telehealth care closing the gap to specialty care · 2019. 11. 7. · telehealth care closing the...
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Telehealth care Closing the Gap to Specialty Care
Dietra Watson, MSN, RN Clinical Informa7cs
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
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.
Telehealth Vision
To make the home and local community into the preferred place of care whenever possible and prac7cal.
Telehealth Values
To use health informa7on and telecommunica7on technologies to improve therapeu7c rela7onships.
Telehealth Background
• Telehealth care is interdisciplinary care • Telehealth care providing quality care
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
Roles and Responsibili7es
• Facility Telehealth Coordinator
• Care Coordinator • Telehealth Clinical Technician
• Consul7ng Provider • Referring Provider
Planning
• Exis7ng programs • Expanding programs • Strategic planning • Maintenance
Telehealth modali7es
• Clinical Video Telehealth (CVT)
• Home Telehealth (HT) • Store and Forward (SFT)
Defining Technology
• Synchronous • Video conferencing • Asynchronous
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
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
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
CVT Encounter Growth
2 96 463
908 825 816 973
2,012
4,582
5,889
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
What is SFT
• Stores clinical data • Medical images electronically forwarded • Common areas SFT are used
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
SFT Image Growth
27 446
775
2,592 2,849 2,900 2,994
3,797
5,242
0
1,000
2,000
3,000
4,000
5,000
6,000
2005 2006 2007 2008 2009 2010 2011 2012 2013
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
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
Performance Improvement
• Collabora7ve workgroup
– Establishes performance improvement plan – Performance measures – Workload data – Systema7c approach – Telehealth quality
What is HT?
• Disease Management • Tracks pa7ent outcomes • Supports primary care providers preventa7ve care goals
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.
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
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
Flow of a Telehealth Visit
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
Ques7ons & Comments
References Radhakrishnan, K., Jacelon, C., & Roche, J. (2013, June). Associa7on of comorbidi7es with home care service u7liza7on of pa7ents
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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), 413-‐8. Retrieved from hmp://search.proquest.com/docview/223310652?accoun7d=458
Stanhope, M., & Lancater, J. (2010). Founda6on of nursing in the community: Community-‐oriented prac6ce, (3rd ed.). St Louis,
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