Telehealth care Closing the Gap to Specialty Care. Dietra Watson, MSN, RN Clinical Informa7cs

Transcription

1 Telehealth care Closing the Gap to Specialty Care Dietra Watson, MSN, RN Clinical Informa7cs

2 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

3 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.

4 To make the home and local community into the preferred place of care whenever possible and prac7cal. Telehealth Vision

5 Telehealth Values To use health informa7on and telecommunica7on technologies to improve therapeu7c rela7onships.

6 Telehealth Background Telehealth care is interdisciplinary care Telehealth care providing quality care

7 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

8 Roles and Responsibili7es Facility Telehealth Coordinator Care Coordinator Telehealth Clinical Technician Consul7ng Provider Referring Provider

9 Planning Exis7ng programs Expanding programs Strategic planning Maintenance

10 Telehealth modali7es Clinical Video Telehealth (CVT) Home Telehealth (HT) Store and Forward (SFT)

11 Defining Technology Synchronous Video conferencing Asynchronous

12 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

13 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

14 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

15 CVT Encounter Growth 7,000 6,000 5,889 5,000 4,000 4,582 3,000 2,000 1, ,

16 What is SFT Stores clinical data Medical images electronically forwarded Common areas SFT are used

17 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

18 SFT Image Growth 6,000 5,000 5,242 4,000 3,797 3,000 2,000 2,592 2,849 2,900 2,994 1,

19 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

20 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

21 Performance Improvement Collabora7ve workgroup Establishes performance improvement plan Performance measures Workload data Systema7c approach Telehealth quality

22 What is HT? Disease Management Tracks pa7ent outcomes Supports primary care providers preventa7ve care goals

23 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.

24 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

25 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

26 Flow of a Telehealth Visit

27 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

28 Ques7ons & Comments

29 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), 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), Retrieved from hmp://search.proquest.com/docview/ ?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:// Wren, G., Mora,M.,& Forgionne,G.,(2007). An integra7ve evalua7on framework for intelligent decision support systems. Journal of Opera7onal Research, 195(2),