Partnering of Clinical and Technical Leadership in Developing a Successful Telemedicine Program

Jeffrey Barnello Senior Technical CoordinatorNicholas Slamon M.D. Medical DirectorNemours CareConnect

Pass that Telemedicine Bill

Michael Kurliand, MS RNTelehealth & CareConnect Program Director

&

Current State

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What is parity?

29 States + Washington DC have a telemedicine parity law*

health plans cover services provided via telemedicine to the same extent the plan covers those services if provided through in-person visits.

http://www.americantelemed.org/policy/state-policy-resource-center#.Vi1h2K6rTEo

Not all laws are created equal

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Physician services only

In person visit first time

Mandates payment for tele, but not parity

Rural coverage and/or urban coverage with low population

Medical professional has to be with patient

Only in-state specialists

APN’s, PA’s, LSW, Therapists, etc.

Ability to establish relationship via tele

Payment for services at the same rate as an in-person visit

Coverage for services regardless of where the patient lives in the state

Treat within capability of technology and scope of medical professional

Allow out of state specialist up x visits

Formula

1. Commitment- Personnel; Administrative and Clinical Champions and Government Affairs- Organizationally; C-suite endorsed and supported, financially and

strategically

2. Community- Medical Society of Delaware- Delaware Healthcare Association- Delaware Telehealth Coalition- University of Delaware; Parkinson’s Clinic- Nemours, A. I. duPont Hospital for Children

3. Collaboration- Leveraging each other’s strengths and momentum- Keeping each other informed- Drafting the Bill

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Formula4. Lobby

- Frame your advocacy message and make your case- Door-to-door through the capitol- Become the resident subject matter expert- Maintain visibility; be present during the votes, at the lunch table, etc.- Provide testimony

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‘Savings are going to come from system changes, not lowered reimbursement to providers.’

Opportunity Costs of Ambulatory Medical Care in the United StatesAuthor: Kristin N. Ray, MD, MS; Amalavoyal V. Chari, PhD; John Engberg, PhD; Marnie Bertolet, PhD; and Ateev Mehrotra, MD, MPH

‘This is about increasing access.’

‘A win for the community, payors, and providers.’ – provide real life examples.

http://hin.com/blog/2014/01/07/infographic-the-doctor-shortage/

Success and Resources

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Unanimously passed both the House and Senate

Snapshot

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Planned Implementations

School Pilot

International Medicine & 2nd Opinion Service

Jefferson University Health System

Surgery – post op and MFM

Audiology Portfolio - Newborn hearing screening, Diagnostic follow up ABR, Tympanogram, CI, and Speech

Rheumatology

Adolescent Medicine

Infectious Disease

Oncology

Cardiology

Direct to Consumer Q1 2016

Services

Critical Care

Nutrition

Weight Management

Psychiatry

Palliative Care

GI

Headache Clinic

Urology

Transition of Care

Nephrology

Orthopedics

YTD: ~350

Approximately 2/3 of visits are being paid for by insurance companies

Partnering of Clinical and Technical Leadership in Developing a Successful Telemedicine Program

Jeffrey Barnello Senior Technical CoordinatorNicholas Slamon M.D. Medical DirectorNemours CareConnect

Where we started

Began as an idea to provide visual support to physicians that handled emergency transported patients by phone description only

IRB controlled study to determine effectivenessEasy to use technical platformQuick ROI (cheap but effective)Chose to use IPAD’s

Challenge 1

Clinical and technical teams work togetherHIPAA complianceSecurity buy offImplementation planWho does what?Acceptance of IPAD and use of Facetime as a

commercial device, not just a consumer product

Challenge 2

How do we implement in partner Emergency Departments?

Who do we meet with at partner facilities?How do we manage legal and compliance

questions?Where do we begin to achieve success?

Challenge 3

Need portable and mobile platform. Needs to be effective and cost effective

Locking mechanismHeight adjustmentAbility to chargeBranding

Challenge 4

Private vs. public Wi-Fi. Stability neededEnsuring open network portsNo management application that eliminates ability

to connect anytimeWork with partner facility clinical and technical

teams in one implementation meeting

Challenge 5

Physician adoptionProve ease of use and simplicityHas to work the first time, every timeEnsuring carts are stored and located in a

centralized area within the ED so they do not become “lost”

Nursing buy-inNeed to get consentKeep the work flow simple

Challenge 6

Create a specific Epic note type to document all encounters

Create a report process so we can study and learn the program’s effectiveness

How can we bill for consults?

So, what are our results?

Locations

1. Bayhealth Kent 2. Bayhealth Milford 3. Bayhealth Smyrna 4. Beebe 5. Exceptional Care for

Children 6. Inspira Bridgeton 7. Inspira Elmer 8. Inspira Vineland 9. Inspira Woodbury 10. Jennersville 11. MLH Bryn Mawr 12. MLH Lankenau 13. MLH Paoli 14. MLH Riddle 15. Nanticoke 16. Nemours Dover Clinic 17. Nemours Seaford Clinic 18. Phoenixville 19. TJU Methodist (Sept 2015)20. Union

So, what are our results?

Delaware Telemedicine LawDeployed over 50 carts to partnering ED’s, NICU’s,

PED’s Floors (DE Valley and Florida Operations)Internal deployment to inpatient areas for consultsDeployment for schools program to support school

nursesOn cruise ships (Florida Operations)Over 360 consults in 18 monthsOver 510 combined telehealth visits (consults and

outpatient visits

Transition to Vidyo platformAdding peripheral devices (stethoscope, otoscope)Deployment to Urgent Care CentersDeployment to select Pediatrician OfficesSchools sports programContinue to add more outpatient visits and clinics

What is the future?

http://youtu.be/tXQ-evjHqGk

Questions?