february 29, 2016 - himss
TRANSCRIPT
Using Telehealth to Manage Patient Populations
February 29, 2016
Sarah Rhoads, PhD, DNP, APRN
Education Director, Center for Distance Health
Associate Professor
University of Arkansas for Medical Sciences
Introduction of Speaker
• Brief Introduction by Speaker
Conflict of Interest
Sarah Rhoads, PhD, DNP, APRN
Royalty: Angel Eye Camera Systems, LLC
Agenda
• Introduction
• Learning Objectives
– Telehealth is an Important Part of Care Coordination – the Nurse Role
– Remote Monitoring Helps Transition Patients to Home
– Telehealth and Mobile Computing Helps to Manage Patient Populations in Different
Care Settings
• Questions
Learning Objectives
• Explain why telehealth is an important part of care coordination –
the nurse role
• Identify innovative approaches to manage care
• Summarize how mobile technologies are used by nurses to manage patient populations
• List examples of how telehealth and remote monitoring are being used to optimize care
across multiple settings
An Introduction of How Benefits Were Realized for the
Value of Health IT
http://www.himss.org/ValueSuite
“Where you live, should not determine whether you live or die.”
Source: ThinkStock
Telehealth is part of the solution….
Source: UAMS Creative Services
Jennifer’s Story
Source: UAMS Creative Services
Telehealth is a Mechanism
• The means by which healthcare is delivered
Source: UAMS Creative Services
Telehealth
• The use of telecommunications technologies to increase the efficiency and quality of health care services, education, public health, research, and administration
Source: UAMS Creative Services
Examination • Legally recognized examination
through telehealth/telemedicine technology that provides the practitioner with information equal or superior to an in person examination.
Provider-Patient Relationship
• Equivalent to an in-person exam
• Conforms to the standard of care expected of in-person care
• If necessary, incorporates peripherals and diagnostic tests sufficient to provide an accurate assessment/diagnosis
Source: UAMS Creative Services
World’s Leader in the Cost of Care
Cost Efficiencies
• Better management of chronic diseases
• Shared health professional staffing
• Reduced travel times
• Fewer or shorter hospital stays
Telehealth is an Important Part of Care Coordination – the
Nurse Role
Source: UAMS Creative Services
Role of a Telehealth Nurse
• Nurse presenter –Clinic setting
• Nurse case manger-Diabetic educator
• Public health nurse-STD clinic
• Health couch- Insurance companies
• Tele-ICU nursing-Remote sites
• Clinical tele-health coordinator- Train the trainer
ANGELS
Antenatal | Neonatal | Guidelines | Education | Learning | System
Began in 2003 as the first program of its kind to link three state agencies to serve a common purpose in managing a state-wide women’s health crisis
• Arkansas Department of Health
• Arkansas Department of Human Services
• University of Arkansas for Medical Sciences
ANGELS
• Medically Underserved
– 73 of 75 counties medically underserved
• Low Birth Weight
• Poor Health
• Poverty
ANGELS Triage Call Center
Patient Triage
Doc-to-Doc Consults
Coordinates Hospital
Transfers
Facilitates Acute
Telemedicine Consults
ANGELS Triage Call Center
and the Arkansas Telemedicine Model
• Education and training for providers
• Centralized tech support and triage call center 24/7
• Telemedicine network and infrastructure
• Evaluation and quality improvement
• Case coordination and Evidence-Based Guidelines/Protocols
Offer Community, Needs-Based Services
ANGELS Impact on Arkansas
• More high-risk mothers diagnosed earlier in pregnancy
• Mothers from rural areas more likely to deliver high-risk, low birth rate babies at
UAMS
• More preterm infants born in hospitals with neonatologists
• Declining neonatal mortality rates
AHRQ named ANGELS the OB/GYN telemedicine model for the nation
ANGELS Call Center Results
(2014 Annual Report)
• 17,829 calls
• 611 OB transport requests
• 551 OB transport arrivals
• 439 OB consults
• 16,228 nurse triage calls
Source: UAMS Creative Services
Remote Monitoring Helps Transition Patients to Home
• ANGELS Triage Call Center
• ANGELS Home Monitoring Project
Source: UAMS Creative Services
ANGELS Home Monitoring Project
ANGELS Home Monitoring Project
has application
in high-risk obstetrics –
specifically Preeclampsia
Source: ThinkStock
Facts
Source: ThinkStock
Home Monitoring Pilots for High-Risk OB
Phase 1 Clinical Pilot – Began May 1, 2014
• Postpartum patients with a diagnosis of Preeclampsia at delivery
• Discharge home with monitoring equipment: blood pressure device, pulse ox, scale
• ANGELS Triage Call Center receives readings, responds to alerts
• Allows for safe, early discharge
Phase 2 Research Pilot – Began January 1, 2015 ended September 2015
• Same concept as Phase 1
• Research study (IRB approved)
• Implementation of solutions to “lessons learned” in Phase 1
Enrollment and Outcomes
Aim 1
• Examine the patient factors that influence enrollment in the study and usage of the mHealth monitoring system
Aim 2
• Determine the impact of mHealth usage on patient perceptions of mHealth monitoring
Aim 3
• Determine the effect of the mHealth usage on treatment adherence and health outcomes
Preliminary Findings
Source: ThinkStock
Monitoring Patients at Home – Nurse Role
Source: UAMS Creative Services
Telehealth and Mobile Computing Helps to Manage Patient
Populations in Different Care Settings
• ANGELS Call Center
• ARSAVES
• Tele-colposcopy Clinic
Source: UAMS Creative Services
ARSAVES
Arkansas Stroke Assistance Through Virtual Emergency Support
Source: UAMS Creative Services
ARSAVES Results
(2014 Annual Report)
• 99% of the Arkansas population is now within a 60-minute drive to a stroke-ready hospital
• 48 hospitals across the state currently participate in the program
• Treatment rate for giving t-PA for stroke has risen approximately 29%
• 500 patients have received t-PA since ARSAVES began in 2008
Source: UAMS Creative Services
Tele-colposcopy Clinic
• APN/nurse practitioner at each originating site (where patient is located) are trained to collect biopsy specimens under the supervision of a UAMS OB/GYN faculty member via telemedicine (distant site)
• Biopsy specimens sent to UAMS lab
Source: UAMS Creative Services
Tele-colposcopy Clinic
Source: UAMS Creative Services
Tele-genetics
Source: UAMS Creative Services
Follow-Up and Case Management
Source: UAMS Creative Services
The last mile……
• Hospitals
• Clinics
• Nursing Homes
• Dentist Offices
• Schools
• Work Places
• Home Health
Legal and Ethical Issues
Legal Issues
Source: UAMS Creative Services
Credentialing
Licensure and Interstate Commerce Act
Source: https://www.ncsbn.org/nlc.htm
Documentation
• Anything that is documented in a face to face encounter should be documented in a telemedicine encounter
– Plan of care
– Follow up
– Instructions, current medications, new medications
– Protect the privacy of the patient
Patient Confidentiality & HIPAA
Source: UAMS Creative Services
Ethical and Legal Issues
McWilliams, J. (2010, January 11) Connecting cell phones with medicine in Botswana. Penn Current. Photo credit: Ryan
Littman-Quinn. Retrieved from http://www.upenn.edu/pennnews/current/node/3215
A Summary of How Benefits Were Realized for the
Value of Health IT
http://www.himss.org/ValueSuite
Resources
Credentialing
– http://cchpca.org/sites/default/files/Credentialing_Under_Medicare_and_Accreditation_Programs_0.pdf
– http://www.jointcommission.org/assets/1/18/20110705_LTC_Credentialing.pdf
Telehealth Nursing Certification
– http://www.aaacn.org/telehealth-nursing-certification
Policy
– http://www.hrsa.gov/ruralhealth/about/telehealth/
– http://www.telehealthresourcecenter.org/toolbox-module/licensure-and-scope-practice#6
Gilbert, HV, J Yan, and SJ Hoffman. 2010. “A WHO Report: Framework for Action on Interprofessional Education and Collaborative Practice”. Journal of Allied Health 39(Supplement 1): 196-197.
Rn.com (2013, June 20) Interprofessional Collaboration. Retrieved from http://www.rn.com/getpdf.php/1892.pdf?Main_Session=0c7d338fb741e35dc663010a8e86bc8b
WHO (2010). Framework for action on Interprofessional education and collaborative practice. Retrieved from http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf
Abrams, M., Nuzum, R., Mika, S., and Lawlor,G. (2011). Realizing Health Reform’s Potential How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers. The Commonwealth Fund.
Source: telehealthresourcecenters.org
Resources
South Central Telehealth Resource Center
www.Learntelehealth.org
E-mail: [email protected]
Phone: 1-855-664-3450
Arkansas eLink
www.arkansaselink.com
E-mail: [email protected]
Phone: 501-603-1280
National Telehealth Policy Resource Center
www.telehealthpolicy.us
E-mail: [email protected]
Phone: 1-877-707-7172
American Telemedicine Association
Telehealth Nursing Special Interest Group
www.americantelemed.org
Questions
Sarah Rhoads, PhD, DNP, APRN
Education Director for the Center for Distance Health
Associate Professor, Department of Obstetrics and Gynecology
University of Arkansas for Medical Sciences
Little Rock, Arkansas