Strategic Opportunities and Challenges in Telemedicine ALEXANDER NASON JOHNS HOPKINS MEDICINE INTERACTIVE PROGRAM DIRECTOR

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1 Strategic Opportunities and Challenges in Telemedicine ALEXANDER NASON JOHNS HOPKINS MEDICINE INTERACTIVE PROGRAM DIRECTOR

2 Agenda Johns Hopkins Medicine Telemedicine Primer Challenges and Lessons Learned Johns Hopkins Telemedicine Things to Consider

3 Conclusions Potential for Improved Service Delivery Cost, Efficiency, Greater Satisfaction No Universal Solution Environment Specific, Standards are the Key Sustainability is of Primary Concern Collaborative System Architecture Technology Allows for a Relationship

4 Historic Billings Building 4

5 New Clinical Building 5

6 6

7 7

8 8

9 Current Systems (9+) Patient Portal JHH JHBMC HCGH Suburban JHCP Registration/ Scheduling Epic MEDITECH, Epic, GE (IDX) MEDITECH MCKESSON GE (IDX) ADT Keane MEDITECH MEDITECH MCKESSON Inpatient EMR Eclipsys MEDITECH MEDITECH MCKESSON Ambulatory EMR Eclipsys (limited) MEDITECH/LSS MEDITECH/LSS (limited) GE (Centricity EMR) N/A GE (Centricity EMR) Specialties Varied Varied Varied Varied N/A Health Information Exchange (CRISP) EPR2020 Enterprise clinical data and document repository Hospital Billing Keane MEDITECH MEDITECH MCKESSON N/A Professional Billing GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX) 9

10 Core Clinical System Vision Patient-centered Single tightly integrated solution Encompasses all major areas of EHR functionality Includes workflow as well as content and data Enables seamless coordination of care delivery Requires careful TCO and ROI analysis Require redesign of care 10

11 Johns Hopkins Medicine Critical juncture Entity centric approach has reached its limits Patient centered care requires coordination of care across JHM Populations and preventive health require longitudinal patient and data management Must enable operational efficiencies, cost controls, and productivity Must achieve quality and patient safety well beyond meaningful use 11

12 TELEMEDICINE PRIMER 12

13

14 Definition Telemedicine, Telehealth, Telecare The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Health Resources and Services Administration s - Office for the Advancement of Telehealth

15 Benefits of Telehealth to the Community Helps Overcome Distance and Access Physician Shortage Areas Improves Local Health Care Offers Diagnostic and Clinical Support Supports Knowledge Transfer Improves Responsiveness in a Changing Environment Decreases Costs; Improves Resource Utilization

16 Telemedicine Synchronicity Synchronous (Real-time) Data Transmitted As They Are Generated And Received With No Perceived Delay Natural Person To Person Interactions High-Bandwidth Telecommunications Examples: Patient Monitoring In ICU, Stroke, ED Support

17 Telemedicine Synchronicity Asynchronous (Storeforward) Data Collected Offline Unnatural Or No Person-To- Person Interactions Low-bandwidth Or Long Distance Telecommunication Examples: Radiology Dermatology Second Opinion Service

18 Model of Telehealth Success Services Assessment Development Training Infrastructure

19 Challenges - Internal Human Factors and Culture Acceptance by Physicians/Patients/Users IT Department Facilities Reimbursement Costs Licensure / Regulatory Evaluation and Research Business Planning - Sustainability

20 Third party reimbursement for telemedicine is expanding slowly States 11 states now require reimbursement of telemedicine by all private insurers Medicaid 14 states require reimbursement Medicare reimburses telemedicine services in rural areas Source: American Telemedicine Association 20

21 Alternative Reimbursement Models Subscription Models Contractual Services Grants Philanthropy 21

22 Challenges - External Communication Client Infrastructure Vendor Conflicts Cultural Considerations Environment Local Legal Issues Costs Time Zones (DST) Customs/Shipping

23 Overcoming Barriers Create Partnerships (Relationships) Know Your Client/Audience (Culture, Time Zones, Work Week, Motivation) Experience Telehealth Incentivize Users (Not Only Money) Integrate it into Strategic Mission Be Non-Threatening ; Be Complimentary Show Return On Investment Recognize What You Cannot Control

24 Real World Problems Acute Care Response Stroke Chronic Disease Management Diabetes, Obesity, CHF Physician Shortages i.e. Intensivists Global Issues Pandemic Flu SARS Hurricane Katrina - Asian Earthquake Bio-terrorism Global Economics

25 Demand for care at home is growing Percent of the population with a chronic condition 79% of individuals with long-term chronic care needs live at home and account for 75% of health expenditures Source: Chronic Care in America available at Agency for Healthcare Research and Quality 25

26 and increasingly feasible 26

27 JOHNS HOPKINS 27

28 The Challenge: Sharing Knowledge and Expertise Effectively, Efficiently and Economically

29 JHM Anesthesiology / Critical Care Intensive Care PICU Cardiology Dermatology Emergency Medicine Gastroenterology Infectious Diseases Johns Hopkins Community Physicians JHM International Johns Hopkins Healthcare Johns Hopkins Homecare Group Minimally Invasive Surgical Training Center Neurology Obstetrics and Gynecology Ophthalmology Otolaryngology Pediatric Psychiatry Physical Medicine Rehab Radiology

30 30

31 31

32

33

34

35

36 THINGS TO CONSIDER 36

37 Mobile Platform Social Networks / Social Media Wisdom of Crowds Education Accountable Care Organizations Patient Protection and Affordable Care Act 37

38 Lessons Learned Challenges are Likely Collaborative & Adaptable The Road is Long Keep It Simple Not Everyone Will Participate Successes Will Outpace Failures

39 Focus on Don Berwick s (CMS Administrator) goals: Better care (IOM-Chasm Report) Better health Lower cost Expand evidence base Ensure information continuity Help to lead care system redesign 39

40 Conclusions Potential for Improved Service Delivery Cost, Efficiency, Greater Satisfaction No Universal Solution Environment Specific, Standards are the Key Sustainability is of Primary Concern Collaborative System Architecture Technology Allows for a Relationship

41 Source: Gartner Group

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