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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
