Telestroke Planning Questionnaire

Transcription

1 Backgrund: The Alberta Prvincial Strke Strategy (APSS) is a cllabrative mdel f inter-reginal rganizatin and delivery f strke care that fcuses n cnnectins between tertiary and primary strke centers. One bjective f APSS is t use high speed telemedicine technlgy t increase the efficiency and allw access t a full range f diagnstic and treatment activities regardless f the lcatin f the patient. A Telestrke Wrking Grup has been frmed t arrange telehealth supprt fr the APSS. The purpse f this grup is t crdinate use f telehealth t prvide an efficient, reliable netwrk t supprt strke care that perates seamlessly acrss Alberta. Respnses t this questinnaire will prvide infrmatin fr the Telestrke Wrking Grup t supprt: develpment f a prvincial telehealth implementatin plan fr the Acute strke cmpnent f APSS and planning fr use f telehealth infrastructure, implemented fr telestrke, fr ther urgent/ emergent healthcare applicatins. In additin, respnses will supprt develpment f a funding applicatin t Canada Health Infway. Please cmplete by July 10, 2006 and return t: Questins? Telehealth Branch Alberta Health and Wellness 17 th Flr Telus Plaza Nrth Twer Edmntn, Alberta T5J 1S6 Fr further infrmatin cntact: Sharlene Stayberg Chair, Telestrke Wrking Grup Telephne: (780) sharlene.stayberg@gv.ab.ca Re Sectin B: Bev Culham Prject Manager, Alberta Prvincial Strke Strategy Telephne: (403) bculham@hsf.ab.ca Part A- Reginal Infrmatin Cmpleted by: Blayne Iskiw / Lynette Lutes Psitin/Department: Directr, Reginal Telehealth / AB Health Authrity/Bard: Capital Health Page 1

2 Part B Reginal Plans: 1. Please specify status f planning t migrate t a telehealth mdel fr hyperacute phase f strke at rural sites with CT technlgy. [Emergency rm telemedicine cnsultatin invlving live tw-way vide and transmissin f CT images t enable a care decisin n administratin f t-pa (tissue plasmingen activatr), a highly effective clt-busting drug that shuld be given under supervisin f a neurlgist] Migratin in prgress may include implementatin fr ff-hurs (specify implementatin date expected, partial r 24/7 implementatin) Sites/cmments: Sept 2006 g-live live fr Hintn site. Other sites (i.e. Camrse, Llydminster, etc) t be added thrughut fall and early winter. 24/7 implementatin t begin fall 2006 (interim 24/7 supprt prvided by phne cnsultatin and PACS mnitring). Migratin planning underway - (expected timeframe) Sites/cmments: Intend t migrate within next 3 years but n immediate plans because lacking a key resurce - (e.g. lcal physician resurces, ability t digitally transmit CT scans t specialist center...). Please state which resurces are lacking. Sites/cmments: Currently, n plans t migrate within next 3 yrs - (e.g. TPA already administered at reginal site). Please prvide ratinale if there are n plans t migrate. Sites/cmments: Yet t be determined Sites/cmments: 2. Initial plans fr ther applicatins/uses f telehealth technlgy implemented fr hyperacute strke (e.g. ther trauma, cardilgy, translatin in ER, mental health urgent services...) Planning underway (specify applicatin(s) PICU/Ped s ER Intend t use (applicatins nt yet determined) Please list knwn majr expenditures required fr planned new telehealth applicatin 3. Other planned uses f telehealth technlgy related t the Alberta Prvincial Strke Strategy Pillar #1. Strke Preventin + Health Prmtin Planned Use Enhance Telehealth services fr existing strke service delivery in remte areas f the regin and surrunding central and nrthern regins (i.e. Strke Preventin Clinic). Page 2

3 #2. Acute Strke Care #3. Strke Rehabilitatin + Cmmunity Reintegratin #4. Evaluatin + Quality Imprvement Cntinued expansin f Strke Rehabilitatin services and educatin ffered via Telehealth (i.e. SLP). Cntinued expansin f discharge planning and telementring via Telehealth. Establish evaluatin methdlgies and tls and are cnsistent with APSS standards and CH prtcls (i.e. Quality Framewrk). Establish and measures services against APSS/CH develped benchmarks. Part C- Technical Requirements 4. What new telehealth systems are required fr (specify mdels): a) hyperacute strke care Immediate: One (1) Tandberg 6000 cdec with tw (2) 30 Plasma mnitrs fr the UAH-based Acute TeleStrke rm. One (1) Tandberg 6000 cdec with tw (2) 50 Plasma mnitrs fr the Critical Care Line (CCL) call centre (supprting 24/7 implementatin) One clinical PACS viewer fr the Acute TeleStrke rm Shrt-term (<12 mnths): Fur (4) laptp-based videcnferencing units t supprt ff-site supprt frm Strke Neurlgists. b) ther strke care (e.g. rehabilitatin, health prmtin, etc) Telehealth systems are already in place t prvide ther strke care. One (1) Tandberg Intern II t supprt telerehabilitatin (i.e. SLP) services ut f Glenrse Rehabilitatin Hspital (GRH). 5. Please describe the prpsed slutin. What systems and netwrk infrastructure will be used, including bandwidth, netwrk access, netwrk security etc, fr: a) videcnferencing? Videcnferencing cnnectivity pssible via Alberta SuperNet (IP) r ISDN netwrks. Maximum bandwidth available is 2Mbps but expected nrmal cnnectivity t be at <1Mbps. All Telehealth calls are ruted thrugh the CH Telehealth Bridge, using varius firewall transversal devices, gateways, gatekeepers and ruters. All calls will be fully encrypted. b) CT scans? CT images will be transmitted t CH frm the remte sites via the Alberta Supernet netwrk. A pint-t-pint cnnectin is created by the netwrking teams at each site t establish a secure, encrypted tunnel fr transmissin. Page 3

4 6. Fr service receive sites - What is the regin s technical apprach fr sharing CT images bth within the regin and between regins? Hw will ther diagnstic/ medical infrmatin be shared with the cmprehensive strke center? N/A Fr service prvisin sites Please describe the regin s apprach related t receiving CT images frm ther regins. What technical, security and change management [E.g. remte access t PACS lgin] issues are anticipated in prviding services t multiple ut f regin sites? Hw will this be apprached? At this pint in time there are n anticipated cncerns with accessing secure CT images with in the Strke clinic. Pilt test will be cmplete t wrk ut any issues that may arise prir t g live date. The UAH PACS system can be cnfigured t accept images frm ther PACS systems nce the netwrk tunnel has been established. This allws service receive sites t push CT images nt the UAH PACS system. Currently there are 5 clinical review statins in the UAH ER department where these images can be reviewed. 1 f these statins is ideally lcated beside the Telehealth vide cnference equipment. Currently hme review is pssible but with the frthcming integratin with NetCare it will be pssible fr all physicians. Issues f resurce availability t wrk n setting up the netwrk and PACS cnnectins seems t be an issue. S far all technical issues seem t be minr. 7. Hw will this integrate with Reginal systems and the IM/IT DI initiative? (e.g. what EHR assets will be used fr telestrke?) Please include timelines fr integratin? Hw will the technical apprach change (between interim t rutine service)? T be determined Page 4

5 Part D Ptential Infway Funding Request Matching Surce New Ttal Expenses APSS AB Health Regins $/InKind Other Surces (Please specify in-kind r $) Infway Investment (50% f ttal eligible csts) When d yu expect t have invices fr entire expense? Capital/One Time Csts Dec 06 Dec 07 Dec 08 Telehealth Technlgy/Equipment $130,000 $65,000 $65,000 Switches, ruters, server space Peripheral medical devices N/A N/A Basic Clinical Rm Enhancements* $5,000 $2,500 $2,500 Privacy Impact Assessments Prject Planning (including develpment f a management mdel + definitin f clinical & technical requirements + develpment f plans t address gaps including CT/Netwrk issues) Prject Management/Cntrl Prject Implementatin (e.g. develpment f technical supprt) N/A $20,000 $10,000 $10,000 $29, 600 $14, 800 $14, 800 $2,640 $1,320 $1,320 Change Management/Prgram Adptin/Cmmunicatins Strategy (e.g. $18, 400 $9,200 $9,200 implementatin tl kit resurces) Training $4,000 $2,000 $2,000 Evaluatin $12,800 $6,400 $6,400 Ttal One Time Csts $222, 440 $111,220 $111,220 *Please explain the clinical benefits f the expense, e.g. Rm lighting nt ptimal t ensure accurate diagnsis. Ttal f Infway Investment cannt exceed the ttal f matching funding. Nte: Infway prvides 50 matching funding n ne-time expenditures. Operatinal csts are nt eligible. APSS funding as well as Reginal perating, capital and in-kind surces are recgnized. Page 5

6 Part D2: Additinal Financial Infrmatin fr Ptential Infway Funding Request 1 Day = 8 hurs Telehealth Technlgy/ Equipment Tandberg 6000 cdec with plasma mnitrs ($25,000) Vide Cnferencing system fr the UAH TeleStrke rm Tandberg 6000 cdec with tw plasma mnitrs ($27,500) Vide Cnferencing system fr the Critical Care Line (CCL) call centre which prvides 24/7 services Fur laptp based videcnferencing units ($24,000) t be used t supprt ff-site strke neurlgists Tandberg Intern II Videcnferencing Unit ($18,500) Videcnferencing system t supprt telerehabilitatin (i.e. SLP) services frm the Glenrse Rehabilitatin Hspital PACS Clinical PACS Viewing Statin ($35,000) Unit fr the UAH TeleStrke rm t be used by the strke neurlgists t review CT images transmitted frm remte sites. Prject Management Business Analyst ($40/hr fr 10 days ttal) building reprt template building prcess flw building accunts building and distributing invices Directr Reginal Telehealth ($50/hr fr 10 days ttal) recruiting specific clinical leads Directr Reginal Strke ($50/hr fr 10 days ttal) recruiting specific clinical leads Prgram Crdinatr TeleStrke ($50/hr fr 20 days ttal) clinician & physician supprt Service Crdinatr Reginal Strke ($50/hr fr 10 days ttal) clinician & physician supprt Clinical Facilitatr Telehealth ($40/hr fr 20 days ttal) clinician & physician supprt Prgram Implementatin Technlgy Manager Telehealth ($40/hr fr 2 days ttal) installatin f vide cnferencing equipment Prgram Crdinatr TeleStrke ($50/hr fr 5 days ttal) implementatin f plicies & prcedures implementatin f cmmunicatins plan and evaluatin framewrk Change Management Directr Telehealth ($50/hr fr 10 days ttal) develpment f specific cmmunicatin strategies discussin f plicies & prcedures Telehealth pamphlets creatin f patient and health care prfessinal infrmatin brchures Directr Reginal Strke ($50/hr fr 10 days ttal) develpment f specific clinical cmmunicatin strategies discussin f clinical plicies & prcedures Page 6

7 Training Clinical Facilitatr Telehealth ($40/hr fr 10 days ttal) initial telehealth clinician training & supprt develpment f specific cmmunicatin strategies Prgram Crdinatr TeleStrke ($50/hr fr 5 days ttal) clinician supprt Service Crdinatr Reginal Strke ($50/hr fr 5 days ttal) clinician supprt Liaisn Reginal Telehealth ($40/hr x 10 days ttal) Liaisn with ther reginal health authrities Develp and maintain change management initiatives and strategies Prgram Crdinatr TeleStrke ($50/hr fr 10 days ttal) prvide new telehealth clinician training t increase the adptin f the TeleStrke tpa Pilt prject and expand clinical services. Evaluatins Evaluatin Crdinatr/Data Analyst ($40/hr fr 30 days ttal) creatin f evaluatin templates cnstructin f statistical tracking tls analyzing evaluatin data evaluatin reprt develpment Clinical Facilitatr Telehealth ($40/hr fr 10 days ttal) creatin f questinnaire templates Prject Planning Directr- Reginal Telehealth ($50/day fr 10 days ttal) identify/recruit/secure stakehlders draft cmmunicatins plan, evaluatin framewrk assemble prject team, wrk plan, prcesses draft service level agreements allcatin f resurces (human and financial) Directr Reginal Strke ($50/hr fr 10 days ttal) identify/recruit/secure clinical stakehlders draft clinical cmmunicatins plan, evaluatin framewrk assemble clinical prject team, wrk plan, prcesses draft clinical service level agreements allcatin f clinical resurces (human and financial) Prgram Crdinatr TeleStrke ($50/day fr 15 days ttal) identify/recruit/secure clinical stakehlders draft clinical cmmunicatins plan, evaluatin framewrk assemble clinical prject team, wrk plan, prcesses draft clinical service level agreements allcatin f clinical resurces (human and financial) Service Crdinatr Reginal Strke ($50/hr fr 15 days ttal) identify/recruit/secure clinical stakehlders draft clinical cmmunicatins plan, evaluatin framewrk assemble clinical prject team, wrk plan, prcesses draft clinical service level agreements allcatin f clinical resurces (human and financial) Page 7

8 Part E- Implementatin/ Issues 9. Please describe any barriers t migratin e.g. shrtage f specialized staff, incmplete PACS/RIS implementatin, etc. Staff shrtage lack f physician r nurses. The limited number f strke cases within a remte area, therefre, staff wuld need n ging clinical updates increasing remte sites wrk lad. Barriers t migratin include: PACS cnnectivity between remte sites and CH (currently in prcess) SuperNet (IP) videcnferencing cnnectivity (currently in prcess) 10. Please list any implementatin tls that yur regin is develping/ has develped (e.g. prcess maps, prcedures, CT technician check-list, training prgrams.) which are available fr sharing/ becming a prvincial template. Standardized acute strke physician rders, TPA prtcl, prehspital guidelines, prcess flw algrithm, TPA administratin educatin. TeleStrke Prcess Flw Dcument (includes remte EMS patient cntact t remte tpa administratin)..see attachment. 11. Please identify any critical issues r challenges currently being faced by the regin in implementatin f telestrke cmpnents f the Alberta Prvincial Strke Strategy. What is yur regin s planned apprach t address these issues? N/A 12. Hw are privacy and security issues being addressed? E.g. is the regin s current telehealth PIA being amended? What type f security assessment is planned? Reginal Telehealth is amending is Telehealth PIA t include Acute TeleStrke. videcnference calls will be via secure and fully encrypted netwrk. All 13. Des yur planned clinical wrkflw differ frm the appended Telestrke Pathway? Yes Page 8

9 Part E2- Infway Funding Requirements/ Prject Management Schedule Nte: cmpletin f the fllwing sectin is nt required at this time. Prject Adptin Targets and Perfrmance Measures: This is the means by which cmpletin f yur prject will be assessed. These will need t be specific, achievable and measurable and specify hw the prpsal meets the essential criteria. A perfrmance measure is a result, nt an activity. Describe hw the targets and utcmes were prjected and hw thse targets will change with additinal investment. Integratin/ Sustainability Plan: Cmpnents include: 1. Has nging funding f peratinal csts been secured? 2. Will the prgram cntinue fr at least a three year timeframe? 3. Based n lessns learned, please describe any mdificatins r majr changes t prgram peratins. Prject Management Schedule Milestnes/Activities Initiatin Grant agreement in place Prject Manager recruited Advisry/Steering Bdy in place Timeline First Cnsult Established and dcumented clinical and peratinal prcesses Implemented all technlgy Reach adptin/utilizatin targets; sustainability/integratin plan in place Training f clinical telehealth staff Prject evaluatin Clinical Services Delivery (list services): Other Service(s) Delivery Page 9

10 Appendix TELESTROKE PATHWAY Patient displays signs & symptms f disabling strke within 3-6 hurs f nset EMS ntifies clsest available CT/ tpa site Strke Team in ED assesses patient Fllws thrmblytic prtcl Assess need fr Telestrke Cnsult Call Rapid Access Line/Critical Care Lines called t initiate Telestrke Pathway in Calgary/ Edmntn Telestrke cnsult frm XX Incming ED in Calgary/Edmntn ntified f incming Telestrke Cnsult Calgary/Edmntn prepares telehealth wrkstatin (vide link) Transmit CT Scan t PACS Calgary/Edmntn Strke Team ges t Telehealth Wrking statin tpa site establishes Telehealth Link Calgary/Edmntn view CT via remte/lcal PACs Calgary/Edmntn Strke Team and tpa site Strke Team cnduct Telestrke patient assessment and review CT. Telestrke cnsult dne. Treatment rdered and administered Patient admitted r transprted t Calgary/Edmntn fr further mnitring and treatment Page 10