telehealth care closing the gap to specialty care · 2019. 11. 7. · telehealth care closing the...
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Telehealth care Closing the Gap to Specialty Care
Dietra Watson, MSN, RN Clinical Informa7cs
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What is Telehealth?
• The use of electronic informa7on and telecommunica7ons technologies to support long-‐distance clinical health care
• Can refer to remote non-‐clinical services, such as provider training, image transmission, administra7ve mee7ngs, and con7nuing medical educa7on, in addi7on to clinical services.
• Primarily used as a means of preventa7ve and proac7ve care
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Telehealth Mission
To provide the right care in the right place at the right 7me through efficient, cost effec7ve, and appropriate use of health informa7on and telecommunica7on technologies.
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Telehealth Vision
To make the home and local community into the preferred place of care whenever possible and prac7cal.
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Telehealth Values
To use health informa7on and telecommunica7on technologies to improve therapeu7c rela7onships.
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Telehealth Background
• Telehealth care is interdisciplinary care • Telehealth care providing quality care
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Learning Objec7ves
• Differen7ate between tradi7onal and remote disease management.
• Differen7ate between telehealth care modali7es • Explain telehealth referral process • Explain benefits of telehealth use • Iden7fy exis7ng telehealth programs
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Roles and Responsibili7es
• Facility Telehealth Coordinator
• Care Coordinator • Telehealth Clinical Technician
• Consul7ng Provider • Referring Provider
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Planning
• Exis7ng programs • Expanding programs • Strategic planning • Maintenance
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Telehealth modali7es
• Clinical Video Telehealth (CVT)
• Home Telehealth (HT) • Store and Forward (SFT)
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Defining Technology
• Synchronous • Video conferencing • Asynchronous
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Clinical Video Telehealth
• Facility to Facility
• Facility to Home
Uses advanced Telehealth technologies to make diagnoses, manage/provide care, and perform check-‐ups. Real-‐7me videoconferencing technologies with suppor7ve devices
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An in-‐depth look into CVT
• Facility to Facility – Pa7ent at CBOC – Provider at CBOC or Medical Center
• The VA’s Clinical Enterprise Video Conferencing Network (CEVN) supports the use of medical care technologies to perform clinical video conferencing on the VA’s intranet
• Video Expressway allows for connec7on to non-‐VA facili7es
• Secure/Encrypted behind the VA’s firewall
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CVT CBOC Program Offers § Tele-‐Psychiatry
§ Tele-‐Psychology
§ Tele-‐Pain Medicine
§ Tele-‐Endocrinology
§ Tele-‐Spinal Cord Injury
§ Tele-‐Surgery
§ Tele-‐Blind Rehab
§ Tele-‐Women’s Health
§ Tele-‐Physical Therapy
§ Tele-‐Nephrology
§ Tele-‐Clinical Pharmacy
§ Tele-‐Amputa7on
§ Tele-‐Prosthe7cs
§ Tele-‐MOVE! Exercise
§ Tele-‐Trauma7c Brain Injury
§ Tele-‐Audiology
§ Tele-‐Speech Pathology
§ Tele-‐Home Care
§ Tele-‐Gastroenterology
§ Tele-‐Chaplain Services
§ Tele-‐Neurology
§ Tele-‐Nutri7on
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CVT Encounter Growth
2 96 463
908 825 816 973
2,012
4,582
5,889
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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What is SFT
• Stores clinical data • Medical images electronically forwarded • Common areas SFT are used
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Store & Forward Telehealth • Facility to Facility
• Uses advanced Telehealth technologies to make diagnoses, manage/provide care, and determine the necessity of follow-‐ups
• Imagers acquire and store clinical informa7on (e.g. data, image, sound, video) that is then forwarded to (or retrieved by) another site for clinical evalua7on.
• SFT Programs: • Tele-‐Re7nal Imaging • Tele-‐Dermatology • Tele-‐Wound Care • Tele-‐ECG • Tele-‐Spirometry
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SFT Image Growth
27 446
775
2,592 2,849 2,900 2,994
3,797
5,242
0
1,000
2,000
3,000
4,000
5,000
6,000
2005 2006 2007 2008 2009 2010 2011 2012 2013
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Telehealth Benefits
• Travel Reduc7on – Cost Savings – Time Savings – Compliance
• Increased Pa7ent Sa7sfac7on • Improved No-‐Show Rate • Increased Access & Awareness • Integrates primary care into Specialty Care Process
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How to Refer for Telehealth? • ASK!!! • Clinics schedules are generally set up to capture both CVT and
face-‐to-‐face workload • Eligibility criteria is determined by the service and providers • Co-‐Payments determined by diagnose procedure codes, no
different than tradi7onal visits
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Performance Improvement
• Collabora7ve workgroup
– Establishes performance improvement plan – Performance measures – Workload data – Systema7c approach – Telehealth quality
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What is HT?
• Disease Management • Tracks pa7ent outcomes • Supports primary care providers preventa7ve care goals
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Home Telehealth • Facility to Pa/ent’s Home
• Telemessaging / Telemonitoring
• Pa7ents are monitored at home using home Telehealth technologies
• Goal: Reduce ER visits, hospital admissions, bed days of care
• Pa7ents learn self-‐management skills that allow them to take control of their diagnosis and monitor their condi7on from home.
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Comparing Technologies Wired Devices • Landline or high speed
internet (wired, wireless, cellular) required
• Cabled peripherals provide accurate data
• Real 7me data transmission not available with all vendors
• Dialogs ohen more inclusive
Interac<ve Voice Response
• No Landline or Internet Required
• Cell phone • Same Day Data
Transmission • Inbound/outbound calls • Lack of cabled peripherals • Phone plan required • No reading required
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Telemonitoring Use of two way audio/video technology Provides remote care delivery
– Assessment – Educa7on – Data Collec7on – Mul7ple Peripherals – Digital Photography
• Mimics in-‐person visit • Earlier iden7fica7on of exacerba7on by using stethoscope, mul7ple peripherals, and live assessment
• Regularly used for pa7ents with HF and/or COPD diagnosis
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Flow of a Telehealth Visit
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Solu7on Approach
If we…… • Promote the use of
telehealth services facility wide
• Improve access to specialty care through use of technology
• Integrate telehealth services to manage chronic illness
Then we expect……. • To be more efficient
• To see a decrease in no show rates, wait 7mes and con7nuity
• Reduce re-‐admission rates, reduce emergency care visits, improve overall pa7ent outcomes
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Ques7ons & Comments
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References Radhakrishnan, K., Jacelon, C., & Roche, J. (2013, June). Associa7on of comorbidi7es with home care service u7liza7on of pa7ents
with heart failure while receiving telehealth journal of cardiovascular nursing 28(3), 216-‐227. Roush, K. (2005). Nursing Resources: Health care quality databases. The American Journal of Nursing, 105(8),72 Sevean, Patricia, MA,M.Ed, R.N., Dampier, Sally,M.M.Sc, R.N., Spadoni, Michelle,M.A., R.N., Strickland, Shane,M.ScN., R.N., &
Pilatzke, Susan,M.P.H., R.N. (2008). Bridging the distance: Educa7ng nurses for telehealth prac7ce. The Journal of Con6nuing Educa6on in Nursing, 39(9), 413-‐8. Retrieved from hmp://search.proquest.com/docview/223310652?accoun7d=458
Stanhope, M., & Lancater, J. (2010). Founda6on of nursing in the community: Community-‐oriented prac6ce, (3rd ed.). St Louis,
MO: Mosby/Elsevier. VHA telehealth. (2013). Retrieved from hmp://www.vhatelehealth.gov Wren, G., Mora,M.,& Forgionne,G.,(2007). An integra7ve evalua7on framework for intelligent decision support systems. Journal
of Opera7onal Research, 195(2), 643-‐652.