Abstract
Concurrent Session Abstracts
DIRECT TO CONSUMER STRATEGIES
DTC-07
• Upon completion, participant will be able to recognize the components needed to evaluate DTC solutions. • Upon completion, participants will be able to explain the thought process needed to create and lead an effective collaborative group, support the organization's strategic DTC initiative, and drive leadership support. • Upon completion, participants will be able to demonstrate the steps to take to clearly define the problem(s) and the requirements for the solution.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-06
• Describe how certified nurse practitioners provide asynchronous on-demand urgent care. • Identify how eVisits augment traditional urgent care. • Discuss how eVisits have supported meeting the Quadruple Aim.
References:
1. U.S. Department of Health & Human Services, 2015. Health Care. Retrieved from
2. Bodenheimer T, Sinsky C. 2014. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. Retrieved from
3. Gidwani N, Fernandez L, Schlossman D. 2012. Connecting with Patients Online: eVisits Strategy, evaluation and technology recommendations for an e-visit system.
CLINICAL SERVICES
CS2-05
Within the LINKHF-2 study, 100 patients from across four different U.S. hospitals (Palo Alto, CA, Gainesville, FL, Houston, TX, and Salt Lake City, UT) were enrolled upon discharge related to heart failure decompensation. Patients were provided with a 90-day supply of wearable, disposable, bluetooth-enabled biosensors and a mobile phone with pre-paid data plan for data transmission. Data were collected via cloud-based IT platform across the 90 days and analyzed with multivariate, machine-learning analytics to detect changes from a personalized model of vital sign relationships.
The FDA-cleared analytics being evaluated build a personalized model of vital sign dynamics based on biosensor data captured the first 36 hours after hospital discharge. During that model training period, the system “learns” an individual patient's unique vital sign relationships (HR, RR, and activity) across the full spectrum of activities one would expect in an ambulatory environment. With this, the system analytics develop a personalized baseline by which to measure changes that may be a precursor to an acute care event. After the 36-hour model training period, the system automatically transitions from “learning” mode into “monitoring” mode where it indicates subtle changes that may indicate compensatory behavior within the cardiopulmonary control loop. Personalized anomalies are indicated via time-series plotted index of change from baseline. The higher the index, across a longer period of time, the greater the change from baseline.
This was an observational study. Current standard of care was delivered while data were being collected in the background. A retrospective analysis compared results of the personalized analytics relative to the medical record. The intent of the study was to evaluate 1) how well the personalized, machine learning-based physiology analytics detected acute care events in an ambulatory environment and 2) how early the analytics indicated health deterioration relative to the acute care event. The ultimate goal of the solution is to provide clinicians with a scalable tool that will allow them to manage a post-acute population using passive data collection and sophisticated analytics. The intended benefit is that large, at-risk patient populations can be managed by exception, as indicated by each individual's changes in cardiopulmonary physiology. A simplified ROC analysis yielded an AUC ∼0.81, enabling very high specificity to alleviate false alert burden, while still delivering a potential cost-saving sensitivity.
• understand extended (90-day) continuous ambulatory multivariate physiology data capture using clinical-grade, disposable, wearable biosensors. Will review solution deployment across a 100-patient post-discharge heart failure population, inclusive of biosensor wear compliance. • understand how machine learning-based, FDA 510k-cleared, Personalized Physiology Analytics (PPA) leverage multivariate continuous data (HR, RR, Activity) to detect physiological anomalies that can be a precursor to disease exacerbation. • statistical analysis of performance of PPA analytics within this observational study in the context of A) sensitivity/specificity of detection of acute care events and B) quantification of early warning.
CLINICAL SERVICES
CS2-05
It is notoriously difficult for military members to get much needed behavioral/mental health services, which is why TeleFOCUS was created. TeleFOCUS uses video conferencing so that the military member and their family can meet with a skilled therapist over a real-time audio and video conference, with the intention to learn core resilience skills. Tom Babayan - a licensed Marriage and Family Therapist - is a model supervisor and key therapist that has been practicing TeleFOCUS for over five years. Tom will describe the FOCUS model in more detail during his presentation.
TeleFOCUS has been adapted to treat the entire family at a distance, which is somewhat unique in the realm of telehealth. Tom will share how he engages and treats these military members and their families, as well as teaches them the necessary skills to live a resilience-based life across the states and even countries. Tom will also share his adoption/implementation processes, as well as his clinical observations and outcomes as it directly relates using TeleFOCUS. Additionally, Tom will describe how TeleFOCUS has become a manualized evidence-based practice (EBP).
• Give a background of the FOCUS Program and how TeleFOCUS has helped with its goals in caring for large veteran/active duty military, using a family-centered approach. • Describe how veteran/active duty military face shortages in receiving mental and behavioral healthcare. • Describe the implementation/adoption process of TeleFOCUS, serving military members and their families where they live.
References:
1. MacDermid SW, Lester P, Marini C, Cozza S, Sornborger J, Strouse T, Beardslee W. Approaching Family-Focused Systems of Care for Military and Veteran Families. Military Behavioral Health, 2013;1:31–40.
2. Beardslee WR, Klosinski LE, Saltzman W, Mogil C, Pangelinan S, McKnight CP, Lester P. Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care. Clin Child Fam Psychol Rev. 2013;16(4):394–409.
3. Paley B, Lester P, Mogil C. Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families. Clin Child Fam Psychol Rev. 2013;16(3):245–265.
DIRECT TO CONSUMER STRATEGIES
1:15 PM–1:24 PM Sunday, April 29, 2018
CS1-02
• Explain medical crowd-sourcing and how it can improve urgent care medicine. • Discuss how asynchronous healthcare helps patients and assists health professionals – saving time and improving care. • Describe the benefits of Artificial Intelligence (AI) and algorithm-directed healthcare in ensuring evidence-based medical practice in acute care.
References:
1. Ray KN, Amalavoyal VC, Engberg J, et al. Opportunity costs of ambulatory medical care in the United States. Am J Manag Care. Published online August 18, 2015.
2. Christine Sinsky, MD; Lacey Colligan, MD; Ling Li, PhD, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Int Med. 2016;165(11):753–760.
3. Courneya PT, Palattao KJ, Gallagher JM. Episode And High Patient Approval HealthPartners' Online Clinic For Simple Conditions Delivers Savings Of $88 Per Episode and High Patient Approval. Health Aff. 2013;32(2):385–392.
CLINICAL SERVICES
Ignite Sessions
CS2-02
Patients are eligible for an Express Care visit if they present to our ambulatory triage with low acuity Emergency Severity Index (ESI) scores and are deemed by the greeter RN unlikely to require significant ED resources. Patients are seen by a physician assistant or nurse practitioner. After this medical screening they are evaluated by the telehealth attending. The physicians who care for patients by telehealth are all part of our medical school faculty who do regular emergency department work. Each is board certified in Emergency Medicine and has greater than 5 years of post-residency clinical experience. The physician does a video exam and as needed may call in prescriptions, order ED medications or x-rays, and arrange for follow up care. The Express Care physician reviews discharge and follow up recommendations and directly discharges the patient, providing them with discharge instructions printed to the patient's room.
Since ECS was launched in July 2016, we have seen more than 3,000 patients with a typical length of stay of 35 to 40 minutes - as compared to an average of 2 to 2.5 hours' stay in the ED for patients seen in person via the traditional ED pathway. These improvements in operational metrics have occurred because the implementation of ECS has allowed us to streamline care by reducing workflow interruptions and delays. The diversion of lower-acuity patients to ECS enables providers and staff in the main ED to focus their attention on patients with more emergent medical conditions, thereby making the care of these patients more efficient. The involvement of the telemedicine doctor in these evaluations helps make the financial case for maintaining a dedicated telehealth position.
Patient satisfaction scores for ECS have been outstanding, ranking in the 99th percentile. Our physicians have also indicated that they enjoy providing this virtual care. As part of our ongoing quality assurance program, we monitor 72-hour ED revisit rates for our ECS patients. Currently, the number of ECS patients who revisit the ED within 72 hours of their virtual visit is less than 3%, which is lower than the 3.5% to 7.5% that has been reported for ED patients in traditional settings, When we account for revisits that were part of the initial treatment plan, the revisit rate is less than 2%. The majority of these unplanned returns do not result in any change in treatment. Even more impressively, to date none of these ECS 72-hour return visit patients have required an admission for inpatient hospitalization.
• Describe how Telemedicine Emergency Department Physician can treat patients who are physically in the Emergency Department. • Define the departmental and patient level advantages of using a dedicated Telemedicine physician to care for low acuity emergency department patients. • Explain the role Express Care Service in streamlining Emergency Department efficiency for low acuity patients.
References:
1. Ward MM, Jaana M, Natafgi N. Systematic review of telemedicine applications in emergency rooms. Int J Med Inform. 2015;84(9):601–16. Epub 2015/06/15.
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DIRECT TO CONSUMER STRATEGIES
DTC-05
In addition to the post acute care, myNursebot can also engage patients with chronic diseases like Diabetes and Hypertension. It can ask for their vitals, glucose readings and blood pressure readings repeatedly to establish the pattern. myNursebot can engage the doctor's office if the patient's readings are above the target established by American Diabetes Association and JNC guidelines.
myNursebot is currently supported on Amazon's Alexa platform and will be supported on Google's Home, Microsoft Cortana and Apple's Siri as well.
myNursebot improves compliance and increases the patient satisfaction substantially. It also aims to reduce workload on nursing staff by asking questions timely and perhaps repeatedly for them. It may reduce healthcare cost because healthcare provider can do early interventions in a out-patient facility instead of hospitalization.
• recognize that voice apps can provide better patient satisfaction by asking right questions at the right time to patients recovering after acute care or managing chronic conditions. • see through that voice applications can reduce workload on the nursing staff. • understand that voice applications can increase patient engagement and compliance in managing and monitoring their health.
References:
1. Dr. Sandeep Bhargava, Emory Hospital (
Direct to Consumer Strategies
DTC-03
Asynchronous visits are patient initiated eVisits where the patient answers online questionnaires that are provided based on the symptoms or condition identified. Answers are routed to the provider for assessment and allow flexibility in responding within one business day when there is open time in their schedule. Providers can diagnose and treat, request additional information, or request the patient make an in-person appointment. Average provider time spent is approximately three minutes. Patient time saved could be hours, especially when same day access with a specific provider is often scarce.
Synchronous visits use audio and video to connect patients and provider, real-time, but at a distance. Mobile video visits are conducted through a secure patient portal that can be accessed via an app on a smartphone or through a website on a video-enabled computer. In this case, the patient does not have to travel to the provider's office, yet has the ability to see the doctor for dedicated, one-on-one time to discuss their condition or concerns. Patient travel, as well as exposure to other patients in a doctor's office waiting room, is eliminated. Video brings the provider to the patient via a virtual house call, overcoming time and transportation barriers. Patients have indicated that they are very satisfied with the convenience, as well as the dedicated time and attention of their provider. Doctors indicate their satisfaction through their ability to easily reach patients who otherwise may have been unable to attend an appointment, as well as the ability to have focused time to discuss the patient's health, wellness, concerns, and treatment plan.
At HFHS, the Virtual Care team is delivering on its mission: 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. Technology enabled asynchronous and synchronous encounters allow for radically convenient patient care which eliminates barriers while allowing doctors to provide high quality care, without added cost or time. House calls are again a reality and the future of interacting with your doctor on a video screen is here. And you don't need to have the last name of Jetson!
• To identify strategies to employ technology-enabled delivery alternatives to provide radical convenience to patients (care anytime/anywhere) as well as providers (treating appropriately and via patient preference). • Apply technology-enabled delivery alternatives to reach patients who otherwise may experience barriers to care (such as transportation, child care, working hours). • To create in-person clinic access by providing efficient care in an appropriate technology-enabled delivery format to patients not requiring a physical exam by the provider.
Operations and Implementation
O-02
The English fluency of these individuals will vary, of course, but the expectation is that around 41% of this community - or 27.5 million people - will be considered “limited English proficient,” meaning they speak the language less than very well.
Apart from LEPs, estimates are that 1 in 20 Americans are deaf or hard of hearing. In round numbers, studies say that nearly 10 million are hard of hearing, while another 1 million are functionally deaf.
How do LEPs, the deaf, and hard of hearing participate in telemedicine, a modality that generally assumes a patient's English fluency, as well as their ability to hear?
To put a finer point on it: Imagine being from one of these vulnerable populations when a natural disaster or other public-safety emergency strikes and healthcare access is even more essential. What do you do when you need help but language and cultural barriers seem insurmountable? To meet your needs, it is essential that healthcare providers and first responders have access to technology that enables fast and effective communication.
The presentation, “Innovations in Remote Interpretation Delivery,” will offer a perspective on the ways in which organizations can incorporate remote interpretation into their telemedicine programs. It will help attendees comprehend how significant advancements in technology are already improving communication between LEP, deaf, and hard-of-hearing patients and their providers, resulting in improved health outcomes, reduced readmissions, and improved patient satisfaction.
The presenter will review recent breakthrough innovations, including cloud-based, multi-channel-interpretation routing, which enables healthcare organizations, public safety, and first responders to swiftly meet the language needs of these populations regardless of location. He will then discuss innovations in on-demand translation that utilize real-time text and chat.
The session will also include a discussion on near-future advancements in improving language access and increasing efficiencies through artificial Intelligence, machine learning, and robot automation.
• Understand the role of language access in telemedicine. • Identify recent innovations enabling effective communication for limited English proficient and deaf and hard of hearing patient populations. • Identify methods to integrate language access solutions into their telemedicine initiatives to improve patient safety and patient satisfaction while reducing readmissions.
References:
1. Video Interpreting Testimonial: University of Cincinnati Medical Center is the nation's premier teaching hospital. Believing that the patient should own-their own-healthcare, we partner with the patient, and together we build a plan for their health.
2. Link to videos about language access innovations:
Operations and Implementation
Ignite Sessions
O-04
30 faculty members were divided into groups of 5–8 participants for the round table sessions, which were designed to: provide a program overview, demonstrate simulated patient care encounters, and allow for hands-on practice. Topics covered included program standards, workflows, virtual presence training, technical equipment, and an introduction to the ECC Virtual Handbook, an easily accessible online resource developed for provider reference and decision support.
Individual sessions enabled the prospective ECC provider an opportunity for hands-on practice of the new skill and allowed for assessment of program readiness and proficiency. These sessions consisted of three simulated consultations, ranging from simple medical questions to sensitive subjects and complex situations (e.g., dealing with an angry parent, disclosure of sensitive information). Proficiency was assessed using a dichotomous checklist; employing the technique of deliberate practice to ensure that mastery was achieved on critical items. The checklists were developed according to a review of existing literature and expert feedback.
• By the end of the presentation, the audience will be able to describe how to develop a comprehensive blended model training curriculum for a new telemedicine program. • By the end of the presentation, the audience will be able to describe the implementation of the various modalities of a blended model training curriculum. • By the end of the presentation, the audience will be able to evaluate the impact of a telemedicine training curriculum.
CLINICAL SERVICES
CS2-04
• Upon completion, participants will be able to better understand where the federal and state regulatory telehealth regulatory structure is headed by the year 2020. • Upon completion, participants will be able to begin to prepare for upcoming changes in the telehealth regulatory structure. • Upon completion, participants will be better prepared for deploying telehealth programs under forthcoming telehealth regulatory changes.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-02
• Understand Telehealth Network Grants from the Office for the Advancement of Telehealth (OAT). • Understand what OAT has learned from its grantees. • Understand how telehealth can improve access to and quality of care for rural residents.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-04
• Understand grant programs of the Office for the Advancement of Telehealth (OAT) in the Federal Office of Rural Health Policy, HRSA. • Understand how to benefit from OAT programs such as the Telehealth Resource Centers. • Understand how to receive notice of new grant opportunities.
CLINICAL SERVICES
CS1-04
Well rooted relationships within a hub and spoke model provides the community hospital access to exceptional systems of care through the TeleNeurology Program, where the infrastructure of the academic medical center is leveraged to the benefit of the patient with deep process and system integration. This is evident by our commitment to work with our spokes to increase retention of IV tPA patients at the community hospital. An extension of this initiative is our TS-LVO2OR process which involves timely acquisition and transfer of specific CTA images, allowing our Neurologists and Neuroendovascular specialists the ability to triage patients for emergent endovascular therapy while also identifying those patients who can remain at the community hospital. Door to groin puncture as low as 17 minutes have been observed at our facility through this process. For those patients that receive IV tPA via the TeleNeurology Program and remain at the community hospital, a 90-day mRS is performed by the TeleNeurology Network Liaison and the results are made available to the community hospital.
Other aspects of our quality initiative include data collection from our TeleHealth Portal and from our sites to guarantee we are providing a comprehensive evaluation of our program. We also provide our sites with quarterly data for their review and as a means of providing constructive, actionable feedback.
In conclusion, a clinical quality initiative is a necessary component of any successful and sustainable TeleNeurology Program.
• Describe how the hub and spoke relationship can effect the success of clinical quality initiatives. • Describe how different clinical quality initiatives can be interwoven to gain greater leverage. • Describe how a clinical quality initiative can contribute to the improvement of the overall success of a TeleNeurology program.
References:
1. (November 3, 2016). Telemedicine Quality and Outcome in Stroke A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;(E3):e25: 1-24. Retrieved September 13, 2017, from
OPERATIONS AND IMPLEMENTATION
O-05
• Describe the impact that telehealth research, or lack thereof, has on federal and state legislation, regulations, and on the acceptance and adoption of telehealth by multiple stakeholders. • List the barriers to conducting rigorous telehealth research at both the institutional and multi-institutional level. • Formulate an effective action plan to stimulate the development of telehealth research as a central focus of telehealth development across the country.
References:
1. McSwain SD, Bernard J, Burke BL Jr, Cole SL, Dharmar M, Hall-Barrow J, Herendeen N, Herendeen P, Krupinski EA, Martin A, McCafferty D, Mulligan DA, North S, Ruschman J, Waller M, Webster K, Williams S, Yamamoto S, Yeager B. American Telemedicine Association.
2. Harvey JB, Yeager BE, Cramer C, and McSwain SD. Impact of Telemedicine on Pediatric Critical Care Triage. Pediatric Critical Care Medicine. September 2017. Publication pending.
3. National Quality Forum. Creating a Framework to Support Measure Development For Telehealth. August 2017. Download draft at
DIRECT TO CONSUMER STRATEGIES
DTC-01
• Upon completion, participants will be able to identify and use behavioral economics based approaches to increase patient acceptance of telemedicine. • Upon completion, participants will be able to identify opportunities and apply tailored direct-to-consumer communications to drive use of telemedicine. • Upon completion, participants will be able to understand approaches to increase provider telemedicine adoption.
DIRECT TO CONSUMER STRATEGIES
DTC-02
• Describe the principles of human-centered design and how to directly apply design thinking to telemedicine program development. • Understand how to solicit information from patients in a systematic fashion. • Apply principles of human-centered design at their own health system by understanding how it was applied at the University of Michigan.
References:
1.
OPERATIONS AND IMPLEMENTATION
O-03
• Upon completion, participant will be able to describe how electronic health record implementation has impacted telemedicine encounter volumes (store and forward and live video) across multiple organizations in Alaska. • Upon completion, participant will understand the opportunities/challenges to telemedicine that a new EHR implementation brings (including perspectives from providers, support staff, revenue cycle, IT and telehealth application integration). • Upon completion, participant will be able to describe the telemedicine workflow and technical changes that should be considered before and after implementing an EHR.
OPERATIONS AND IMPLEMENTATION
O-01
• Upon completion, participants will be able to explain the relationship between blockchain and telehealth. • Upon completion, participants will be able to appraise the use of blockchain within their telehealth program. • Upon completion, participants will be able to plan a potential blockchain strategy for various telehealth modalities.
References:
1.
2.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-01
• Upon completion the participant will understand a method to evaluate the whole cost of treatment for certain low acuity conditions in various treatment venues. • Upon completion the participant will understand the various quality and cost considerations that should be made in accessing the effectiveness of new telehealth programs. • Upon completion of this session, the learner will have access to benchmark data in conducting their own analysis of direct-to-consumer programs.
References:
1. Gordon E et al. Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization. JMIR. 2017;19(2).
2. Ashwood JE et al. Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending. Health Aff. 2017:36(3):485-291.
DIRECT TO CONSUMER STRATEGIES
CLINICAL SERVICES
CS1-03
• Demonstrate the migration and integration of telehealth services inside and alongside an EMR. • Deliver outcomes and metrics highlighting program success. • Identify barriers and outline effective leadership roles to ensure program success.
CLINICAL SERVICES
CS2-03
• Recognize the need for common measures to evaluate the impact of telehealth in schools on clinical and process domains. • Discuss the coordination of care between school-based programs and the medical home. • Articulate five of the proposed basic standards for the use of telehealth in schools.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-03
• Upon completion participant will understand methods to identify demand and capacity in developing telehealth services. • Upon completion, participant will be able to describe elements of a business case analysis applied to telehealth services. • Upon completion, participant will be able to list metrics to consider in a business case analysis for telehealth services.
CLINICAL SERVICES
CS2-01
• Describe why collaboration between providers, care managers, and telehealth specialists is critical to ensuring the right diagnosis and the right treatment. • Identify how data and analytics aid the identification of highly complex, high cost cases. • Demonstrate how combining clinical intelligence with telehealth can change the trajectory of complex cases.
References:
1. Zimmerman Young, E. (2017, Apr 4). Mayo Clinic researchers demonstrate value of second opinions. Retrieved from
CLINICAL SERVICES
CS1-01
• Identify key stakeholders in your state that must be “at the table” and involved in decision making for implementation of a successful school-based telehealth program. • Recognize the policy implications and operational groundwork that must be in place to implement a successful school-based telehealth program. • Understand the importance of multi-disciplinary care in school-based telehealth to include physicians, nurse practitioners, school-nurses, mental health professionals and administrators.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-05
• Understand Medicare's carve-out for TeleHealth and the new codes for 2018 including fee-for-service professional component, facility fees, originating sites, definition of rural, and eligible providers and services. • Explain state-based Medicaid regulatory language and how to ensure coverage by researching, identifying and understanding state regulatory and legislative language governing Medicaid payment for services delivered via TeleHealth. • Identify the requirements for non-traditional CMS, Medicaid and Private Payer reimbursement for bundled and episode of care payment programs, value based purchasing, shared savings, and quality/cost payment models.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-19
• Understand the factors that facilitated the early growth and current sustainability of teleradiology. • Appreciate the challenges teleradiology is currently financial and organizational facing and how other specialties can learn from them. • Apply lessons from teleradiology regarding payment and quality initiatives to other clinical specialties using telemedicine.
OPERATIONS AND IMPLEMENTATION
O-10
In the beginning stages, HFHS worked with early clinical adopters to develop care redesign opportunities, standards and streamline implementation. As the program matured, the deployment and adoption of virtual care has fostered growth year over year in both synchronous virtual video visits/consults and asynchronous/store-and-forward encounters. Through July 2017, HFHS has conducted 1,500 virtual video visits/consults and over 1,100 asynchronous/store-and-forward encounters. In addition, 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.
Through the use of project management tools, standardization, and operational strategy, HFHS the Virtual Care department has been able to support the mission which includes improvement to the healthcare experience by leveraging virtual care to increase access, reduce costs, improve workflows, increase quality, improve customer convenience and enhance existing portals. Through successful pilot experiences, the team was able to use lessons learned and PDCA (Plan, Do, Check, Act) methodology to fine tune the virtual care implementation and structure to support adoption and scalability in program deployment. As we progressed through program deployments consistent themes presented as opportunities for improvement. These roadblocks and opportunities included reimbursement, EMR integration, compliance (i.e. security, licensure, and credentialing), and the patient's perception. The key roadblocks to the patient's perception included awareness of the value proposition for telehealth, confidence that telehealth was good medicine, and the evolution of telehealth as a more visible part of our healthcare system. In tandem, some of the keys to the successful infrastructure and programs have included executive leadership support, engaged stakeholders, communication, dedicated telehealth subject matter experts for the enterprise, and standard processes.
Henry Ford Health System's Virtual Care footprint continues to grow, and as it does the infrastructure and processes will evolve to ensure that we are creating a sustainable and innovative product. This pioneering product will “drive” the adoption and scale of Virtual Care throughout the organization, which has allowed us to not only predict, but create our future in telehealth.
• Upon completion of the presentation, the participant will be able to understand key project management and process components to obtain adoption and scalability in virtual care program development. • Upon completion of the presentation, the participant will be able to develop an operational strategy based on meaningful and demonstrated tactics. • Upon completion of the presentation, the participant will be able to recognize obstacles, keys to success, learnings and opportunities in care redesign using virtual care.
CLINICAL SERVICES
CS1-10
• Understand the role of nurses in implementing telehealth solutions. • Define four options available to nurses in a variety of settings. • Provide two examples of ways to implement successful projects.
References:
1. American Academy of Ambulatory Care Nursing, (2014, May) Telehealth nurse practice survey, Retrieved from
2. Hicks SA, Cimarolli VR. The effects of telehealth use for post-acute rehabilitation patient outcomes. J Telemed Telecare 2016;(0,0) Retrieved from
3. Taylor J, Coates L. Caring from a distance: the role of telehealth. Nursing Times. 2015;111(28/29):18-20, Retrieved from
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-13
• Identify virtual visit payment options typically considered by commercial insurers. • Describe the importance of developing a virtual visit strategy that optimizes financial goals, as well as outcomes and patient experience. • Identify insurer concerns regarding payment for virtual visits and describe successful approaches to collaborate with insurers to overcome these concerns.
DIRECT TO CONSUMER STRATEGIES
DTC-08
Mobile health (m-Health)-the use of mobile phones/tablets to help improve health-is a way to improve health outcomes in many different conditions, including T1D. Mobile technology is almost ubiquitous today in the USA. Nearly 75% of teens and 76% of parents have access to a smartphone.
The objective of this study was design, develop, and conduct a pilot test of a mobile app for adolescents with T1D and their parents to aid in this transition using a user-centered design.
Stage 1 - This qualitative study included 12 teens, 9 parents, and 5 pediatric diabetes educators who participated in a focus group or interview. Four themes emerged: 1) family communication characteristics, 2) denial, 3) provider communication characteristics, and 4) transition facilitators. Using this feedback, we worked with app developers to create a wire frame of the app.
Stage 2 - We presented the wireframe to two separate focus groups. The focus groups were conducted with 5 adolescents ages 10-13 and separately with 7 parents. Our app concept was well-received and participants thought it would help aid in the transition to adolescent self-management. Their feedback was used to refine the app in preparation of final development.
Stage 3 - Feedback from the focus groups was compiled to drive app development. Full design and development of the app took 10 months.
Stage 4 - We recruited 15 parent/teen groups to use the MyT1DHero app for four weeks. At posttest they asked questions regarding satisfaction and ease of use of the app. They also participated in short phone interviews regarding their experience using the app. Additionally, we used server data to examine actual app usage.
Ten family dyads completed the study. Three main themes emerged, 1) app crashing issues, 2) problems with notifications; and 3) positive feedback. These results were used to refine the app for future testing. The survey results indicated that all the participants were satisfied with the app and thought that it was easy to use.
• Demonstrate the importance of user-centered design. • Identify lessons learned in an mHealth app prototype study. • Identify key features of working with adolescents and parents in app development.
References:
1. Holtz BE, Murray KM, Hershey DD, Dunneback JK, Cotten SR, Holmstrom AJ, et al. Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents. JMIR mHealth and uHealth. 2017;5
2.
3. van der Velden M, Sommervold MM, Culén A, Nakstad B. (2016). Designing interactive technologies with teenagers in a hospital setting. In Perspectives on HCI Research with Teenagers (pp. 103-131). Springer International Publishing.
DIRECT TO CONSUMER STRATEGIES
DTC-13
• Identify barriers to and drivers of clinician acceptance of direct to patient virtual care. • Rank patients' perceived benefits in using asynchronous care. • Understand the tradeoffs in meeting the needs of both patients and clinicians in delivering asynchronous care.
References:
1. Dixon RF, Rao L. Asynchronous Virtual Visits for the Follow-up of Chronic Conditions. Telemed J E Health. 2014;20(7).
2. Ganguli I, Wasfy JH, Ferris T. What Is the Right Number of Clinic Appointments? Visit Frequency and the Accountable Care Organization. JAMA. 2015;313(19):1905-1906.
3. Patient and Provider Satisfaction Research within Massachusetts General Hospital.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-07
Lack of services and resources for expert wound care during hospital stay can lead to increased wound chronicity and acuity, contributing to increased emergency department (ED) visits, unplanned hospital admission and readmission rates, increased length of stay (LOS), lost hospital revenue, and decreased patient/family satisfaction. Additionally, creating a model for wound care services to extend beyond the inpatient setting provides continuity of care to further improve patient outcomes and reduce additional healthcare utilization.
Opportunities will be highlighted to connect wound care specialists during hospital stay, at nursing homes, and during home health visits. The value proposition and business case will be presented for each opportunity, summarized as follows:
Direct Impact (Patients, Providers) • Early detection and rapid treatment • Greater access to specialty care/increase referrals • Reduces incidents of long-term disability • Reduced hospital length of stay • Patient and provider satisfaction • Patient remains at appropriate level of care • Reduces costs of unnecessary transfers
Indirect Impact (Broader community) • Reduces costly inpatient rehab and nursing home care • Keeps patients in their community • Improves bottom line of community hospitals
• Identify opportunities for telewound care across the continuum in acute and post-acute care. • Understand the value proposition and business case for telewound care across the continuum. • Apply the value proposition for telewound care within the attendee's own healthcare organization.
DIRECT TO CONSUMER STRATEGIES
DTC-10
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-09
• Evaluate the current and potential reduction in greenhouse gas emissions from a Neuro-Emergent telemedicine consultation program. • Identify potential reductions in Greenhouse gases for other Telemedicine programs. • Conduct comparison of the size of greenhouse gases reductions to other models and CO2 emissions.
References:
1. EPA, US. Sources of Greenhouse Gas Emissions. Retrieved December 16 (2013):2013.
2. U.S. Energy Information Administration (2016). Electricity Explained - Basics.
3. Dullet, NW, et al. Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants. Value in Health 2017;20(4):542-46.
OPERATIONS AND IMPLEMENTATION
O-07
• Explain how a patient portal helps to create relationships between patient and healthcare teams. • Discuss the unique characteristics of Mayo Clinic's patient portal that contribute to its success. • Identify ways to use patient portals as part of relationship building.
CLINICAL SERVICES
CS2-07
Patients are eligible for an Express Care visit if they present to our ambulatory triage with low acuity Emergency Severity Index (ESI) scores. After receiving a medical screening by a Physician Assistant or Nurse Practitioner, patients are evaluated by the telehealth attending. The physicians who care for patients are all part of our medical school faculty who do regular ED work. The physician does a video exam and as needed can call in prescriptions, order ED medications or x-rays, and arrange for follow-up care. The Express Care physician reviews discharge and follow-up recommendations and discharges the patient, providing them with discharge instructions directly to the patient's room.
Since Express Care was launched in July 2016, we have seen more than 5,000 patients with a typical length of stay of 35 to 40 minutes - as compared to the average stay of 2 to 2.5 hours. The implementation of this program has allowed us to streamline care by reducing workflow interruptions and delays, and allows providers and staff in the main ED to focus their attention on patients with more emergent medical conditions. Patient satisfaction scores have been outstanding, ranking in the 99th percentile. Our physicians have also indicated that they enjoy providing this virtual care. As part of our ongoing quality assurance program, we monitor 72-hour ED revisit rates for our ECS patients. Currently, the number of ECS patients who revisit the ED within 72 hours of their virtual visit is less than 3%, which is lower than the 3.5% to 7.5% that has been reported for ED patients in traditional settings.
• Describe how Telemedicine Emergency Department Physician can treat patients who are physically in the Emergency Department. • Define the departmental and patient level advantages of using a dedicated Telemedicine physician to care for low acuity emergency department patients. • Understand the role of Express Care Service in streamlining Emergency Department efficiency for low acuity patients.
References:
1. Virtual Consultations With Doctors Speed Up Non-Emergency ER Visits At Area Hospital. CBS New York Video Link:
2. Can tech speed up emergency room care? Wall Street Journal Article Link:
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-11
• Clearly identify and understand the relative value of their technology needs based upon their program design, financial resources and patient population. • Understand the purpose, value and process of completing a telehealth technology environmental scan. • Select the most appropriate technology or technologies for their program using a weighted comparison analysis tool.
CLINICAL SERVICES
CS2-09
• Describe how video sharing, speech recognition, and machine translation technologies can create a new asynchronous model of mental healthcare. • Learn how to implement novel informatics and telehealth technologies for research and quality improvement within a large health system. • Compare and contrast machine translation versus in-person human interpretation services.
References:
1. Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999;56(12):1109-15.
2. Ryan C. Language Use in the United States: 2011: American Community Survey Reports. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau. 2013.
3. Yellowlees P, Odor A, Burke Parish M, Iosif AM, Haught K, Hilty D. A Feasibility Study of the Use of Asynchronous Telepsychiatry for Psychiatric Consultations. Psychiatr Serv. 2010;61(8):838-40.
DIRECT TO CONSUMER STRATEGIES
DTC-09
• Understand the Brazilian market for direct-to-consumer urgent care services delivered by telemedicine and its potential to grow exponentially. • Recognize regulatory issues and biggest challenges to scalability and implementation of synchronous telemedicine programs in Brazil. • Detail how ongoing synchronous videoconference-based telemedicine programs at Hospital Israelita Albert Einstein were developed, specifically the Virtual Emergency Room, a direct-to-patient urgent care delivery system, and its preliminary results.
DIRECT TO CONSUMER STRATEGIES
DTC-12
• Understand and appreciate the key legal and regulatory rules for direct-to-patient telemedicine services across the United States. • Conduct their own due diligence and identify legal requirements for their telemedicine company, as well as effective compliance strategies to address them. • Engage in meaningful discussion of legal and regulatory issues specifically tailored to direct-to-patient entrepreneurs.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-10
• Upon completion, participants will be able to explain the concept of a measurement framework and its application to assessing and evaluating telehealth services. • Upon completion, participants will be able to appraise the effectiveness of measure concepts in assessing specific modalities of telehealth and their use across various clinical areas. • Upon completion, participants will be able to identify those measure concepts and existing quality measures they can use to assess and evaluate telehealth services within their own program.
References:
1.
2.
CLINICAL SERVICES
CS1-06
• Upon completion, participants will be able to identify key areas of concern when initiating telepsychiatry practice. • Upon completion, participants will be able to understand interjurisdictional practice issues when practicing telepsychiatry. • Upon completion, participants will be able to understand prescribing and patient safety practice when practicing telepsychiatry.
References:
1. Greene J, Yellowlees PM. Electronic and remote prescribing: administrative, regulatory, technical, and clinical standards and guidelines, April 2013. Telemed J E Health. 2014;20(1):63-74.
2. Shore J. The evolution and history of telepsychiatry and its impact on psychiatric care: Current implications for psychiatrists and psychiatric organizations. Int Rev Psychiatry. 2015;27(6):469-75.
3. Shore JH. Telepsychiatry: videoconferencing in the delivery of psychiatric care. Am J Psychiatry. 2013;170(3):256-62.
OPERATIONS AND IMPLEMENTATION
O-08
• Demonstrate the clinical, operational, financial value achieved through the integration and adoption of a cloud-based telehealth/virtual specialty care tool within a large county jail (public health System, community-oriented not-for-profit perspectives). • Highlight the benefits an eConsult/eReferral tool can have on average response time, no-show rates, avoidable visits, cost savings (e.g., transportation and security), patient safety and health outcomes in correctional health. • Identify best-practices for care coordination around specialty care, through the use of a virtual specialty care solution to identify and prioritize patients in need of timely access to specialty resources.
DIRECT TO CONSUMER STRATEGIES
DTC-11
• Measure success in a virtual clinic by identifying key metrics and understanding how to interpret their trends. • Set proper patient expectations for virtual care through positive digital marketing messaging. • Understand why it is critical for collaboration between marketing and providers to improve patient experience and maintain high quality outcomes.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-08
• Compare and contrast three different approaches to successfully offering sustainable tele-emergency services. • Analyze the benefits and effectiveness of tele-emergency services through a review of research findings. • Demonstrate knowledge of methods for evaluating and building the evidence base for telemedicine.
References:
1. Fairchild RM, Kuo SF, Laws S, O'Brien A, Rahmouni H. Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition. Open Journal of Nursing. 2017;7:721-33.
2. Mohr NM, Vakkalanka JP, Harland KK, Bell A, Skow B, Shane DM, Ward MM. Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients. Telemed J E Health. July 2017, ahead of print.
3. Van Oeveren L, Donner J, Fantegrossi A, Mohr NM, Brown CA 3rd. Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study. Telemed J E Health. 2017;23(4):290-97.
OPERATIONS AND IMPLEMENTATION
O-09
• Identify, analyze, and visualize data. What are the trends and trajectories? • Compare reason for visit, demographic, and clinical data across different sources of care: nurse advice lines, telemedicine, and emergency department. Why do patients seek care and where do they go? • Outline an approach to defining evidenced-base practice. How can we use benchmarking results, process and outcome data, best practice, and commonsense in clinical care and guideline development?
CLINICAL SERVICES
CS1-08
• Upon completion, participant will be able to demonstrate how to issue spot a telehealth arrangement. • Upon completion, participant will be able to recognize issues that may need legal review. • Upon completion, participant will be able to use a checklist of legal issues to review that will serve as a practical takeaway for participants.
OPERATIONS AND IMPLEMENTATION
O-06
• Describe the unification of public and private partnerships when faced with historic complex, fast-moving crisis to adapt existing models by incorporating telemedicine as a hub in hurricane disaster management. • Describe the essential relationship between the routine utilization of telemedicine in pre-disaster healthcare and effective employment in disaster situations. • Describe the use and implementation of traditional media outlets and different Social Media Platforms for Disaster Management.
References:
1. We are just now clearing debris post-Hurricane Irma in South FL. The data we are collecting is brand new from experience of Hurricanes Matthew, Harvey and Irma; all of which will be presented should our proposal be accepted.
CLINICAL SERVICES
CS2-06
• Upon completion of this session the participant will be aware of the Collegial Multisite Difficult Case / Sentient Event Review protocol. • Upon completion of this session the participant will be able to use a protocolized review to amplify performance improvement, knowledge dissemination and teambuilding. • Upon completion of this session the participant will be able to utilize the protocol for the debriefing process from introduction through collaborative examination of the essential components of the case.
References:
1. Cannon-Bowers JA. Individual and team decision making under strPs.\' Theoretical underpinnings. In: Cannon-Bowers J.A., Salas E. (eels.): lvfaki11g Decisions Under Stress: Implications for Individual and Team Training. Washington, DC: American Psychology
2. Sc1las E, et al.: Special section commentary: Opportunities and challenges for human factors and ergonomics in enhancing patient safety. Hum Factors 2006;48:1-4.
3. Mathieu JE, et al. The influence of shared mental models on team process and performance. J Appl Psychol 2000;85(2):273-83.
CLINICAL SERVICES
CS1-07
• Are you using telehealth? • If yes, how are you using telehealth? • If not, why not?
The results showed that almost 40% of FQHCs use telehealth and 20% more are either planning to implement or are researching the use of telehealth. Mental health is the most common service. A few FQHCs reported they had stopped using telehealth. This presentation will examine the results for users and non-users in the context of rurality, state, service types or other characteristics. Reasons for non-use such as technology, reimbursement, regulations or other issues will be addressed.
• Know the extent of telehealth usage by Federally Qualified Health Centers. • Understand what clinical services are being addressed by telehealth in FQHCs. • Understand the impediments to increased use of telehealth in FQHCs.
CLINICAL SERVICES
CS2-10
• Upon completion of this session the participant will be familiar with the emergent innovation and opportunity for evolved practice in the N of 1 patient care construct. • Upon completion of this session the participant will have a guide for the creation of assessment based, evidence driven, context specific, patient care plans. • Upon completion of this session the participant will have a guide to N = 1 care and the use of Telehealth as a model for the N = 1 single patient trial.
References:
1. Guyatt G, Sackett D, Adachi J, Roberts R, Chong J, et al. A clinician's guide for conducting randomized trials in individual patients. CMAJ 1988; 139: 497-503.
2. Buchman TG. Nonlinear Dynamics, Complex Systems, and the Pathobiology of Critical Illness. Curr Opin Crit Carer2004;10:378–382.
3. Suki B, Alencar AM, Sujeer MK, et al. Life-support system benefits from noise.
4. Mutch WA, Harms S, Ruth Graham M, et al.: Biologically variable or naturally noisy mechanical ventilation recruits atelectatic lung. Am J Respir Crit.
CLINICAL SERVICES
CS1-09
• Upon completion, participant will be able to identify technology innovations to increase fidelity to evidence-based mental health practices. • Upon completion, participant will be able to generalize how adaptations in existing technology may impact patient care. • Upon completion, participant will be able to consider which types of technologies may be leveraged in order to augment telemental health treatment.
CLINICAL SERVICES
CS2-08
• Outline key steps to implement virtual programs supporting: multidisciplinary tumor boards, discharge planning, and pre/post chemo visits; that are designed to improve care coordination, clinical outcomes, and patient/provider satisfaction. • Explain the implementation challenges, service costs, and the effective management of financial impacts to tertiary healthcare institutions arising from cancer care digital platforms and virtual care programs. • Describe upcoming virtual care programs in development, such as integrated dashboards linked to data analytics and data trending, that will create new care opportunities and transform cancer treatment.
References:
1. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017
2. Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncology, 2017;3(4):524-48.
3. Singleterry J. (2017). The Cost of Cancer: Addressing Patient Costs. The American Cancer Society Cancer Action Network.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-12
• List concrete benefits that telehealth programs provide long-term/post-acute care (LTPAC) providers. • Identify revenue models that enable LTPAC operators to pay for telehealth solutions. • Describe ways to leverage telehealth for competitive advantage with referral sources and client retention.
DIRECT TO CONSUMER STRATEGIES
DTC-16
The clinician who requests this remote monitoring is prompted to set parameters in which to be notified if the patient falls outside of “normal” range. These breaches generate an alert to the monitoring clinician, indicating intervention is needed. The clinician contacts the patient and first attempts to make adjustment, keeping patient in the home, however, if necessary, patient is instructed to return to hospital.
• Gain an understanding of how to develop a direct to consumer telehealth program utilizing with scalable infrastructure to monitor patients in the home with chronic health conditions post procedure. • Define how to illicit patient participation in self-care and integrate with an EMR patient portal. • Define and take advantage of our “Lessons Learned” to streamline setting up this process in their facility.
CLINICAL SERVICES
CS1-11
• Use an Implementation Checklist to Develop a Telehealth Transition of Care Program. • Apply Quality Improvement Tools in Telehealth Implementation. • Systematically Identify Medically Complex Patient Cohorts that would Benefit from Telehealth.
References:
1. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-67.
2. Skolarus TA, Lehmann T, Tabak RG, Harris J, Lecy J, Sales AE. Assessing citation networks for dissemination and implementation research frameworks. Implementation Science 2017;12:97.
3. Cady RG, Erickson M, Lunos S, et al. Meeting the Needs of Children with Medical Complexity Using a Telehealth Advanced Practice Registered Nurse Care Coordination Model. Matern Child Health J 2015;19:1497-1506.
CLINICAL SERVICES
CS1-14
We designed a pragmatic, randomized research evaluation among patients in behavioral health crisis who present to an ED and receive a telepsychiatric consult. We describe team composition, design of the BH-VPN service, and enrollment status. The results herein focus on the effect this initiative has on the conversion from ED discharge to hospital admission.
Available evidence suggests that adoption and utilization of virtual care in tandem with wrap-around services may reduce utilization and improve health outcomes. However, variations in study designs limit our ability to draw definitive conclusions. By integrating virtual patient navigation into the existing telepsychiatry program, we expect to decrease the number of patients admitted for inpatient psychiatric treatment from the ED. The methods and results described here provide a template for conducting research to improve outcomes among behavioral health patients that present to an emergency department.
• Participants will possess a template for conducting research to improve outcomes among behavioral health patients that present to an emergency department. • Participants will walk away with an understanding of lessons learned to implementing and managing a randomized research evaluation among patients in behavioral health crisis. • Participants will be able to interpret the results of a virtual patient navigation program aimed at reducing conversion from ED discharge to hospital admission.
CLINICAL SERVICES
CS2-13
• Describe the statewide telestroke network. • Compare patient process measures and outcomes in those treated via the telestroke network and those receiving traditional care accessed through the hub emergency department. • Evaluate the safety of tPA when administered thorough telestroke within a 4.5-hour window.
References:
1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731.
2. Al Kasab S, Adams RJ, Debenham E, et al. Medical university of South Carolina telestroke: A telemedicine facilitated network for stroke treatment in south carolina-a progress report. Telemed J E Health. 2017;23(8):674-77.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-16
• Understand how growing digital platforms, as demonstrated over the last 20 years, displaces local providers, with clear analogies to the development of each phase of new Internet services. • Describe the competitive dynamics that will evolve as telemedicine platforms threaten the practices of established local providers and detail strategies for success. • Describe the critical role building trust and a superb consumer experience will play in the growth of telemedicine and detail several clear methods of realizing these objectives.
References:
1. Are Healthcare Systems About to be Amazoned? Telemedicine and Lessons from Internet Services, The Huffington Post
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DIRECT TO CONSUMER STRATEGIES
DTC-14
When children are trained on the proper administration of their preventative and rescue medication and the reasons for each, they are better able to manage their condition themselves. This empowers them to take care of themselves, enables them to focus more on their academic pursuits, and frees up parents and school healthcare professionals.
In order to best meet students' needs, we developed a curriculum, delivered remotely, designed to give elementary school children the information they need to better understand and manage their asthma. We also established a system of evaluations to determine comprehension and iteratively made improvements to better understand students learning. Furthermore, we added behavioral measures (from students, parents, and the school) to determine if the implementation was having a tangible, practical effect on students' ability to focus on school.
In this session, participants and discussants will collaboratively consider key components of a successful school-based model including brainstorming additional ways these partnerships can be strengthened, contribute to the ongoing development of the evaluative material, explore the strengths and weaknesses of the existing results and methodologies. Takeaways include practical tips for building a successful model that can include both educational and clinical components as well as suggestions on developing an effective evaluation.
• Develop a school-based curriculum that trains students how to manage their chronic asthma. • Design and implement an assessment that evaluates students' comprehension of the principles of asthma management and gives behavioral evidence of successful management. • Analyze results to allow for ongoing intervention as needed and ensure continued viability of solution.
DIRECT TO CONSUMER STRATEGIES
DTC-18
• Identify strategies and tactics that maximize conversion rates for patient enrollment in a healthcare program. • Design an effective patient onboarding process that helps activate patients in managing their own care. • Demonstrate competency with consumer-focused outreach and communication.
References:
1. Groeneveld IF, et al. Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Activity 2009;6:80.
CLINICAL SERVICES
CS1-13
• Identify the value of a teleneonatology program. • Successfully perform and document a simulated teleneonatology consult. • Determine how teleneonatology can be included in your current practice.
References:
1. Fang JL, Carey WA, Lang TR, Lohse CM, Colby CE. Real-time video communication improves provider performance in a simulated neonatal resuscitation. Resuscitation. 2014;85(11):1518-22. Epub 2014 Aug 15.
2. Fang JL, Collura CA, Johnson RV, Asay GF, Carey WA, Derleth DP, Lang TR, Kreofsky BL, Colby CE. Emergency Video Telemedicine Consultation for Newborn Resuscitations: The Mayo Clinic Experience. Mayo Clin Proc. 2016;91(12):1735-43 Epub 2016 Nov 22.
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CLINICAL SERVICES
CS2-12
• Demonstrate how to utilize screen capture software to create custom diagnostic imaging review videos for patients. • Understand how to utilize the program in their clinical workflow. • Describe how personalized multimedia can be used in a multitude of clinical settings and care transitions.
References:
1.
OPERATIONS AND IMPLEMENTATION
O-13
• Upon completion, participants will be able to leverage the PETAL Framework to engage communities and advance health equity. • Upon completion, participants will learn how to leverage existing technologies, data standards and analytics to address health disparities. • Upon completion, participants will learn practical strategies, tips and techniques to address health disparities in their individual systems and communities.
References:
1.
OPERATIONS AND IMPLEMENTATION
O-15
- Nobody else is really interested in the work I do
- I don't have the time to put my findings into words, especially words that others would understand
- My manuscript was rejected; why resubmit?
- I don't know how to say what I think, what I've done, or what I've discovered in a way that would make sense to others
- These are really interesting findings, but statistical analysis will kill me; or my results
- This work isn't good enough for that journal
- I don't think there's anyone who'd be interested in collaborating on this project
- This will cost too much money
- This was such a small sample; the results are probably meaningless. I do not understand the statistics necessary to do this work.
- This work was already done
The principal aim of this workshop is to facilitate and stimulate scholarly publication in telemedicine.
Planned topics and (presenters) follow:
Introduction; Why Publish?
Getting started; setting up; work environment; staying focused; following through
Open Access journals (including blogs); publishing a book; submission process
Statistics
Making the editors happy: Following author instructions; responding to revision suggestions; contacting editors; etc.
• Describe the key elements of a well-written telemedicine research or white paper. • Compare and contrast the characteristics of a “good” paper with those of a “bad” one. • Show how an unsatisfactory paper can be converted into one that is acceptable for publication.
DIRECT TO CONSUMER STRATEGIES
DTC-19
• Define the different types of telepharmacy and how they are expanding the reach of the pharmacist. • Explain community or outpatient telepharmacy, how it started, and how it is helping the pharmacist to better deliver care to patients. • Describe the regulatory environment around the U.S. and what states are doing with rules.
References:
1. Source: Update: Independently Owned Pharmacy Closures in Rural America, 2003-2013; RUPRI Center for Rural Health Policy Analysis, Rural Policy Brief June 2014; Fred Ullrich, BA; Keith J. Mueller, PhD Source: Source: ‘Pharmacy Deserts’ Are Prevalent In.
2. Source: Quarles & Brady LLP analysis & report, July 2016;Source: North Dakota Telepharmacy Project
3. Source: Pharmacists as Influencers of Patient Adherence, August 21, 2014, Joseph Moose, PharmD, and Ashley Branham, PharmD, BCACP. Source: Lack of pharmacy access sends some patients back to the hospital; Oregon State University and Oregon Health & Science.
OPERATIONS AND IMPLEMENTATION
O-11
• Gain insights into the planning and development of an innovative consortium network model to create a multi-stakeholder telehealth network to save lives and improve patient outcomes. • Acquire an understanding of care integration planning that brings rural and urban telemedicine and telehealth remote monitoring stakeholders together to create economies of scale and reduce costs. • Understand the planning and operational deployment of a telestroke, telehealth remote monitoring, and virtual urgent care and other programs in a rural setting with diverse stakeholders.
References:
1. Ostrom E. (2008). Governing the Commons. Cambridge, NY: Cambridge University Press.
2. Komaramy J.K., et. al. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care. Health Aff, 2011;30(6):1176-1184. Available at:
3. HRSA. “The Network Guide: A technical assistance resource developed by the Health Resources and Services Administration (HRSA) and the National Association of Community Health Centers (NACHC). Available at:
DIRECT TO CONSUMER STRATEGIES
DTC-15
• Articulate the methodologies related to Online Group Counselling (OGC) programs and identify the practical applications for this service modality. • Summarize the benefits of using innovative digital solutions like OGC to reach new and historically difficult to engage users, improve user engagement, and enhance service delivery options. • Report on best practices, client satisfaction, and outcomes related to Online Group Counselling services.
References:
1. Mark Attridge, PhD, MA, President Attridge Consulting, Inc.,
2. Jan Price, LCSW, CEAP, Director, Education and Credentialing, Employee Assistance Professionals Association,
3. Bob McLean, CAE, President, REM Association Services, PO Box 3146, Norfolk, VA 23514-3146, P 703-416-0010, F 703-416-0014,
CLINICAL SERVICES
CS1-16
• Describe patient safety benefits of a post-ED discharge virtual care program; • Quantify adoption rates in this unique post-acute ED application of telehealth; and • Contrast patient satisfaction data before and after implementation of the Safe Transitions program.
CLINICAL SERVICES
CS1-15
• Assess their organization's emergency and disaster preparedness. • Gain a new understanding of the needs of foreign language and Limited English Proficiency speakers in a crisis situation, as well as what provisions are required by law. • Design a scalable and effective crisis management plan and procedure that offers customers the resources and help they need in every language.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-17
• Identify the diverse factors that compel investigation of tele-ICU adoption – and how they differ by hospital type or setting. • Understand how various hospitals participate in, and benefit from, the resources of a tele-ICU program differently. • Recognize what influenced – and continues to influence – hospital and system leaders' valuation of tele-ICU at their particular organization.
References:
1. Tele-ICU Clinical,Operational, and Financial Results for Takoma Regional Hospital.
2. Tele-ICU Clinical,Operational, and Financial Results for Western Maryland Health System.
3. Tele-ICU Clinical,Operational, and Financial Results for St. Elizabeth Healthcare.
CLINICAL SERVICES
CS2-11
• Upon completion, participants will be able to identify key components necessary to plan for rapid deployment of Telemedicine in preparation for response to a disaster. • Upon completion, participants will be able to define key barriers to success and potential solutions in relation to establishing connectivity in times of natural disasters. • Upon completion, participants will be able to utilize knowledge gained from this seminar to plan for a similar response within their respective Telemedicine programs.
References:
1.
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CLINICAL SERVICES
CS1-12
• Define virtual reality, augmented reality, and telepresence and illustrate common applications in life, science, medicine and healthcare. • Describe types of VR, AR and TPr and suggest a spectrum of levels on a continuum for the participants involved. • Discuss the role of VR, AR and TPr in individual learning and in engagement and communication with others.
References:
1. Parsons TD, Gaggioli A, Riva G. Virtual reality for research in social neuroscience. Brain Sci. 2017 Apr 16;7(4):pii:E42.
2. Boninger ML, Wechsler LR, Stein J. Robotics, stem cells, and brain-computer interfaces in rehabilitation and recovery from stroke: updates and advances. Am J Phys Med Rehabil. 2014;93(11 Suppl 3):S145-54.
3. Hilty DM, Randhawa K, Maheu M, Pantera R. A concise review of virtual reality, augmented reality and telepresence: definitions, approaches and applications. J Technology in Behav Sci, Submitted.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-18
• Understand the healthcare technology innovation “scene” in Chicago and the Midwest more broadly, and the role of geography in managing a successful company. • Identify why 90% of start-ups fail to survive, and learn the principles, guideposts and strategies of successful companies to thrive (and to not fall within the 10% that do not). • Understand when to keep forging ahead with the creation and operation of a promising digital health company and when to “close up shop” to explore other opportunities.
References:
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VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-14
• Incorporate previous successes and challenges into the design process (tested framework, workflows, mitigation of regulatory, licensing, credentialing, and reimbursement hurdles). • Identify tangible indicators of TeleHealth opportunities and success. • Learn of improved collaboration/collegiality strategies between originating and distant site, measured by increases in TH consults/utilization.
References:
1. Wechsler LR, Demaerschalk BM, Schwamm LH, et al. Telemedicine Quality and Outcomes in Stroke. Stroke (2017): 48:e3-e25.
2. Kirch DG, Petelle K. Addressing the Physician ShortageThe Peril of Ignoring Demography. JAMA. 2017;317(19):1947–48.
OPERATIONS AND IMPLEMENTATION
O-14
• Identify the existing and evolving use cases for artificial intelligence in healthcare operations. • Identify the legal, regulatory and operational challenges associated with use cases. • Explore new challenges presented by the application of artificial intelligence in healthcare.
DIRECT TO CONSUMER STRATEGIES
DTC-17
• Identify how a social media community can benefit patients, patient family caregivers, and clinical staff while staying compliant with privacy laws. • Empower patients to reduce isolation that results from chronic disease. • Enhance patient-centered delivery of surgical care by providing asynchronous answers to questions and concerns that often go ignored causing isolation and a perceived disconnect with their provider.
VALUE (BUSINESS STRATEGY AND FINANCIAL MANAGEMENT)
V-15
• Learn about the methodologies used to develop and deliver a complex, multi-faceted Provincial eConsult Initiative. • Gain insights from research from clinical champions and user experiences representing the perspective of primary care providers and specialists. • Understand the value drivers resulting in better access to specialist care and shorter wait times.
References:
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OPERATIONS AND IMPLEMENTATION
O-12
• Understand the clinical and economic evidence for telemedicine's impact on reducing hospital readmissions. • Differentiate the clinically-relevant features of commercially available systems. • Reference case studies of successful implementations & the key financial and operational drivers of success.
References:
1. MATRC - Telehealth Efficacy, Efficiency and Evidence Base.
2. ECRI Research and Health System Client case studies.
3. VA research.
CLINICAL SERVICES
CS2-14
• Describe solutions to address technological, administrative and clinical challenges. • Explain the challenges delivering telehealth services in a primary care network that includes FQHCs and RHCs. • Discuss techniques for improving physician engagement in providing and using telehealth services at both distant and receiving sites.
ePoster Presentations Abstracts
Clinical Services
EPOSTER PRESENTATIONS
EP-100
Growth of TeleProsthetics and Orthotics has been hindered by the “hands-on” approach 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 using new technologies. TeleProsthetics and Orthotics is now being considered as an exciting alternative model of care that can assist patients in gaining their ultimate functional outcome.
Veterans residing in rural areas can greatly benefit from the growth of TeleProsthetics and Orthotics. In addition to mobility issues, many have socioeconomic factors that affect their ability to receive needed care. Moreover, many live in areas that are void of Prosthetic providers. 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 TeleProsthetics and Orthotics. For over half a decade, the Midwestern VAMCs have been a national leader in the VA for the number of Veterans served by TeleProsthetics and Orthotics. In the Midwest, TeleProsthetics and Orthotics program was initiated in 2012, and a handful of patients was seen at the VAMCs in Wisconsin. The Teleaudiology program has expanded and is conducted at VAMCs in Madison, Tomah, and Milwaukee, WI as well as the VAMC in Danville, IL. The TeleProsthetics and Orthotics program has exponentially grown from 16 patients in 2012 to over 650 patients in 2017.
This poster presentation will focus on the necessary tools for a successful TeleProsthetics and Orthotics program. It will discuss equipment, staff training, quality management, and data driven outcomes, including rurality and patient satisfaction, with a focus on practical applications and lessons learned.
• Implement a successful Prosthetics and Orthotics program through Telemedicine. • Describe the benefits of TeleProsthetics and Orthotics as it relates to patient satisfaction and reaching rural Veterans. • Demonstrate relevance of lessons learned through Prosthetics and Orthotics Telemedicine program.
Clinical Services
EPOSTER PRESENTATIONS
EP-101
• Upon completion of this session, participants should be able to explain how telehealth has been successfully used for remote patient monitoring beyond eICU, home, and chronic care settings. • Upon completion of this session, participants should be able to demonstrate how virtual specialty care benefits rural patients. • Upon completion of this session, participants should be able to distinguish clinical outcomes measuring benefits of remote patient monitoring.
References:
1. Kleinpell R, Barden C, Rincon T, McCarthy M, Zapatochny RJ. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units. Am J Crit Care. 2016;25(1):14–20.
2. Williams LM, Hubbard KE, Daye O, Barden C. Telenursing in the intensive care unit: transforming nursing practice. Crit Care Nurses 2012;32(6):62–69.
3. Goran SF. Measuring tele-ICU impact: does it optimize quality outcomes for the critically ill patient? J Nurs Manage. 2012;20(3):414–28.
Clinical Services
EPOSTER PRESENTATIONS
EP-102
In order to deal with a great number of patients seeking emergency care for suspected dengue fever, many hospitals, especially public ones, set up especial tents for dealing with massive patient overflow. Patients were referred to those “Dengue tents” mostly from primary care units. The routine procedure consisted of an initial screening performed by registered nurses, including vital signs (temperature, blood pressure, heart rate, and respiratory rate), and blood sampling for platelet count, hematocrit and a point-of-care dengue-specific diagnostic test (NS1 antigen testing).
There is no specific treatment for dengue fever. Intravenous or intensive oral hydration and clinical support therapies are the mainstream of treatment. Brazilian Ministry of Health defined specific guidelines for risk classification and treatment, which were precisely followed. After initial screening and blood testing, patients were classified by potential risk of complications, oral or intravenous hydration were prescribed and patients were then referred for a live video visit or traditional consultation with a medical doctor, following a simple queue. The physician was responsible for deciding between discharge, outpatient treatment or hospitalization.
Between April and May 2015, over 2900 patients attended our Telemedicine-assisted “Dengue tent”, located at the parking lot of a primary-care health facility in a remote area of São Paulo. During working hours, there were ten doctors available onsite and one at a distance, available through real-time videoconference. More than 2000 patients (67%) received the diagnosis of Dengue fever, 272 (13,6%) of which evaluated by a real-time video consultation. 256 (94,1%) were immediately discharged and only 16 cases (5,9%) were referred to traditional care, additional intravenous hydration or hospital admission.
In conclusion, our experience shows that in a resource poor environment facing an overflow of patients due to a dengue fever outbreak, a telemedicine-guided strategy within a “Dengue Tent” can be an effective solution to optimize patient flow and staff allocation. There is a potential cost reduction and an achievable 94,1% resolution rate without compromising quality of care.
• Understand and define use of telemedicine in a crisis situation, such as a dengue fever outbreak. • Conduct a telemedicine-guided strategy for optimal risk classification and treatment decision in high demand for emergency service situations. • Assess the results of a telemedicine-guided strategy designed to deal with a major infectious disease outbreak in a resource-poor environment.
Clinical Services
EPOSTER PRESENTATIONS
EP-112
• Identify trends in the growth of a school-based telehealth program. • Recognize the limitations of data collection from an EHR and the need for additional tools to analyze impact of a school-based telehealth program. • Describe the factors impacting year over year utilization of a school-based telehealth program.
Clinical Services
EPOSTER PRESENTATIONS
EP-113
Until recently, the practice of transferring patients with ocular conditions was standard of care at a local community hospital emergency department. Of all transfers from the community hospital ED to the ED at the nearest academic tertiary care institution, 40% are for eye conditions, and many are ultimately deemed unnecessary transfers. Most patients who present to an emergency room with an eye complaint will have a minor condition that likely can be safely diagnosed and managed remotely with a high-resolution camera. Tele-ophthalmology with video visits is not common in ophthalmology as specialized equipment, such as a slit lamp, is often necessary and requires skilled users. However, most patients who present to the ED with an eye problem have minor anterior segment conditions which can be evaluated with a simple high-resolution camera, which does not require a highly trained operator.
In hopes of improved outcomes, a pilot initiative to evaluate ocular emergencies using remote technology for a video visit combined with a high-resolution hand-held camera was implemented at the community hospital ED. Through the telemedicine program, when patients are triaged and noted to have an eye problem, they are given the option to connect with an ophthalmologist by video for remote evaluation rather than wait for an in-person examination by a provider not trained in eye care.
Since implementation of this technology three months ago, 8 patients have been remotely evaluated and 7 were deemed to not require transfer to a second ED. All patients were seen in person for a follow-up evaluation, which confirmed the telemedicine diagnosis in each case. Each avoided transfer saved the patient significant waiting time, up to 100 miles travel if traveling by car and the health system between $4,000 and $6,000 if an ambulance transfer was avoided.
Ophthalmology tele-consultation in the ED allows accurate diagnosis and demonstrates considerable savings incurred by the healthcare system by reducing patient transfers and a second emergency admission. Patient time and transportation savings are also realized. Tele-ophthalmology in the community hospital ED is a viable alternative to transfer to a tertiary care center for in person evaluation by an eye care provider.
• Understand the nature of eye emergencies and the frequent lack of on-call ophthalmic providers in community hospital emergency departments. • Recognize how tele-ophthalmology can be utilized in the emergency department. • Appreciate potential benefits to patients and reduction in healthcare costs realized with tele-ophthalmology visits in the emergency department.
References:
1. Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of Eye-Related Emergency Department Visits. JAMA Ophthalmol. 2016;134(3):312–19.
Clinical Services
EPOSTER PRESENTATIONS
EP-114
At the Medical University of South Carolina Children's Hospital Pediatric Burn Program, we have designed, developed, deployed and trialed a novel smartphone application (TeleBurn app) to treat partial thickness burns in the outpatient setting. The app allows the provision of tertiary clinical burn care directly in the patient's home through store-and-forward pictures, text messaging, video conferencing, educational videos, and frequently asked questions (FAQs). After IRB approval, we retrospectively reviewed clinical outcomes and feasibility data in pediatric burn patients with partial thickness burns. A comparative study was performed between a cohort of patients offered the TeleBurn app with standard therapy (APP) compared to a similar cohort of patients burns treated with standard therapy alone (ST). Clinical burn care was provided to 32 patients via the APP and 25 patients with ST in patients with partial thickness burns treated with advanced burn dressings on an outpatient basis, such as Mepital AG and Biobrane. In the APP cohort, feasibility data demonstrated that 74% of patients and families used the app, with 26% refusing, in 14 counties in South Carolina, with more than 50% usage across all major ethnic groups. There were no burn wound infections or unexpected return to clinic or the emergent department. For the APP group, a total of 239 burn store-and-forward pictures (mean, range: 6, 0-34) were sent. 529 messages were sent between burn expert provider and the patient/family, with a range of 0-162. Four patients utilized the video calls (11%). The burn dressing change tutorial videos were accessed by the 32 patients a total of 155 times (4.2, 0–10). The FAQ page was accessed by the 32 patients a total of 120 times, range: 0–14. In comparing APP to ST groups, the populations had similar burn characteristics, with the mean %TBSA in the APP cohort of 4% (range: 1–16%) vs 6% (range:1–15%) in the ST group (p = 0.75). The time to burn healing in days was similar between groups (APP vs ST, (mean±SD, range) 12.6±5.7, 6-25 vs 11.6±4.7, 5-22, (p = 0.9). The mean number of in-person clinical encounters was 3.3 versus 0.93 (p = 0.03).
This project describes a functional, tested, scalable TeleBurn app in clinical use in a pediatric burn program in South Carolina. Further prospective, randomized study may validate home-based clinical burn care via mobile technologies, improving access to expert burn care to a vulnerable population.
• Define the role of telemedicine in the outpatient treatment of acute burn injury. • Describe the rationale for using telemedicine for the outpatient treatment of burn injury. • Understand the benefits of using a smartphone application for the direct provision of care to burn injured patients at home.
References:
1. Wallace DL, Hussain A, Khan N, Wilson YT. A systematic review of the evidence for telemedicine in burn care: with a UK perspective. Burns. 2012;38(4):465–80.
2. Wallis L, Fleming AJ, Hasselberg M, Laflamme ML, Lundin J. A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care. PLoS One. 2016;11(2):e0147253.
3. Theurer L, Bashshur R, Bernard J, Brewer T, Busch J, Caruso D, Coccaro-Word B, Kemalyan N, Leenknecht C, McMillan LR, Pham T, Saffle JR, Krupinski A. American Telemedicine Association Guidelines for Teleburn. Telemed J E Health. 2017;23(5):365–75.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-124
• Grasp the opportunities and challenges of an employed provider group. • List 3 examples of the clinical quality benefits of an employed provider workforce including antibiotic stewardship, primary care based mental health and peer review. • Describe the quality performance of a leading national medical practice.
References:
1. JAMA. 2016;315(17):1864–1873. doi:10.1001/jama.2016.4151
2. JAMA Intern Med. doi:10.1001/jamainternmed.2015.8248 Published online April 4, 2016.
3.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-125
• Understand how redesigning a virtual care user interface based on user experience data can impact key metrics. • Name the key components of user experience and how each relates to virtual care. • Characterize the impact of user experience on patient satisfaction and successful visit completion.
References:
1. Gold WR, Manning TR, Street RL. (1997). Health promotion and interactive technology: theoretical applications and future directions. Mahwah, NJ: Lawrence Erlbaum Associates.
2. Irizarry T, Dabbs AD, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Research. 2015;17(6). doi:10.2196/jmir.4255

3. Bate P, Robert G. (2007). Bringing user experience to healthcare improvement: the concepts, methods and practices of experience-based design. Oxford: Radcliffe Pub.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-126
This ePoster presentation will explore the factors that have contributed to the successes and struggles of the on demand rapid flu testing implementation and discussion of Mission Virtual Clinic's motivation for implementation.
• Discuss the need, the implementation, and successes and challenges of on demand rapid flu testing. • Review guidelines including treatment options for diagnosis of flu through the Virtual Clinic. • Review of on demand rapid flu testing data to include utilization, protocol adherence, and customer satisfaction.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-135
We offer a comprehensive Patient Recruitment, Engagement & Loyalty program for reimbursable Chronic Care Management. The Cloud DX platform delivers remote patient monitoring, vital signs integrated directly into the EMR, time tracking for reimbursement billing, and a full suite of patient engagement and education tools that includes a personalized kit of medical devices the patient gets to keep at home.
Cloud DX Connected Health Kits include an Android tablet computer, Pulsewave® wrist-cuff blood pressure monitor and any combination of wireless scale, oximeter, thermometer & glucometer, delivered directly to patients / users. Our pre-installed mobile software app offers cloud-based services that generate unique metrics including cardiac anomaly score, care plan adherence score and mobile dashboards accessible from any browser.
Cloud DX clinical workflow optimization software includes smart scheduling & medication reminders, smart notifications of changes to remote vital signs, secure 2-way text messaging & 2-way video conferencing with the patient, a mobile Health News Feed that delivers curated videos, articles, questionnaires and surveys plus the ability to add patient 'friends & family' to the circle of care.
Our customers use the integrated Cloud DX platform to streamline clinic workflows, recruit eligible patients for chronic care management programs, educate patients regarding their conditions, connect patients to care plan resources, involve patients' families in their care and drive patient loyalty to the reimbursement program. In one on-going pilot project (in Ontario, Canada), Cloud DX Connected Health services improved patient adherence to care plan from 67% (before the pilot) to 89%.
• See the value connected health has on improving patient care. • Feel empowered to take charge of their own health and monitor vital signs. • Feel confident knowing clinician help is only a button away.
References:
1.
2.
3.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-136
The burn telemedicine team is always looking to improve the way they provide care. Two areas of focus have expanded utilization of telemedicine; use of the full time burn psychotherapist and asynchronous store and forward telemedicine services.
Psychotherapy is offered full time at Regions Burn Center as of 2015 by an LCSW. In 2017 to make accessing care easier the psychotherapist started offering telemedicine follow up appointments to patients. This not only made it easier and more convenient for patients to receive care, it also helped the Regions Burn Center track PHQ9 scores, a key metric used in predicting post-traumatic stress.
While video telemedicine follow ups have been sown to be an efficient method to reduce the number of loss to follow up cases, additional processes may improve upon this rate such as transmission of burn pictures through an asynchronous store and forward system. In particular, allowing patients to transmit burn pictures directly from home in a safe and secure method was a key motivator for Regions Burn Center to develop a store and forward service. Multiple transmission methods were considered and many found to be useful.
Future uses of telemedicine currently under exploration are complementing in-person remote clinic visits, school reentry program assessments and virtual vocational rehabilitation services.
• Analyze the challenges around using various telemedicine platforms as a hub site for burn care. • Explain the value of a burn psychotherapist and their use of telemedicine to provider care to patients in a large geographic area. • Compare various transmission methods of pictures in a store and forward application in a burn department, including submission of pictures directly from patients at home.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-137
When patients need to be seen face-to-face at TAMC, whether inpatient or outpatient, additional coordination is required, and additional transparency of information supports a smoother and safer handoff of the patient. From the coordination of the flight medical crew on a military aircraft to the scheduling of multiple specialty visits prior to arrival to decrease the length of stay/time away from home, integrating the key roles for visibility supports better quality of care in a fiscally responsible manner.
The Pacific Asynchronous TeleHealth (PATH) system is a HIPAA-compliant platform used for provider-to-provider teleconsultation and, when required, aeromedical evacuation case management. PATH improves the quality of care provided, and reduces costs and length of stay. The purpose of the presentation is to review the overall workflow of PATH, using clinical examples as indicated that also demonstrate the various administrative support roles required. Additional data and clinical examples will show how PATH decreases the need for face-to-face referrals, and improves care coordination for complex and/or critical patients who require in-flight care on military flights.
• Upon completion, participant will be able to describe the importance of transparency between medical facilities using asynchronous communications when patient movement is involved. • Upon completion, participant will be able to describe key components of a successful platform that serves the dual role of asynchronous tele-consultation and patient movement. • Upon completion, participant will be able to describe the challenges of integrating tele-consultation with patient referral and movement across a very large geographic area.
References:
1. Mahnke CB, Jordan CP, Bergvall E, Pinsker JE, Person DA. The Pacific Asynchronous TeleHealth (PATH) System: Review of 1,000 Pediatric Teleconsultations. Telemed J E Health. 2011.
2. Lin AH, Cole JH, Chin JC, Mahnke CB. The Health Experts onLine at Portsmouth (HELP) system: One-year review of adult and pediatric asynchronous telehealth consultations. SAGE Open Medicine, 2016.
3. Navy and Marine Corps Public Health Center. Return on Investment Analysis of Health Experts onLine at Portsmouth (HELP). May 2016.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-147
In efforts to provide care for existing patients while accommodating new patient demand, our team is strategically expanding three key virtual care programs: virtual visits, eVisits, and eConsults. We strongly believe that expansion will improve patient access, engagement and experience.
As we scale our virtual visits program across the institution, we are targeting specific surgical and medical specialties with access challenges and strategic value to the organization. The specialty providers determine each patient's clinical appropriateness for program enrollment. Patients have enjoyed the convenience and flexibility that virtual visits offer, and by reducing or eliminating time needed for the waiting room, administrative duties, and rooming, providers typically complete a virtual visit in half the time scheduled for a routine office visit. This efficiency directly improves access by allowing office visits to become available for new or complex established patients. We will describe this effect with our organizational dashboard designed around telehealth.
The Brigham Health E-Visit program consists of a virtual tool that improves patients' access to their primary care providers (PCPs). The patient completes an online questionnaire; the provider reviews the patient's answers and determines the plan of care. The goal of the E-Visit tool is to control the PCP clinic's urgent primary care walk-in traffic. Providers are often able to virtually recommend at-home treatment for minimal severity conditions; thus, fewer patients need a provider's office visit time. In addition to this patient initiated process, we will pilot provider-initiated E-Visits in the near future. Our presentation will illustrate the E-Visit program's effect on PCP access and project E-Visits' expanded effects after we implement provider-initiated E-Visits.
Finally, providers, often PCPs, refer patients to specialists when they lack the expertise to diagnosis or treat a specific condition. Oftentimes, these referrals are clinically appropriate, but in many cases providers are able to treat the patient with appropriate specialty-specific information. The E-Consult program allows providers to virtually connect with specialists within the EHR to ask patient-specific clinical questions. The responding E-Consultant (specialist) offers expert advice and treatment recommendations. By keeping low severity patient care in a lower cost setting, specialists are able to prioritize new or complex follow up patients. We will demonstrate E-Consults' effect on patient access in our virtual care dashboard.
At the ATA conference, our team will share our lessons learned in scaling our virtual care pilots into organization-wide programs and present an evaluation dashboard used to assess virtual care's effects on patient access.
• Upon completion, participants will be able to describe our strategies, goals and lessons learned in expanding from small virtual care pilots to organization-wide programs. • Upon completion, participants will be able to demonstrate how we measure the value and impact that ambulatory virtual care has on clinical access in specialty departments. • Upon completion, participant will be able to outline how a large academic medical center spread virtual care across varied departments, practices, and providers.
References:
1. Harvard Business Review Article: One Hospital's Experiments in Virtual Healthcare (
2. American Journal of Kidney Diseases Journal: Electronic Consultations in Nephrology: Pilot Implementation and Evaluation (
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-148
One of the leading priorities of this office was to create a dedicated, centralized dashboard to communicate the value and impact of its projects within and beyond the institution. The framework below describes the process of building this dashboard.
Substantively, our health system has the following environmental characteristics with regards to data infrastructure and development of its telemedicine programs: 1. Decentralized operations with centralized IT 2. Heavy consolidation of IT under its EMR system 3. Highly prioritized data security within its data bureaucracy 4. Decentralized, clinically driven development of telemedicine programs 5. Limited consumer assessment surveys available for telemedicine 6. Degrees of socioeconomic determinants of health in target populations 7. Scalable relationships with third-party vendors for application development 8. Multi-hospital system in several states, a significant international division, and two major EMR vendors
Within this environment, the office attempted to develop its dashboard with the following milestones: 1. Data needs assessment 2. Resource assessment 3. Operationalization 4. Determination of KPIs 5. Test environment with use cases
Across the following value dimensions: 1. Access 2. Effectiveness 3. Experience 4. Financial Impact/Cost 5. Carbon Emission Reduction 6. The joy of medicine
The presentation will describe the lessons learned and achieve its learning objectives by examining the interactions between these three categories of environment, milestones, and dimensions and how they affect the liberation of data.
The findings discussed in the presentation will be useful for entities seeking practical information on large-scale, centralized telemedicine data collection in decentralized environments. It will also compare consequences of engagement with third-party data collection versus “home-grown” apparatuses and generally, the difficulties in collecting telemedicine data in modern, large health systems.
It will also provide mini-cases and examples demonstrating these interactions with specific emphasis on data liberation for large academic institutions.
• Identify available institutional resources and partnerships for telemedicine data. • Decide when to engage a third-party data apparatus. • Prospectively frame telemedicine data-collection initiatives.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-149
Thirty-six percent of the nurses surveyed responded that they strongly believed that the child would have visited an ED or Urgent Care Center if they had not been seen through the school telehealth visit. This equates to approximately 3,155 patients being highly likely to utilize these services. With a cost difference of approximately $1,215 between the ED and the school telehealth service, and approximately $106 between Urgent Care and the school telehealth service, this program potentially provides over $2 million in cost savings.
Forty-three percent of nurses responded strongly believed the school telehealth program reduced illness-related absenteeism, with another 38% somewhat agreeing. Furthermore, another 43% strongly believed the child would have left school without the school telehealth program.
On the other hand, over three-quarters of caregivers reported that the child would have missed at least a half of a school day without the telemedicine program. Based on responses, the school telehealth program may have averted over 12,000 illness-related absence days from more than 6,000 student contacts. At an average reimbursable rate of $9,559 per student for the State of Texas (in 2015), or a $53.11 per day reimbursement, this equates to over $650,000 saved to school districts in absences averted.
Transportation costs are yet another aspect of cost savings provided to the caregivers. By applying a $0.55 reimbursable rate to the distance brackets, the school telehealth program potentially saves upwards of $100,000 in travel costs. The average midrange cost for caregivers traveling at least 1 mile is almost $10.00.
• Discuss and identify carious avenues of exploring cost-savings opportunities found within a school telehealth program. • Discuss the potential indirect cost savings of school telehealth programs as a subsection of determining overall value for this and similar programs. • Discuss and identify challenges of determining cost savings, and determine the next steps in more accurately assessing cost savings.
References:
1. Robertson B, Clutter M, Hall-Barrow J. Telemedicine's greatest benefits may come through school-based programs. Telemedicine Magazine, 2017;Spring, Issue 8: 36-37.
2. Ashwood JS, Mehrota A, Cowling D, and Uscher-Pines L.. Direct-to-consumer telehealth may increase access to care, but does not decrease spending. Health Aff. 2017;36(3):485-91.
3. Dullet NW, Geraghty EM, Kaufman T, Kissee JL, King J, Dharmar M, Smith AC, and Marcin JP. 2017. Impact of a university-based outpatient telemedicine program on time savings, travel costs, and environmental pollutants. Value in Health. 2017;20:542-46.
Clinical Services
EPOSTER PRESENTATIONS
EP-103
• Demonstrate the implementation of a comprehensive telehealth program to care for newborns. • Demonstrate the impact of telemedicine consultations on transfer rates from rural hospital nurseries when compared to telephone consultations, the current standard of care. • define a new model of care to provide neonatal telehealth services to rural hospital nurseries from a tertiary care center to differentiate themselves in a competitive healthcare market.
Clinical Services
EPOSTER PRESENTATIONS
EP-104
• List key quality measures when developing and implementing a quality monitoring program within the participant's organization. • The participant will be able to compare their quality review process with the current process Cleveland Clinic is implementing. • Identify ways to develop guidelines to support evidence based practice.
References:
1. Healthcare 2014, 2(1), 74-93; doi:10.3390/healthcare2010074
Clinical Services
EPOSTER PRESENTATIONS
EP-105
• Participants will understand that there are currently no systematic reviews of psychiatric mental health advanced practice nurses' role using synchronous telepsychiatry. • Participants will understand the method used for this systematic review, including PRISMA guidelines and GRADE quality assessment. • Participants will understand the current utilization and recognize future opportunities for psychiatric mental health advanced practice nurses using synchronous telepsychiatry.
References:
1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Ser.
Preliminary Prior Research Presentation:
2. Finley, B.A., Maxiner, R., Shea, K. M., & Slebodnik, M. (March 2017). Psychiatric Mental Health APRN Telepsychiatry Usage: A Scoping Review. Poster presentation at AZBio Expo. Tempe, AZ.
Systematic Review Yielded Articles:
3. Bostrom AC. Technological advances in psychiatric nursing: An update. Nurs Clinics N America. 2016;51(2):51-160.
4. Ellington E. Telepsychiatry by APRNs: An answer to the shortage of pediatric providers? Issues Ment Health Nurs. 2013;34(9):719-721.
5. Ellington E, Repique RJR. Telemental health adoption can change psychiatric-mental health nursing practice. J Am Psychiatric Nurs Assoc. 2013;19(4):222-24.
6. Fetter MS. Improving information technology competencies: Implications for psychiatric mental health nursing. Issues in Mental Health Nursing. 2009;30(1):3-13.
7. Foster PH, Whitworth JM. The role of nurses in telemedicine and child abuse. CIN: Computers, Informatic Nurs 2005;23(3);127-31.
8. Gabel S, Sarvet B. Public-academic partnerships: Public-academic partnerships to address the need for child and adolescent psychiatric services. Psychiatric Services. 2011;62(8):827-29.
9. McGuinness TM, Ellington E. Telepsychiatry for children and adolescents. J Psychosocial Nurs Ment Health Serv. 2011;49(2):19-22.
10. Miller AS. Adolescent alcohol and substance abuse in rural areas: How telehealth can provide treatment solutions. J Addictions Nurs. 2005;16(3):107-15.
11. Savin D, Garry MT, Zuccaro P, Novins, D. Telepsychiatry for treating rural American Indian youth. J Am Acad Child Adolesc Psychiat. 2006;45(4):484-88.
12. Staller JA. Psychiatric nurse practitioners in rural pediatric telepsychiatry. Psychiatric Services. 206;57(1):138-38.
13. Stamm BH. Clinical applications of telehealth in mental healthcare. Profess Psychol: Res Practic. 1998;29(6):536.
14. Tschirch P, Walker G, Calvacca LT. Nursing in tele-mental health. J Psych Nurs Ment Health Serv. 2006;44(5), 20-7.
Clinical Services
EPOSTER PRESENTATIONS
EP-106
Subjects were also asked if their pain level increased after the first exercise and in the event that it did, they were asked to indicate by how much it increased by picking one of the following three options on the smartphone: 1-4 pain was a bit stronger; 5-7 pain was moderately stronger; and 8-10 pain was much stronger. The algorithm allows increasing the daily load on 1%, if the assessment of pain after exercise was not >7 points on 10-point scale and progressive limb edema was absent. If pain persisted or questions persisted, subjects were invited for a visit to the doctor with correction of the rehabilitation algorithm.
The orthopedic surgeon, during telerehabilitation, took significantly less time to consult patients (2.3 min – 0.4) than the traditional rehabilitation (12.6 min – 2.9). Patient satisfaction was higher for the telerehabilitation (83.1% - 14.2) than for the orthopedic surgeon's traditional rehabilitation (33.1% – 8.9).
• To provide telerehabilitation of patients with injuries of the elbow joint of the upper extremities. • To use a smartphone with gyroscope, G-sensor and magnetometer for telemonitornig. • To improve the quality of life of patients with injuries of the elbow joint of the upper extremities and reduce the cost of the rehabilitation period.
References:
1. Resolution of the XVI Congress of orthopedic and traumatologists of Ukraine. 2013. Kharkiv, Ukraine.
2. Welk GJ, McClain J, Ainsworth BE. Protocols for evaluating equivalency of accelerometry-based activity monitors. Med Sci Sports Exerc 2012;44(1 Suppl1):S39–S49.
3. Dannecker KL, Sazonova NA, Melanson EL, Sazonov ES, Browning RC. A comparison of energy expenditure estimation of several physical activity monitors. Med Sci Sports Exerc 2013;45:2105–2112.
Clinical Services
EPOSTER PRESENTATIONS
EP-115
In order to address the greatest burden of disease in a traditionally underserved urban neighborhood, we developed the capacity to provide secure, live audio-visual encounters for patients with difficult to manage hypertension, diabetes and chronic kidney disease. Patients are referred to the program by their primary care provider, with the ability to obtain both initial consultation and ongoing care from a specialist at their usual site of care, the FQHC. Participating specialties include cardiology, endocrinology, and nephrology. The program has been able to successfully obtain reimbursement from the local Medicaid program as well as private insurers. Formal evaluation of provider and patient satisfaction, clinical outcomes and other detailed program metrics is ongoing and interval results from Year 1 of this 3 year grant supported study will be presented.
Experience to date has demonstrated keen interest, with demand outstripping available provider hours for certain conditions and demonstrates promise regarding improved access to care for urban underserved patients who often face a disproportionate burden of chronic disease and numerous barriers to accessing specialty services, including transportation and time lost from work. Early success in billing and reimbursement bodes well for future financial sustainability. Challenges remain regarding provider to provider communication for full care integration.
According to a recent national survey, the majority of community health centers do not offer telemedicine services, and the number of urban centers using telemedicine was far lower than rural centers. Our experience developing a new program for specialty care via telemedicine at an urban FQHC may inform future efforts to enhance the use of telemedicine at community health centers, improve access to care for underserved patient populations, and advance best practices of clinical care integration.
• List common barriers to care for urban, underserved patients for chronic disease management. • Describe a model of specialty care service delivery via telemedicine at a Federally Qualified Health Center. • Describe challenges to care integration and financial sustainability in developing a specialty telemedicine program for underserved patients.
References:
1. Schwamm LH. Telehealth: Seven Strategies To Successfully Implement Disruptive Technology And Transform Healthcare. Health Aff. 2014;33(2):200-06.
2. Neuhausen K, Grumbach K, Bazemore A, Phillips RL. Integrating Community Health Centers Into Organized Delivery Systems Can Improve Access To Subspecialty Care. Health Aff. 2012;31(8):1708-716.
3. Shin P, Sharac J, Jacobs F. Provision of Telemedicine Services by Community Health Centers. Online Journal of Public Health Informatics. 2014;6(2):e185.
Clinical Services
EPOSTER PRESENTATIONS
EP-116
STP consultations, scheduled based on the patients' and psychiatrist's availabilities, were typically conducted in a clinic-like manner wherein multiple STP consultations were conducted over a half-day period. ATP interviews consisted of a patient interview conducted by the SNF onsite facility social services staff using the MINI questionnaire. ATP video-recorded consultations were then stored and viewed by the treating psychiatrist. Consultation notes were generated within 5 days. Follow-up STP and ATP consultations occurred at 6 and 12 months.
The primary outcome measurement was the psychiatrist-completed Clinical Global Impression (CGI). We also examined the medication recommendations reduction or addition of medications made by the psychiatrist. Finally, participant responses to a modified version of the Parent Telemedicine Satisfaction Survey were collected.
• To describe the potential of a novel telepsychiatry model, asynchronous telepsychiatry (ATP), for use with skilled nursing facility (SNF) populations. • To assess whether significant differences exist between ATP and synchronous telepsychiatry (STP), the traditional method of delivering telepsychiatry to SNFs, with regards to acceptability and feasibility. • To analyze and interpret ATP and STP clinical outcome data, namely CGI, medication reduction/addition recommendations and patient satisfaction, generated in a year-long study with SNF populations.
References:
1. Talbot JA, Coburn AF. Challenges and opportunities for improving mental health services in rural long-term care. University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center 2013; 50:1-34.
2. Morgan D, Innes A, Kosteniuk J. Dementia care in rural and remote settings: A systematic review of formal or paid care. Retrieved June 27, 2017, from
3. Yellowlees PM, Odor A, Parish MB, et al. A feasibility study of the use of asynchronous telepsychiatry for psychiatric consultations. Psychiatr Serv 2010;61:838-40.
Clinical Services
EPOSTER PRESENTATIONS
EP-117
Baycrest Health Sciences and The Centre for Aging and Brain Health Innovation began planning of two pilot projects in April 2016. The goals of the projects were to reduce emergency department visits and provide patients with complex chronic conditions to stay at home while being able to see a physician.
The Integrated Community Care Team (ICCT) and the Geriatric Psychiatry Community Service (GPCS) are comprised of physicians, nurses, social workers and various allied health professionals. Members of these teams provide an important service to homebound older adults with complex needs. They visit patients at home to provide assessments and/or recommendations on either complex conditions or psychiatric assessments for patients with depression and memory loss.
Due to various conditions that may arise while visiting a patient at home, the teams on occasion rely on input from colleagues that are not present. It was identified that ICCT and GPCS would benefit from using telehealth technology in the Virtual Care Project. The project utilizes telehealth to connect with a geriatrician or psychiatrist in the hospital during a home visit. The connection is made using a tablet brought to the patient's home. After the assessment is completed the physician is connected using the tablet via the Ontario Telemedicine Network (OTN) App.
A telehealth appointment no longer consists of physician/patient visit using room based systems. Smart phones and tablets have turned the technology into a mobile healthcare solution which reduces risks to vulnerable and complex patients while improving their safety and wellbeing.
• Define what services the Integrated Community Care Team (ICCT) and the Geriatric Psychiatry Community Service (GPCS) provide to Baycrest patients and clients. • Describe how the use of telehealth has changed from pricey room based systems to affordable mobile solutions (ie: tablets and smartphones) • Interpret the benefits of how telehealth saves time for the patient, caregvers and family members and clinicians.
Clinical Services
EPOSTER PRESENTATIONS
EP-118
• Describe the differences or similarities in rheumatoid arthritis disease activity at baseline and follow-up in patients seen by telemedicine compared to in-person only. • Understand the differences or similarities in quality of care for rheumatoid arthritis at baseline and follow-up in patients seen by telemedicine compared to in-person only. • Compare and contrast the views of telemedicine by rheumatoid arthritis patients seen by telemedicine compared to in-person only.
References:
1. McDougall JA, Ferucci ED, Glover J, Fraenkel L. Telerheumatology: A Systematic Review. Arthritis Care Res (Hoboken). 2016 Nov 18. doi: 10.1002/acr.23153. [Epub ahead of print] PubMed PMID: 27863164; PubMed Central PMCID: PMC5436947.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-128
Descriptive statistics evaluating the characteristics of all e-visits as well as those which were not resolved were calculated. Chi-square tests were used to compare resolved and unresolved e-visits, evaluating differences between patient factors (age, gender), disease factors (condition being evaluated), and e-visit factors (response time, time the e-visit was submitted) All analyses were performed using SPSS.
• Describe the prevalence of unresolved e-visits for acute conditions. • Identify factors associated with unresolved acute e-visits. • Formulate strategies to reduce the number of unresolved e-visits for acute conditions.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-129
• Understand the development of metrics to meet NDAA 2017 investments to ensure telemedicine operations and ROI support key decision making. • Discuss how Army applied and the guidance of Department of Health Human Services “Creating a Framework to Support Measure Development for Telehealth”. • Compare and contrast how military telemedicine is the same but different from stateside telemedicine.
References:
1. Creating a Framework to Support Measure Development for Telehealth, National Quality Forum, Dept of Health and Human Services 31 AUG 21017.
2. National Defense Act Authorization Act 2017.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-130
Notwithstanding, the vast majority of healthcare providers have not been able to incorporate telehealth technologies - despite the desire to do so.
To better understand the pain points and roadblocks involved in using telehealth technology solutions, MobileHelp Healthcare recently reached out to healthcare providers with a comprehensive survey.
The results demonstrate that while the benefits of using telehealth are very clear to those in the provider space, the capability to invest in a new program or expand an existing one has significant challenges - from fiscal difficulties to personnel shortages.
Examining the results affords the opportunity to understand how those challenges can be addressed by products on the market today.
The Survey: Results Support Telehealth
The primary concerns among healthcare provider participants fell among five topic areas: 1. Increasing patient load; 2. Retaining trained nursing staff; 3. Readmission penalties; 4. Patient satisfaction rates; and 5. Increasing operating costs.
More than 80% of the participants felt “increasing operating costs” was the biggest concern, followed by “retaining trained nursing staff” and “patient satisfaction rates.”
When asked follow-up questions related to technology and its ability to help address the major areas of concern, healthcare providers offered the following feedback: While only 29% of respondents reported using technologies like remote patient monitoring (RPM) to ease the burden of the issues expressed in major areas of concern, more than 85% of respondents felt RPM could benefit their patients in multiple ways.
The results of the survey is underscored by other studies, which indicate technology - and telehealth specifically - has the potential to 1) reduce healthcare costs, 2) provide much needed support to staff, and 3) increase patient satisfaction for an ever-growing patient population.
Growing Telehealth Utilization - and Challenges to Address
The data collected by this survey reflect the healthcare providers' desire to utilize technology to 1) more fully understand patient conditions and status, 2) offer ongoing care to their patients outside the traditional clinical setting, and 3) provide their patients with supplementary tools.
To address these needs, this poster will explore how new consumer-facing technology solutions are providing patients with the benefits of traditional remote patient monitoring with additional aspects such as video visits or the ability to provide customized education related to specific disease states.
Following the reimbursable period, patients have the opportunity to keep the telehealth equipment and shift to monitoring their own vital signs - allowing healthcare providers to essentially step out of the clinical care process - while giving patients the tools they need to engage more fully in their own care in the long-term.
In addition, a medical alert can be incorporated, which allows patients to access emergency help if and when they need it - a key feature for patients moving outside the traditional clinical care environment.
• Upon completion, participants will be able to define the results of a recent survey conducted among healthcare providers around use and implementation of telehealth solutions; • Upon completion, participants will be able to understand how to invest in a new telehealth program or expand on an existing one – and potential program challenges. • Upon completion, participants will be able to discuss how telehealth challenges can be addressed by thinking about consumer-facing technology in new ways.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-138
São Paulo is the largest and most populous city in Brazil. Although Brazilian public Unified Health System guarantees universal health coverage, there is great inequality of access to good quality specialized healthcare, mainly in low-income areas. By July 2017, there were 477 public primary care facilities working in São Paulo, with a mean 16000 patients referred monthly to dermatologist consultation, exceeding the public system capacity of 10,000 visits per month. This imbalance lead to a mean waiting time of six months and a 65000+ patients long queue.
Since dermatologic examination is mostly visual, the field of tele-dermatology has grown exponentially with the recent advance of high definition image communication technologies. Tele-dermatology programs are already consolidated in well-developed countries and accuracy has been widely accepted to be comparable to in-person visits.
In early 2017, the city Health Department partnered with Hospital Israelita Albert Einstein, one of the country's most important private non-profit healthcare organizations, to develop a tele-dermatology program, aiming to reduce waiting times, increase quality of dermatologic care, reduce costs, and collect data to develop an artificial intelligence algorithm able to assist on skin lesions diagnosis, a full triple-aim program.
In brief, a Web-based platform was developed in-house to allow secure storage of images and patient information, available to trained hospital staff dermatologists for adequate documentation of diagnosis and recommendations. Trained nurses are responsible for filling patient data forms and perform the collection of digital images for asynchronous image and clinical data evaluation by a staff dermatologist. Diagnostic hypotheses, treatment options and recommendations are recorded for each case. Eventually the patient receives one of three evaluation results: 1) Definite diagnosis and treatment recommendation - return to primary doctor; 2) Suspected malignant lesion - ordered skin biopsy; or 3) Unable to give a definite diagnosis - referral to in-person dermatologic consultation.
Along with the patient-centered strategy, a dedicated technology staff was designed to develop an artificial intelligence algorithm using acquired image data. Deep learning techniques are being used to automatically suggest a probable diagnosis for skin lesions.
This e-poster will present the tele-dermatology program development, its implementation challenges and preliminary results. Over the first 40 days of implementation, 2054 skin lesions were evaluated. 47.9% of the patients were given a definite diagnosis and avoided an in-person consultation, 46.4% were referred to traditional care and 5.7% were directly referred to skin biopsy. The early-scale project is designed to evaluate 65000 skin lesions by early-2018. Deep learning algorithms are being generated and details about the developing process will be presented, as well as its first accuracy results.
• Define main steps to implement a tele-dermatology service able to reach thousands of patients. • Determine the cost-reduction potential of a tele-dermatology approach. • Get acquainted to artificial intelligence algorithms being developed to automatically screen skin lesions.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-139
Despite the successful history of the Center for Telehealth, a comprehensive patient satisfaction review has never been conducted. In order to promote and grow the services of the center, both within the health system and with outside partners, we need evidence that shows the value and quality of the care we support and provide. My Master of Public Health thesis is a comprehensive satisfaction review and will be completed in December 2017. My study will assess the overall patient satisfaction with telemedicine services provided by the UVA Center for Telehealth at several of our rural partner sites. Furthermore, my study will evaluate the difference in satisfaction between various telehealth delivery systems: video consults, phone conversations, image transfer, and group education sessions. This is a mixed-methods study. The qualitative portion will consist of extensive interviews conducted with participants over the phone, and the quantitative portion will consist of Likert scale surveys filled out by patients in the clinics who choose to participate. In addition, a demographics assessment will be completed to assess differences in satisfaction between patients.
In fact, there is a lack of qualitative research on patient satisfaction with telemedicine. Also, there has been no standard satisfaction tool or assessment developed, as the field of telemedicine is extremely diverse and has not been universally adopted. Garcia et al. (2007) noted in their study, “Patient satisfaction can play an important role for decision makers implementing telemedicine systems. Yet there remains a limited understanding on what exactly constitutes satisfaction and what are the dimensions that define it.” A literature search revealed that the majority of published studies are quantitative studies involving Likert scale survey assessments (e.g. LeRouge et al., 2015). Therefore, this qualitative research will be critical not only to improve and grow the UVA Center for Telehealth, but also to contribute to the existing field of telemedicine satisfaction literature. Additionally, I was unable to find a qualitative study that comprehensively looked at the difference in telemedicine delivery methods, which will be an important part of my study.
After completion of the study and subsequent analysis, the findings will not only inform the Center for Telehealth of current patient satisfaction but will also be used to develop and implement a satisfaction tool to be used with every telemedicine encounter.
• Upon completion of this session, participants should be able to understand how to complete a mixed-methods study (qualitative + quantitative components). • Upon completion of this session, participants should be able to understand important aspects of developing a patient satisfaction tool to apply to their own programs. • Upon completion of this session, participants should be able to compare patient satisfaction with telemedicine at a large academic institution to satisfaction at their institutions.
References:
1. Garcia M, Han W, Adelakun O. Defining dimensions of patient satisfaction with telemedicine: An analysis of existing measurement instruments. Proceedings of the 50th Hawaii International Conference on System Sciences. 2017:3793-3802.
2. LeRouge C, Garfield M, Henver A. Patient perspectives of telemedicine quality. Patient Prefer Adher. 2015;(9):25-40.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-140
This e-poster intends to present a full-scale live video telemedicine service to assist critically-ill patient transportation between same-institution locations and was developed by the Hospital Israelita Albert Einstein Telemedicine Center. Considered one of the best hospitals in Latin America, Hospital Israelita Albert Einstein is a 650-bed high complexity general hospital located in the city of São Paulo, the largest and most populous city in Brazil as well in the southern hemisphere.
Albert Einstein has four full-equipped satellite emergency department locations distant 5 to 15 miles from the main building. All patients requiring hospital admission should be transported to the main building. Due to heavy traffic, even with ambulance priority, transfer duration can easily reach more than one hour. Under these conditions the potential need of medical intervention or complications during the conveyance increases.
However, since after medical evaluation and treatment most patients requiring admission to a semi-intensive or intensive care unit are already stable at those locations, selected low-risk cases could be suitable to be transported under telemedicine-assisted supervision by a physician. As a result, a single doctor can be available to assist multiple transportations without the need to be onboard, reducing idleness and optimizing costs without compromising patient safety.
Therefore, a protocol was designed to select patients with lower risk of transportation, mainly excluding those considered unstable, needing advanced respiratory support and/or vasoactive agents. Also, STEMI and acute stroke patients were also excluded from telemedicine-only supervision transportation. Selected patients were transported by a trained paramedic, connected through 4G broadband internet connection on an onboard tablet device, under live video supervision by a staff physician at the hospital.
Over the first six months of 2017 there were 766 critically-ill patient transportation between distant emergency departments and the main building, 606 (79%) of which were assigned to medical supervision by telemedicine. That figure represents roughly a 30% reduction in transportation costs. Medical intervention has been needed on only 1% of the cases, all of which considered safe to be done under supervision at a distance. There were no severe adverse events reported nor technological malfunction/loss of signal reports (it's a highly-urbanized area). Therefore, transportation of selected low-risk critically-ill patients under physician supervision by telemedicine can be considered safe and feasible. A continuing analysis of the results is being carried on, and a thorough cost-benefit analysis is under investigation.
• Implement a telemedicine solution to assist critically-ill patient transportation by ambulance for short distances. • Design a protocol to select patients suitable to transportation assisted by telemedicine, replacing the need for an onboard physician. • Understand most common caveats in the implementation of a telemedicine-assisted transportation system.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-141
The goal is for the viewer to understand how a study is being performed to understand value in a niche area, as well as appreciate how many large organizations were willing to come together to resolve this question.
• Appreciate how many parties are part of a telemedicine program. • Describe how a telemedicine program can add value by reducing unnecessary transfers from senior living facilities. • Understand study design and data sharing between organizations.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-150
Provider engagement is critical in the success of a telehealth, particularly as part of a large healthcare system initiative. Without the buy-in of the practicing physicians, nurse practitioners, physician assistants, social workers, and counselors, the first and lasting impressions to the patient and family are at risk. The appropriate conversion of a strong “bedside manner” to a similar “webside manner” depends on it. At minimum, busy clinicians envision telehealth as a neutral change to their modus operandi (i.e. protection). Ideally, they find it an improvement by creating more proficiency, efficiency and/or revenue (i.e. incentives). Thus, we follow the mantra to “protect and incent” providers in order bring champions to a telehealth program.
Specific “protect and incent” strategies are culturally-specific to the healthcare system in which they are employed. For example, when providers are part of a protected, non-incentivized, capitated salary structure, then trickling incentivized revenue down to the providers may not be necessary. But maintenance/reduction or expected workload with maintenance/improvement of lifestyle will be more important in this situation. Conversely, in an RVU or billable working model, incentivized pay may be essential.
During the ePoster presentation, we will demonstrate how to create a 2 × 3 grid: with protect and incent along the x-axis, and workload, lifestyle, and compensation along the y-axis. This will demonstrate the value of this provider strategy exercise that should accompany any new telehealth offering. An early understanding of the potential motivations and deterrents to provider participation will become apparent via real life examples from the authors' programs as well as comparative national and regional programs. Specific examples will include telestroke, telepsychiatry, teleICU, direct-to-consumer primary/urgent care visits, direct-to-consumer specialty care visits, and virtual second opinions.
With careful consideration and a sophisticated understanding of added value from telehealth programs, healthcare administrators appreciate how critical it is to protect and incent their provider champions.
• Consider the complicated interplay between provider willingness to participate in telehealth and its impact on workload, lifestyle, and compensation. • Review the potential motivations and deterrents to provider participation in telehealth. • Examine the concept of “protect and incent” to create provider champions and telehealth value.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-151
After the implementation of the Telemedicine service, 1,800 telemedicine consults were generated within a 5 year period. A retrospective study was performed to analyze the average number of consults per department and generate a volume analysis. Statewide average physician salaries for each specialty were determined in order to characterize the cost of non-productive downtime. Average transit time was calculated for each facility. This enabled us to determine what the average cost of having a physician onsite would require. It also enabled us to determine the number of man hours lost and cost of long transit. The study found that there is a significant cost-savings associated with the inpatient Telemedicine program. Approximately three million dollars was saved over the course of 5 years by preventing increases in provider non-productive time, preventing increase in provider staffing without a commensurate increase in revenue, and decreasing transit time. It was also estimated that the average physician would save approximately 1.5 hours driving per work day due to the Telemedicine consult service.
• Demonstrate how the development of a telemedicine consult service can provide care to patients by providing increased access to specialists, leading to quicker diagnosis, and decreased time to treatment. • Determine the effect of an inpatient telemedicine consult service on non-productive transit time. • Describe the value of a telemedicine service through decreased non-productive time for physicians and reducing episodic consults to reducing the backlog of other clinical duties secondary to remote coverage.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-152
• Present potential benefits of Teleneurology. • Determine patient cost savings and health outcomes. • Describe 90-day and lifetime benefits to payer and patient.
References:
1. Kepplinger J, et al. Emergency Transfer of Acute Stroke Patients within the East Saxony Telemedicine Stroke Network: A Descriptive Analysis. Int J Stroke 2014;9(2):160-65. Print.
2. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012;43(8):2078-2085.
3. Demaerschalk BM, Raman R, Ernstrom K, Meyer BC. Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemed J E Health. 2012;18(3):230-37.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-153
The American Diabetes Association, along with several other professional organizations, recommends that all diabetic patients in the U.S. have an annual dilated retinal exam (DRE) to evaluate for the presence or absence of DR(3). Currently, on average, less than 65% of patients are compliant with these recommendations(4). Due to late detection of disease, many of these patients will require costly treatment and many will suffer preventable severe vision loss from DR.
As a method to increase DRE compliance and early detection of sight-threatening DR, teleretinal imaging uses specialized cameras to acquire retinal photos in primary care clinics. Ophthalmologists remotely interpret the retinal images and return a diagnostic report to the primary care provider. Patients with vision-threatening eye disease are urged to follow up with an ophthalmologist for a dilated eye exam.
The effectiveness of teleretinal imaging is well documented, with evaluation rates increasing from 30% to over 90%(5). However, this study is the first comprehensive assessment of current costs of DR and the monetary effect of the implementation of teleretinal screening.
Welch Allyn and RTI Health Solutions have developed an economic model that employs the gold-standard for cost-effectiveness models - a Markov-based approach with health states to capture: (1) the incidence and progression of DR, including progression to clinically significant macular edema (CSME) and irreversible severe vision loss; (2) the detection and treatment of vision-threatening DR and CSME; and (3) death over a 10-year time period for both the entire U.S. diabetic population as well as only the Medicare population.
Early results of the model show that with the current paradigm of DR detection, that is, referral to an ophthalmologist for a DRE by the primary care provider, the rate of blindness from DR will continue to increase over the next 10 years. Additionally, costs associated with screening and treatment will rise steadily, largely because DR is not being detected in the early stages when it can be treated effectively and cost effectively. Implementing teleretinal screening nationwide could reverse the trend and decrease the rate of severe vision loss from diabetes. In addition to preserving vision, teleretinal imaging results in a global cost savings, largely due to less-costly screening and the cost-effectiveness of early treatment. Additional statistics, including actual costs saved and percent reduction in diabetes-related blindness, will be included in the final presentation.
• Upon completion, participants will be able to understand the health-related and financial burden of diabetic retinopathy on the United States. • Upon completion, participants will be able to understand how changing the paradigm for diabetic retinopathy evaluation can reduce rates of diabetes-related blindness and save costs to patients, providers, and payers. • Upon completion, participants will be able to understand how economic modeling can help researchers understand the health and financial impacts of changing the standard of care.
References:
1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes care. 2013; 1-14. doi: 10.2337/dc12-2625
2. Vision Health Initiative (VHI) Common Eye Disorders. Centers for Disease Control and Prevention Website.
3. American Diabetes Association. Diabetic Retinopathy. Diabetes care. 2002; 25(suppl 1): s90-s93. doi: 10.2337/diacare.25.2007.S90
4. Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and P
5. Mansberger SL, Sheppler C, Barker G, Gardiner SK, Demirel S, Wooten K, Becker TM. Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: A randomized clinical trial. JAMA Ophthalmol. 2015;133(5):518-25.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-127
• describe detection mechanisms of postures. • understand benefits of employing sensor technology in healthcare system. • understand the use of inertial measurement units in the elderly care.
References:
1. Capela NA, Lemaire ED, Baddour N, Rudolf M, Goljar N, Burger H. Evaluation of a smartphone human activity recognition application with able-bodied and stroke participants. J NeuroEngineering Rehabilitation. 2013;13(1):5.
2. Gokalp H, Clarke M. Monitoring activities of daily living of the elderly and the potential for its use in telecare and telehealth: a review, Telemed J E Health. 2013;19(12):1-14.
3. Su B, Tang Q, Wang G, Sheng M. (2016). The Recognition of Human Daily Actions with Wearable Motion Sensor System. In Z. Pan, A. D. Cheok, W. Müller, & M. Zhang (Eds.), Transactions on Edutainment XII (pp. 68-77). Berlin, Heidelberg: Springer Berlin Heidelberg.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-160
Clinical Services
EPOSTER PRESENTATIONS
EP-107
• Improve outcomes in patients diagnosed with sleep apnea using telehealth encounters as a cornerstone in a disease management protocol. • Better understand the basic elements of a successful clinical pathway for managing patients with sleep apnea. • Demonstrate the process for developing a clinical protocol to manage sleep apnea patients in a wide range of clinical settings.
References:
1. Kim et al. An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea. Sleep 38(7), 1027–37 (2015).
2. Rosen CL, Auckley D, Benca R et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sl
3. Redline, S. Screening for Obstructive Sleep Apnea: Implications for the sleep health of the population. JAMA 2017;317 (4):368-70.
Clinical Services
EPOSTER PRESENTATIONS
EP-108
Avera is now leveraging their advanced telemedicine platform to reintegrate behavioral healthcare into all aspects of their care delivery system. Recognizing that suicidal individuals can fall through the cracks in an often fragmented healthcare system, their eBehavioral Health program links primary care providers in the field with pharmacopsychiatry specialists and “triage therapists” to improve screening, early intervention, and access to specialists. The new program, based on the Zero Suicide framework, is helping Avera deliver more responsive, convenient and personalized patient care while avoiding high acuity/high cost emergency visits and associated admissions. It's also leading to greater physician satisfaction by helping non-behavioral health providers have confidence that specialists will support them and their patients if they reach a point where they cannot provide care. The results of the program thus far have been impressive, including a 13% decrease in suicide attempts, nearly 50% reduction in associated ED visits, and over 20% reduction in admissions.
In this hands-on Learning Lab session, attendees will see how they can reintegrate behavioral health into their own care systems using telemedicine to save lives, save money, and provide more effective patient-centered care. Following an overview of the Avera program and its results, the speakers will walk through the Zero Suicide framework's “7 Essential Elements of Suicide Care” – Lead, Train, Identify, Engage, Treat, Transition, and Improve – and show how they can be supported through telemedicine. Throughout, they'll discuss best practices for the use of telemedicine for behavioral health and how to avoid pitfalls during the design and implementation of a program.
Suicide prevention is the ultimate expression of patient safety and one of the most fundamental responsibilities of the healthcare system, making this session relevant to care organizations of all kinds.
• Describe how the Zero Suicide model can be used to integrate behavioral health back into all aspects of healthcare in order to save lives and reduce costs. • Define the challenges of implementing the seven elements of Zero Suicide, as well as demonstrate ways to use innovation to overcome these challenges. • Demonstrate a variety of ways telemedicine can be used to solve for challenges in rural behavioral healthcare that are proven to improve patient outcomes and decrease costs.
References:
1.
Clinical Services
EPOSTER PRESENTATIONS
EP-109
Physical Therapy has always been known for its “hands-on” treatment approach, and has taken a third-row seat, behind Primary and Orthopedic physicians in treatment of MSDs. With the changing healthcare landscape, we will see a change in how, where and when patients are treated. We will also see a change in the gatekeeper role for MSDs.
In order to keep up with these demands, clinicians have to change the very foundation of how we have traditionally operated. Currently, we require tedious paperwork and “hands-on” evaluations and treatments. We will discuss how our functional assessment tools, evaluations and home instruction can be more efficient and convenient, without losing integrity. New ways to modify how we can perform certain testing/treatments virtually, have been investigated and will be discussed. Not every patient is suited for telerehabilitation, we will provide guidance on how to determine who is suited. Lastly, we will outline limitations to telerehabilitation and how to prepare and minimize these challenges.
We can now bridge technology and the virtual assessment to reach more individuals with musculoskeletal disorders (MSDs) and consequently: reduce costs, improve convenience, eliminate waiting time to see MSD specialist, improve accessibility in rural areas, maintain high satisfaction rates, and improve outcomes.
• How to collect important PMH, Pain Levels and Functional Scales in a virtual world without extensive paperwork and time requirements? • What clinical skills are required to transition from a “hands-on musculoskeletal assessment” to a virtual one, without losing the assessment integrity? • Understand limitations of telerehabilitation and how to overcome and prepare for these challenges?
References:
1.
2.
3.
Clinical Services
EPOSTER PRESENTATIONS
EP-110
The objective of our study was to evaluate the specific dermatologic conditions presented at Dermatology ECHO by participating providers, and examine the accuracy of diagnoses. Our goal was to understand if attending Dermatology ECHO sessions improves the diagnostic ability and accuracy for participating providers.
Data from the presenting PCPs (patient demographics and provisional diagnosis), as well as the data from Dermatology ECHO specialty hub team (final diagnosis and treatment options) were collected via standardized Dermatology ECHO case forms.
There were 141 unique, de-identified patient cases presented from November 2015 to July 2017 during the 62 Dermatology ECHO sessions. Of the 141 cases, we analyzed 122 case presentations, which had complete and accessible data regarding provisional and final diagnoses.
• Recognize the Dermatology Extension for Community Healthcare Outcomes (ECHO) Project as a means of providing virtual education and mentoring to rural and underserved primary care providers. • Analyze the Dermatology ECHO evaluation results, in terms of case presentations and didactic topics. • Describe the outcomes regarding accuracy of diagnoses from the Dermatology ECHO Project.
References:
1. B. Alper, J. Hand, S. Elliott, S. Kinkade, M. Hauan, D. Onion and B. Sklar, “How much effort is needed to keep up with the literature relevant for primary care?, J Med Libr Assoc, pp. 429-437, 2004.
Clinical Services
EPOSTER PRESENTATIONS
EP-111
This session aims to improve patients' self-monitoring practices post-hospital discharge, quickly identify critical warning signs, decrease hospital readmissions and reduce healthcare costs for CHF patients by integrating remote monitoring ePRO and connected devices into standard outpatient care practices.
Sixty patients were enrolled in the study (Female 32%, Male 68%) with a median age of 62. 42 patients (70%) continue to actively use the mobile apps and smart devices to track blood pressure and weight. All 60 patients have completed one month of active usage while 9 patients have dropped out. Overall, there have been 6 hospital readmissions (12%) after month, mainly due to non-compliance and other chronic related disease. Barriers faced in enrollment included: on-boarding time (30 minutes), competition with other initiatives and research trials at Mount Sinai, language barrier, and low health literacy.
Given the increasing burden of CHF on patients and healthcare systems, there is a critical need for an effective, sustainable, and feasible remote monitoring system for CHF patients following hospital discharge. The ability for providers to access patient-reported outcomes and vital signs in real-time can significantly impact the quality of outpatient care, potentially reducing readmissions and costs. CHF patients are showing positive health outcomes; CHF patients had a 7% readmission rate compared to the national rates of >20% readmission rate within 30 days of discharge1. Enrollment challenges were overcome by enrolling CHF patients 2-3 days before expected discharge and adding a patient coordinator to hospital rounds. These latest advances in remote monitoring show promise for the future of technology-connected healthcare.
• Upon completion of this session, participants should be able to understand improvement in patients' self-monitoring practices post-hospital discharge, as well as identify critical warning signs. • Participants should understand the decrease hospital readmissions and reduction in healthcare costs for CHF patients by integrating remote monitoring ePRO and connected devices into standard outpatient care practices. • Demonstrate the workflow and implementation science required to make remote monitoring successful for transitions of care and readmission reduction.
References:
1. Celler BG, Sparks RS. Home telemonitoring of vital signs–technical challenges and future directions. IEEE J Biomed Health Inform. 2015 Jan;19(1):82-91. doi: 10.1109/JBHI.2014.2351413. Epub 2014 Aug 22.
2. Kane PM, Daveson BA, Ryan K, Ellis-Smith CI, Mahon NG, McAdam B, McQuilllan R, Tracey C, Howley C, O'Gara G, Raleigh C, Higginson IJ, Koffman J, Murtagh FE. Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure. BMJ Support Palliat Care. 2017;7(4):470-70.
3. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation.
Clinical Services
EPOSTER PRESENTATIONS
EP-119
A total of 759 and 2,080 patients was imaged using NM-UWFI during the 130 working days before and after the initiation of no-fee imaging on 10/16/2016, respectively. The difference represents a 274% increase in the number of patients imaged after 10/16/2016. There were no statistically significant differences between groups in the distribution of DR severity (before: 50.2% no DR, 30.1% mild DR and 19.7% referable DR; after 48.9%, 32.3%, 18.8%, p = 0.54). However, with the increased surveillance rates, there was a 292% increase in the number of eyes with mild DR and a 261% increase in referable DR that required closer follow-up and possible treatment. Ninety-two additional cases of proliferative DR were identified, which would prevent 6.7 cases of severe visual loss, with a total cost savings of $211,874 (cost of severe loss = $31,623). No differences were observed in gender, ethnicity, or HbA1c. In this cohort in patients with referable DR, self-awareness was low over-all, with no significant difference between the before and after groups (39.4% vs 43.8%, p 0.3725).
In summary, providing NM-UWFI as part of comprehensive diabetes care increased the number of patients identified by nearly 3-fold. These data suggest the removal of barriers to eye care may substantially increase patient surveillance rates which should translate into improved long-term patient outcomes.
• Recognize the impact of increased accessibility on surveillance rate for diabetic retinopathy. • Understand impact of out of pocket costs in a telemedicine program as a barrier to increased surveillance for diabetic retinopathy. • Demonstrate the value of retinal screening as part of comprehensive diabetes care at no additional cost to patients or their insurers at a tertiary academic diabetes specific medical center.
Clinical Services
EPOSTER PRESENTATIONS
EP-120
• Upon completion, participant will be able to outline the field and aims of precision mental health. • Upon completion, participant will be able to outline the top 10 most promising precision mental health solutions which can be paired with telepsychiatry services. • Upon completion, participant will be able to outline the state-of-the-art of technologies pertaining to vision learning in psychiatry, genetic guidance of medications, and personality-driven adherence tools.
References:
1.
2.
3.
Clinical Services
EPOSTER PRESENTATIONS
EP-121
The project started with one physician making videos with the use of a screen capture program and sending them to patients by the use of a digital content management system. These videos captured the physician's insight into the patient's condition with the visual of the patient's diagnostic imagery and extended the physician-patient conversation to be replayed by the patient on any digital device at their convenience. The physician had great patient feedback however the process was labor intensive. In order to have a more elegant workflow and accessibility to other staff he teamed up with the hospital system and an outside software vendor to create a more robust automated program in a web client. The program was expanded to be used to create personalized videos for inpatient discharge process as well.
Two pilot studies were created to garner formal patient feedback in order to make improvements to the software. It was recognized that only about 40% of the patients who received the video accessed it upon leaving the office. Because of this we realized the importance of signing up the patient and showing them how to use the web client before they left the hospital. To measure efficacy we retrospectively analyzed Patient Satisfaction Surveys that were sent to our patients by a third party for the years 2015-2016. The Press Ganey Clinician and Group Experience Survey and HCAHPS surveys were analyzed. For each question Top Box Ratio scores, or frequency that patients chose the most positive answer, were calculated for patient groups: those receiving a personalized video intervention and those who received the standard of care. For every question analyzed the video group had a higher overall top box ratio. Our ongoing Zelen Randomized Clinical Trial studying personalized multimedia in the discharge process currently has 111 patients enrolled.
Not only were these outpatient “Virtual office visits” useful to the patient, they were useful to our inpatient staff as well. If our staff knew there was a preoperative patient who received a video they would review the video to enhance their understanding of the case so that they could be more prepared to postoperatively care for the patient.
The implementation of a personalized multimedia software platform led to increases in satisfaction and engagement for both patients and their care team.
• Upon completion, participants will be able to identify how transitions in care can beenhanced by personalized multimedia. • Upon completion, participants will be able to describe the workflow for creating and disseminating patientpersonalized multimedia. • Upon completion, participants will be able to describe the relationship between personalized multimedia, patient engagement and patient satisfaction.
References:
1.
Clinical Services
EPOSTER PRESENTATIONS
EP-122
Since 2007 the Brazilian Ministry of Health promotes the Telessaude Brasil Redes Program, that empowers multiple Telemedicine Nucleus in all States to offer teleducation and teleassistance to remote and unserved urban areas. We have been coordinating NUTTs - Nucleo de Telemedicina e Telessaude - in the State of Goias, Brazil, since 2007.
Teleophthalmology has been used by our center as a strategy in blindness prevention for the last 10 years through the use of itinerant non-mydriatic fundus cameras, where digital retinal pictures are remotely evaluated by ophthalmologists. It has been able to detect the four major blindness causes: cataract, glaucoma, diabetic retinopathy and age related macular disease. Still, the burden of uncorrected refraction errors had not been met.
We present the use of a portable wearable remote refraction system, using adaptive lens technology, to address this burden. All exams took place at Primary Care Units in the State of Goias, remotely supervised by a certified ophthalmologist. A portable refractometer linked to a wearable refractor was used to perform refraction exams in 1348 patients. Portable video slit lamp and video indirect ophthalmoscope were available and used whenever needed to address any special request from the remote ophthalmologist.
We present the design of this blindness prevention strategy, its results and a critical analysis of the lessons learned.
This remote refraction blindness prevention strategy is ready to be spread through Brazil as a permanent Teleophthalmology service and can be reproduced as an effective tool to prevent blindness from refractive errors, specially in underdeveloped countries.
• Understand Primary Care limitations in Brazil. • Observe Remote Refraction as a Strategic tool to prevent blindness due to refractive errors. • Discuss involved Technology.
References:
1. Schellini S, Ferraz F, Opromolla P, Oliveira L, Padovani C. Main visual symptoms associated to refractive errors and spectacle need in a Brazilian population. Int J Ophthalmol. 2016;9(11):1657-662.
2. Sreelatha OK, Ramesh SV. Teleophthalmology: improving patient outcomes? Clin Ophthalmol (Auckland, NZ). 2016;10:285-95.
3. Haddad A, da Silva D, Monteiro A, Guedes T, Figueiredo A. Follow up of the Legislation Advancement Along the Implementation of the Brazilian Telehealth Programme. J Int Society Telemed eHealth. 2016;4,e11 (1-7). Retrieved from
Clinical Services
EPOSTER PRESENTATIONS
EP-123
• Understand the differences in demographic and clinical characteristics of children (≤18 years old) who obtained outpatient neurology consultations through telemedicine and children who obtained outpatient neurology consultations in-person. • Understand whether outpatient neurology consultations provided through telemedicine are associated with lower ‘no-show’ rates of scheduled consultations compared in-person consultations. • Understand whether the tele-neurology program is associated with a reduction in the rate of unplanned hospital and emergency department encounters.
References:
1. Dall TM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013;81(5):470-478.
2. Timpano F, Bonanno L, Bramanti A, et al. Tele-Health and neurology: what is possible? Neurological Sciences. 2013;34(12):2263-2270.
3. Patel AD, Wood EG, Cohen DM. Reduced Emergency Department Utilization by Patients With Epilepsy Using QI Methodology. Pediatrics. 2017;139(2).
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-131
• Describe how to develop a direct-to-consumer lactation telehealth program. • Define how to integrate lactation service with an EMR patient portal. • Take advantage of our “Lessones Learned” to streamline setting up this service at their facility.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-132
In this session, Teladoc will share its pre- and post- crisis learnings including: - Which communication strategies proved most effective in reaching patients who were evacuated, staying in shelters and away from regular power sources? - When were the greatest times of need? How did volume of requests, as well as the type of requests (from general medical to behavioral health), evolve throughout the crisis? - How did patients who needed care most prefer to receive it? What was the mix of outreach by phone vs. web and video? - When care providers are also among those being evacuated, what strategies assure care needs are adequately met, with state-licensed and board-certified staff, trained in delivering care via telehealth?
* Note to ATA organizers: we anticipate that this will be an interactive session and we intend to invite hurricane-impacted Teladoc client speaker/s to join us as a participant in the dialogue. However, as we are still in active crisis response mode, we were unable to secure those client speaker names in time for today's submission deadline. If accepted, we will submit client speaker names as a part of the November confirmation.
• Consider modern communications strategies, including mobile and social, to increase awareness of telehealth services in affected areas. • Assess provider network scale and quality network, effectively mobilize clinicians to provide telehealth services during crisis. • Anticipate and mitigate crisis-related clinical and operational challenges.
Direct to Consumer Strategies
EPOSTER PRESENTATIONS
EP-133
To date, over 5,000 telemedicine visits have been conducted between the patient and their own primary care physician or specialist. this has led to several hundred thousand dollars in cost-savings and improved access to care.
• Integrate telemedicine into a multi-specialty medical group. • Avoid common mistakes when implementing a direct-to-consumer telemedicine program. • Design a return on investment model suitable for their payor mix.
References:
1. Patient Testimonial -
Operations and Implementation
EPOSTER PRESENTATIONS
EP-142
• Manage a successful implementation of a synchronous video visit platform through a team governance structure, clear assignments of tasks, regular status meetings, and collaborative working sessions. • Define legal and technological challenges early on by engaging proactively with the appropriate channels to brainstorm alternative approaches and adjustments to scope. • Demonstrate strong product ownership, advocacy for the consumer, and robust project management skills through a small focused group, which will drive buy-in and championship from critical stakeholders.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-143
• The audiences will be able to realize correct blood pressure measurement at home, and how to manage blood pressure records. • To learn the meaning of blood pressure variability (BPV) and BPV applications on stroke prevention. • To learn the BPV analysis, and the development of a new blood pressure monitoring system.
References:
1. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. (2013). 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society
2. Crichton GE, Elias MF, Dore GA, Torres RV, et al. Measurement-to-Measurement Blood Pressure Variability Is Related to Cognitive PerformanceNovelty and Significance. Hypertension, 2014;64(5):1094-1101.
3. Palatini P. (2014). Day-by-Day Blood Pressure Variability. American Heart Association.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-144
• Upon completion, participants will be able to identify the federal, state and institutional mandates driving the adoption of formal training and certification programs. • Upon completion, participants will be able to explain ways that academic and community organizations can partner to speed the development and dissemination of interventions that are discipline and setting appropriate. • Upon completion, participants will be able to implement the development of telehealth training and certification programs that support team-based care across populations.
References:
1. Edirippulige S, Armfield NR. Education and training to support the use of clinical telehealth: A review of the literature. J Telemed Telecare. 2017;23(2):273-82.
2. Randall K, Steinheider B, Isaacson M, Shortridge A, Byrd S, Ciro C, Ross H, et al. (2016). Measuring knowledge, acceptance, and perceptions of telehealth in an interprofessional curriculum for student nurse practitioners, occupational therapists, and physical therapists. J Interact Learning Res. 2016;27(4):339-53.
3. Henry BW, Block DE, Ciesla JR, McGowan BA, Vozenilek JA. Clinician behaviors in telehealthcare delivery: A systematic review. Adv Health Sci Educ Theory Pract 2016;22(4):869-88.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-145
From its inception our program has aimed to increase access to care in a particularly rural state with a physical and mental health provider shortage and a costly chronic disease burden. Development of the program has been led by data in two ways. First, three costly chronic disease use-cases were identified and telehealth solutions were designed that added efficiency to the system, rather than duplicating care. The physical health component of our program has targeted pediatric asthma, as one of the most common chronic diseases of childhood and attention deficit/hyperactivity disorder as a common chronic disease that directly impacts educational disparities. The telemental health program was designed to compliment existing school-based mental health services by targeting children affected by childhood traumatic stress and treating PTSD. These specific use cases addressed concerns of key stakeholders such as patients, school-districts, payers and state law makers as well as existing gaps in the healthcare system using proven standards of treatment.
Secondly, geographic data was used to guide program implementation and expansion to target the areas of highest need. The pilot sites were selected based upon rurality and provider shortages as well as burden of healthcare disparities. Once feasibility in these pilot sites was established, rapid program expansion was guided by careful “heat mapping” of the most expensive chronic disease burden.
These targeted approaches have driven quality, health and cost-savings outcomes. Outcome data regarding improved adherence to treatment guidelines when compared to traditional in-person methods, increased symptom management and analysis of impact on costly utilization patterns will be presented. The authors will discuss specific steps in developing and implementing a school-based telehealth program that is focused on increasing access to care and service utilization while improving management of chronic disease and decreasing overall cost for chronic health conditions in a specific youth population. However, this program will serve as a “case study” for use of precision public health techniques and the authors will use their experience to present lessons that are generalizable to telehealth programs across a broad spectrum of applications.
• Describe the importance of “Precision Public Health” methods in the design and implementation of a large scale telehealth program. • Understand how using a data-driven approach to program design can impact downstream quality, health and cost outcomes. • Using the multidisciplinary school-based health program presented as a model, apply these methods to other telehealth applications.
Operations and Implementation
EPOSTER PRESENTATIONS
EP-146
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-154
Access to a hospitalist physician should not be dependent on where a patient lives or the time of day care is needed. Supporting critical access hospitals in order to keep patients close to home and progress care around the clock is the main goal of the Hospital Telemedicine service. Through engaging key stakeholders and thinking innovatively the Hospital Medicine Service Line has furthered their pursuit of achieving the Triple Aim.
This presentation will detail the new staffing model and patient care system at Regions Hospital in support of rural hospitals during the evening and night time shifts. A checklist of the implementation steps to consider when deploying a hospital telemedicine program will be included, such as operations and workflow, reimbursement, technology & device support, contracting, credentialing, training & education and marketing. Clinical competencies and lessons learned from developing and supporting an overnight acute care telemedicine service will be shared in this presentation. A critical component to a successful hospital telemedicine service is support by Originating Site staff. A description of the process Regions Hospital undertook to engage rural site leadership and frontline nursing staff will be included.
• Analyze the pros and cons of using a virtual hospitalist staffing model to complete hospital admissions at various Originating Site through video telemedicine. • Recognize the importance of early collaboration with each Originating Site to ensure hospitalists and nursing staff are comfortable with the hospital telemedicine admission process. • Explain how hospital medicine services can complete hospital admissions using video telemedicine technologies and systems.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-155
• Describe an effective business model for teleEmergency services in small, rural hospitals. • Demonstrate awareness of physician and advanced practice provider recruitment and retaining improvement and improved job satisfaction. • Compare financial and staffing models for rural hospitals before and after implementation of teleEmergency services.
References:
1. Effect of tele-emergency services on recruitment and retention of U.S. rural physicians. Rural and Remote Health.
2. The Business Case for Telemedicine, Telemed J E Health.
3. Advancing the Transition to a High Performance Rural Health System.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-156
Per 1,000 PERS users, 380 ambulance transports were requested annually. 46% of emergency transports were classified as “physical or psychological symptoms”, with reasons including respiratory problems, chest and other pain, illness and dizziness, whereas only 23% of emergency transports were due to a fall or fracture. Further, the most common principal diagnoses for unplanned hospital admissions after these transports were CHF, COPD, urinary tract infection, pneumonia and septicemia.
• Identify medical reasons why elderly enroll into a PERS service. • Classify situations that lead to ambulance transport in PERS users. • Identify most common medical diagnoses of emergency hospitalizations in PERS users.
References:
1. Agboola S, Golas S, Fischer N, Nikolova-Simons M, Op den Buijs J, Schertzer L, Kvedar J, Jethwani K. Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data. BMC Health Serv Res. 2017;17(1):282.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-157
After the study revealed the telemedicine-enabled visits had significantly shorter median ED lengths and lower total patient charges and higher patient and provider satisfaction, with no safety concerns based on readmissions within 72 hours, the practice became standard of care.
Telepsychiatry consultations have become the standard procedure for pediatric psychiatric emergencies after the initial study indicated a cost-benefit and a breakeven analysis of 112 patients. The use of telemedicine for psychiatric service consultation grew 100% in the next fiscal year and the model is demonstrating promise for increasing access to other specialized healthcare needs.
• Upon completion learners will be able to identify opportunities in their facility where a similar approach can be applied. • Upon completion learners will be able to understand the value of ROI in telemedicine applications and how to calculate a break-even analysis of an application of telemedicine. • Upon completion learners will be understand the aspects of types of revenue and fixed and variable costs used in calculation.
Value (Business Strategy and Financial Management)
EPOSTER PRESENTATIONS
EP-158
The Chat with a Doctor program is set up to operate as a HIPAA-compliant instant message system, so patients can chat and share images with a doctor, connecting in less than 85 seconds on average. Launched without advertising in November 2016; the virtual care program was rapidly scaled to be available to all 660,000 Kaiser Permanente Colorado members through their patient portal from 8am-10pm, seven days-a-week with no co-pay.
Chat with a Doctor has been very well received and volume is growing rapidly. In its first weeks, the program averaged 45 encounters per week, however that number has grown rapidly to upwards of 700 encounters per week; upwards of 200 patients per week are repeat patients.
In its first few months, KP Colorado physicians have effectively diagnosed and treated a wide array of conditions with Chat with a Doctor. Seventy percent of chat encounters are handled with advice only or a prescription, 18% are referred for appointments in the KP system, 7% are sent to our Urgent Care centers, 2% to our acute diagnostic centers, 1% are referred to the ED, while only about 3% abandon chat prior to disposition.
One unexpected positive outcome of the program is its ability to connect to members who have been historically difficult to engage. This segment of the population-young, healthy individuals-often opt not to have a PCP and avoid the health system until an injury or unexpected illness force them to. Many of these encounters, which previously represented a significant portion of our unnecessary ED and acute care visits, have been managed via chat.
We have found this point of contact to aid us in engaging with these members, helping them to navigate our system and provide an additional level of satisfaction with the KP system. With the expansion of the service to mobile platform, we expect utilization by this younger age group to grow even further, greatly increasing the cost savings generated by it.
The asynchronous nature of the communication allows physicians to handle multiple simultaneous chat threads, leveraging the physician's time and creating efficiencies not attainable in other 1:1 encounters. Chat has become one of our highest-resolution lowest-cost care channel.
With increased utilization came an opportunity to offer more specialized advice. We have added Pediatricians, Ob/Gyn NP's, a clinical pharmacist and soon, will add a Behavioral Health Specialist in addition to support agents who assist with scheduling those patients felt to need in person care.
During the presentation, patient enrollment and physician staffing processes for Chat with a Doctor will be reviewed. Service adoption and care metrics for this unique telehealth application will be described, as well as future service line and platform development plans.
• Describe access to care benefits of an asynchronous virtual care program. • Quantify adoption rates in this unique text-based application of telehealth. • Contrast patient engagement and satisfaction levels pre- and post-implementation of an asynchronous telemedicine program.
CLINICAL SERVICES
EP-159
• Understand the structure of a successful care model. Specifically, the combined team approach to ICU care including all ICU staff and care coordination between daytime on-site physician and night Teleintensivist. • The participants will gain knowledge as to the quality metrics and critical outcomes that need to be measured and followed in a telemedicine intensivist program. • The participants will also gain an understanding of some economic and staffing factors that affect delivery of intensive care.
References:
1.