Meeting the Triple Aim through Telemedicine

Transcription

1 Meeting the Triple Aim through Telemedicine John J. Kornak, MS, Director of Telehealth University of Maryland Medical Center Kerry Palakanis, DNP, FNP-C Crisfield Clinic, LLC.

2 Definitions: Telemedicine and TeleHealth The American Telemedicine Association (ATA) is the major advocacy group for telemedicine in the United States. Telemedicine defined as: the use of medical information exchanged from one site to another via electronic communications to improve a patient s clinical health status. TeleHealth defined as: a broader definition of remote healthcare that does not always involve clinical services, ATA uses the terms in the same way one would refer to medicine or health in the common vernacular. 2

3 Remote Patient Monitoring (RPM) RPM is a subset of telehealth in which personal electronic devices, or devices attached to a kiosk, transmit patient health information to health care providers.

4 mhealth or Mobile Health mhealth or Mobile Health is the delivery of healthcare services via mobile communication devices to improve health, healthcare services and health research.

5 TeleHealth at the University of Maryland A Telemedicine B ICU Care Management Providing clinical support and care remotely by continuously capturing, analyzing & sharing clinical data generated during care delivery Remote Patient Consults Includes collecting and sending patient data for interpretation leading to faster, more timely clinical decisions B TeleHealth D Provider to Provider Video Integrating Conferencing providers practicing at UMMC and community locations for patient case conferences or medical education Home-Based or Self-Care Providing home-based care or self care with technologies that assess health status and chronic disease management 5

6 Remote Critical Care Management Service in 10 hospitals Tele-Health Services in place at UMMS and Across the State UM Clinicians are currently providing an array of services Remote Patient Consultations and Diagnostic Data Interpretation Tele-Stroke, High-risk Prenatal Medicine, Psychiatry, Genetic Counseling, Pediatric Cardiology Provider Conferencing UM Greenebaum Cancer Center & Radiation Oncology: tumor boards and patient case review conferences Distance Learning CME Programs by SOM Faculty Home Monitoring GI (inflammatory bowel disease) out patient self-management 6

7 University of Maryland ecare Team comprised of: Critical Care Nurses Data Coordinators Board Certified Critical Care Physician (insert CORE photo) Remote Intensivist management provided: 7 pm-7 am weekdays Weekends and holidays 24/7 Critical Care Nursing Support Goal: Right care at the right place at the right time 7

8 Meritus Medical Center Union Hosp. UMMS Midtown UMMS at Chestertown Calvert Memorial Hospital UMMS at Easton Peninsula Regional Charles Regional St. Mary s Hospital UMMS at Dorchester Atlantic General

9 UM Tele-Stroke: At Carroll Hospital Center UM Tele-Stroke Program Vision Improve health outcomes and care coordination of stroke patients in the State of Maryland UMMC stroke experts will provide tele-consultations that include examining the patient, reviewing CT scans and speaking to the patient and family. The best course of action is determined and a treatment recommendation is then made. UM Tele-Stroke program implementation phase at Carroll Hospital Center with Go Live: December 9,

10 Remote Patient Consultation Programs High Risk Perinatal Fetal Medicine and OB/GYN Greenebaum Cancer Center Genetic Counseling Verizon Wireless Grant Deployed 15 ipads to community oncology practices for ease of access to UMGCC specialists UM Department of Psychiatry School-based tele-psychiatry several counties in Maryland B-HIPP Psychiatry 2 sites (Crisfield and Cambridge, MD + 1 future site) Employee Assistance Program (EAP) In Planning Problem Gambling Expansion Advanced Liver Disease Program (in planning) Video-enabled Grand Rounds/Tumor Boards/Webinars UM Department of Pediatrics School-based care - Howard Co. Public School & Health Dept. ER-to-ER consultation - UM Shore Health (in planning) 10

11 Triple Aim through Telemedicine Telehealth/ telemedicine as critical tools for helping to achieve the Triple Aim: 1.) Better care 2 More access to care with less disruption to lives. Easier for patient s to adhere to appointment times. Less overwhelming than visiting a doctor s office in person. Improve the patient-provider relationship by making it less intimidating. Providing for opportunity for increased interaction Resulting in better outcomes for patients. Gives patients greater access to specialty care providers who might not be in their geographic area. Source: 2 Advanced Telehealth Solutions How Telehealth Hits the Mark on the Triple Aim 11

12 Triple Aim through Telemedicine Telehealth/ telemedicine as critical tools to achieving the Triple Aim (cont.): 2.) Better health for all populations 2 Allows providers to manage care with drastically improved efficiency while not compromising care for younger population. Helps all healthcare providers move more quickly by allowing them to see more patients in less time. Receive remotely generated health monitoring information about patients for improved response time. Provide ongoing, interactive patient education. Source: 2 Advanced Telehealth Solutions How Telehealth Hits the Mark on the Triple Aim 12

13 Triple Aim through Telemedicine Telehealth/ telemedicine as critical tools to achieving the Triple Aim (cont.): 3.) More efficient and reduce costs 2 Reduces the cost of providing healthcare. Allows providers to manage more patients in less time. Reduce personnel costs because less staff are able to manage more clients. Research shows that telehealth reduces hospital readmission, decrease length of stay, and cuts down on emergency room visits. Source: 2 Advanced Telehealth Solutions How Telehealth Hits the Mark on the Triple Aim 13

14 Telemedicine in Primary Care Innovation at the Crisfield Clinic It starts with an idea I was thinking, I want to, I think we can improve, I think that we should/could Corporate Culture - Encourage, foster and reward innovative thinking Define the customer & what we can offer (needs assessment) Going from product/service to solution develop business plan, explore funding, ensure sustainability, plan for implementation (Integration) Enhancing value through complementary assets (Collaboration) 14

15 Telemedicine in Primary Care Innovation Where Do You Start? Needs Assessment/Community Profile Most Important Step to Innovation Overall health and well-being is influenced by and dependent upon the community in which we live and work. In order to understand identified health indicators and disparities of a community, it is imperative to understand the geographical location, demographic population, and socioeconomic factors. County Health Assessments Robert Wood Johnson County Health Rankings State Health Improvement Plan (SHIP) Data Maryland Department of Education School Report Cards Maryland Department of Business & Economic Development State Telemedicine Gaps Analysis (ATA) The challenges to providing quality health care services and delivery to rural Maryland largely result from geographic isolation and lack of the critical population mass necessary to sustain a variety of primary and specialty services. 15

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17 Telemedicine in Primary Care Integration Solving Access Issues Project CRAB Creating Resources Across Barriers School-based Telemedicine in 6 area schools Initial Funding - USDA RUS Grant SHIP Smith Island Health Improvement Plan Telemedicine on 2 cities in Smith Island Funding RUS grant, ongoing search HELP Somerset Health, Education & Learning Program Community Health Workers/telemedicine access mhealth device deployment to at risk patients Funding - HRSA Rural Outreach Grant (application in process) **All programs sustainable through billing for telemedicine care services 17

18 Telemedicine in Primary Care Crisfield Clinic - Collaboration 18

19 Questions/Comments?! 19

20 Building bridges between tertiary care centers and rural communities Laura Kelley, M.D. Medical Director Children s National Programs at PRMC

21 Obstacles and Challenges

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23 Obstacles Delmarva Peninsula Rural area, large referral region 2-3 hour drive to next pediatric tertiary care center No flight days 20% (weather restricts helicopter transports) No local Pediatric Specialists

24 Solutions

25 Telemedicine programs 24 hour echocardiogram ED to ED telemedicine communication Telemedicine Diabetes clinic Sleep studies EEG Future potential areas for telemedicine : Infectious disease Psychiatry Neurology Dermatology

26 Children s/prmc Diabetes clinic: started October 2013

27 Attendance almost 100% - No no-shows Compliance: Endocrine Outpatient Visits October November December January 97

28 Patient/Family satisfaction

29 Caregiver Satisfaction of a Pediatric Telemedicine-based Diabetes Program Nancy M. Smith, DNPc, CRNP, FNP-BC

30 Impact of Pediatric Diabetes Increased prevalence of diabetes in racial/ethnic minority groups. Barriers to pediatric diabetes care. Rural Healthy People decrease health disparities and improve access to care.

31 Patient-centered Medical Home (Berwick, Nolan & Whittington, 2009)

32 Caregiver Stress Pediatric diabetes is very challenging for families and affects their quality of life. Lack of access to specialty providers. Commonly report increased stress, anxiety, depression, financial strain, and family conflict. (Cousino and Hazen (2013)

33 Pediatric Diabetes Complications Many children with type 1 diabetes fail to achieve their glycemic control. Serious long term consequences o Retinopathy o Nephropathy o Neurological and Cardiovascular disease. DKA is the most common cause of death. Psychological problems. (ADA, 2014)

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35 Pediatric Diabetes Telemedicine Literature Review Decreased hospitalizations, saving $27,000/yr. (Malasanos, Burlingame, Youngblade, Patel & Muir, 2005). Lower HbA1c, improved quality of life, reduced calls by the school nurse, and fewer hospitalizations and emergency department visits (Izquierdo et al., 2009).

36 Methods Caregiver Satisfaction Survey Conducted over 2 months from April 2014 through May 2014, averaging 7 encounters per month. The project took place at a pediatric outpatient clinic on the Eastern Shore of Maryland in partnership with Washington Nationals Diabetes Care Complex.

37 Characteristic n (%) Type of Diabetes Type 1 14 (100) Type 2 0 (0) Number of years diagnosed with diabetes 0-2 years 5 (36) 3-5 years 6 (43) 6-8 years 2 (14) 9-11 years 0 (0) years 0 (0) years 1 (7) Prior established patient of diabetes physician Yes 6 (43) No 8 (57) Child s race/ethnicity White 2 (14) Black 11 (79) Non-Hispanic 14 (100) Hispanic 0 (0) Other 1 (7) Travel time to the telemedicine clinic Less than 30 minutes 12 (86) minutes 2 (14) More than 1 hour 0 (0) Travel Prior Telemedicine Less than 1 hour 2 (2) 1-2 hours 0 (0) 2-3 hours 10 (71)

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39 Multidisciplinary Collaborative Continuous QI Teamwork Dependable technology High level of collaboration for acute illnesses between school nurses, clinic nurse practitioners, the CNMC diabetes specialist and pediatric hospitalist. CNMC emergency line for after hours Care coordination with primary care and school nurses

40 Future Research Psychological considerations: caregiver burden and Health-related quality of life (HRQL). Clinical metrics: HbAIC Health care cost: utilization of services, hospitalizations and emergency room use.

41 Conclusions Caregivers are extremely satisfied with telemedicine visits to meet their families needs. Telemedicine is reducing access to care barriers and improving pediatric diabetes chronic care management. Telemedicine has the potential to relieve caregiver burden and empowerment through increased selfmanagement education and monitoring. Telemedicine has a future role in value-based medical homes to improve the outcomes, quality and cost of care.

42 Questions/Comments?! 43