Small and Rural Best Practices Webinar: Telemedicine Strategies. April 23, 2015

Transcription

1 Small and Rural Best Practices Webinar: Telemedicine Strategies April 23, 2015

2 Funding for this program was provided through the Medicare Rural Hospital Flexibility Grant program. 2

3 Continuing Education Credit The Illinois Hospital Association is authorized to award 1.0 hours of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement or recertification in the American College of Healthcare Executives. Participants in this program wishing to have the continuing education hours applied toward ACHE Qualified Education credit should indicate their attendance when submitting application to the American College of Healthcare Executives for advancement or recertification. Continuing education is only provided to those who attend the live webinar. 3

4 Carle Regional Outreach Jason Peoples ehealth Coordinator

5 Telemedicine Pioneer Recognized as A Telemedicine Pioneer by AMD Telemedicine not only did Carle help pioneer telemedicine in its early days, it has managed to sustain and grow its telemedicine practice for more than two decades.

6 Benefits Improved Access - access to patients, but also allows providers and health facilities expansion of reach. Cost Efficiencies - reduced travel, fewer/shorter hospital stays, increase efficiency through improved management of medical conditions. Improved Quality - improved outcomes and patient satisfaction and patient compliance. Patient Demand - access to providers not available locally, medical services available reducing long distance travel.

7 Get Started Physician Champion Identify outreach needs Partner with Business Development and Compliance Partner with Coders and Revenue Cycle- reimbursement by payors Engage Information Technology Team(s) Actively engage partnership with regional facility - i.e., CAH, Rural Clinics, Skilled Nursing Facilities, etc.

8 Key Factors in Implementation Support of technology platforms Ease of use- Simplified technology IT/Vendor support Leverage Existing platforms and infrastructure Build on Success!

9 Telehealth Services Ambulatory Inpatient Other Sleep Medicine Pediatric Surgery evisit Developmental Pediatrics Infectious Disease- CMH Patient transports Cardiology OB on-call CHRHC Ortho Hand-CC Oncology APN/Hospitalist- CMH TeleHome Health Infectious Disease- CMH Registered Dieticians- CHRHC Endocrinology Urology- PCH Nephrology Diabetic Eye Screening Neonatology- MFM Outreach

10 evisit

11 evisit evisit Conditions Sinus/Allergy symptoms Cough/Bronchitis Diarrhea Red Eye Sore Throat UTI Nausea/Vomiting Vaginal Irritation Build in progress Diabetes High Blood Pressure Low Back Pain Headache Constipation Bedwetting- Pediatrics Sleep- Pediatrics

12 Key Points to Success It s all about the patient Technology has to be easy Funding can be found in unique places

13 Resources Department of Health and Human Services Medicare Fee-For-Service Program for Telehealth Originating sites Distant Practitioners Telehealth Services Billing and payment for professional services Billing and payment for originating site facility fee MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

14 Herrin Hospital Terence Farrell, FACHE, VP/Administrator Catherine Hungate, Telemedicine Coordinator

15 How we got here Where are we going By: Terence Farrell and Catherine Hungate

16 Lack of Specialty to care for the rural population One Psychiatrist Physician to care for 1.5 million Delta area patients Delta region hospitals to further as a team Need to search for grant, obtained thru USDA Sustained through collaboration with SIU School of Medicine and SI Connect

17 Present and Future State Grant Realm Implementation presently in SIH hospitals in the ER for Tele-Neurology Phases: Harrisburg Medical Center, Marshall Browning, Hamilton Memorial, and Union County Telemedicine in Maternal/Fetal with Memorial Hospital Carbondale and Wash U/BJC Piloting Neurology in ICU at Herrin with Pulmonary in June 2015 Future State: In home CHF program, Harrisburg Neurology and Behavioral Health Behavioral Health in May 2015 Pilot Behavioral Health in Herrin in May 2015

18 Strict Policies Provide Procedures (Yes and No workflow) Provide documentation to meet standards and guidelines Remember this is new for staff and patients! Feedback is important Patient rounding, continuously measuring the level of care your physicians and staff are providing patient rounding Patient feedback is your best marketing tool!

19 FHN Memorial Hospital Robert Geller, MD, MS, FIDSA Vice President of Medical Affairs Kathryn J. Martinez, RN, MSN Chief Nursing Officer

20 Vision: Memorial Hospital Healthcare Excellence for our Communities Located in Freeport, Illinois: Population 25,560 Largest employer in town Serves 5 rural counties 100 bed hospital 8 bed ICU

21 Providers Memorial Hospital o 1 Infectious Disease, 1 Pulmonologist, 1 Neurologist, 3 Cardiologists, 2 General Surgeons, 2 Gastroenterologists, 1 ENT Physician o o o Primary Care Physicians (Family Practitioners & Internal Medicine Physicians) responsible for 24-hour ICU coverage Difficulty recruiting specialty Physicians to Freeport No Intensivists ICU Nurses o o o o 18 ICU RNs 14 are CCRN-certified, 1 is currently preparing to take the exam Experience ranges from less than 1 year to 40 years in the ICU Clinical Nurse Specialist

22 Innovative Solution FHN Memorial Hospital s intensive care team collaborated with UW Health e-care of Wisconsin to bring e-icu technology to our ICU to care for our critically ill patients together. The e-icu was activated in August of 2010.

23 e-care A program that is co-sponsored by the University of Wisconsin Hospital & Clinics and the University of Wisconsin Medical Foundation Mission: By working together with our clients, we will: Enhance the quality of patient care Improve patient safety Increase patient, family and staff satisfaction

24 Goals Augment current ICU Care o o o o Obtain 24-7 access to Specialty & Intensivist Physicians Reassure FHN ICU patients & families that care can be safely and effectively be provided at FHN, reducing the burden of anxiety and travel Reduce the burden on FHN Providers, allowing them to more effectively care for patients in their clinics and promoting work/life balance Reduce the burden on FHN ICU Nurses, allowing them to more efficiently provide care to their patients Reduce Transfers Ensure Quality of Care & Improve Compliance with ICU Best Practices

25 Collaboration FHN ICU & e-care Multidisciplinary Rounds o Performed each morning between o o Rounds are performed in patient rooms with patients, families and care team present Everyone comes together to focus on the effectiveness and safety of the care provided Benefits of Multidisciplinary Rounds o o o Promotes patient-centered model of care Increases communication and collaboration among the care team, patient and family Improved quality of care and safer environment

26 FHN/ UW-Madison Collaborative Projects Everyday Best Practices Insulin Protocol for Hyperglycemia Therapeutic Hypothermia Blood Transfusion Alcohol Withdrawal Procedures

27 Outcomes Apache Score Pre-ICU Apache score 48.4, Current Apache score 53 Mortality & LOS o ICU mortality decreased (5.4% pre-e-icu to 3.9% post-e-icu 2014), average LOS decreased (actual is 2.95 versus predicted 4.40) o Q Best Practice Data o VTE Prophylaxis: Rx started < 24 hours of unit admission: 100% o Stress Ulcer Prophylaxis: 100% compliance on patients vented greater than 24 hours 100% Compliance with at-risk patients with APACHE diagnoses of head injury or coagulopathies

28 Conclusions Steady increase in acuity over time, impacting entire hospital Decrease in ICU mortality, LOS and overall hospital mortality Nearly 40% reduction in the number of transfers out of the ICU since e-icu activation High staff satisfaction The collaborative relationship between FHN nurses and physicians and UW Health e-care of Wisconsin has truly brought the best possible care to our patients.

29 SIU School of Medicine Nina M. Antoniotti, RN, MBA, PhD Executive Director of Clinical Outreach

30 QUESTIONS? 30

31 IHA Resources

32 IHA Resources IHA members can access Commitment To Transformation resources at: 32