Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically...

43
Robert Abel, MSN, RN, CHPN, CMC, CCM Chief Nursing Officer and Director of Palliative Care Telehealth: Virtual Care IS a virtual reality OMNE /ANA-Maine Annual Meeting Nurses: Leading the Redesign of Care Delivery in Maine September 29, 2017 Freeport, ME

Transcript of Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically...

Page 1: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

Robert Abel, MSN, RN, CHPN, CMC, CCM Chief Nursing Officer and Director of Palliative Care

Telehealth: Virtual Care IS a virtual reality

OMNE /ANA-Maine Annual Meeting Nurses: Leading the Redesign of Care Delivery in Maine

September 29, 2017 Freeport, ME

Page 2: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

2

I have no relevant financial or nonfinancial relationships in the products or services

described, reviewed, evaluated or compared in this presentation

Page 3: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Overview • Tele-What? Definitions • History • Types of Virtual Care • Benefits/Drawback • Licensing • The Future of Nursing in Maine -beginning to formulate solutions

3

Content

Page 4: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

4

Overview

Page 6: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

6

The IHI Triple Aim framework describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

- Improving the patient experience of care (including quality and satisfaction);

- Improving the health of populations; and

- Reducing the per capita cost of health care.

IHI Triple Aim

Page 7: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

… a tool to bridge the chasm between what patients say they want and what they actually experience.

7

MHCAH Telehealth …

Page 8: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

Tele-what?

Page 9: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• 1. a combining form meaning “distant,” especially “transmission over a distance,” used in the formation of compound words: telegraph. (dictionary.com)

9

Tele-

Page 10: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• noun 1. the diagnosis and treatment of patients in remote areas using medical information, as x-rays or television pictures, transmitted over long distances, especially by satellite. (dictionary.com)

10

Telemedicine

Page 11: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• noun 1. (US & Canadian) health care based on consultation by telephone and telemedicine. (dictionary.com)

11

Telehealth

Page 12: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• It’s all in who’s talking, but our local health care providers are distinguishing them in part based on whether or not a physician is involved.

12

What’s the difference really?

Page 13: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Administrative • Clinical • Ethical • Financial • Readiness • Team Development • Technology

13

Telehealth A to Z

Page 14: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

Case Management Correctional telehealth Deaf/hearing services Diabetic retinopathy screening Dietician services Disease management Doctor-to-doctor consultation Enterostomal therapy Forensic/court services Genetic counseling Long-term Care Medication therapy management (MTM) Neonatal/Pediatric intensive care unit (NICU/PICU) Pain management Palliative care Pre/post-natal care Speech therapy Spine therapy

14

Telestroke Wound care Adult, Individual and Group, Marital, Family and Sex Therapy Behavioral psychology and health (including mood, eating disorders) Chemical dependency aftercare (Addiction therapy follow-up) Chemical dependency therapy (Addiction therapy) Consultation to Schools Couples’ counseling Developmental (lifespan) counseling Psychiatric medication therapy management Psychological Assessment Psychological testing and interpretation Psychopharmacology Stress and health management

What is being offered today?

Page 15: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

Allergy/Immunology Anesthesia Cardiology Critical Care Dentistry Dermatology Otolaryngology (ENT) Emergency Medicine Endocrinology Family/General Practice Gastroenterology Infectious Diseases Internal Medicine Maternal/Fetal Medicine

15

Mental/Behavioral Health Neurology Oncology/Hematology Ophthalmology/Optometry Orthopedics Pathology Pediatrics Psychiatry Pulmonology Rehabilitative Medicine Rheumatology Surgery Urology

What is being offered today?

Page 16: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

16

The History

Page 17: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

Within minutes of the shots, the news was conveyed around the world by telegraph wire, in time for the late newspaper editions in the US. In the era before radio, thousands stood in cities across the country outside newspaper offices, awaiting the latest bulletin from Buffalo

Fears that McKinley would not survive the day of his shooting were allayed by reassuring bulletins issued by Cortelyou based on information from the doctors.

In the early morning of September 13, McKinley suffered a collapse. Urgent word to return to Buffalo was sent to Vice President Roosevelt, 12 miles (19 km) from the nearest telegraph or telephone in the Adirondack wilderness; a park ranger was sent to find him

17

1901

Page 18: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

18

Late 1800’s through 1960’s

Page 19: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

19

1992

Page 20: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

20

Early 2000’s

Page 21: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

21

2017

Page 22: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

22

2017

Page 23: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

23

2017 Telestroke

Page 24: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

24

Types of Virtual Care

Page 25: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Live Video (Synchronous)

• Store-and-forward (Asynchronous)

• Remote Patient Monitoring

• Mobile Health

25

Domains

Page 26: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Live video

• Real-time two-way interaction

• Typically digital (i.e. Broadband) connection

• Often is used to substitute a face to face meeting such as consults

• Saves time and cost in travel

26

Live Video (Synchronous)

Page 27: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Data is

- Collected

- Recorded

- Sent a provider

• For example digital health history file including x-rays and notes

27

Store-and-forward (Asynchronous)

Page 28: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Medical and health data is

- Collected, then

- Transferred to a provider elsewhere

• Provider then continues to monitor the data and any changes that may occur

• Often rehabilitation, chronic care, or elderly clients trying to stay in the community in their own homes as opposed to a care facility

28

Remote Patient Monitoring

Page 29: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Health

- Information

- Education

- Monitoring

- Care • That is present on and supported by mobile communication devices such as cell

phones or tablet computers. This might include an application, or text messaging services like appointment reminders.

29

Mobile Health

Page 30: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Telehealth Tablets

• Virtual Care Software • Secure Text

30

Hardware & Software

Page 31: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

31

The Peripherals

Page 32: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

32

Benefits & Drawbacks

Page 33: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Continue and enhanced partnerships with health care providers

• Expand service offerings

• Innovative ways to engage patients

• Enhanced patient engagement

- Dignity and Respect » Patient and family knowledge, values, beliefs and cultural backgrounds

are incorporated into the planning and delivery of care.

33

The Pluses

Page 34: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Enhanced patient engagement - Information Sharing

» Patients and families receive timely, complete and accurate information in order to effectively participate in care and decision-making.

- Participation » Patients and families are encouraged and supported in participating in

care and decision-making at the level they choose.

- Collaboration » Patients and families collaborate in policy and program development,

implementation and evaluation; in professional education, as well as in the delivery.

34

The Pluses

Page 35: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Population needs to catch up to technology

• Insurance coverage issues

• Need to focus more broadly on healthcare outcomes (population health)

• Understanding that technology is a piece of the bigger puzzle

35

Challenges

Page 36: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Unfamiliar technology

• Lack of scalability

• Preference for “own physician”

• Lack of payer coverage

36

Challenges

Page 37: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• Lead advocacy efforts within local health system for contract negotiation with private payers

• Incorporate monitoring reimbursement in payment system for private and state payers

• Develop business plan for private pay options • Integrate health system protocols and practice guides in telehealth

practice • Develop and diligently monitor resource utilization • Advocate for uniform platform across providers • Identify system opportunities for grant awards

37

Strategies for Enhanced Sustainability

Page 38: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

38

Licensing & Regulation

Page 39: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

39

Professional Licensure RN

Page 40: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

40

Professional Licensure MD

Page 41: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

• ….HIPPA

• ….FDA

• ….OSHA

• ….CDC

• …. etc, etc

41

What about….

Page 42: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

42

The Future of Nursing in Maine

Page 43: Telehealth: Virtual Care IS a virtual reality...•Real-time two-way interaction •Typically digital (i.e. Broadband) connection ... • Incorporate monitoring reimbursement in payment

THANK YOU

Questions?