Methodology and Approaches to the Implementation of Telehealth ProgramsThe US and State of Hawaii Case Studies

Christina Higa, Co-Director, Pacific Basin Telehealth Resource Center, University of Hawaii at Manoa

0900-1030

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Health

Resources and

Service

Administration

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PRESENTATION OUTLINE

• Telehealth Definitions

• U.S. National Overview

• State of Hawaii

• Approaches & Methods: Department of HealthFamily Health/ Genetic Counseling (in-clinic) Early Intervention Services Model (in-home)School Based Clinic Model (in-school)

• Summary of Key Approaches

TELEHEALTH DEFINITIONS

US NATIONAL OVERVIEW

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TIPPING POINT FOR TELEHEALTH ADOPTIONIncrease in adoption & acceptance:

• Consumer: 64% willing to have a video consult with a doctor* (American Well/Harris Poll study)

• Providers: ~200 telehealth networks, 3500 telehealth services sites

* http://go.americanwell.com/rs/335-QLG-

882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf

Reasons for tipping point:

• Patient wait times: 24 days** to see a doctor in person, 3 mo for specialist in HI, < 3min online

• Direct to consumer concerns, encroaching on local markets

• Health Care Systems embracing TH: disruptive technologies & health care payment reform

• Telehealth cost efficient and improve quality of care

**Merritt Hawkins 2017 Study

* Source: www.cchpca.org

STATE TELEHEALTH LAWS AND POLICIES

STATE OF HAWAI`I

STATE OF HAWAI`ITelehealth Law - Act 226 (1/2017)• Requires Medicaid to cover services provided

through telehealth; • Lifts restrictions on originating site including patient

home or work;• Requires malpractice coverage for telehealth

equivalent to f2f coverage;• Specifically includes store and forward, remote

monitoring, live consultation & mhealth• Does not require presence of two providers and a

patient, appropriately;• Permits provider-patient relationship to be

established via telehealth by referral• (Provider must have Medical License in Hawai`i)• (Federal laws apply for prescription of controlled

substances)

Governor Ige Signs SB2395 into Law

Telehealth to improve health access

Plan: The State of Hawaii lacks

clear objectives regarding

telehealth, this despite recent increasing proliferation of cost-

effective technology and

supportive public policy. The DOH

will work with community to

establish governance and

accountability in assuring

telehealth as a sustainable, if not

preferred modality for specialty

provider shortages, long waitlists for specialists, geographic

barriers, improve access to certain

kinds of care, and to support

specialty consultation to primary

care practices. Community

Paramedics is a developing venue

for Telehealth.

STATE OF HAWAI`I DEPARTMENT OF HEALTH:

TELEHEALTH PRIORITY (2015-2018)

STATE OF HAWAI`I DEPARTMENT OF HEALTH INITIATIVES

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Sylvia Mann, M.S., C.G.C.Supervisor, Genomics Sectionsylvia@hawaiigenetics.org

Work Force

Development

Continuous

Evaluation

Infrastructure

Implementation

FAMILY HEALTH DIVISION

Overarching Goal: By July

2020, 100% of programs use

telehealth to provide services

and education for families and

providers.

Develop a framework for

Family Health Programs to

reach goal

Partner with PBTRC & others

Build on the successes &

experiences of tele-genetics

Family Healthservices for infant,

children, families,

including special

needs: newborn

screening, genetic

counseling, prenatal,

child development,

etc.

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Workforce Development: Telehealth Training

In Person:• Target: Administrators, Providers, IT Support

• 1-Day Training

• Protocols

• Policies

• Technology

• Telepresense

• Simulated Case Studies/ Practice

Online Modules:• Introduction to Telehealth and Telemedicine

• Clinical Applications Overview

• Telehealth Technology

• Facility Design

• Telepresenting Best Practices

• Telehealth Applications

• Telehealth Policy and Legal Issues

• Business Models in Telehealth

• Telehealth Project Planning

• Telehealth in Practice for Public Health Activities

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EARLY INTERVENTION SERVICES (EIS) PROGRAM

• EIS Population: Infant – 3 Years Old & Families

• Federal/ State Mandate

• Developmental Concerns

1. Physical (sits, walks)

2. Cognitive (pay attention, solve problems)

3. Communication (talks, understand)

4. Social or emotional (plays with others, has

confidence)

5. Adaptive (eats, dresses self)

• Services: Wide Range from audiology, nutrition,

physical therapy, speech therapy, to vision, focus on

building capacity of family members

Overarching Goal: Meet Federal

Office of Special Education, System

Improvement plan (quality and

access of services)

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Use Case• DOH Primary Service Provider(Home-Visits)

• Telehealth connection with Specialist

Approach• Attend Family Health Service initiated

telehealth training (online and in person)

• Establish a TH working group: program

manager, primary service providers, care

coordinators, specialists, TH SMEs (PBTRC) and

‘family advocate’ representative

• Develop Protocols

• Pilot & Evaluate

• Scale Up

Protocol Content:• Introduction to TH

• Sharing TH With Families

• TH in the Individualized Family Support Plan

(IFSP)

• Technical Requirement and Equipment

Needed

• Setting Up Zoom Video Telecon

• Guidelines for Primary Service Provider (PSP)

or Care Coordinator (CC) in the Family’s Home

• Guidelines for Therapist Providing “Remote”

Consultation

• Basic Trouble Shooting: At a Home Visit

• Basic Trouble Shooting: At the Program Office

• Securing the Device in the Field, HIPAA

EARLY INTERVENTION SERVICES (EIS) PROGRAM

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DOE/DOH/FQHC COLLABORATION

Hawaii Schools & Telehealth

• Nurse Aids – Not qualified to administer meds

• FQHC school based health centers (2 Waianae & 1 Kahuku)

• DOH Chronic Conditions, Family Health Framework for TH

Opportunity

• Expand to other uses: diabetes,

Individualized Education Plan

(IEP), etc.

Use CaseCurrent Asthma Situation: School is

cutting the grass today, causes Asthma

attack for child who uses her inhaler;

must report to the nurse aid office;

must be sent home; parent take off

work, child miss school

Telehealth: Teleconsult between

student and RN at a school based health

clinic; digital stethoscope, video

interview; student stays in school

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SUMMARY OF APPROACH TO IMPLEMENTATION OF

TELEHEALTH PROGRAMS• Buy-In at all levels (overarching vision &

workflow)

• Planning, Planning, Planning Wide Involvement

• Training – leverage, modify existing frameworks

• Partner within Department and outside (PBTRC)

• Pilot: infrastructure, administration, human

behavior

• Establish evaluation metrics during the planning

of the program and measure, evaluate, modify

• Then…Scale Up.

Mahalo for your time!