Marc Newell, MD, FACC, Minneapolis Heart Institute

TELEHEALTH

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Outline for today’s talk

•What is Telehealth about?

•Why do Telehealth?

• What does a visit look like/how does it work?

• What’s novel? – Bedside ultrasound physical exam adjunct

• Where are we now in the program?

• Where is the program going?

• How does this fit into MHI’s Outreach?

Goals

• Increase patient satisfaction and outcomes, and reduce health care costs.

• Partner with physicians and hospitals to deliver telehealth services for patients in their communities.

• Decrease inter-hospital transfers.

• Reduce the need for patients and their families to travel long distances to see a specialist.

• Improve continuity and convenience of routine and post-hospital follow-up care.

Rationale: Why are we doing this?

• Our country’s economy is buckling under the cost of health care.

• Rationing health care is not an option.• We have to change---we need to transform

how and where we deliver health care.- More emphasis on early prevention - Focus on chronic disease

management• Better access to specialty services for

complex patients (heart attack, stroke), and for conditions, e.g. mental health, that are undertreated and poorly resourced.

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Cardiac Telehealth (or Telecardiology) will improve population health by providing tools and clinical capabilities within and beyond the traditional health care settings. We will do this by:

– Extending our world class expertise to all communities and health care facilities

– Becoming a virtual health system integrating care across the healthcare continuum and beyond

– Promoting the Triple Aim (quality care, positive patient experience, at a reduced cost)

Vision

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Why Do Telehealth?

•Clear wins:–Increased access to specialty care

• Care delivered more often• Care delivered close to home, in a familiar environment• Easier on the patient’s family and support system

–More “touches”• You can literally be in two places at once!• Huge implications from a group and system perspective

–Research possibilities• Assess what benefits (and drawbacks) are present• Become a leader in an expanding field

–A key to prepare for the new world of Affordable Care

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Telehealth and the Triple Aim

• Telehealth fits extremely well into the concept of the IHI Triple Aim:– Patient experience

• We will measure by patient satisfaction survey• Less travel time, care provided closer to home• Easier access to care

– Improve health of populations• Increase timely access to specialty providers • No need to increase the number of specialty providers• More specialty care available in more locations

– Decrease cost of care• Improved appropriate “triage” to tertiary care and further

testing (downstream testing)• Less hospitalizations/ER visits due to increased access to

care

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• In our program, local or Allina-employed nurse practitioners travel to rural communities to have direct patient visits and then connect the cardiologist with the patient via telehealth video equipment.

• This results in a real time, face-to-face visit, where all patients can ask questions and interact, just as they would in a traditional clinic appointment.– Each patient’s medical history and test results are

available to the cardiologist in advance of the appointment.

– The patient documentation appears in Electronic Medical Record and formal dictations are still completed by the cardiologist.

How does it work?

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• Currently slotted for 6 patients per day

• Goal is to see new patients or established patients with new problems– For programmatic development (and patient

convenience), all are welcome

• Logistics– Information for patients and schedulers is key

– Fostering understanding and support from local providers is essential

• Understanding this is a supplement and not a replacement of services!

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How does it work?

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• Example template for workflow from the clinic/patient perspective:

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Sample Workflow

Visit time Lab time Echo/Ultrasound time

9 AM 7:45 AM 8:15 AM

10 AM 8:45 AM 9:15 AM

11 AM 9:45 AM 10:15 AM

1 PM 11:45 AM 11 AM

2 PM 12:45 PM 1 PM

3 PM 1:45 PM 2 PM

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• A rapidly evolving (and exciting) part of medicine and cardiology is bedside ultrasound as an adjunct to the physical exam

• Able to assess left ventricular function, pericardium, do a limited valve review

• We will study this systematically, the hypothesis is:– Shorter time to diagnosis– Less downstream testing– More appropriate treatment, initiated sooner

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CardioVascular Ultrasound Physical Exam (CVUPE)

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• One challenge of not being physically present with the patient is the exam

– Some use nurses with audio-stethoscopes

– We chose an NP/PA face-to-face interaction

– Seeing the patient via ultrasound• Gives the cardiologist a direct look above and beyond

the video monitor and reported exam

• Dramatic increase in diagnostic and prognostic information to the remote provider

• Let’s be honest: our echo data far exceeds our stethoscope findings!

Why CVUPE (Ultrasound)?

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Thank you!

• Marc Newell– Cardiologist, Minneapolis Heart Institute

– Director of Telehealth and Telecardiology, Allina Health

– Director of Outreach Services, MHI