Valley City, North Dakota

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1 Valley City, North Dakota

2 E-Health & Telehealth: Virtually Becoming One North Dakota e-health Summitt November 19, 2014 Maureen Ideker RN BSN MBA, Director of Telehealth Essentia Health, Duluth, MN Marsha Waind MOTR/L, CHT,CLT, Manager Regional Services, Altru Health Systems

3 Objectives 1. Review telehealth basics for CMS coverage/eligibility. 2. Highlight areas of legislative concerns/updates needed. 3. Define over 10 HIT functions used to support a single telehealth visit. 4. Identify importance of Tele-home-monitoring

4 Telemedicine/Telehealth Interactive videoconferencing conducted in real time with audio and visual Provider at hub, patient at spoke For purpose of a medical or healthcare encounter Telemedicine refers to a medical visit Telehealth is the broader term and includes any healthcare, medical, educational visit or home monitoring

5 Why Telehealth is growing now? Consumer Demand and Technology available Wireless (hot spots) Broadband secure networks, more affordable HIEs Scarcity of specialists Prevention/Wellness/ Control of chronic disease Aging demographics

6

7 Valley City, North Dakota

8 I. North Dakota Telehealth Activity

9 Essentia Health- North Dakota Telehealth Services Hub/Spoke Model development Adult Psychiatry..Minot to Jamestown, Valley City and Lisbon Dietician Fargo to same sites and Wahpeton Pharmacist- Medication Therapy Mgmt Detroit Lakes, MN to same sites Medical Weight Loss-Bariatrician.Ely, MN to same clinic sites

10 Home Monitoring units for CHF Fargo to 45 homes Scales only 0 hospital readmissions in past 6 months for CHF 200 patients in CHF program, 45/200

11 Fargo Hub provides e-er To Ada and Graceville MN Supports use of NP/PA in the ERs

12 In Development at Essentia Health for North Dakota Wound Care Dermatology Child Psychiatry Stroke/Neuro

13 Increased Use of Mobile Essentia Health Hot spots/wireless IPADs, PCs Secure network 24/7 coverage

14 ND Telehealth Programs Altru Avera Catholic Health Initiative (CHI) Essentia Health Sanford Veterans Administration (VA) ND Bioterrorism (BT-WAN) North Region Health Alliance

15 Discounted USAC Program Greater MN Telehealth Broadband Initiative Discounted broadband at 65% through the previous FCC Pilot Project Already serving 66 MN and ND sites Contact the Community Health Information Collaborative in Duluth address: CHIC - Open to New Members!

16 Valley City, North Dakota

17 II. Telehealth Basics & Legislative Concerns with the Basics.

18 Eligible Sites - CMS Physician/Practitioner Office Critical Access Hospital (CAH) Federally Qualified Health Center (FQHC) Hospital Rural Health Clinic Hospital-based or CAH-based Renal Dialysis Center (including satellites) Skilled Nursing Facility Community Mental Health Center 18

19 Legislative Concerns: Eligible sites for services No: Group Homes Homes Kiosk Personal Computers

20 Eligible Providers CMS has identified these: Physician (MD/DO) Nurse Practitioner Physician Assistant Nurse Midwife Clinical nurse specialist Clinical psychologist Clinical social worker Registered dietician/nutrition professional 20

21 Legislative Concerns: Providers Covered Under CMS No: Pharmacists Diabetic Educator RNs Genetic counselors Rehab Therapists (Speech, PT, OT) Audiologists

22 Reimbursement - CMS Health Professional Shortage Area (HPSA) or Non-MSA County Must be live, interactive services Patient must receive service in an eligible rural site (Hospital, Clinic, etc.) Provider payment is the same as for an inperson visit (GT Modifier used) A facility fee is paid to remote sites (Q3014) 22

23 CMS rules need updating Reimbursement Parity-telehealth covered same as in-person for all services No metro (MSA) eligibility Add sites Add providers covered No store and forward dermatology

24 Jamestown North Dakota

25 III. HIM Interfaces of Telehealth

26 HIM Functions/Telehealth Downloading vital signs Notification of ready for specialist- green dot Notification by text of needing telehealth nurse assistance for end of visit Documentation on both sides of the visit Complete coding After Visit Summary

27 Additional EMR & Telehealth Coding reminders Shared consult notes Direct On-Line After Visit Satisfaction surveys E-messaging between patient/providers

28 Documentation/Communication Within Essentia Health.Epic EMR HIE Direct Scanned to EMR PACS - Sharing

29 Traps & Barriers Readiness of labs, tests, required procedures prior to Telehealth consult Chart Scrubbing Timely communication back to referring source and/or access to consult notes Its not all about the technology Relationship building with the providers Learning to use Specialty Care in rural settings

30 Lisbon North Dakota

31 IV. Home-Monitoring Part of the Virtual Future

32 National Savings Projected from Remote Monitoring in 2010 Impact Advisors, LLC in Telemedicine Trends and Technologies predicted annual savings in the US to be: $10.1 billion for CHF $ 6.1 for Diabetes $ 4.9 for COPD Access to broadband determines the feasibility of telemedicine. (1)

33 U of MN MN Telehealth Network Research 1998 Telehomemonitoring N = 150 (2) (3)

34 Telehome monitoring (Cardiac Example) Daily recording of - Weight - Blood Pressure - Pulse - Oxygen Saturation - Spirometry 34

35

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37 37

38 Beacon Case Study 53 y.o. female with more than 6 chronic conditions 13 hospital admits in 2011, $156,000 Remote Monitoring and self management conducted resulting in: 1 ED visit and 1 brief hospitalization in 2012: $2500

39 Financial Considerations CMS does not cover, MN MA covers but requires video component ND MA does not cover at all ACO Context Lease (Per unit/per month) or purchase

40 gptrac

41 Learn How to Implement Telehealth Programs 2014 Blandin Foundation-LightSpeed Broadband Applications Grant to Essentia Health Deer River Clinic Pick up Flyer

42 References (1)Impact Advisors, LLC. Telemedicine Trends and Technologies. Version 1. Published 2/8/2010 (2)Finkelstein S, Speedie S, Potthoff,. Home telehealth Improves Clinical Outcomes at Lower Cost for Home Healthcare. Telemedicine and e-health Vol 12, N0 2, 2006: (3)Finkelstein S, Speedie S, Zhou X, Ratner E, LeMire T, Valley K, Dahle L. Virtual assisted-living Umbrella for the Elderly (VALUE): What the community thinks. Chumber NR, Neurgaard B, Koob R, Qin H, Joo Y. Evaluation of a carecoordination/home-telehealth program for veterans with diabetes. Eval health professions 2005;28: Johnston B, Wheeler L, Deuser J, Sousa KH. Outcomes of the Kaiser- Permanente Tele-Home health research project. Arch Fam Med 2000;9: Klapper B, Kuhne H. Patient self-management by telehealth using the Bosch model of care. Journal of Telemedicine and Telecare 2010;16: Snell, A. Reducing Hospital Readmissions Using Remote Patient Monitoring and Patient Engagement Tools. Beacon Research Study, Ascension Health Presentation, Indianapolis, 2013.

43 Maureen Ideker, MBA, BSN, RN Marsha Waind, MOTR/L, CHT, CLT

MN Rural Health Conference Presentation

MN Rural Health Conference Presentation MN Rural Health Conference Presentation June 25, 2013 Maureen Ideker RN BSN MBA - Director of Telehealth Essentia Health Marsha Waind MOTR/L, CHT, CLT Manger Regional Services Altru Zoi Hills - gptrac

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