M A R K S I N G H M DA . C H A K R A B A RT I M D

D E B Z O N A R N

Nursing Home Telemedicine Program

Mark Singh MD May 20, 2009 --- Confidential ---

Background: Clinicore

Leading edge Nursing Home Telemedicine company

Staff Back Ground Nursing home, hospital and clinic based medical

practice Medicare Advantage, Tufts Medicare Preferred case

management Nursing home medical management Affiliated with multiple hospitals in the south of

Boston region Relationships with Boston Tertiary hospitals Active involvement with major EMR implementation

projects in the regionMark Singh MD May 20, 2009 --- Confidential ---

Telemedicine: The Concept

John DoeClinical ResultsLabs: WBC 12

Hct 32Bun 45, Cr 2.4

John DoeEncounter Notes

Assessment:Pneumonia,

uncomplicated, stablePlan: observe, Abx

View ResultsVisualize patient,

examine with nurseDocument the

Encounter

Mark Singh MD May 20, 2009 --- Confidential ---

• Physician can remotely assess a patient using high-definition video conferencing and formulate a plan

• Key elements• View clinical results• Visualize the Patient• Document the encounter: assessment and plan

Medical Care Issues in Nursing Homes

Inconsistent Physician coveragePhysicians generally not onsite to address

medical problems as they arise: Pneumonia Wounds Rashes/lesions Post-Op issues, complications Other medical problems that usually require onsite

examination or close daily monitoring

Mark Singh MD May 20, 2009 --- Confidential ---

Consequences of Sub-optimal Physician Coverage

Needless emergency room visits/Ambulance rides

High admission and re-admission rates to hospitals

Delay in treatment for wounds/infections with resulting complications

Poor outcome measures (DPH, JCAHO)

Decreased Patient/Care-giver satisfaction

Mark Singh MD May 20, 2009 --- Confidential ---

Medicare Implications

Nursing Home Pay-for-Performance demonstration “Nursing Home Value-Based Purchasing”

demonstration Criteria includes “appropriate

hospitalization” Implications for re-imbursement/quality

measures 30 day Re-Admission Reduction

May be tied to hospital reimbursement Likely to be a reportable outcome by

hospitals Hospitals transfers will go to SNFs with low

re-admission rates and with good clinical programs in place

House Bill, HR 2068: will expand Medicare telemedicine coverage if passed

Mark Singh MD May 20, 2009 --- Confidential ---

Telemedicine Allows for On Demand Physician Care

Allows medical problems to be addressed by a physician as they occur

Treat patients onsite appropriately without having to transfer to the ER.

Cost savings: fewer ambulance trips

Improved Outcomes: Lower hospital admissions and re-

admission rates Fewer complications: wound care, post-

surgical careMark Singh MD May 20, 2009 --- Confidential ---

Does Telemedicine Work?

Telemedicine via video conferencing is comparable to in person evaluation (study done at MGH, May 2009, Journal of Telemedicine and Telecare)

Telemedicine can increase physician onsite availabilityDoes Onsite physician availability improve

outcomes? Multiple studies have concluded that onsite physician

availability at the nursing home and effective communication is key in reducing hospital admission rates and improved quality of care

Mark Singh MD May 20, 2009 --- Confidential ---

Nursing Home Implementation

Prerequisites Wireless broadband access in Nursing home DPH notification: intent to implement telemedicine

Promotion and training Staff physician consent process Nursing staff

Procedural and Compliance Nursing home credentialing of Clinicore physicians Approval of patient consent forms and process

Telemedicine equipment deployment Go live

Mark Singh MD May 20, 2009 --- Confidential ---

Clinicore Telemedicine Extension Program

Leveraging telemedicine equipment for administrative functions: virtual conferencing with multi-site organizations Remotely located “Lead Administrator” can “meet”

with entire local leadership team via high definition video conferencing

Nurse Training/Education via Video conferencing Educational rounds with local specialists

Infectious disease: i.e.,H1N flu, MRSA, review of in-house infections

Wound care Post-operative careMark Singh MD May 20, 2009 --- Confidential ---

Demo Slides

Mark Singh MD May 20, 2009 --- Confidential ---

Mark Singh MD May 20, 2009 --- Confidential ---

Telemedicine Cart Features

• Wireless high-definition videoconferencing

• Mobile: can be moved to patient room

• Wireless connectivity, internal battery

• Peripheral devices

• Exam camera for wounds, close ups

• Digital Stethoscope

Patient Evaluation at Nursing Home

Mark Singh MD May 20, 2009 --- Confidential ---

Images captured remotely during live sessions

Mark Singh MD May 20, 2009 --- Confidential ---

Patient with recent MRSA wound infection

Patient with new rash

Telemedicine Clinical Documentation

Consult note is generated for each encounter Note sent/faxed to patient’s nursing home physician Note for sent to nursing home for insertion into chart

Sample note See attached

Mark Singh MD May 20, 2009 --- Confidential ---