Bricks and Mortar of a Telehealth Initiative

Transcription

1 Bricks and Mortar of a Telehealth Initiative Session 279, Date of Session: March 8, 2018 Suzanne Richardson, MSN-HCSM, RN Laurie Eccleston, MPA, RN, CPHIMS 1

2 Conflict of Interest Suzanne E. Richardson, MSN-HCSM, RN Laurie R. Eccleston, MPA, RN, CPHIMS Have no real or apparent conflicts of interest to report. 2

3 Agenda Who are we serving? What does the service look like and who is involved? How do we think we can provide this service? What challenges have we faced? Did we achieve our objectives? Is there anything we could have done better? 3

4 Learning Objectives Identify at-risk patient populations that would benefit from an organized transitional care model based on remote patient monitoring and telehealth management Illustrate the steps required to develop an automated telehealth program as it pertains to management of chronic health conditions Develop an appropriate project framework that includes all the necessary disciplines, roles and responsibilities 4

5 Academic medical center established in 1824 Four hospitals Medical University Hospital Ashley River Tower Hospital MUSC Children s Hospital Institute of Psychiatry More than 10,000 employees Medical Center and University Six schools of Health Professionals Primary and specialty care Regional Level 1 Trauma Center 709 inpatient beds Over 36K inpatient encounters 23hr Obs visits >5,600 >66K Emergency department visits Nearly 3,700 Ambulatory surgeries Annual 1.2 million Outpatient visits 120 Off-campus care settings Over 580 actively enrolling clinical trials 5

6 MUSC as a leader in telemedicine Founding member of the multi-institution, South Carolina Telehealth Alliance (SCTA) Named a National Telehealth Center of Excellence (COE) Health Resources and Services Administration cooperative agreement to identify and collaboratively promote telehealth best practices MUSC s breadth and depth: > 200,000 tele-interactions; > 140 sites; 77 unique tele-services; 27 SC counties 6

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8 Aortic Stenosis 101: The What 8

9 Aortic Stenosis 101: The Why 9

10 Aortic Stenosis 101: The When 50% After the onset of symptoms, patients with severe AS have a survival rate of 50% at 2 years and 20% at 5 years without AVR Ramaraj R, Sorrell V. Degenerative aortic stenosis. BMJ 2008 Lester, S, et. al. The natural history and rate of progression of aortic stenosis. Chest

11 Aortic Stenosis 101: The Who Good quality of life Progressive decline Decreased stamina Increased fatigue Shortness of breath Fainting/frequent dizziness Chest pain 11

12 Aortic Stenosis 101: The How Therapy options: 1. Gold Standard - savr 2. New technology - TAVR 12

13 Aortic Stenosis 101: The How Medtronic Evolut R Edwards LifeSciences Sapien3 13

14 Geographic landscape Transcatheter aortic valve replacement (TAVR) Age >70yo Multiple co-morbidities Complex care transitions MUSC as a quaternary hospital 14

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16 It starts with an idea 16

17 The gauntlet 17

18 The pitch 18

19 Attractive program pilot Tightly controlled population Manageable volume for pilot Significant year-over-year growth leads to real-time scalability State of SC telehealth funding 19

20 Turning dreams into reality 20

21 Value of Clinical Collaboration to build an app Promotes collaboration and communication among interdisciplinary teams Focus on clinical excellence and ability to promote usability and adoption by those who will directly use the technology tools Talent and perspectives from various functional domains to share and exchange information for decision making Recognizes subject matter experts with deep knowledge in healthcare and clinical workflows to drive the design of technical solutions that transform business needs Helps bridge the gap between clinical and technical staff to create solutions that are flexible and improve outcomes based on intended workflow and care delivery 21

22 Software Developer System Architect 22

23 Software Developer End User EHR build analyst Clinician ehealth Compliance Clinical Informatics Billing System Architect Project Manager Inventor TeleHealth Care team 23

24 Clinical Informatics GUI? Gooey? Advocates for the delivery of care needs to be the driving force behind the technology Acts to fill the gaps between informatics clinical champions, and technical staff to leverage technology to improve outcomes Assess, design, and evaluate workflows for effectiveness through the use of clinical knowledge and comprehension of technology solutions Assists in translating end user requirements into technical requirements 24

25 From this To a dream realized 25

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27 518 days in development 27

28 Lack of Workflow analysis Decisionmaker ID key stakeholders Standard project docs 28

29 Lessons Learned and Recommendations Billing / Coding Challenge Get It Right No clear understanding and limited knowledge by compliance and billing on appropriate coding. Initially gave wrong codes causing delay in template build and documentation. Know who will reimburse for the services, what are the correct codes, what are the covered settings, what is the fee schedule, and scope of care 29

30 Lessons Learned and Recommendations Copyright laws Challenge Get It Right Initial screening questions were pre-built in the application without prior approval from the questionnaire committee and required removal Determine who is responsible for obtaining exclusive rights permission on use of copyrighted materials prior to building within an application 30

31 Lessons Learned and Recommendations Hardware/Software Compatibility Challenge Get It Right Compatibility of custom built application working on the appropriate supported device that was selected for specific patient population Determine if the structure that houses healthcare applications can work together with the intended device, does the device have the operating system that enables the framework for it to work within 31

32 Lessons Learned and Recommendations Integrate / Interface Challenge Get It Right Inability of custom built app and EMR to assimilate thus requiring use of two applications for patient navigation and importing of data What are the interfacing capabilities between the application and EMR, what data format will the EMR accept for importing data, where will the data reside within the EMR 32

33 Lessons Learned and Recommendations Device Testing Challenge Get It Right Of the three peripherals, one had difficulty connecting to the device due to a lack of a trusted relationship During usability testing, incorporate multiple devices in the same area at the same time to detect pairing issues 33

34 Change Control We got it right! Post go-live with involvement from key stakeholders to monitor and track all change requests Meets every two weeks and reviews issues, break-fixes, and minor enhancements that have been identified and submitted Requests are reviewed and either approved or denied All changes are made and tested prior to release cycle production moves 34

35 Change Control Database 35

36 Patient Home Monitoring Devices and Guidelines Pulse Oximeter Blood Pressure Monitor Heart Valve App Weight Scale 36

37 Outcomes Avoided pneumonia with nursing education Avoided knee-jerk medication adjustments by lifestyle modifications Patient testimonials: I m 78 years old and I found this easy to do. I felt more secure knowing that someone was watching over me. My husband was more nervous about me having the procedure than I was. Sending in my reading everyday gave him peace of mind. My blood pressure was high one day. [The nurse] called me and asked what I ate yesterday. I told her I had some chicken noodle soup and saltines. She told me that the sodium in my food can cause my blood pressure to go up. I didn t know [my blood pressure] could be affected that much by a bowl of soup and some crackers. 37

38 Tom: Beta Test Patient 38

39 Questions Suzanne Richardson, MSN-HCSM, RN (843) Laurie Eccleston, MPA, RN, CPHIMS (703) Please complete online session evaluation 39