partnering of clinical and technical leadership in developing a successful telemedicine program...
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Partnering of Clinical and Technical Leadership in Developing a Successful Telemedicine Program
Jeffrey Barnello Senior Technical CoordinatorNicholas Slamon M.D. Medical DirectorNemours CareConnect
Pass that Telemedicine Bill
Michael Kurliand, MS RNTelehealth & CareConnect Program Director
&
Current State
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What is parity?
29 States + Washington DC have a telemedicine parity law*
health plans cover services provided via telemedicine to the same extent the plan covers those services if provided through in-person visits.
http://www.americantelemed.org/policy/state-policy-resource-center#.Vi1h2K6rTEo
Not all laws are created equal
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Physician services only
In person visit first time
Mandates payment for tele, but not parity
Rural coverage and/or urban coverage with low population
Medical professional has to be with patient
Only in-state specialists
APN’s, PA’s, LSW, Therapists, etc.
Ability to establish relationship via tele
Payment for services at the same rate as an in-person visit
Coverage for services regardless of where the patient lives in the state
Treat within capability of technology and scope of medical professional
Allow out of state specialist up x visits
Formula
1. Commitment- Personnel; Administrative and Clinical Champions and Government Affairs- Organizationally; C-suite endorsed and supported, financially and
strategically
2. Community- Medical Society of Delaware- Delaware Healthcare Association- Delaware Telehealth Coalition- University of Delaware; Parkinson’s Clinic- Nemours, A. I. duPont Hospital for Children
3. Collaboration- Leveraging each other’s strengths and momentum- Keeping each other informed- Drafting the Bill
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Formula4. Lobby
- Frame your advocacy message and make your case- Door-to-door through the capitol- Become the resident subject matter expert- Maintain visibility; be present during the votes, at the lunch table, etc.- Provide testimony
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‘Savings are going to come from system changes, not lowered reimbursement to providers.’
Opportunity Costs of Ambulatory Medical Care in the United StatesAuthor: Kristin N. Ray, MD, MS; Amalavoyal V. Chari, PhD; John Engberg, PhD; Marnie Bertolet, PhD; and Ateev Mehrotra, MD, MPH
‘This is about increasing access.’
‘A win for the community, payors, and providers.’ – provide real life examples.
http://hin.com/blog/2014/01/07/infographic-the-doctor-shortage/
Success and Resources
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Unanimously passed both the House and Senate
Snapshot
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Planned Implementations
School Pilot
International Medicine & 2nd Opinion Service
Jefferson University Health System
Surgery – post op and MFM
Audiology Portfolio - Newborn hearing screening, Diagnostic follow up ABR, Tympanogram, CI, and Speech
Rheumatology
Adolescent Medicine
Infectious Disease
Oncology
Cardiology
Direct to Consumer Q1 2016
Services
Critical Care
Nutrition
Weight Management
Psychiatry
Palliative Care
GI
Headache Clinic
Urology
Transition of Care
Nephrology
Orthopedics
YTD: ~350
Approximately 2/3 of visits are being paid for by insurance companies
Partnering of Clinical and Technical Leadership in Developing a Successful Telemedicine Program
Jeffrey Barnello Senior Technical CoordinatorNicholas Slamon M.D. Medical DirectorNemours CareConnect
Where we started
Began as an idea to provide visual support to physicians that handled emergency transported patients by phone description only
IRB controlled study to determine effectivenessEasy to use technical platformQuick ROI (cheap but effective)Chose to use IPAD’s
Challenge 1
Clinical and technical teams work togetherHIPAA complianceSecurity buy offImplementation planWho does what?Acceptance of IPAD and use of Facetime as a
commercial device, not just a consumer product
Challenge 2
How do we implement in partner Emergency Departments?
Who do we meet with at partner facilities?How do we manage legal and compliance
questions?Where do we begin to achieve success?
Challenge 3
Need portable and mobile platform. Needs to be effective and cost effective
Locking mechanismHeight adjustmentAbility to chargeBranding
Challenge 4
Private vs. public Wi-Fi. Stability neededEnsuring open network portsNo management application that eliminates ability
to connect anytimeWork with partner facility clinical and technical
teams in one implementation meeting
Challenge 5
Physician adoptionProve ease of use and simplicityHas to work the first time, every timeEnsuring carts are stored and located in a
centralized area within the ED so they do not become “lost”
Nursing buy-inNeed to get consentKeep the work flow simple
Challenge 6
Create a specific Epic note type to document all encounters
Create a report process so we can study and learn the program’s effectiveness
How can we bill for consults?
So, what are our results?
Locations
1. Bayhealth Kent 2. Bayhealth Milford 3. Bayhealth Smyrna 4. Beebe 5. Exceptional Care for
Children 6. Inspira Bridgeton 7. Inspira Elmer 8. Inspira Vineland 9. Inspira Woodbury 10. Jennersville 11. MLH Bryn Mawr 12. MLH Lankenau 13. MLH Paoli 14. MLH Riddle 15. Nanticoke 16. Nemours Dover Clinic 17. Nemours Seaford Clinic 18. Phoenixville 19. TJU Methodist (Sept 2015)20. Union
So, what are our results?
Delaware Telemedicine LawDeployed over 50 carts to partnering ED’s, NICU’s,
PED’s Floors (DE Valley and Florida Operations)Internal deployment to inpatient areas for consultsDeployment for schools program to support school
nursesOn cruise ships (Florida Operations)Over 360 consults in 18 monthsOver 510 combined telehealth visits (consults and
outpatient visits
Transition to Vidyo platformAdding peripheral devices (stethoscope, otoscope)Deployment to Urgent Care CentersDeployment to select Pediatrician OfficesSchools sports programContinue to add more outpatient visits and clinics
What is the future?
http://youtu.be/tXQ-evjHqGk
Questions?