Design YOUR Own Virtual Visit February 29, 2016

Kathy H. Wibberly, PhD, Director

Conflict of Interest

Kathy Hsu Wibberly, PhD

Has no real or apparent conflicts of interest to report.

Agenda

1. Learning Objectives

2. Looking Back: How We Got Here

3. Looking Forward: Opportunities and Challenges

4. Intentional Design: Back to the Future?!

5. Questions

Learning Objectives

•Review the current landscape of telehealth with a focus on enabling digital encounters

•Assess the approach to using technology to provide care in a virtual setting

•Recognize the components of creating a successful telehealth program leveraging virtual visits

Looking Back: How We Got Here

Health Care - Past

Health Care - Present

Progress??? CARE PAST PRESENT

Location Home Clinic/Hospital

Provider Generalists Specialists

Interaction Frequent Episodic/Periodic

Relationship Personal Impersonal

Unit Family/Community Individual

Focus Health Disease

A mechanism for enhancing health care, public health, health administration and health education delivery and support, using electronic communication and

information technology.

Necessity Breeds Invention Telehealth - Past

It’s A Good Fit for Rural Health

It Started with Rural

It Looked Like This

Videoconferencing

It Started with Synchronous

Telestroke – Time is Brain

• Administration of tPA

at stroke centers =

10% - 20% of ischemic

stroke patients

• Administration of tPA

outside of stroke

centers = 1% - 2%

(without telestroke)

and 10% - 20% (with

telestroke)

Parkinson’s Care

This program has saved patients

roughly 20,000 miles of travel

It’s Not Just For Rural Specialty

Care

Telehealth + Rural?

PCMH + Telehealth? It’s A Good Fit for the

PCMH

It Looks Like This

Remote Patient Monitoring

Was Added

Types of School Based Telemedicine

Care Provided – 2011 Survey of 46

Organizations

Remote Patient Monitoring: Real Patients/Real

Outcomes – Large Academic Medical Center

Remote Patient Monitoring: Real Patients/Real Outcomes –

Medium Sized Rural Health System

Remote Patient Monitoring: Real Patients/Real Outcomes –

Small Rural FQHC Look-Alike

Replication Underway

http://cotnexperience.blogspot.com/p/blog-page.html

• 72% decrease in

costs

• 50% decrease in

hospital bed days

• 81% decrease in ER

visits

Paradigm Shift

Telehealth Future Is Here…

House calls trump virtual care because the provider:

a. Has patient's medical history

b. Can touch the patient

c. Can use medical devices

d. Virtual care is equivalent

Looking Forward: Opportunities

and Challenges

Integration of telehealth into

mainstream care delivery

https://www.accen

ture.com/us-

en/insight-virtual-

health.aspx

Assess

Reasons for Adoption Abound

Assess

Reasons for Adoption Abound

Assess

Reasons for Adoption Abound

Assess

But The Struggle Is Real

What % of outpatient care can be effectively done virtually?

a. 15% or less

b. 50% or less

c. 70% or less

d. more than 70%

Assess

Challenges

Organizational

Clinical

Financial

Technology

• Current IT infrastructure

• Broadband connectivity

• Network integrity

(security, utilization,

firewalls, hardware, QoS)

• Existing equipment

• Staffing

Needs

• Providers

• Patients

• Data/

Information

Coding and Billing

Administration

• Buy-In

• Staffing

• Scheduling

• Training

• Policies, Procedures and

Protocols

Purchasing

Contracting

Assess

Current State

What the patient wants What the provider wants

What the clinician wants to do What the clinician is trained to do

Slow EMR Integration with Telehealth

One-Off Solutions and Pilots

What About Asynchronous?

What About mHealth

Continuity of Care

What is the greatest barrier to virtual care? a. Technology

b. Reimbursement

c. Patient and Provider Buy-In

d. Other

Intentional Design:

Back to the Future?

CARE PAST PRESENT FUTURE

Location Home Clinic/Hospital Anytime/Anywhere

Provider Generalists Specialists Team

Interaction Frequent Episodic/Periodic Continuous

Relationship Personal Impersonal Personal

Unit Family/Community Individual Population

Focus Health Disease Prevention

What Do You Want YOUR Health

Care to Be Like?

Opportunities

What Do You Want YOUR Health

Care to Be Like?

The Champ!

What Do You Want YOUR Health

Care to Be Like?

http://www.himss.org/ValueSuite

http://www.the-

alliance.org/Blog/8_Ke

y_Questions_to_Consi

der_When_Adding_Tel

emedicine_to_Your_Be

nefit_Plan/

What is the greatest benefit to virtual care?

a. Reduce Health Care Costs

b. Improve Access to Care

c. More Productive Workforce

d. Better Patient Experience

Questions

www.facebook.com/MATRC

www.MATRC.org