Intermountain Healthcare’s “Build vs. Buy”

Telehealth Implementation Strategy

Kim Henrichsen, VP & CNO Intermountain HealthcareCrystal Jenkins, RN Blue Cirrus Consulting Dan Watterson, PMP Blue Cirrus Consulting

Build It or Buy It? Establishing a Telehealth Platform

BIO

Kim Henrichsen, RN, MSN

• 30 years Nursing Practice• Graduate of Advanced Training Program, Institute of

Delivery and Research Intermountain• Completed Wharton Nurse Executive Fellowship

Program• 28 years staff and progressive leadership positions

with Intermountain Healthcare

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HospitalsIntermountain = 22• State of Utah = 56 • (38% of the hospitals, 44% of the beds, 56% of the

discharges)

Physicians• Intermountain employs approx. 1,000• Affiliated with an additional 4,000• Operates approx. 185 clinics

Health Plan• SelectHealth insures roughly 650,000 residents

of UT and ID (25% of the UT market)• Initiated MA and Medicaid product in 2013

EmployeesIntermountain - approximately 35,000

Intermountain Healthcare

Intermountain Healthcare

• Vision to be a “Model Healthcare System”

• Overriding core value to deliver excellence in patient care

• Known worldwide for clinical programs and innovative clinical IT solutions

• History of self developed IT solutions

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Teleservices Vision

Provide Intermountain Healthcare patients, enrollees, families and employees access to a collaborative, efficient, and user friendly enterprise communication platform that eliminates barriers of place and time, improves safety, and contributes to “extraordinary care in all its dimensions.”

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Teleservices Framework

TeleDailyLiving use of technology to enable people to live independently in their own homes.

TeleMedicine use of audio/video technologies to enable remote consultations between patients, physicians and healthcare professionals, as well as peer-to-peer consultations.

TeleHealth use of monitoring equipment to a monitoring center. Monitored by qualified nurses to act on the information.

TeleCoaching involves monitors and coaches who provide individual support to patients to help them more effectively manage their health conditions.

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• Supports Intermountain’s vision of Shared Accountability

• Care for more people through improved access and better utilization of physicians and other providers

• Reduce delays in care delivery and improve clinical outcomes

• Focus on patient engagement and wellness activities

• Expand availability of information and communication for providers and patients

Why Telehealth?

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• Improves adherence to best practices • Supports clinicians in the complex in critical care areas• Improves clinical and financial outcomes• Improves ability to support patient management with chronic

disease• Provide physicians and other providers tools that make

practicing quality medicine efficient• Lower the need for future facilities • Keeps more patients closer to home • Provides clinical expertise and resource to rural hospitals• Creates opportunities for new referral patterns and

partnerships

Why Telehealth?

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• Robust existing EMR• History of successful internal systems

development• Teleservices strategy is planned across most

service lines and many vendor systems are service specific.

• Already established as an industry leader in automated clinical alerts

• Restrictive vendor licensing limitations• Many vendor solutions not suitable for the

Intermountain custom environment.• Cost

Why Build vs. Buy?

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Leadership / Operations• Telehealth business plan was developed

with a conservative approach.• Hired a Telehealth Innovator to assist in

creating direction to the program.• Hired a Telehealth Business Operations

Director to coordinate efforts across departments and facilities.

• Engaged Blue Cirrus Telehealth experts to assess readiness to implement.

Laying the Groundwork (Key Decisions)

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Technology• Develop stand alone AV platform

independent of clinical systems.• First phase of Teleservices will use

new AV platform and existing EMR “as is”

• Cerner will be implemented system wide in 2014 and 2015 and will be integrated with self developed AV platform.

Laying the Groundwork (Key Decisions)

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• TeleCritical Care retreat was planned and executed with a project kick off approach.

• Blue Cirrus Telehealth experts interviewed key project stakeholders and a Telehealth Readiness Assessment was developed and presented to Intermountain CMO, CNO and Telehealth Steering Committee.

Getting Started

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• Blue Cirrus Telehealth experts were engaged to provide Program/Project Management and Clinical Operations leadership for the project and act as advisors to the system CMO, CNO & Telehealth Oversight Committees.

• Clinical project leadership hired and on-boarded

• Initial telehealth clinical program (TeleCritical Care) rollout schedule was approved.

Post Readiness Assessment

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Intermountain Teleservices Today and Beyond

Dan Watterson, PMP Blue Cirrus Consulting

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BIO

Dan Watterson, PMP

• 20+ years Clinical IT implementation experience• 10+ years Telehealth implementation experience

working with over 35 health systems as a Project Executive or Project Manager

• Critical Care Nurse

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Customized AV platform…

• Utilizes and integrates with Microsoft Lync.• Call routing and queuing based on service.• Xi3 PC serves as an “AV Server”• 32” or 42” TV for video display• Axis camera & Jabra mic-speaker combo• IR transmitter to control TV function• Remote agents use company standard PC/Laptop

and webcam.

What was Developed?

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Video, audio, instant-message,

screen-share, multi-party, call-routing

Teleservices Platform Capabilities

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Video, audio, instant-message,

screen-share, multi-party, call-routing

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• TeleICU pilot live since December 3, 2013 testing clinical workflows and technology.

• 12 facilities and 260 beds to be live on TeleICU by Fall of 2014.• Ongoing development and improvement of AV solution to

include: family to patient room visits (Skype), high end microphone option, multi camera setup and integration with external service providers.

• Numerous programs planned to implemented in 2014 to include:

Current State and Future Plan

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• Behavioral Health• Cardiovascular• Intensive Medicine• Oncology• Pediatric Specialty• Primary Care• Surgical Services• Women & Newborns• Care Process Models

• Food and Nutrition• Imaging• Pathology• Pharmacy• Pain Management• Rehabilitation• Respiratory Care• Case Management• Interpretation

Planned Telehealth ImplementationsClinical Programs Clinical Support Services

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Clinical Implementation Best Practices for Telehealth

Crystal Jenkins, RN BSN MHI Blue Cirrus Consulting

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BIOCrystal JenkinsRN BSN MHI (Masters of Health Innovation)

• 18 years Critical Care Nursing Practice• 10 years Nursing Leadership Influence• 5 years Telehealth Operations/Implementation Expertise for large

healthcare system, monitoring 500+ varied care level patients, in 5 Western States, from 4 remote locations, including Tel Aviv, Israel.

• 6 years as Adjunct Faculty, Arizona State University-MHI/DNP programs

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Readiness Assessment Performed via Interviews of Key Stakeholders

Observations, Recommendations and Action Plans were categorized into the following topics:

• Leadership• Culture• Clinical Operations• Technology

Clinical Implementation Best Practices

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• What problem are you trying to solve?• Identified Leadership to Support/Promote

Telehealth• Executive Sponsor(s)• Physician• Nursing

• Baseline data to support Telehealth Initiative• Outcome Measures/Goals of Program

Clinical Implementation Best PracticesLeadership

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Is there Alignment Between:• Key stakeholders• Business Plan/Implementation Strategy• Clinical/Technical Leaders• Project Management• Organizational Initiatives R/T Telehealth

Program Objectives

Clinical Implementation Best PracticesLeadership

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Telehealth is NOT ‘Big Brother’

Eliminate Telehealth assumptions and ambiguity• Create Marketing/Communication Plans

• Internal• External

Create effective education plans• Initial• On going

Clinical Implementation Best PracticesCulture

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• Align Telehealth with Organizational Initiatives/Strategy

• Assess Current Organizational/ Specialty Area Goals

• How will Telehealth contribute to these goals?

• How will the Telehealth program be involved on a committee/planning level?

Clinical Implementation Best PracticesCulture

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Assessment of current practicesIdentify inconsistencies that could impact outcomes

• Use of Electronic Medical Record (EMR)• Use of Electronic/Enterprise Data Warehouse (EDW)• Data Collection/Reporting Practice• Policy/Procedure

Clinical Implementation Best PracticesCulture

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Staffing Model• Type of Model/Hours of Operation

• Continuous• Episodic• Responsive

• Clinician Coverage • Expert• Specialist• Physician Extender

Clinical Implementation Best PracticesClinical Operations

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Staffing Model Impacts• Budget• Workflows• Technology • Quality Outcomes

Clinical Implementation Best PracticesClinical Operations

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• Are services reimbursable?

• How will operating budget be funded?• Reimbursement• Grants• Allocating costs/charge per bed/patient• Insurance/vendor support• Skill set of remote clinicians• Impact on Organization Initiatives• Impact on Clinical Outcomes

Clinical Implementation Best PracticesBudget

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• Dependent on staffing model• Hours of coverage• Clinical support type/skill

• Designed to impact Telehealth Clinical Outcomes R/T Organizational Strategy

• Dependent on Access to EMR, Data & Patient via Camera • Dependent on Engagement

• Remote Clinicians• Bedside Clinicians

• Supported by Executive Sponsor(s)/ Organization Executives

Clinical Implementation Best PracticesWorkflows

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Dependent on:• Available vs. Required to deliver appropriate and safe care• Capability to access clinical data remotely• State of Integration/Utilization

• Remote Clinicians• Bedside Clinicians

Clinical Implementation Best PracticesTechnology

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Dependent on• Consistent practice throughout Organization

• Policy/Procedure• Documentation• Data Collection

• Utilization of the Telehealth program, clinical resources and associated technology

• Relational Coordination between remote and bedside clinicians• Shared Goals• Shared Knowledge• Mutual Respect

Clinical Implementation Best PracticesQuality Outcomes

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Program Management and Technical Implementation Best Practices

for Telehealth

Dan Watterson, PMP Blue Cirrus Consulting

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• Define governance process for Telehealth initiatives.• Create a formal project with clearly defined senior executive

sponsor, clinical business owner, IT business owner and a project manager.

• Fully understand what you are implementing or building. i.e. technical standards (Hardware & Software), integration requirements, licensure restrictions, cost of ownership.

• Ensure technology meets clinical or business need.

Project/Program Prerequisites

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• Do not move forward without clear defined project and business ownership.

• Create a formal project charter (what, who, when and how)• Create a program specific implementation oversight /

steering committee.• Conduct formal project kickoff meeting lead by senior

executive sponsor. Why are we doing this!!• Ensure all IT functional departments are represented on

project team.

Project/Program Prerequisites

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• Plan with end in mind! • Begin support and release management planning from

the start. • Create a formal communication plan. Engage facility or

corporate communications team from the start.• Clearly define technical implementation roles and

obtain approval from IT leadership.• AV experts should plan technology placement with input

from bedside clinicians.

Planning

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• Communicate, Communicate, Communicate…• Keep in scope! If changes are needed they should be

vetted through the change management process (defined in project charter).

• Evaluate effectiveness of all implementation components. Is this effective? Change what isn’t working.

• Include support teams in equipment installation and configuration activities

Execution and Control

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• Communicate, communicate, communicate…• Create a formal activation plan.• OVER-staff for Go Live!• Include support teams in Go Live process.

Activation

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• Formal Transition to Support• Document Lesson’s Learned

Intermountain Examples• Get multi-specialty feedback on AV requirements. • One size does not fit all!• Don’t implement technology unless there is a clinical need.• Be aware of other IT initiatives in relation to technology

installation.

Closure

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Pro: You own it!• Customized for system’s specific needs• Minimal to no licensure limitations• Lower cost of ownership

Pros and Cons

Con: You own it!• Implementation of Telehealth is a complex CLINICAL

initiative supported by technology.• Long term commitment to develop, implement and

support.• Enhancement requests are system specific vs. multi system

input.

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www.blue-cirrus.com www.intermountainhealthcare.org

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