Shirl Johnson, DNP, APRN, CNS, MHA

Shirl Johnson, DNP, APRN, CNS, MHA

Objectives Define Remote Patient Management Describe efforts and the infrastructure to support RPM Understand the role of the APN

Nursing Recognition Norton Healthcare has earned the National League for Nursing s esteemed four-year designation as a Center of Excellence (COE) in nursing education for 2013-2017. Academic Practice Partnerships Doctor of Nursing Practice BSN to DNP Institute for Nursing Tracy E. Williams, DNP, R.N. Senior Vice Present and System Chief Nursing Officer

REMOTE PATIENT MANAGEMENT JOURNEY: Tele-Care

Surviving and Thriving. Healthcare reform has transformed our nation s healthcare system and reimbursement structure. The shift in payment structures to improve quality, lower cost and to create a culture of sustainable outcomes has created urgency in today s healthcare environment. 5

Agenda For Change Non-Negotiable & Current State Our Vision (2013-2020) Return on Investment Quality Metrics Education and Training Maximize Technology Usage Coordination of Care

Vision(2013-2014) Conduct needs assessment for gaps in service Identify consultative services available via EMR Assess resources for potential site deployment Determine remote site team composition Consult with Clinical Information Analysts to identify gaps in care associated with the Affordable Care Act Present to System executives for approval

Vision (2014-2015) Determine leadership for remote site Executive sponsor Medical director Operations director Identify patient population or service Develop evidence based standardized guidelines and protocols

Vision (2014-2015) cont. Return on Investment (ROI) Create business plan Calculate current salary requirements and benefits Assess associated costs related to Tel-Acute Care model Calculate costs for hardware and software Understand state and federal reimbursement laws and restrictions Submit budget program

End State ( 2016 2017) Remote Patient Management Solution: Tele Care Creation of a system APRN consult service located in a central location Available 24/7 Via two way interactive platform (i.e. Skype) Allows every RN in NHC to access clinical expert in real time. RN Bedside support and education Issue Orders 10

RPM Roadmap for Project Completion An integration of Evidence-based practice (EBP) and Quality Improvement (DMAIC)

Define Project Team Charter Project Description Project Scope :Sepsis and Early Warning Sign Key Performance Outcome Measure (KPMO) Financial Indicators Benefit to customer Business Results

Interdisciplinary Team: Stakeholders Clinical and Subject Matter Operational Chief Nursing Officers V.P. and Chief Financing Officer Nursing Systems V.P. of Health Policy V.P. Chief Information Officer Experts Nursing Pharmacy Physicians Mission and outreach Project Management Educators Information Systems

Measure: Clinical Center for Medicare & Medicaid: operational definitions Severe Sepsis Within 3 hours of presentation Within 6 hours of presentation Guidelines for repeat assessment of volume status and tissue perfusion Data Mining in electronic medical record : Epic

Analyze Phase Technical Ability to maximize the EMR Dashboards Human Resources Consensus Model: Acute and Family Practice Practitioner Equipment Monitors Communication: dedicated phone lines,

Improve Clinical/ Best Practice Standardization of order sets Human Resources Sponsoring Physician/Collaborative Interviewing and hiring of Advance Practice Providers Created work stations for Remote Patient Management Maximize EMR Best Practice Alerts in Epic (BPAs) Dashboards

PARTS OF RPM DASHBOARD

Dashboard Components

When to call You think a patient is becoming septic Questions about disease processes Questioning whether or not to call a Rapid response New onset Fever On the fence of when to call MD Gut feelings/nurse concern Changes in vital sign trends *** Please note these are a few examples, not an exhaustive list; call us anytime day or night***

COMMUNICATION: WHAT WE DO Surveillance of early warning of patient decline Surveillance of early warning of Sepsis Serving as your 24/7 resource if you have a question or concern about a patient Enter specific orders based on RRT order sets Problem solve Recommend interventions and guiding you to helpful information.

Cultural Acceptance Nursing unit engagement for clinical support from RPM Remote Patient Management providers are dedicated and engaged The program has improved dialogue between physicians and Remote Patient Management APNs.

Remote Patient Management Value Proposition Quality Care + APNs Cost

Control: RPM Cost Benefits 2016 Metric Q1 Q2 Q3 Q4 2016 Statistics Early Warning 420 277 457 579 1733 Sepsis 319 477 659 663 2118 Clinical Communication 592 733 537 433 2295 Charts Reviewed 8639 9685 9166 8732 36222 Charts Per Hour 3.96 4.43 4.15 3.95 4.51 Productive Minutes Spent Per Chart Review 16.41 13.71 17.54 16.93 14.87 Cost Avoidant Interventions per 100 Charts Reviewed* 8.55 7.79 12.18 14.22 10.63 Cost Avoidance Early Warning $ 122,886.97 $ 81,046.88 $ 133,712.73 $ 169,408.00 $ 507,054.59 Sepsis $ 190,968.82 $ 285,555.26 $ 394,509.25 $ 396,904.00 $ 1,267,937.33 Total $ 313,855.79 $ 366,602.14 $ 528,221.98 $ 566,312.00 $ 1,774,991.91 RPM Operating Expense VS Cost Avoidance RPM Total Cost Avoidance $ 313,855.79 $ 366,602.14 $ 528,221.98 $ 566,312.00 $ 1,774,991.91 RPM Operating Expenses Actual $ (157,652.00) $ (187,561.00) $ (181,927.00) $ (173,592.00) $ (700,732.00) Total $ 156,203.79 $ 179,041.14 $ 346,294.98 $ 392,720.00 $ 1,074,259.91 Cost-Benefit Metrics Benefit-Cost Ratio 1.99 1.95 2.90 3.26 2.53 Return on Investment 99.08% 95.46% 190.35% 226.23% 153%

Inbound Calls/ Consultations

Collaborations MyChart- video visits and e-visits Mammography Initiative Screening Mammogram and Diagnostics

Next Steps Acute Care: 1 st on Call for Hospitalists Telehealth: Peripheral's Devices ( High-risk patents)

Summary Advance Practice Nurse (APN) is able to practice at the full extent of their education and training. Create standard and decrease variability Enhance effectiveness and outcomes To effectively use resources and gain efficiency To provide right model of care for right patient in right bed with right caregiver