care Systems. Diabetes Care, 2011. 34(11): p. 2477-2485.
3) Kirwan M, et al. Diabetes self-management smartphone application for adults with type 1 diabetes: randomized controlled trial. Journal of medical Internet research, 2013. 15(11): p. e235.
Presentation #: EP-109
Track: Clinical Services
Presentation #: EP-128
The Texas Tech University Health Sciences Center Telemedicine, Wellness, Intervention, Triage, and Referral (TWITR) Project was created following a grant from the Criminal Justice Division, Office of the Governor for the State of Texas (Grant Nos. 2731701 and 2731701) to create a model for identifying students at risk for committing school violence and intervene with those students before acts of violence occur. The program objectives are to promote school safety, to provide assessment and referral services to students who may be struggling due to behavior health issues, and to provide further training and support to teachers, school counselors and administrative staff.
The model uses Licensed Professional Counselors (LPCs) to go into schools and assess junior high or high school students who have been identified by school personnel as having behavioral problems possibly leading to violence. If, through the assessment, a student is identified as requiring mental health care, either a referral for individual and/or family counseling is made or the student is referred to a medical school department of psychiatry for telemedicine psychiatric services. A total of two telemedicine psychiatric sessions are provided and if additional services are needed then the student would be incorporated as a patient in the psychiatry clinic. For those students needing psychiatric services, telemedicine sessions between the school and the Psychiatry Clinic are provided. In this manner, students could have up to two telemedicine psychiatric sessions while they remain in school, which has prevented students from having long waits to receive care and prevents the need for prolonged leave from school.
The project provides services to students referred from a total of ten rural school districts that surround the Lubbock, Texas area: Abernathy ISD, Brownfield ISD, Crosbyton ISD, Idalou ISD, Levelland ISD, Littlefield ISD, Plainview ISD, Ralls ISD, Shallowater ISD and Lubbock Cooper ISD.
Track: Operations and Implementation
Presentation #: EP-142
Presentation #: EP-143
With the Internet rapid development, many conventional industries transform their products and services into the electronic-merchandise. New applied technique will rely on Internet to come true, for instance, telemedicine, telehealth and telemonitoring, etc. Compared with the business model in the past, Internet accelerate e-commerce development without the restriction of time and space. For this reason, establishing a secure health information system appropriate for our country will help the charge for Internet service put into practice.
In this thesis, we propose a security health information system which not only keep high efficiency but also strengthen the anonymity between customers and hospital. The customers consider their requirements and put purchase order of ECG on the mobile, and then the doctor are going to find a purchase order of ECG (PO-ECG) appropriate for trade in the web site. Besides, timestamp will solve the problem or dispute in the trade and make our scheme more flexible. For example, the patient does not need to find any doctor for trade, the system will auto find suitable doctor. In the future, we will address ourselves to solve the problem of the high transaction cost and complex transaction process in the real world.
Track: Operations and Implementation
Presentation #: EP-148
Presentation #: EP-149
The process is: (1) the families need to collect a CPT code(s) at a laboratory of their preference; (2) they have to go to their primary care physician (PCP) to have a special application form for the genetic test filled out, (3) their PCP or themselves need to submit that information along with the report of the outpatient genetic consultation to the insurance; (4) if the insurance still denies the test, they can submit an appeal letter; and (5) if it's finally approved, they must go to the same lab where they got the CPT code for the test.
REFERENCES
1) Phone calls to the insurance company by the Hospital's billing department
2) Interview to parents of patients
3) Tele-Genetics Main Database and comparison of actual Fiscal Year with previous Fiscal Years
Track: Transformation
Presentation #: EP-158
Healthcare reform and rapidly increasing market competition are driving independent physician practices to transform. Unfortunately, these smaller practices are often starved for the resources and expertise necessary to adopt new methods and technologies and thus find themselves facing a tough choice - join a large health system that has the needed resources or bear the considerable expense of transforming their practices on their own. Although physicians often view joining a health system unfavorably - citing reduced consumer choice, increased panel size, elimination of physician autonomy, and reduced earning potential as key detriments - many do not have ability to maintain their independence and sacrifice their autonomy in exchange for transformation.
To provide an alternative to health system assimilation, a large group of independent providers in Michigan formed a Clinically Integrated Network which supports physician independence by offering systems and processes for transforming care and improving quality, collaboration, and care coordination while retaining practice autonomy and individuality. As a first step, the Clinically Integrated Network incorporated and expanded upon a direct-to-consumer telemedicine service recently established by one of the Network's member-practices.
The expansion of this service has created an innovative new Telemedicine Collaborative which enables member-practices to provide custom-branded virtual care to their patients and, importantly, to coordinate patient care across all participating practices. The web-based service offers the consumer access to multiple independent practices in a single online visit (sometimes within a single clinical encounter via multi-way video) and currently includes urgent care, primary care, and specialty care services. Behavioral health care and wellness services will be added soon. The Clinically Integrated Network and its Telemedicine Collaborative are being very well-received by the physician community and much of the recent interest in the Network is focused on the innovative new approach to telemedicine.
Independent physicians wishing to embrace transformation and adopt new models of care have had few options and have increasingly turned to health systems for resources and expertise, sacrificing individuality as a result. Today, physicians in Michigan have an alternative - the Clinically Integrated Network and its Telemedicine Collaborative - that helps practices transform and maintain independence.
Presentation #: EP-159
REFERENCES
1. Campos Filho AS, Gomes AS, Novaes MA. (2013). 3D Visualization Environment for Analysis of Telehealth Indicators in Public Health. In: 14th World Congress on Medical and Health Informatics - MedInfo, 2013, Copenhagen. Proceedings of the 14th World Congress on Medical and Health Informatics, v. 192. p. 1152-1152.
2. Hart SG, Staveland LE. (1988). Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research. Advances in Psychology, 52(C), 139-183.
3. Seipel S, Carvalho L. Solving combined geospatial tasks using 2D and 3D bar charts. In 16th International Conference on Information Visualization. pp. 157-163, 2012.
Track: Clinical Services
Presentation #: EP-110
1. Define the role of telestroke in increasing utilization of tissue plasminogen activator for acute ischemic stroke, and recognize potential delays in treatment time over telemedicine.
2. Identify predictors for longer time to treatment with tissue plasminogen activator; specifically delays in the time between when an acute ischemic patient arrives to the spoke emergency room and when a telestroke consult is paged (door-to-page time).
REFERENCES
1. Wechsler RL, Tsao JW, Levine SR, et al. Teleneurology applications: Report of the Telemedicine Work Group of the American Academy of Neurology. Neurology. 2013;80(7):670-676.
2. Solenski N, Southerland A, Shephard T, et al. The EQUITe Telestroke Study. Stroke. 2016;47:A84 (Abstract).
Presentation #: EP-111
In 2003, the University of Utah Burn Center identified a need to find innovative and creative ways to increase access to high quality burn care in the Intermountain Region. The Medical Director at the time, Dr. Jeffrey Saffle, began seeing patients via video technology, obtaining a grant in 2004 to expand to several sites. Patient volumes in the beginning years were low, averaging just over one visit per month. In 2016, so far, the University of Utah TeleBurn program has had over 500 telemedicine encounters.
The Burn Center at the University of Utah Hospital is comprised of a fifteen bed ICU, a burn operating room, five room outpatient clinic, therapy gym, children's play room and a telemedicine suite. One key component of care at the Burn Center at the University of Utah is the focus on an interdisciplinary approach to care. By coordinating complex patient care plans with an entire care team each day on the inpatient unit, providers and clinicians are not only able to help the patient and their family understand the many elements of a successful recovery, but it also allows the team to understand the patient's worldview, and personalize the care they receive where possible.
Our objective when beginning the TeleBurn program's transformation was to ensure that the approach to burn care remained as closely tied to the mission of the Burn Center as possible. At the beginning of 2015, it became apparent that a formalized approach to interdisciplinary telemedicine was necessary in order to ensure all regulatory and compliance requirements were being met as this approach continued to grow in popularity. Beginning with the licensure of APCs to help expand our capacity to provide follow-up care, we also began licensing Physical Therapists, Occupational Therapists and Licensed Clinical Social Workers.
Several barriers do exist that hinder the rapid adoption of a fully interdisciplinary TeleBurn program at the University of Utah. Licensure and credentialing of clinical staff such as Nurses, Physical and Occupational Therapists, Registered Dieticians, Respiratory Therapists, and Psychosocial staff. Barriers in regards to reimbursement for these varied therapy services also remain. Barriers to reimbursement by CMS also challenge the ability to treat TeleBurn patients in the home setting, or in non-rural areas. While specialty service and global billing practices do apply to many burn patients, many non-surgical patients are not covered under these same billing conditions.
In conclusion, the focus on creating an interdisciplinary TeleBurn program has allowed us to not only increase patient volume, but to ensure that the full spectrum of burn care can be provided wherever possible. As the regulatory aspects of telemedicine become more clear, our ability to broaden our offerings in regards to dietary care, child life issues, physical and occupational therapy, etc, will be able to grow as well.
Track: Clinical Services
Presentation #: EP-118
Ocular telemedicine has the potential to lessen risk of vision loss and transform the manner ocular care is provided. Recent advances in communication interfaces and automation along with mobile and telecommunications technology is fueling the medical care industry's interest in new methods and technologies to deal with ocular health and performance. Automation and emerging advanced communication platforms such as augmented and virtual reality may successfully lead to the clinical application of more precise and efficient tele-ophthalmology systems for the benefit of patients. In this talk, we will overview interesting applications piloted or adopted in healthcare settings that could potentially reform the patient experience, improve clinical outcomes, deliver innovative new therapies, and better train healthcare professionals.
REFERENCES
1. N. Foreman, L. Korallo (2014). “PAST AND FUTURE APPLICATIONS OF 3-D (VIRTUAL REALITY) TECHNOLOGY”. Scientific and Technical Journal of Information Technologies, Mechanics and Optics. 14 (6).
2. Augmented Reality Revolutionizing Medicine”. Health Tech Event. Retrieved 9 October 2014.
3. Wearable Computing: A first step towards personal imaging”, IEEE Computer, pp. 25?”32, Vol. 30, Issue 2, Feb. 1997
Presentation #: EP-119
Allied healthcare professionals are defined as, “those health professions that are distinct from medicine and nursing.” (Association of Schools of Allied Health Professions). These providers are integral to pediatric healthcare. Often allied healthcare providers are key members of a multidisciplinary team that can provide care to the whole child. This includes dieticians, speech therapists, occupational therapists, and health educators. We faced a challenge with how to balance strategic priorities to continue to grow our telehealth program, while having ongoing reimbursement challenges in our state. However, there was an opportunity to consider utilizing telemedicine to leverage staff most efficiently and demonstrate cost savings for the hospital. Our allied health provider teams developed several key telehealth programs that demonstrated clinical value and cost neutral or cost savings for our organization. Our nutrition therapy program was able to save the cost of an entire FTE (national average ∼$55,000) by implementing a telemedicine nutrition therapy at one of the hospital outpatient facilities utilizing traditional telemedicine equipment. Previously, a full FTE was staffed at this facility but faced less than 50% utilization. When one of the therapists left, this position was not filled, and we developed telehealth nutrition therapy consults at that location. This program leveraged existing capacity of therapists at our main hospital to meet the needs. This program has been so successful we are currently expanding to 2 additional sites and have also started to include a social worker via telemedicine into those same clinics. Our audiology team implemented telehealth to enable audiologists and technicians to provide hearing aid support via a web-based link sent to families or schools. Often these patients would have to wait days or even weeks to be seen to trouble-shoot a hearing aid issue if it could not be easily solved via the telephone. When they were seen in person, they filled precious clinic spots, for an often not reimbursed or low reimbursed service. By moving these visits to telemedicine on demand model using newer web-based technology, we are not only providing clinical care sooner to the patient, but also allowing for our in person clinical time to be utilized to see patients with indications that are more likely to be reimbursed. Finally, our educator team that works with oncology patients had challenge of covering an existing large unit, and a new 10-bed inpatient oncology unit. Rather than having inefficiency of sending an educator to the other unit twenty miles away whenever teaching was needed, they implemented a telemedicine education program with those patients needing instruction. This enabled them to save approximately $76 per session in mileage and non-productive time. Last fiscal year 15.8% (N = 123) of our telemedicine encounters were provided to patients by an allied health care provider. The clinical outcomes have been consistent with in person care, technical needs are easily met with existing technologies, and cost savings and staffing efficiencies are being realized.
REFERENCES
1. (September 21, 2016). Definition of Allied Health. Retrieved from
Track: Operations and Implementation
Presentation #: EP-144
The year 2016 marked Shriners Hospitals for Children's (SHC) creation and implementation of the SHC Telehealth Care Network. An exciting and transformative initiative for the organization, SHC launched the Telehealth Care Network with three of its twenty-two hospitals across the U.S., Mexico, and Canada. Each of the three initial SHC Hospitals (Philadelphia, Salt Lake City, and Galveston) partnered with two to three key geographic regional affiliates to setup conveniently located pediatric Tele-Orthopaedic and pediatric Tele-Burn clinics. Since going live in May 2016, the results of the SHC Telehealth Care Network include; establishing a new geographic footprint in Mexico and across the US, increasing access to pediatric specialties for medically underserved areas, excellent patient/family satisfaction, and a reduction in miles traveled to care and transportation costs. The optimal results of the SHC Telehealth Care Network's implementation to date have justified the organization to plan the enterprise wide rollout to the remaining nineteen SHC hospitals.
Presentation #: EP-145
Our team developed a virtual health solution to provide synchronous telemedicine specialty support capabilities to special forces providers in a deployed theater of operation. This Proof of Concept, along with other projects lead by RHC-A (P), is designed to support operational medicine and improve care for our Soldiers where it is needed most. In addition, the team built the internal resources both at the Region and at Regional Hubs to manage the oversight of Operational VH. Clinical support, workflow, policy and technical solutions were operational and deployed to the point of need on August 8, 2016. Additional testing and validation of value is ongoing with the special forces community. Standardized workflows and SOPs will make these programs Dependable, Achievable and Replaceable so they can be easily transportable across the Special Forces Community.
Track: Operations and Implementation
Presentation #: EP-146
Presentation #: EP-147
Presentation #: EP-162
The management of organizations of health care within a population implies greater challenges every time due to the complexity of elements and variables that determine the results and limited effectiveness of an articulated system regarding the level of health of each user. Today's medical attention is characterized by greater demands on knowledge, more elements included in patient care, higher commitments to quality care and increasing participation of human, technological and administrative resource.
Current methodologies of organization and delivery of health services does not cover all expectations of patients nor of their families partly due to the science and technology involved in providing health services: knowledge, experience, specific interventions, devices and drugs have moved much faster than the ability to dispense this knowledge and technology in safe, effective and efficient manner. How to achieve better health outcomes, improved quality of services, greater involvement of patients in their healthcare attention, improved perceptions of the real system and favorable outcomes with the application of all available resources?
The transformation of health systems requires, among others, strengthening, management and efficiency in general medicine (primary care physicians). Primary care health requires increasingly better informed physicians, constant support, with immediate availability of more effective knowledge and with the possibility to implement patient engagement in the management of the health care. It is necessary that the primary care practice increases value even more in the complete cycle of care.
This breakthrough in medical care has important effects on effective and perceived quality consultation, the same thing that controls the inappropriate use of medical specialist consultation reduces unnecessary use of diagnostic tests and clinical laboratories. Additionally, it makes specialist consultation now that the patient arrives comprehensively checked with the necessary information so that the specialist can make decisions and guide the case.
The transformation and strengthening of the general practitioner today makes it possible with the use of information technology, education and communication. The inclusion of care, treatment guidelines, alert and prevention systems adverse events or errors, even mobile applications in Electronic Medical Records (EMR) protocols are now widely available for help and consultation support. However, the consultation process remains an individual, autonomous and solitary exercise if you want and demand of expertise, memory and level of knowledge of the doctor who performs it.
The inclusion of Teleconcept in the armamentarium of primary care management physicians contribute greatly to achieving these objectives. Teleconcept, known as a tool of telehealth, allows that the primary care physician count online and synchronously with the support and clinical concept of all medical specialists required at the time of the query to achieve more effective attention and add value in the care process through the information and communications technology.
Medical specialists enrolled in this process are always available and when the required primary care physician requires them, in a synchronized manner with the primary care consultation physician offering medical history and collectively analyzing the case, completing the examination and diagnostic support whilst deciding to request and share the therapeutic indications of the case. Additionally the doctor continues the care process through monitoring and case management including remote satellite is continued, and the patient has the possibility from that moment to interact with the therapeutic team that has performed the attention, to ask questions and advance his or her treatment or coordinate further consultations.
The teleconcept doctor has had a major deployment in Colombia, South America with a widespread practice in remote and inaccessible areas as well allowed for the concept of a medical specialist synchronously in the office of the primary care physician and its results have been impacting on care costs, decreasing the reference to medical specialist, the cost of transportation, the use of diagnostic and clinical support whilst improving patient satisfaction. Today it is possible to note the realization of 120,000 teleconcepts with favorable results.
Presentation #: EP-167
Healthcare simulation has long been used to promote the exploration of procedures and processes related to the provision of healthcare with high acceptance rates seen in the pre-hospital as well as hospital-based provider groups (Abelsson et al., 2015). The combined use of telehealth technologies (carts, cameras, peripherals) with high-fidelity simulation mannequins (complete with vitals, motion, fluids) affords healthcare systems with new paths for delivering education and improving the quality of clinical practice. Telehealth outreach projects led by the Medical University of SC and SC Area Health Education Consortium are connecting community providers with simulation training focused on clinical decision making processes. While also meeting the educational needs of health professions students during their academic training, healthcare professionals are supported through interactive simulations exercises provided at a distance. These are two areas of innovation related to ! telehealth education. Using telehealth equipment and programmable mannequins co-located within a virtual training laboratory, local paramedics and neonatal respiratory therapists are being trained to better address airway management cases while remaining in their home communities. Pilot programs have demonstrated significant value and resulted in expansion into full-scale training programs. Community hospitals and emergency medical agencies are benefiting from improved access to educational programs while partnering with experts to address the integration of evidenced-based practice protocols into a variety of care settings. Outcomes show increased learner confidence in managing these cases and decreased decision response times through the training scenario progression. Confidence and acceptability of the simulation and telehealth technologies are self-reported to be “somewhat” to “very” high for all participants. Pre- and post-test data comparisons show that 62.5% of partiicipants improved their scores on the knowledge assessments. For airway management scenarios, participants regularly decreased their time to intervention while working through increasingly complex case parameters - all from a distance through telehealth supported simulation exercises. Additional findings show improved care coordination between referring entities and statewide policy recommendations for emergency management agencies resulting in improved training for providers, outcomes for patients and care management among institutions. Applications for this innovative training modality extend to a wide-range of community providers and facilities tasked with coordinating care and managing the health of rural populations.
Describe the benefits telehealth simulation training provides to health professions students and practicing providers.
Apply lessons learned from telehealth training to clinical providers and the populations they support. Demonstrate improved competencies in the provision of emergency medicine services through the provision of simulation training.