EMTN Telemedicine Retreat
8/14/2015
What is Telemedicine?
What is Virtual Health ?
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Virtual health is designed to enable the widest range of services for an individual or population needs across a care episode, across time, across the care continuum and across care sites. Technology platforms will be useful to meeting this expectation.
For one patient, many encounters, many clinical
channels and services
Medication compliance & management
Monitor Nutrition and physical
activity
Visits with care team
Virtual supports groups
Caregiver/ family training
Virtual psychosocial
support
Extended care/step-down
care
Home visits and self-management
Health status monitoring
Remote health status monitoring
Remote visits for follow-up
MedicationCompliance
management
Physical activity tracking with devices
Virtual clinical encounters
Virtual psychosocial support for patient and families
Virtual support groups for patients and families
Caregiver and family training
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Why not just traditional telemedicine?
What is a virtual health platform?
A User Story Describes use of the Service and Required Functional
Requirements
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Virtual Care Delivery Platform “Modules”Identifying and delivering “modules” of capabilities increase flexibility and speed to market.
Consumer Experience
• Clinician referral services
• Customized portal• Friends and family
access
Video and Collaboration Technologies
Core Functions• Alerting• Scheduling• Analytics• Etc.
Clinical Services and Applications
• Clinical consultations• Biometric monitoring• Secure messaging• Clinical
documentation
Peer and Self-Management Social Platforms
• Curated support groups
• References & information
• Self-tracking
Functional Requirement Use Case Description1 Beneficiary End User Functional Requirements
a End User Registration Use Case 1 Ability to register a member and dependentsi Solicit Registration Use Case 1 Email or notify beneficiary registration material and link
to servicesii Validate End User Registering Use Case 1 Optional: Perform additional identity validation of end
user registering beyond that provided by a TPA and/or self-insured employer
iii Coordinate Identity within Mental Health Services
Both Share end user identity as appropriate with other partners
b End User Access to Mental Health Services
Access and use mental health capabilities
i Manage Profile Use Case 1 Define and update individual demographic, insurance and preference data
ii Document Medications Add, change and remove medications- User enters medications Both End user can change, enter additional, or remove
medications, including medication, dosage, frequency and other information. Would include the ability to document over-the-counter and prescribed medications
- Medications prescribed by provider Both Ability to see and import medications prescribed by a healthcare provider, including medication, dosage, frequency and other information
iii Document Health Activity and/or Device Data
Both End user can enter data collected about their activity or from a monitoring device. The data entry can be manual and/or through a device interface
iv Enter mental health peer and self-support social platform
Both Access and use a social platform for mental health support and services
Functional Requirements Defined in the User StoriesThe following three pages list the functional requirements described in the user stories. Each of these requirements would need to be met by a VHS technology platform to offer the identified services. Functional requirements are also supported with user flows.
Functional Requirement Use Case Descriptionv Find a Provider Both Search a list of Virtual Care Platform-provided providers
for mental health, pharmacy and medication therapy management (MTM) services
vi Schedule Mental Health / TelePsychiatry Visit
Both Schedule a visit for a tele-psychiatrist and/or other Mental Health Service. At the time the visit is scheduled, ensure information is shared with the professional about the beneficiary to support the scheduled visit
vii Initiate TelePsychiatry / Mental Health Visit
Both Initiate a video session for a mental health consultation
viii Schedule TelePharmacy / MTM Visit Both Schedule a visit for a tele-pharmacist and/or MTM service. At the time the visit is scheduled, ensure information is shared with the professional about the beneficiary to support the scheduled visit.
ix Initiate TelePharmacy / MTM Visit Both Initiate a video session for a tele-pharmacist and/or MTM consultation
x Escalate and Schedule TelePsychiatry / Mental Health Visit
Both Notify the end user and appropriate professional Virtual Care Platform support that a social platform monitoring professional has recommended a consult with a healthcare provider outside of the social platform. Ensure documentation to support the recommendation is recorded
xi Record Encounter Notes Both Document and store any virtual visit consult or SOAP notes
xii Create and administer assessments Both Ability to define a variety of assessments that can be taken by beneficiaries including health, disease and engagement assessments
Functional requirements are also described through clinical workflows found in the appendix
Functional Requirements Defined in the User Stories
Functional Requirement Use Case Description2 Virtual Health Platform delegated Administrator and Provider Functional Requirements
a Third-party Administrator (TPA) Setup Use Case 1 Manage member and dependents from TPA
b Virtual Visit Provider Setup Both Manage providers and provider schedules
c Social Platform to Virtual Health Platform Member Data Sharing
Detailed and aggregate data sharing on individual end users
i Organize and Send Member Self-assessment Data
Both From the mental health social platform, share the completion of any assessments taken within the platform
ii Organize and Send Patient Aggregate Use Metrics
Both Share and record individual usage data available on the mental health social platform
d Bill TPA Both Billing for an encounter is sent to a TPA
Functional requirements are also described through clinical workflows found in the appendix
Functional Requirements Defined in the User Stories
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Standard Platform Core Technology to Understand “Gaps”
Technical Capability and Ability to Deliver• Unified
communication• Solution
components• Integration• Technology
capabilities• User support• Performance and
alignment with CHI
Ability to Deliver Technology Categories and Capabilities:
• Rules• Unified communications• Scheduling• CRM• Content management• Care management• Resource management• Analytics• Call center• Personal remote devices• Channel to virtual
services• Data management
Data on 360 View of Patient Care:
• Stores• Use in application• Exchange with 3rd
parties• APIs to external systems
Compliance/Security Areas:• Access controls• Audit and accountability• Compliance• Configuration
management• Data encryption• Identification and
authentication
• Incident response• Maintenance• Media protection• Personnel security• Risk assessment• Security assessments• System and
communications protection
Compliance/SecurityRequired security capabilities to ensure the protection and use of patient health information. Compliance with defined regulations.
FunctionalFeatures and functionality required to provide capabilities to meet the needs of a variety of users and clients.
TechnicalRequirements which define how technology is to be used or how it must perform to provide engaging, usable functionality to meet the needs of end users.
DataData requirements to capture, integrate and share across the ecosystem to provide needed capabilities to a variety of clients.
Business, Cap and Partner
Business history, structure, financial strength, and market position to deliver Clients’ capabilities
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Core TechnologiesCore technologies must meet a range of requirements to provide the required features and functionality.
• Medication adherence /dispense devices• Remote monitoring• Specialty remote devices
2. Personal & Remote Devices• Rules o Actionable criteria
• Unified Communication o IM, Screen share,
HD video, phoneo Messaging and alerts
• Scheduling• Customer relationship
management (CRM)• Content Management
and Health Tools• Care Management• Resource Management• Analytic • Health Contact Center
1: Engines
• Portals• Smart phone and mobile device applications• Social / information platforms
3. Channel to Virtual Services
• Diverse Data interfaces (Patient provided data, EMR / clinical, history, PBM, LAB results, TPA, etc. )
• Remote device gateway• Data Warehousing (vendor specific)
4. Data Management
Identified services mapped to technology categories required to provide desired functionality
Technologies Required to Meet Service Requirements (1 of 2)
Online scheduling
and wait-time information
Medication therapy
managementVirtual clinical
encounters
Digital (multi-channel) education content
Online risk-centered self-improvement
program
Self-monitoring
applications / devices
Disease-specific
navigator (low
intensity)
Self-care management
support1. Engines Rules X X X XUnified Communication X X X X XScheduling X X X XCRM X X X X Content Management and Health Tools X X X X X Care Management XResource Management X X Analytic X Health Contact Center X X
2. Personal and Remote Devices Medication adherence /dispense X XRemote monitoring X Specialty remote devices
3. Channel to Virtual Services
Portals X X X X X X XSmart phone and mobile device applications X X X X X XSocial / information platforms X X X X
4. Data Management
Diverse Data interfaces X X Remote device gateway X Data Warehousing X X X X X X
Total 6 5 6 5 6 11 10 8
Secure messaging information and support
Risk self-assessment
tools
Virtual group visits /
sessionsOnline social
networks
Multi-disciplinary care team encounters
Personalized care path and engagement
program
Care management
services1. Engines Rules X X XUnified Communication X X X X XScheduling X X X XCRM X X X XContent Management and Health Tools X X X X XCare Management X X XResource Management X X Analytic X X XHealth Contact Center X X X
2. Personal and Remote Devices Medication adherence /dispense XRemote monitoring XSpecialty remote devices X
3. Access to and Provider of Virtual Services
Portals X X X X X Smart phone and mobile device applications X X X X XSocial / information platforms X X
4. Data Management
Diverse Data interfaces X X XRemote device gateway XData Warehousing X X X X X X
8 5 6 3 8 12 15
Identified services mapped to technology categories required to provide desired functionality
Technologies Required to Meet Service Requirements (2 of 2)
Beneficiary
Monitoring Data
Mental health social platform
Guide
HS / EMR Data Repository
Single sign-onData feeds
Legend
Core VHS Engine
Alerts, reminders
Analytics
Other tools
contracted health professionalsClinical pharmacists
Clinical providersMental health providers
Virtual Visit Platform (Tele-psychiatry, mental health, MTM, tele-pharmacy, etc.)
TPAEMR, etc.
(e.g., medication history)
Personal devices
Patient portal
Self-management mobile apps
Identity Validation
T↔V
B↔V
M↔V
U↔V
I↔VD↔V
P↔V
Use Case 1: End user is supported through a online -accessible portal
Use Case 1 led to a high-level, conceptual architecture described in the figure. The red symbols identify system integration points.
A High-level, Conceptual Architecture
Use Case 1
Use Case 2
.
Notatio
nTechnology Solutions Included in the System Integration
U↔V End user to and from VHS technology solution. For example, integration
from an end user-controlled personal health record.
T↔V TPA and/or self-insured employer technology platform and VHS technology
solution. For example, member demographics for eligible members.
I↔V Identity validation service and VHS technology solution. Used to perform
identity validation.
M↔V MDLive virtual visit platform and VHS technology solution.
B↔V Big White Wall (mental health social platform) and VHS technology solution.
P↔V Healthcare provider and VHS technology solution. For example, medication
history from a beneficiary’s primary care physician.
D↔V Device data integrator and VHS technology solution. For example, a device
data collected by Qualcomm’s 2net and integrated with the VHS technology
solution.
Systems to be Integrated to Achieve Virtual ServicesThe table lists the systems to be integrated to achieve the identified services. Each system to system integration was documented based on the technology assumptions. For instance, system integrations were documented between the a IDS platform and MDLive as the best fit to case 1 requirements for video consults.
What’s next ? What’s this IoT?
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Digital devices permeate every aspect of our lives – at home, in the car, on the road, and in health care.
The Digital Age is Here, Consumers want to be Connected
Mobile health and fitness devices projected to be shipped by 2017.
515M
Want to monitor their health with connected devices that send information to their doctor or people they choose.
56%Of revenue estimated to be generated from health and wellness devices for 2018.
$8B
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Digital Disruption in the Health Landscape
By 2020, an estimated 50 billion devices around the globe will be connected to the Internet.
Source: DHL, Cisco 2015
50 BILLION DEVICES
The connected health segment is projected to grow to $2.4 billion by 2018 at a 36% CAGR between 2013-2018.
Source: Infonetics, Jan 2015
$2.4 BILLION GROWTH
97% of surveyed healthcare organizations agree that IoT will be the most strategic technological initiative their organization will undertake this decade.
Source: Zebra Technologies 2015
97% HEALTH CARE ORGS
Organizations that don’t have a well-defined IoT Virtual Health Strategy in the upcoming years will fall behind as the market matures.