Telehealth

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Telehealth

• An Implementation Map

Mary DeVany, Director Avera Telehealth /Great
Plains TRAC
Chief Nurse Exec. Symposium November 13, 2008
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Where is Avera?
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Who is Avera?

• Five states
• 233 locations
• 87 communities
• 13,100 employees

71,550 Sq. Miles
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History

• We began in 1993
• But

Over 10,000
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Top Seven Specialties
Total 2005-2008
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Today

• 14 specialties
• 26 different providers
• 200 referring physicians
• 25 communities served

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Now Two Focuses

• Specialty care services
• Scheduled
• Out-patient and in-patient
• Acute, 24-hour available services
• Always available
• Critical services

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Extending to Other Areas

• ePharmacy
• Emergency Department
• Tele-Stroke
• Tele-Urgent Care
• CareVIEW

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Before We Get Started
lets get our terms straight.
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Telehealth vs. Telemedicine

• Umbrella term
• Various technologies
• Interactive video
• Remote monitoring
• Etc.

• the use of medical information exchanged from
  one site to another via electronic communications
  to improve patients' health status.
• Am. Telemedicine Association
• www.atmeda.org

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Why?

• Reasons for the program
• Main purpose?
• Which path will you take first?

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Gaining Organizational Buy-in

• Identify expectations

• Know who you are talking to

• Build awareness

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Administrators

• Impact to the budget
• Travel costs
• Ancillary services
• Improves staff education
• It is an expectation
• Increases services available
• Public relations
• Healthcare Center

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Providers

• Patient care
• Outreach
• Reimbursement
• Impact on their practice
• Reduced travel
• Access to education

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Patients

• Access to specialty care
• Reduced travel
• Impact on family (time/budget)
• Access to disease-specific education

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Community Leaders

• Reduces employees time away from work
• Keeps more dollars home
• Improves the perception of the quality of care
  available in the community
• Increase community education opportunities

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Others Families, etc.

• Quality health care close to home
• Comfort and familiarity
• Staying connected

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Where to Begin?

• Have a plan
• What will be YOUR application?
• Why are you getting the equipment in the first
  place?
• Who is your champion?
• What are their goals/needs?

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Where to Begin?

• Establish the timeline
• Program development
• Network readiness
• Equipment purchased/installed
• Initial implementation
• Program expansion

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Things to Consider

• Administrative
• Culture
• Acceptance
• Interest
• Scheduling

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Things to Consider

• Technology
• Network
• Compatibility
• Support (!)

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Things to Consider

• General
• Equipment
• Space
• Initial Funding
• Sustainability
• Coordinator

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Things to Consider

• Patient Interactions
• Reimbursement
• Licensure
• Credentialing
• Privacy
• Consent
• Needs vs. Capacity

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How to Implement?

• Againhave a plan
• Start smallone event or specialty
• What is the initial interest of your champion
• Build upon successes

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Keep Eyes on the Road!

• Focus should be on the application
• The benefits
• The patient
• NOT the equipment
• Bells and whistles

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Build Awareness

• As (the) Telehealth Leader, you are
• Teacher
• Researcher
• Detective
• Politician
• Sales/marketing
• and more!

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Customer Service

• Hands-on assistance
• Provide helpful tools
• Incorporate into current process or practice
  whenever possible
• Make it as easy as you can

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Customer Service

• Focus on your remote sites!
• Understand their needs/issues
• How does it feel at their side?
• Get them involved
• Establish a process
• Who is the site coordinator
• What do they need?

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What is the Impact?

• Know why your program is important
• Cost savings
• Personnel time
• Quality of patient care
• How?

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Track the Data!

• Figure out what you want to prove
• Identify the data needed
• Track it from the beginning

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Education/Administration
Medicare A Newsline (1 hour, monthly) Time
frame January 1 through June 30, 2001 Four
Avera McKennan telemedicine sites only
Cost savings for all facilities attending
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Education/Administration

• Savings Estimates of Events for One Year
• Only 1 participate
• Mileage _at_ 0.345/mile
• Non-productive time _at_ 18/hr

Does not include any other costs such as meals,
motel, etc.
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Special Successes

• Has this really made a difference?

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Pediatric Echocardiology

• Reduced turnaround from two to four days for the
  results, too immediate

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Infectious Diseases

• Results (Chart Review)
• 94 (106/113) - Change in treatment
• 68 (77/113) - Change in antibiotic
• 14 (16/113) dose change
• 12 (14/113) not necessary
• Thus, 26 of all the patient were on unnecessary
  or incorrectly dosed antibiotics

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Maternal Fetal Medicine

• OB Ultrasounds
• Around 500 annually
• Immediate interpretation
• Studies done live via telemedicine take less time
  than viewing the tape

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Avera Milbank Rural Site

• Ancillary Services
• Provided because of telehealth
• 67 patients
• 24 different services
• 33 services/test performed
• 24,456 in charges

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Avera eICU Care
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Avera eICU

• Demonstrated to the organization the impact of
  telemedicine on patient care

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How will Telemedicine Impact

• The emergency department?
• Monitoring at the bedside?
• Mom and dad staying in their home?
• Design of a nursing home?

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Why is this Important?
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Great Plains Telehealth Resource Assistance
Center
www.gptrac.org
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Great Plains TRAC

• On-Line Resources at www.gptrac.org
• Call 1-888-239-7092
• Regional Telehealth Conference
• July 16-17, 2009
• Minneapolis, MN

Save the Date!
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Helpful Links

• Great Plains Telehealth Resource Assistance
  Center www.gptrac.org
• Center for Telehealth and e-Health Law
  (CTeL)www.ctel.org
• American Telemedicine Associationwww.atmeda.org
• Health Resources Services Administration/Telehealt
  hwww.hrsa.gov/telehealth
• National Rural Health Associationwww.nrharural.or
  g
• Rural Health Resource Centerwww.ruralcenter.org
• Rural Assistance Centerwww.raconline.org
• Telemedicine Information Exchangewww.tie.telemed.
  org
• National Organization of State Offices of Rural
  Healthwww.nosorh.org

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Questions?
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Contact me
Mary DeVany, Director Avera Telehealth/Great
Plains TRAC mary.devany_at_mckennan.org
1-605-322-6038 or 1-888-239-7092