telemed clinicore
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MARK SINGH MDA.CHAKRABARTI MD
DEB ZONA RN
Nursing Home Telemedicine Program
Mark Singh MD, A.Chakrabarti MD, Deb Zona
May 20, 2009
Background: Clinicore
Leading edge Nursing Home Telemedicine company
Staff Back Ground Nursing home, hospital and clinic based medical practice Medicare Advantage, Tufts Medicare Preferred case
management Nursing home medical management Affiliated with multiple hospitals in the south of Boston
region Relationships with Boston Tertiary hospitals Active involvement with major EMR implementation
projects in the region
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Telemedicine: The Concept
John DoeClinical ResultsLabs: WBC 12
Hct 32Bun 45, Cr 2.4
John DoeEncounter Notes
Assessment:Pneumonia,
uncomplicated, stablePlan: observe, Abx
View ResultsVisualize patient,
examine with nurseDocument the
Encounter
Mark Singh MD, A.Chakrabarti MD, Deb Zona
• Physician can remotely assess a patient using high-definition video conferencing and formulate a plan
• Key elements• View clinical resultsView clinical results• Visualize the PatientVisualize the Patient• Document the encounter: assessment and planDocument the encounter: assessment and plan
Medical Care Issues in Nursing Homes
Inconsistent Physician coveragePhysicians generally not onsite to address
medical problems as they arise: Pneumonia Wounds Rashes/lesions Post-Op issues, complications Other medical problems that usually require onsite
examination or close daily monitoring
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Consequences of Sub-optimal Physician Coverage
Needless emergency room visits/Ambulance rides
High admission and re-admission rates to hospitals
Delay in treatment for wounds/infections with resulting complications
Poor outcome measures (DPH, JCAHO)
Decreased Patient/Care-giver satisfaction
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Medicare Implications
Nursing Home Pay-for-Performance demonstration “Nursing Home Value-Based Purchasing”
demonstration Criteria includes “appropriate hospitalization” Implications for re-imbursement/quality
measures 30 day Re-Admission Reduction
May be tied to hospital reimbursement Likely to be a reportable outcome by hospitals Hospitals transfers will go to SNFs with low
re-admission rates and with good clinical programs in place
House Bill, HR 2068: will expand Medicare telemedicine coverage if passed
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Telemedicine Allows for On Demand Physician Care
Allows medical problems to be addressed by a physician as they occur
Treat patients onsite appropriately without having to transfer to the ER.
Cost savings: fewer ambulance tripsImproved Outcomes:
Lower hospital admissions and re-admission rates
Fewer complications: wound care, post-surgical care
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Does Telemedicine Work?
Telemedicine via video conferencing is comparable to in person evaluation (study done at MGH, May 2009, Journal of Telemedicine and Telecare)
Telemedicine can increase physician “virtual onsite” availability
Does Onsite physician availability improve outcomes? Multiple studies have concluded that onsite physician
availability at the nursing home and effective communication is key in reducing hospital admission rates and improved quality of care
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Nursing Home Implementation
Prerequisites Wireless broadband access in Nursing home DPH notification: intent to implement telemedicine
Promotion and training Staff physician consent process Nursing staff
Procedural and Compliance Nursing home credentialing of Clinicore physicians Approval of patient consent forms and process
Telemedicine equipment deployment Go live
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Clinicore Telemedicine Extension Program
Leveraging telemedicine equipment for administrative functions: virtual conferencing with multi-site organizations Remotely located “Lead Administrator” can “meet” with
entire local leadership team via high definition video conferencing
Nurse Training/Education via Video conferencing Educational rounds with local specialists
Infectious disease: i.e.,H1N flu, MRSA, review of in-house infections
Wound care Post-operative care
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Demo Slides
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Telemedicine Cart Features
• Wireless high-definition videoconferencing
• Mobile: can be moved to patient room
• Wireless connectivity, internal battery
• Peripheral devices
• Exam camera for wounds, close ups
• Digital Stethoscope
Patient Evaluation at Nursing Home
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Images captured remotely during live sessions
Mark Singh MD, A.Chakrabarti MD, Deb Zona
Patient with recent MRSA wound infection
Patient with new rash
Telemedicine Clinical Documentation
Consult note is generated for each encounter Note sent/faxed to patient’s nursing home physician Note for sent to nursing home for insertion into chart
Sample note See attached
Mark Singh MD, A.Chakrabarti MD, Deb Zona