2

Challenges

Goal

eHistory

Solution

Conclusion

Access to care / Quality care affordable care / IT / Finance / Workflow

Improve outcomes / Improve access / Ease to care / Prove value

Our Evolution

eICU/ Telestroke/ Telepsy / Telepharmacy/ Teleortho

Easier than looks / Communication / Acceptance / Results

Discussion Surrounding Telehealth

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• Not-for-profit, community health system

• 6 acute adult care hospitals

• 18 Urgent Care Centers

• 1 Tertiary Care Center

• 1 Academic Care Center

• Miami metropolitan area

Baptist Health South Florida

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First Telehealth program - eICU6 hospital turned on = 143 beds

eHistory

2012: 30 Step down beds added

7 Mobile Carts are turned on in ED’s

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Telepsy and e-Primary Care Visit

Home Health - remote telemonitoring

ePharmacy and Telestroke

TeleOrtho

Transfer Center comes Online –Tele Communication Hub

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workflow

FinanceIT

Telehealth

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Challenge is to provide the same level of care to

all critical care patients regardless of where

they’re located----rural hospital (critical access)

to tertiary hospital.

Challenge

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• $10.5 billion cut from projected Medicare hospital payments over 10 years for inpatient or overnight care

• The shortage of Intensivists will reach 35% by 2020

• By 2030, there will be about 72.1 million older persons, more than twice as many as in 2000

Challenge

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Finance

•Start up costs for eICU

$8 million

• Annual Operating costs

$5 million

Non Reimbursable ,no funding for telehealth

Acceptance

•Seen as intruders…Trusting relationships take time to develop

Technology

• Interoperability between software limiting the sophisticated data analysis

• Always changing

• Enhanced video components since inception to 2 way video

Challenge

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Better Utilization of Limited Resources

The concept of a tele-ICU was developed by 2 intensivistswho knew there was a severe shortage of ICU doctors inthe country. They developed a system to use technology tobetter utilize limited people resources. This concept hasgrown to include experienced critical care nurses andclinical pharmacist. And is spreading across the country intoevery avenue of healthcare.

Solution

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Q22006

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Q42006

Q12007

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Q32007

Q42007

Q12008

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Q42008

Q12009

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Q42009

Q12010

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Q42011

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Q22012

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Q42012

Q12013

Q22013

Q32013

Q42013

Q12014

ICU Lives saved -10.5 5 14 23 13 63 62 7 43 71 64 90 69 70 93 98 102 90 97 57 70 57 77 79 95 89 90 112 90 108 98 104

-20

0

20

40

60

80

100

120

ICU Livessaved

Lives saved in last year = 400

ICU lives saved in excess of APACHE® predicted

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5 ICU Days saved = $43,175,000 cost

-2000

-1000

0

1000

2000

3000

4000

Q22006

Q32006

Q42006

Q12007

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Q12009

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Q12010

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Q12014

ICU Days Saved

Linear (ICU Days Saved)

ICU days saved in excess of APACHE® predicted

20149,982 ICU days avoided = $18M cost avoided

>14,000 Nursing Interventions

> 12,000 eMDInterventions

618 Falls avoided in 2010-2014Assume 25% rate of harm =

61 patients avoiding increased LOS in hospitalization$5,315,570

Falls with harm include falls that result in fractures, dislocations, or intracranial injuries. This calculator willcompute the additional patient-days and costs associated with falls with harm at a healthcare facility. To use thecalculator, enter in the blue highlighted fields the facility-level patient-days, total number of falls with harm, fallsresulting in death, additional average length of stay per patient with a fall with harm, and additional average costper patient with a fall with harm. If the facility’s additional average length of stay or additional average cost perpatient is unknown, there are default length-of-stay and cost-per-patient figures provided in the June 2012Pennsylvania Patient Safety Advisory. Once these numbers are entered, percentage of deaths, facility-level falls-with-harm rate, total additional patient-days, and total additional cost per falls with harm are calculated beloweach blue highlighted field. The potential savings section below the current falls-with-harm data displays thepotential savings resulting from 10%, 25%, 50%, 75%, and 90% reductions in falls with harm.

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Estimated cost per day of an ICU day = $1,800

Since 2009-2013

• 23,985 ICU Days saved = $43,173,000 cost avoidance

• 45% Decrease in ICU Mortality since program began

• Lives saved 1,768 since inception

• ePharmacy interventions (2010-2013) 11,433 interventions equates to additional $892,414 savings

Baptist Health South Florida

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Clinical pharmacist reviewing medications at home with the patient

Not aware of any other Home Health Agency in the country providing this service

TelePharmacy

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CV, 36.2%

Diabetes, 16.2%

Neuro Illness, 15.4%

Status Post Surgery, 7.7%

COPD, 6.9%

Wound Care, 6.9%

Renal Failure, 6.2%

Cancer, 4.6%

Illness Categories

1 Disease, 15.0%

2 Diseases36.7%

3 Diseases31.7%

4 Diseases8.3%

Diseases per PT

2%2%2%3%3%

4%

lab review, 7%

food-drug interaction,

21%

drug interaction,

26%

pt education, 26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Types of Intervention

pt education

drug interaction

food-drug interaction

lab review

recommendation to call MD

omission

dose adjustment

fall prevention

compatability

adv drug rx

notify RN

antibiotic monitoring

duplication

Evaluation/Analytics

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2013

• 254 patients monitored remotely

• 420 times MD contacted

• 133 additional nurses scheduled

• 37 patients readmitted = 14% readmission rate

• National average readmission rate 18-23%

• Average cost of readmission is $3,200

Remote monitoring – Staying Healthy at Home

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Telehealth readmission rate to the hospital is 14%

Patients that received ePharmacist readmission rate was 7%

Improving patient outcomes and access to qualitycare in the context of chronic disease management .

A telehealth approach to chronic disease, couldhelp address the source of many preventable coststo the healthcare industry.

National average

readmission rate 18-23%

Telehealthreadmission

rate 14%

ePharmacyreadmission

rate 7%

Results

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Telestroke is cost effective ,sustainable way to allow smaller hospitals with limited neurology coverage to provide equitable access to high quality stroke care.

Telestroke has emerged as an efficient method of delivering stroke specialist care to remote hospitals without expensive on –site helping reduce geographical differences in stroke management

In the state of Florida telehealth non reimbursable

TeleStroke

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Eliminates unnecessary travel or patient transfer

Engineered to increase patient satisfaction

Brings specialty care to rural areas

Extends provider’s geographic reach

Reduces barriers to patient access

Solution

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Since April of 2014 there have been a total of 19 telestroke calls

5 of these telestroke calls were transferred and 14 stayed at the community hospital.

26%

74%

Telestroke

Transferred Not transferred

Results

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TelePsychiatry

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Follow up appointment down via virtual visit

5 patients have had virtual visits all have been extremely satisfied

No reimbursement but done to improve patient satisfaction

Efficient use of time for provider and patient

BHMG Primary care - eVISIT

ePrimary Care

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workflow

FinanceIT

What was needed to put the program together?

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Any Questions??