VA Maine Telehealth Services Tiffiny Rooney, MSN, RN BC Facility Telehealth Coordinator Objectives Overview and benefits Present state of VA Maine Telehealth Services Challenges faced through use and implementation of telehealth Strategies used to mitigate safety issues Lessons learned Future of Telehealth in the VA 1
Telehealth The use of electronic information and communications to provide health care and a broader range of clinical support activities, such as patient education, remote monitoring of health indicators, and self management support. 2
The essential difference between Telehealth and face to face health care is the use of technology to bridge the distance between the patient and the provider. The technology should function effectively so that it is a seamless part of the health care process, not a distraction. VA Curriculum Benefits of Telehealth: Decreased travel for patients and/or providers Saves time for patients Improved access to care, especially specialty care Improved continuity of care/case management Improved access to training 3
Telehealth Modalities Clinical Video Technology (CVT): Clinic to main facility or clinic to clinic CVT into Home (VA Video Connect) Store and Forward (SFT): TeleRetinal Imaging TeleDermatology Home Telehealth: Care Coordination 4
Telehealth Team Telehealth Clinical Technician (TCT) at patient location Facility Telehealth Coordinator : program administrator Technical support staff : National Telehealth Help Desk, Clinical Engineering, Information Technology Distant clinical provider, i.e. specialist or primary care professional providing care Referring provider, who needs to be part of the care communications loop if not involved directly in the telehealth program Role of the Telepresenter in CVT: The TelePresenter is: Set up and ensure that the equipment is working properly. Ensure privacy and safety Provide an orientation to the patient and their family. Obtain consents for telehealth An extension of the provider s eyes, ears, and hands and should facilitate communication between the patient and the provider Facilitate the appointment 5
Clinical Video Telehealth (CVT) Over 500 Veteran appointments a month throughout Maine Home Telehealth Program Over 600 Veterans enrolled Designed for Veterans to participate in self management of chronic health conditions Provide education and assistance to ensure timely access to intervention Information sent via home monitors is reviewed by Registered Nurses trained in telehealth, alerted to providers as needed 6
Store and Forward (SFT) 220 270 Veterans seen a month throughout the state of Maine TeleRetinal Imaging: Screening for Diabetic Retinopathy through imaging, results to readers in Boston. TeleDermatology: Consultation with Dermatology. Images sent to readers in Providence. Same day as PC appt whenever possible. Challenges: Increase in costs especially for the initial costs Need for training in new technologies and mode of clinical teamwork Increase in staffing demands: competencies and appropriate level of care on site, particularly MH support In some cases patients may find it to be a negative experience to have less face to face access to a provider Complicated scheduling both sides and equipment Follow up care and communications with providers 7
During the televisit: Manage and operate the equipment Troubleshoot and resolve problems TCT acts as the provider s hands assisting, moving or positioning the patient or peripheral so that the provider has the best view for clinical needs and patient provider communications are optimized Clearly and accurately describe the patient s condition to the remote provider Carry out instructions from the remote provider After the televisit: Ensure patient understands any follow up instructions Arrange follow up appointment if warranted Complete required documentation for the patient s medical record or QA monitoring programs Complete all procedures for cleaning and shutting down the equipment 8
Maintain the quality of the televisit: Pay attention to room comfort and temperature Lighting, background wash out, clothing size of picture, location of provider and patient on screen Challenge of talking to the screen rather than the patient Noise factors: know how to use mute, avoid fans, side conversations Strategies to mitigate quality or safety concerns TCT Competencies: equipment, clinically specific, Standardized Emergency Protocols: emergency call buttons, phone number confirmation Communication tools (head sets, instant messaging) If Veteran alone in appointment how to reach TCT 9
Lessons Learned Communication, Communication, Communication Takes a team, cannot work one deep Cannot do everything Equipment implementation and maintenance= excessive coordination with IT and CE Technology does not always cooperate, need plan B Future of Telehealth in VA Bringing care to the Veterans home 10
Jabber Software Veterans must have their own computer with speakers and webcam Veterans with High speed internet challenge in some locations, cost to Vet VA provides link and schedules connection, for Veteran to download Mobile CVT Tablet Offers Veteran a self-view or environment view so Providers can see what the Veteran sees, simply lift off the cradle and walk around when needed DOES NOT support any type of medical devices VA approved video application Built in 4G Verizon connection or Wi- Fi capable All the Veteran has to do is charge the tablet on the charging cradle and it s operational Simple to deploy Designed to be deployed Locked Tablet for VA use ONLY No additional cost the Veteran Offers access to My HealtheVet and VA approved apps 11
CVT Patient Tablets with peripherals Rugged tablet with built in stand Supports real time medical devices: Stethoscope, General Examination Camera, BP, Pulse Ox, Temperature, Weight VA approved video application Built in 4G Verizon Connection or Wi Fi capable All the Veteran has to do is plug the device into power and it s operational Simple to deploy Designed to be deployed Locked tablet for VA use ONLY No additional cost the Veteran Offers access to My HealtheVet and VA approved apps QUESTIONS??? 12