collaboration for an effective telehealth project catherine bruno, fache january 2001
TRANSCRIPT
Collaboration for an Effective TeleHealth Project
Catherine Bruno, FACHE
January 2001
Catherine Bruno, FACHE
Current position (4 months)Vice PresidentMedicalis Corporation, Boston, MASoftware company connecting radiologists to ordering physiciansFunded by Brigham & Women’s Hospital
Prior position (11 years)Chief Information OfficerThe Ohio State University Medical Center, Columbus, OH1,000-bed academic medical center
Agenda
TeleHealth LandscapeTechnologyRegulations
Scenario for Collaboration – a TeleHealth Project Framework
Case StudiesThe Ohio State University Medical Center Telemedicine ProgramRadiology at Brigham & Women’s Hospital
TeleHealth Landscape - Technology
The Internet - ConnectivityWorldwide connectionBrowserWireless
Computer HardwareSmaller, faster, lighter, less expensiveVideoHandhelds
Software FrontiersVoice RecognitionCharacter RecognitionData Mining
TeleHealth Landscape - Regulations
New Telemedicine Legislation that expands reimbursement
HIPAA - Clinton Administration Issues Regulations on Medical Record Security
Canada strengthens Internet privacy
New Telemedicine Legislation
Substantially improves existing Medicare coverage of telemedicine effective October 1, 2001
HCFA will issue rules early in 2001
Serves as a major step forward in expanding services throughout the U.S.
HIPAA - Medical Record Security
Effective Feb 26, 2003Covers all medical records and identifiable health information: electronic, paper, & oralProvisions:Consumer Control Over Health InformationBoundaries on Medical Record Use and ReleaseEnsure the Security of Personal Health InformationEstablish Accountability for Medical Records Use and ReleaseBalancing Public Responsibility with Privacy Protections
Special protection for psychotherapy notesEquivalent treatment of public and private sector health plans and providers
Source: HHS Fact Sheet, Dec 20, 2000
Canadian Internet Privacy
Protects personal information disclosed through electronic transactionsJan 1, 2001 for companies that are federally regulatedBy 2004, anyone doing business in Canada must complyConsent of consumers is required if their personal information is used commerciallyConsumers have the right to review any information about them that is on fileA privacy commission is being set up to investigate violationsCompanies must name someone responsible for privacy mattersEuropean companies already operate under similar rules
Source: New York Times, Dec 23, 2000
Agenda
TeleHealth LandscapeTechnologyRegulations
Scenario for Collaboration – a TeleHealth Project Framework
Case StudiesThe Ohio State University Medical Center Telemedicine ProgramRadiology at Brigham & Women’s Hospital
Overview
Effective TeleHealth Projects provide ongoing support for improved health using telecommunications tools
Many TeleHealth projects are initiated as independent projects that are grant-fundedhave a limited scaleoften not part of the health care organization’s technical plan
TeleHealth is not an “Island;” it requires significant integration into the organization and operations for success
Scenario for Collaboration – a TeleHealth Project Framework
Three Keys to Success
Effective TeleHealth
Project
People Processes
Technology
Scenario for Collaboration – a TeleHealth Project Framework
PeopleSupport of key medical staff, administrative, project, and IT staff Sufficient resourcesCollaborate throughout the processCommunicate, communicate, communicateStrict patient confidentiality
ProcessesChange Management Organize and structure the projectEnsure fit with operations
TechnologyIntegration into the organization’s systemsSystems & Technical infrastructure
People: Support of key medical staff, administrative, project, and IT staffMedical Staff involvement and leadershipAdministrative supportProject executive sponsor or committee to remove roadblocksFit with the health care organization’s strategic direction and marketConsensus on clear project goals and expectationsIdentify key end users who can be trusted to shape the projectVendor involvement
People: Sufficient resources
Money for equipment, systems, connectivity, etc
Staff with technical and clinical operational expertise
Large projects require a dedicated project manager
People: Collaborate throughout
the process
Starting in the planning phases
Continuing through design, development or selection, testing, implementation, and support
Regular meetings to track progress and remove roadblocks
People: Communicate, communicate, communicate
Communicate often
Use multiple methodsProject meetingsLeadership meetingsOrganizational communications (regular staff meetings, grand rounds, etc.)Pizza lunchesNewslettersInternetEtc.
People: Strict patient confidentiality
In the United StatesMedicare regulationsNewly created HIPAA privacy rulesState laws on privacy – especially for psychiatric and AIDS informationRegulatory agencies, e.g., JCAHO, CARF
In Canada – new internet privacy regulations
Organizational PoliciesE.g., Research oversight, e.g. Human Subjects Committees
Scenario for Collaboration – a TeleHealth Project Framework
PeopleSupport of key medical staff, administrative, project, and IT staff Sufficient resourcesCollaborate throughout the processCommunicate, communicate, communicateStrict patient confidentiality
ProcessesChange Management Organize and structure the projectEnsure fit with operations
TechnologyIntegration into the organization’s systemsSystems & Technical infrastructure
Processes: Change Management
Build a shared visionDocument current processes and operations - “An accurate, insightful view of current reality is as important as a clear vision.”“Use the gap between the vision and current reality to generate energy for change.” Collaborate to develop new operational procedures to accommodate the new functionality/systemConsider the interconnectedness with the rest of the organizationPrototype the new processes and systemLevel of testing depends on the newness and criticality of the systemMeasure and communicate the results
Source: The Fifth Discipline by Peter Senge
Processes: Organize and structure the project
Assemble and structure the team with the needed skills and knowledgeDefine clear rolesDevelop a reasonable scheduleTrack status; Measure and report project performanceManage Vendor to deliverables and datesImplement the technology in phasesIterative changes to operationsOpportunity for the system to evolve from feedback & experience
Typical Planning Process
WHERE ARE WE NOW?
TASK 1
TASK 2
TASK 3
TASK 4
WHERE ARE WE GOING?
TASK 5
TASK 6
Status Update
HOW DO WE GET THERE?
TASK 7
TASK 8
Environmental Assessment
Status Update
Inventory of Current Environment
Goals and Objectives
Project Organization
Identify/Prioritize Projects
Needs Analysis Alternate Strategy Assessment
Strategy Selection and Plan
Status Update
Processes: Ensure Fit with the Operations
Analysis of current operationsWork with people who do the work every day to redesign the processes to fit the new systemMonitor implementation and change where neededOperational considerations:Convenience/accessibility of locationPhysician schedulingWho do you call with questions or issues?
Scenario for Collaboration – a TeleHealth Project Framework
PeopleSupport of key medical staff, administrative, project, and IT staff Sufficient resourcesCollaborate throughout the processCommunicate, communicate, communicateStrict patient confidentiality
ProcessesChange ManagementOrganize and structure the projectEnsure fit with operations
TechnologyIntegration into the organization’s systemsSystems & Technical infrastructure
Technology: Integration into the organization’s systems, where practicalConformance with standards
Sets the stage for current and future integration of information with other systems and processes
Allows integration with support services
Makes ongoing support and updates easier
Technology: Systems and Technical Infrastructure
Technical standards
Planning
Connectivity
Bandwidth
Vendor support
Support services such as the help desk
Information integration
Obstacles
Obstacles can arise in any area and at any step of the project
With collaboration and consensus on goals, the team can work through all the other obstacles
For exampleIf resources are scarce, the leadership group can figure out how to get what’s neededIf the technology is too immature, you can work out an appropriate exit strategy
Agenda
TeleHealth LandscapeTechnologyRegulations
Scenario for Collaboration – a TeleHealth Project Framework
Case StudiesThe Ohio State University Medical Center Telemedicine ProgramRadiology at Brigham & Women’s Hospital
Examples of Effective Collaboration
Massachusetts General Hospital Teleradiology using electronic imagesSource: “Medical Imaging over the Internet” by Keith Dreyer, DO, PhD, Corporate Director, Partners Healthcare System, presented at eHealthcareWorld, Dec 2000
Real-time stroke intervention, including scoring the deficits and collaborative patient management Source: “Telemedicine-enabled patient care: New Approaches to healthcare delivery” by Lee Schwamm, MD, MGH, presented at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration
DOD Walter Reed Army Medical Center: telemedicine web-based clinical applications to enhance access to subspecialty medical consultation: dermatology, dentistry, echocardiography, sleep medicine, podiatry, and ophthalmology
Source: “Medical Imaging over the Internet” by Colonel Ron Poropatich, MD, Walter Reed Army Medical Center, presented at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration – Case Studies
The Ohio State University Medical Center telemedicine program
Radiology at Brigham & Women’s Hospital
Case Study: The Ohio State University Medical Center
(OSUMC) Telemedicine Program
OSUMC – Telemedicine Program Description
OverviewBegan in 19966,000 consults per year12 specialties with highest use in internal medicine, pulmonary care, and dermatology32 sites, dedicated half-T1 connectionsAdministration shared between OSUMC and Ohio Department of Rehabilitation and Corrections (ODRC)Cost $2.5 millionCut the transport of prisoners by 30%
High physician satisfactionEasy to useReadily met their clinical needs
Three Keys to Success
Effective TeleHealth
Project
People Processes
Technology
OSUMC – People
Key OSUMC and ODRC Medical Staff, administrative, and IT leadership Sufficient resources – Funded by ODRC and a grant from AmeritechFull time OSUMC project leaderFull time technical coordinatorSignificant involvement by Ameritech and OSUMC IT network staff
Close working collaboration between OSUMC and ODRC throughout the processFrequent communication via meetings, phone, etc.Strict patient confidentialityBehind the OSUMC firewallPhysical security
OSUMC - Processes
Shared vision to improve quality and timeliness of care and reduce cost by minimizing patient transports for care Started with a prototype in internal medicineFull time project leader assigned by OSUMC to organize and manage the implementation and ongoing operationsEnsure fit with operationsTechnical coordinator for scheduling the physician time and technical resourcesConvenient/ accessible location at OSUMC
OSUMC - Technology
Systems and technical infrastructureConformance with network standardsSupport by OSUMC network staffVendor support
Case Study: Radiology at Brigham & Women’s
Hospital (BWH)
BWH – Radiology Information Management System (RIMS)
Improve the quality and efficiency of health care services byFacilitating the integration and flow of information among health care providersProviding evidence-based clinical knowledge at the point the physician is placing the orderImproving access to billing code informationMining a data warehouse of indications and results to create evidence-based clinical guidelines
Over 100 radiologists, ordering physicians, and physician office staff using the system for the past 2 years
Radiology: Historical with the Internet
Report Dictation/ Transcription
Text: Call, Fax, US-MailMD Receives Report
MD sees
Patient
Generate Req
ANALOG
PACS
Consult favorite radiologist
Consultation and Advice Engine
Manual Billing Coding
ICD & CPT Mapping, ABN’s
Bill Generated
ImageEnhancement
Structured Ordering &Scheduling
ReportGenerationConsensus Wisdom
Risk ManagementWork listsPatient letters
Web Result Delivery
Indications & Results Analysis
DataWarehouse
Future Ordering
Three Keys to Success
Effective TeleHealth
Project
People Processes
Technology
BWH – People
Support of key medical staff, administrative, project, and IT staff – Medical Staff LeadershipInitiated by a RadiologistSignificant time commitment of the RadiologistSupported by Chair of RadiologySupport from the Hospital COO and CIO
Sufficient resources - Staff to support the system funded by the HospitalSystem DevelopmentImplementationTrainingDedicated System Support Staff
BWH – People
Collaborate throughout the processRadiology leadershipBWH Information Systems and BWH Operations Staff
Communicate, communicate, communicateRegular meetingsClose communication with people using the system during implementation and on an ongoing basis
Strict patient confidentialityConformance to BWH strict patient confidentiality policiesConformance with BWH security: standard login authenticationBehind the BWH firewallPhysical Security of the data centerPrivacy/security standards
BWH - Processes
Change Management Shared vision to improve quality and efficiencyPrototyped the system in a primary care office with a supportive physicianDesigned the system to improve efficiency in the physicians office; added features based on feedback
SchedulingRisk management
Ensure fit with operationsClose working relationship with each physician office and the radiology department
BWH - Technology
Integration into the organization’s systems and technical infrastructureInformation sharing with Partners’ systems: EMPI, radiology and PACSStandard workstations and network connectionsStandard login authenticationStandard fax server connectivityStandard paging server connectivityCentral organizational support for Network, Workstation, Login
Further contact:
Catherine J. Bruno, FACHEVice PresidentMedicalis Corporation850 Boylston St, Suite 312Chestnut Hill, MA 02467
Phone: 617-734-1702Email: [email protected]