Innovative Uses of Telehealth. Session 264 Date of Session March 5, 2018 Michael Adcock, Executive Director, UMMC Center for Telehealth

Transcription

1 Innovative Uses of Telehealth Session 264 Date of Session March 5, 2018 Michael Adcock, Executive Director, UMMC Center for Telehealth 1

2 Conflict of Interest Michael P. Adcock, FACHE Has no real or apparent conflicts of interest to report. 2

3 Agenda UMMC Center for Telehealth History TelEmergency Remote Patient Monitoring 3

4 Learning Objectives Discuss the benefits and challenges associated with having a remote patient monitoring program Outline how to develop a TelEmergency room program Describe how telehealth can be used effectively in rural areas 4

5 UMMC Center for Telehealth History 5

6 What is Telehealth? Telehealth lets providers examine and treat patients remotely, in real time, using online streaming video technology and interactive tools. PATIENT & LOCAL CLINICIAN UMMC SPECIALISTS USING UMMC S ONLINE TELEHEALTH TOOLS 6

7 Why is telehealth important? Currently, 53 of Mississippi s 82 counties are more than a 40-minute drive from specialty care. UMMC CENTER FOR TELEHEALTH Provides specialty care that is convenient for patients Offers vital support for primary care physicians Helps decrease the cost of care and improve patient outcomes Supports population health in underserved areas Provides interactive distance education for providers to improve quality of care 7

8 UMMC Telehealth Timeline 1990s: Diagnostic test interpretation; Adult and Pediatric Cardiology 2003: First videoconferencing of telemedicine; Emergency Medicine 2008: First new specialty added - Psychiatry 2011: Full- time staff assigned to Telehealth 2013: Center for Telehealth formed 8

9 Comprehensive Telehealth Program Telemedicine: Live (Audio-Video) Interaction Scheduled and unscheduled Specialty consults, Primary Care, Employee & Student Health, Prison Health Ancillary health and wellness services Store & Forward & Diagnostic Tests Interpretation Cardiology, Radiology, Neurology, Audiology Dermatology, Pathology, Ophthalmology Remote Patient Monitoring Chronic disease management Hospitals- at risk population, cost avoidance/reduction Clinics-Chronic disease management Post Acute monitoring 9

10 UMMC Telehealth by the numbers 500,000 encounters since UMMC available specialists 35+ specialty services and growing 200+ locations 10

11 UMMC Center for Telehealth locations Community Hospitals & Clinics Mental Health Clinics FQHC s Schools & Colleges Mobile Health Vans Corporations Prisons Patient s Homes 11

12 Clinical Quality Maintain SAME STANDARD as in-person care If the technology can not replicate the exam you would do in-person then the visit is not appropriate for telehealth. Do not cut corners Study clinical outcomes and compare to in-person outcomes. 12

13 TelEmergency 13

14 TelEmergency Catalyst to start the program: Health care climate-workforce shortage ED overcrowding/ diversion Financial burden of community hospitals Staffing cost excessive with locum tenens Declining admissions Declining reimbursement 14

15 TelEmergency Outcomes Evaluation Access to Care 15 rural MS hospitals >500,000 patients treated Multidisciplinary Team NP & Board Certified EM physician Cost Effective Staffing 25% reduction in staffing costs Rural Communities Benefit 20% admissions locally 15

16 TelEmergency Outcomes Evaluation New Site Satisfaction Survey Community Hospital (Q1 2014) 100% Satisfaction Total patients seen with TelEmergency: 884 Total admission to that facility: 208 Total transfers from the facility: 68 Total discharges: 608 Total admission to this facility increased by 101 patients in Q1 of program 16

17 TelEmergency 25% reduction in rural emergency room staffing costs 20% reduction in unnecessary transfers Produced patient outcomes in rural hospitals that are on par with those of the academic medical center Connects 15 emergency departments in rural hospitals with UMMC s Level One Trauma Center Uses real-time video and audio connections 17

18 TelEmergency PATIENT SATISFACTION 96.3% of patients were comfortable or very comfortable with system 98.7% never had difficulty seeing or hearing the UMMC physician 87.3% felt their care was as good or better than with an MD alone 91.2% of patients are more likely to come back to rural ED because of TelEmergency 85.6% rated their overall care as good or excellent ADMINSTRATOR SATISFACTION 100% feel level of care in their ED has increased or remained the same 87.5% feel it cost less or about the same 85.7% feel that their overall ED volume has increased 87.5% are not concerned about a technical failure of the system 87.5% have an overall good or excellent opinion of TelEmergency 18

19 Remote Patient Monitoring 19

20 Sustainable Change: The Three E s Education Phase 1 Engagement Phase 2 Behavior Change Phase 3 Personal Empowerment Phase 4 20

21 Remote Patient Monitoring Chronic disease management in the patient s home including: Daily Health Sessions Personalized Interventions Targeted Education Health Coach Behavior Modification Patient Empowerment 21

22 MS Diabetes Telehealth Network HbA1c 1.7% Retinopathy Found 9 cases Medication Compliance 96% Weight Loss 71 pounds Health Session Compliance 83% Miles Saved 9, No Hospitalizations or ER visits for DM Preliminary results on first 100 patients 22

23 MS Diabetes Telehealth Network 23

24 SB 2646 (2104)- SAF; RPM SENATE BILL NO (As Sent to Governor) AN ACT TO CREATE NEW SECTION , MISSISSIPPI CODE OF , TO REQUIRE HEALTH INSURANCE AND EMPLOYEE BENEFIT PLANS IN 2 THIS STATE TO PROVIDE COVERAGE AND REIMBURSEMENT FOR 3 "STORE-AND-FORWARD TELEMEDICINE SERVICES" AND "REMOTE PATIENT 4 MONITORING SERVICES" TO THE SAME EXTENT THAT THE SERVICES WOULD BE 5 COVERED AND REIMBURSED IF THEY WERE PROVIDED THROUGH IN-PERSON 6 CONSULTATION; TO DEFINE "STORE-AND-FORWARD TELEMEDICINE" AND 7 "REMOTE PATIENT MONITORING"; TO AMEND SECTION , 8 MISSISSIPPI CODE OF 1972, TO INCLUDE EMPLOYEE BENEFIT PLANS IN THE 9 REQUIREMENT FOR INSURANCE REIMBURSEMENT FOR TELEMEDICINE SERVICES; 10 AND FOR RELATED PURPOSES. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI 24

25 Lessons Learned Smaller Tablet Patients need tablets that are more mobile No tethered devices Cords and cables cause confusion and increased technical issues Affordable options Blood glucose strips were not affordable Connectivity Wireless connectivity limited Provide patients with cellular network connectivity 25

26 Future Research Larger sample size Random assignment of treatment Patient and provider satisfaction Analysis of cost effectiveness 26

27 UMMC s RPM Plan Monitoring for patients across multiple chronic diseases Extend to pediatric population Significant cost savings Extend outside of Mississippi s borders Continue innovative approach to bringing healthcare resources into the patient s home 27

28 Patient Feedback 97% 99% 93% 93% Strongly Agree /Agree Strongly Agree /Agree Strongly Agree /Agree Strongly Agree /Agree I would recommend this program to others. I feel this is an important step in my care. The equipment was easy to use. If I had a problem, someone was available to help me

29 Excellent Medication Compliance 98% Yes Did you take all of your medications in the past 24 hours? 53% Another Reason 2% Missed 29 29% I Forgot 15% I Ran Out 3% Side Effects Please tell us why.

30 Remote Patient Monitoring Current RPM Programs Employer based program Chronic disease Diabetes (Adult and Peds) Congestive Heart Failure COPD Hypertension Bone Marrow Transplant Kidney Transplant High Risk Pregnancy Future RPM Programs Asthma (Adults and Peds) Congenital Heart Medical Weight Loss Neonatal 30

31 Questions Michael Adcock, FACHE Executive Director, Center for Telehealth University of Mississippi Medical Please complete online evaluation. 31