UTILIZING TELEHEALTH SERVICES TO IMPROVE ACCESS TO QUALITY CARE IN RURAL SETTINGS

Charles Gizara, MS, BSN, RN, CCMDirector Integrated Care Management

Jennifer Light, RNTelehealth Coordinator

Goals • Gain an understanding of the infrastructure required to support telehealth services in various clinical settings.

• Identify opportunities to improve access to healthcare services in a rural area utilizing telehealth services.

• Gain insight into tele-coordination, decreased utilization and increasing patient engagement. “The Capable Patient”

Goals / Objectives

History• Located in Worcester County, MD• Opened in 1993• 62-Bed Acute Care Hospital• 7 Primary Care Offices Located in MD and DE• Patient-Centered Medical Home• 2 Walk-in Clinics

Acute Care Services:- 19 bed ER - General surgery- Medical surgical services- 8 Bed ICU

Hospitalists program: 10 Physicians 5 Mid - Level Providers

Atlantic General Hospital

Demographics

2020 Vision

Atlantic General Hospital

Most Wired - Advanced

• Telehealth committee• Sr. Leadership support• Provider relations• Information Technology • Health information management • Malpractice assessment• Provider credentialing / risk

management• Technology: equipment / software

Infrastructure

Services • Berlin Nursing & Rehabilitation Center• Maryland eCare© Intensive Care• Shephard Pratt• Kennedy Krieger Institute• University of Maryland Pulmonary/

Cancer Care• Remote Patient Monitoring /

Supportive Care• Medication Therapy Management

Telehealth Services

Atlantic General HospitalTelehealth Project

A collaborative effort between Atlantic General Hospital and Berlin Nursing & Rehabilitation Center with the focus of implementing telehealth services to prevent avoidable transfers, admissions and readmissions.

Goals

Project Goals

• Prevent unnecessary inpatient admissions / readmissions from BNRC to AGH for patients with COPD, CHF, DM, and HTN.

• Reduce all transfers from BNRC to AGH.

• Utilize telemedicine physician consultations as part of pre-transfer protocols.

• Reduce readmissions from BNRC to AGH for patients initially discharged from AGH.

Clinical Algorithm

Clinical Algorithm

YES NO

10

Nursing Home Resident Condition Changes

RN Notifies Nursing Home On-Call MD

Algorithm and Clinical Condition Drive Next Steps

BRNC Provider

Initiates call & Implements

Telehealth Consultation

with AGH Hospitalist

Telehealth conference confirmed

Continue to

monitor or

Transfer to AGH

Consider Transfer to AGH

Continue to Monitor

Patient Remains at

Nursing Home

Results/ Outcomes

%BRNC Patients Admitted to AGH

Reduction in Total Transfers from BNRC to AGH

Results/ Outcomes

Reasons for Transfers include: ER Visits, Hospital Observation, Acute Care Admission, etc…

Re-Admissions to the Acute Care Hospital

Results/ Outcomes

Me

Equipment

Maryland eCare© Services

A partnership between Maryland eCare© , LLC (that includes Atlantic General Hospital) and University of Maryland Medical Center with the focus of improving patient outcomes, reducing mortality rates and decreasing costs for patients admitted to the critical care / intensive care unit.

Maryland eCare is a group of non-profit, independent hospitals committed to improving

patient care and safety for the communities they serve. Participating hospitals include;

Atlantic General Hospital

Calvert Memorial Hospital

Peninsula Medical Regional Center

MedStar St. Mary’s Hospital

Union Hospital of Cecil County

Meritus Medical Center

Advantages:

* Immediate availability of consultation * Immediate intervention and * Prevention of delay in lifesaving treatment* Continuous monitoring*Decreased mortality rates*Efficiency / cost-effectiveness

Zero VAPS since 2008 Zero CLAPSI since 2014

Sheppard PrattAtlantic General Hospital

Behavioral/ Mental Health Telemedicine Services

• First successful telemedicine program at AGH. • Psychiatric Evaluations performed at the Atlantic Health

Center.• FY 2016: 2932 visits performed. • FY 2017: 1778 visits performed to date. • Next Steps: Focus on pediatric mental health evaluations.

Kennedy Krieger Atlantic General Hospital

Development, Learning and Autism Spectrum Telemedicine

• Developed in 2014 through a Grant Opportunity: Carefirst BlueCross Blue Shield.

• Focus: Expanding Access to Care of Pediatric Developmental Learning and Autistic Spectrum Disorders via Telemedicine.

• Accessible Specialty Healthcare saving families additional stress of round-trip travel, gas and added expenditures.

Budgeted for 120 visits per year

FY 2016 FY 2017

113 Visits 117 Visits

• The child is able to respond to the evaluation in the same way as in a conventional office visit.

• Decreased sensory overload• Visits time: 45 minutes• Provides a safe play environment allowing parents to

focus on the provider.• Child specific technology.

University Of MarylandAtlantic General Hospital

Dr. Joseph Friedberg Dr. Peter Costantini

University of Maryland Atlantic General Hospital

• Specialty Pulmonary and Thoracic Surgery Consultation from University of Maryland.

• Multi-disciplinary Team approach.• Less Stress for our patients in the community.• Increased compliance in care.• Cost Effective

Technology

• Expansion of Services

• Physician Engagement

Remote Patient Monitoring/Transitional and Supportive Care Services

• Samsung Tablet: Wi-Fi; 3G/4G• Peripheral Devices: BP, SPO2, Scale• Compatible Glucometers• Daily Monitoring• Ease of Use

Equipment

Remote Patient

Monitoring

Patient Perspective

Philips eClinical Care Companion (eCCC)

• Symptom and health literacy assessments• Icon-based user interface• Health literacy development through

education videos

gh

Remote Patient

Monitoring

The Patient Experience

• Nurse Triage Center

• Escalation

• Patient Centered Medical Home/ Community Care Coordination

Remote Patient

Monitoring

Philips Call Center

Patient Success Remote Patient

Monitoring

Care Coordination

Medication Therapy

Management

Nutrition

Diabetes Education

Pulmonary Clinic

Medication Therapy Management

• AGHRx Rediscripts Pharmacy Concierge Program.

• Medication Therapy Management Clinic.

• Medication Education, Adherence, Compliance, Financial Assistance

• Delivery of medications• Specialty Packaging• Reduction in Utilization• Care Coordination

Readmissions from MTM Population

Patient population= 41 patients

Total Readmissions Avoided= 8 Total ED Visits Avoided= 80

Readmission Rate= 2.4% Estimated cost avoidance $7920

Estimated cost avoidance $40,000

33

Readmissions year prior to MTM Clinic

Readmissions while in MTM

Clinic

9 1

ED Visits year prior to MTM

Clinic

ED Visitswhile in MTM

Clinic

91 11

Go Forward Strategy

• Approved as a FTE program expansion expected to manage up to 100 patients

• Patients from outside PCMH can now be referred to MTM Clinic

• Outcome measures to be tracked will be readmissions and ED visits

• Explore billing for services.

Resources

QUESTIONS / COMMENTS