Transcript: Today, incentives are offered to healthcare facilities that implement new technologies; mostly used for electronic systems In coming years, this is expected to change Will be an expectation that organizations are up-to-date Reimbursement will no longer apply to telehealth services This is a trend, so it cannot be know that this will be implemented Increased Use Forecast By: Amy Whitelaw, Alyssa Lyons and Ben Lescault The STARPAHC Project and the Papago Reservation Ultimately, STARPAHC would provide a full communications between the central station on the Papago Reservation, and a fixed satellite clinic at Santa Rosa, a regularly scheduled mobile health clinic, and a full facility hospital-based clinic at Phoenix. Change in Reimbursement Models Telemedicine: the delivery of clinical care via telecommunications technology-diagnosing, treating or follow up with a patient at a distance Examples of Telemedicine A mobile app that lets physicians treat their patients remotely via video-chat A software solution that lets primary care providers send patient photos of a rash or mole to a dermatologist at another location for quick diagnosis TeleHealth vs. TeleMedicine NASA’s influence on telehealth began with the need to track astronauts biomedical responses including HR, oxygen consumption, heat production and and CO2 levels while under extreme conditions Medical personnel at the Mission Control Center at Johnson Space Center (JSC) in Houston would conduct daily medical conferences to review the astronauts health and adaption to zero gravity NASA continues to promote and develop new technologies to advance the practice and safety of their astronauts through biotelemetry Included a control system on the reservation staffed by physicians connected to a remote clinic and also a mobile health unit Telehealth: the use of telecommunications technologies to deliver health-related services and information that support patient care, administrative activities and health education Examples of Telehealth: A public health app that alerts the public of a disease outbreak A video-conferencing platform for medical education What TeleMedicine Looks Like TeleHealth & TeleMedicine MHealth (Mobile Health) Implementation: “The practice of medicine and public health supported by mobile devices” Smartphones Tablets Other Devices Increase number of users and increase user depth Patient security is important, as more information will be accessed Patient responsibility is required while using mHealth systems Records cannot be shared with outside members; HIPAA violation Abdelhak, M., & Hanken, M. (2016). Health Information (5th ed., Vol. 1). St. Louis, MO: Elsevier. Future of Telemedicine and Telehealth - eVisit Telehealth Solution. (n.d.). Retrieved April 16, 2016, from http://evisit.com/future-of-telemedicine-7-trends-shaping-the-future-of- telehealth/ Medscape Log In. (n.d.). Retrieved April 16, 2016, from http://www.medscape.com/viewarticle/840335 M. (2014, May 24). Telehealth: When technology meets health care. Retrieved April 14, 2016, from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878 Benefits of Telehealth / Telemedicine? (n.d.). Retrieved from http://www.setrc.us/index.php/what-is-telehealth/benefits-of-telehealth-telemedicine/ Josh Savitz RCL Blog. (n.d.). Retrieved from http://sites.psu.edu/savitzrclblog/ Telehealth Start-Up and Resource Guide. (2014, October). Retrieved April 15, 2016, from https://www.healthit.gov/sites/default/files/telehealthguide_final_0.pdf Telemedicine Guide. (2016, January). Retrieved April 15, 2016, from http://evisit.com/what-is-telemedicine/ What is Telemedicine? (2012, January). Retrieved April 15, 2016, from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VxGaK2OUldp Freiburger, G., Holcomb, M., & Piper, D. (2007). The STARPAHC collection: Part of an archive of the history of telemedicine. J Telemed Telecare Journal of Telemedicine and Telecare, 13(5), 221-223. doi:10.1258/135763307781458949 Thompson, V., Decker, B., Hardash, J. A., & Summers, R. O. (2012). NASA (In)novation Ecosystem: Taking technology innovation from buzz to reality. 2012 IEEE Aerospace Conference. doi:10.1109/aero.2012.6187447 Increases access to care Improves health outcomes Improves quality of care Improves timeliness of care Reduces healthcare and cost Improves patient safety Assits with healthcare professional shortages Supports clinical educational programs Promoting Patient Care by Communication The technology used included: Two way video Audio and data communications Home Health Monitoring Phsyicians use the help of machines that are used by the patient in their home Commonly used with diabetes and hypertension patient The Start of TeleHealth Teleradiology System: In the 1950’s major university-based medical hospitals began to put telemedicine into practice by transmitting radiologic images via telephone including X-rays, CT’s and MRI’s The University of
Transcript: Telehealth Quick Overview Identified Issues The organization is a rural medical center in Arizona. Being a hard to recruit and underserved regional hospital, the organization finds a lack of resources The rural medical center is losing specialist providers. Telemedicine might be an option to improve access and care. Our team will be determining if telemedicine is a good fit for this hospital and to propose the process for integrated change. What is Telehealth? What is Telehealth? Leader Roles and Faces of IInovation Leader Roles and Face of Innovation Collaborator Caregiver Hurdler Dream Team Director Anthropologist Sory Teller Experience Architect (Kelley, 2005) Unrepresented Faces Actual Faces Hardworking Competent Cooperative relationships Practical Respectful Flexible Open minded Self aware Listening skills Amanda Amanda Unrepresented Face: Anthropologist Caregiver Social skills: good at relationships and build networks Value teamwork Can motivate Dependable: willing to drop whatever to get the job done Responsible Role model: set an example through my actions Strong sense of duty Good with practical skills Connecting with others Briana Briana Collaborator Unrepresented Face: Cross Pollinator Social Skills Constant improvement Driven by passion Able to look at the big picture Compassionate Visualizing the possibilities Hard working fairness and positively benefiting others Use imagination and think outside the box Emily Emily Unrepresented Face: Experience Architect Hurdler Effective communication: contributes and listens attentively Team player : cooperating fully with others to achieve goals Open minded : handles disagreement and confrontations positively Assertive: working through networks to get things done Social skills: build relationships and rapport with team members Adaptable: adjusts to change and willingness to improvise Creativity/ innovation: generating ideas/taking advantage of new opportunities. team skills: organised, responsible, dependable, committed, perseverance, consistency, hardworking and confident Feeling: Empathetic, compassionate and nurturing Wilhelmina Wilhelmina Unrepresented Face: Storyteller Collaborator Social engagement Determined Observant Cooperative Flexible Teamwork Incorporating technology Organization skills Compassionate Initiate collaboration by facilitating relationships Encourage others by recognizing contributions Social awareness Yuna Yuna Urepresented Face: Director Collaborator Frequent Communication Being flexible Equal contribution Trust in each other Facilitating Factors and Barriers Facilitating Factors and Barriers Location Technology Differences in opinions Facilitating Factors Barriers Different personalities and perspectives Amount of time and engagement Communication Incorporation of technology Group Experiences Group Experiences Take-Aways Do not sweat the small stuff Show respect Mediators Communication Organizational Leadership Impact Organizational Leadership Impact Unintended Consequences Positives Negatives Intended Consequences Positives Negatives Potential Value to the Leadership Intended Positive Telehealth connects providers and patients Decreases needs to hire specialists in rural areas (HealthIT.gov, 2014b) Intended Consequence Intended Consequence Intended Negative Need to add Telehealth department (Telligen & gpTRAC, 2914) Unintended Consequences Positive More specialists available in community Leverage telehealth as recruiting strategy (HealthIT.gov, 2014b) Unintended Consequenes Unintended Consequenes Unintended Consequences Negative Increased IT staff and IT support for both patients and employees (Porter-O'Grady & Malloch, 2018) Need to develop policies and procedures related to telehealth (Telligen & gpTRAC, 2014) Confidentiality Possible need to new mission for the organization Leaders can develop advertising as promotional value to the healthcare system Decreased staff turnover Increased job satisfaction Potential Value to the Leadership Potential Value to the Leadership (HealthIT.gove, 2014b) Organizational Impact Organizational Impact Unintended Consequences Positives Negatives Intended Consequences Positives Negatives Potential value to the organization Increased accessed to specialty providers Time saving for patients Decrease barriers to care Increased communication Better outcomes Retain patients Intended Consequenes: Positive Intended Consequenes: Positive Intended Consequenes: Negative Development and investment of technology Close monitoring for cyber safety Organizational shift Learning curve for staff and community (Telligen & gpTRAC, 2014; bobinet & Petito, 2015) Introduction of new equipment and technology Patient retention Target diverse population Long-term cost saving Unintended Consequences: Positive Unintended Consequences: Positive Unintended Consequences: Negative Fragmented care Decreased face-to-face interactions Possible loss of data Disrupted connection Patient frustration Cost of training and software
Transcript: 70% Brief history of Telehealth 75% of all deaths Medicine Reimbursement Licensure Credentialing/Privileging Connectivity Chronic Disease Management Christianna Novakovic Telehealth Program Coordinator October --, 2016 Why telehealth? Tremendous room for growth Health Provider Shortage Areas (HPSAs) 1920 – Popular Science Magazine predicts "radio doctors" of all health care expenditures 1906 – EKGs transmitted over telephone lines 1989 – MedPhone Corp develops the first interactive telemedicine system Why telehealth? What is telehealth? 1955 – Closed circuit TV used in a Nebraska hospital Telehealth: the use of technology to deliver health care, health information or health education at a distance Telemedicine: the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Barriers to telehealth Telehealth Live Video Store and Forward (SFT) Remote Patient Monitoring (RPM) Mobile Health (mHealth) Definitions people live in 2000s – Rapidly advancing technology and capabilities Telecommunications Technology 59 million Modalities
Transcript: Achieving access to Healthcare for patients across all demographics and geographies Overcoming limited financial resources Large travel distances between affiliated healthcare organizations Managing Healthcare provider shortages Clinician Shortages Delayed Treatment An aging population Language barriers Meeting Professional development requirements Keeping abreast with advancements in medicine Clinical care was available anytime and anywhere Clinicians could obtain consultations with medical centers of excellence anytime and anywhere Home bound patients could be monitored remotely anytime and anywhere Medical education programs were available anytime and anywhere Language was not a barrier to medical treatment Specialist could be available to treat patients and injuries no matter where in the world they were located Hospital and clinical facilities could reduce overhead and establish more efficient operations Monitor patient activities Evaluate tests and labs Collaboration between the patient's healthcare team Storage of images and records for easy retrieval Research Sending prescriptions electronically Dictating data through voice recognition Education for both patient and healthcare team Support for caregivers TELEHEALTH GROUP PROJECT Project Outline What Makes Telehealth Successful? The need for Telemedicine Introduction - Allison Abisch Definition, benefits, Need, changes Current & Future Applications - Kelsey Schneider remainder to be filled in Diabetes Management: can report blood sugars via touch-tone phones Fetal Monitoring: high-risk antepartum patients can be monitored from home for more comfort and less cost Hypertension Management: receive reminders and teachings on course of treatment Allison Abisch RN Telemedicine benefits Diverse Applications Allison Abisch RN Kelsey Schneider RN Application Categories Continued... Application Categories Continued... Objectives Application Categories Broadly defined, telehealth / telemedicine is the transfer of electronic medical data (i.e. high resolution images, sounds, live video, and patient records) from one location to another. Selection of a system that fits the needs of the patient (laptop, desktop, mobile app, customized room Locating videoconferencing facilities near user Schedule times to avoid conflict, being on-time for your slot p519 to continue Allison Abisch RN Telehealth / Telemedicine “What is it?” Reduces barriers to access Increases efficiency for providers Reduces overall healthcare costs Reduces delays in care Retains resources locally Increases patient satisfaction Improves quality of care Consultant and primary provider communication Education to providers Improves health outcomes Virtual accessibility An Introduction to Telehealth & Telemedicine Telehealth Group Data Mining: Research can be easier conducted with large databases for education, evidence-based practice, cost/benefits Education: Healthcare professionals can attend seminars without traveling Psychiatry: Specialists can evaluate patients in outlying facilities Social Work: Can apply services for home visits through telehealth Current and Future Applications Application Categories Continued... Allison Abisch RN Application Categories Continued... Allison Abisch RN Application Categories Continued... Definition of Telemedicine How Telehealth is changing healthcare Advantages of Telemedicine Need for Telehealth Allison Abisch RN How would the world change if… Ambulatory Care settings: will help to monitor compliance of medications Mobile Unit Post-Disaster Care: EMT's and nurses at site of incident can voice needs of victim Home Care: health care team can evaluate client without client leaving home School Clinics: school nurses can collaborate with other professionals about problems observed JENNIFER THORNBURG ELIZABETH ROCK MELISSA ZIOGAS KELSEY SCHNEIDER ALLISON ABISCH Geriatrics: monitor taking medications for those who have memory loss but can stay home Hospice: increase access to services in remote areas Military: physicians can evaluate injured soldiers in the field through medic equipment Virtual Intensive Care Units: Allow experts to monitor distant patients in rural areas, especially when transporting the patient is not possible at that time Cardiology: ECG strips can be read from afar, pacemakers can be reset Dermatology: Specialist can see patient without patient needing to wait for an appointment Pathology: Second opinions on biopsies available through slide transmissions Radiology: Receive images hospitals, no hospital needed at rural hospitals Speech-language pathology: Efficient use of specialty pathologists Counseling: Can stay at home or be in an outpatient setting for services Emergency Care: Facilities can communicate efficiently to prepare for transfer of a patient Pharmacy: Prescriptions can be sent electronically and accessed at a central location Extended Emergency Services: allows doctors to monitor ambulance patients, look over EMT's, initiate
Transcript: Telemedicine Coordinator Workflow Coordinator opens the following programs: CPS, CEMR, Phreesia, and Softphone Step 1 1 Patient calls Telemedicine Coordinator Step 2 2 Coordinator makes sure patient has downloaded Tyto app. If not, they walk through the download process on www.myalliedtelehealth.com Step 3 3 Coordinator pulls up patient on CPS Step 4 4 Coordinator makes sure patient's insurance covers Telemedicine. If not, they explain self-pay rate other than Medicaid Step 5 5 Coordinator places patient on CPS schedule Step 6 6 Coordinator uses Phreesia to send consents, waivers, and collect copay Step 7 7 Coordinator starts update in CEMR for virtualist/provider Step 8 8
Transcript: An elderly female patient has a rash on her buttocks that she needs to see a dermatologist about; she has multiple chronic health conditions and is unable to make the long trip. She is able to go to her local hospital and use telehealth to see the doctor remotely. She doesn’t know what to expect since she has only been told that she will be “seeing a skin doctor on the tv screen”. The patient arrives and is taken into a small room beside the ER waiting room. The doctor appears on the screen, she is uneasy about talking to him on a screen and is very uncomfortable when he instructs the nurse to undress her and use a small camera to get a closer look at the rash on her buttocks. The patient notices that the dermatologist is talking to some people that she is unable to see and realizes that a student and resident have been able to see/hear the appointment without her knowledge or permission. When she leaves she feels like everyone in the ER waiting room is staring at her. She was grateful to see the dermatologist without having to travel but wished she had more knowledge of the experience prior. What should the nurse have done to make this patient feel more comfortable? Thank You! Elderly female patient that has a rash that she needs to see a dermatologist about. She is unable to travel to the specialists office. Patients considering using Telehealth with doctors and specilaists. The patients need information about what is going to take place in visits so that they can decide if it is the best option for them. Also audience could include the doctors arranging the visits. They need to be sure that they educate their paitents on what to expect. Question 8 Question 4 What type of follow-up should be conducted following this appointment? Ethical Dilema continued Telehealth: Patient Do you feel that education regarding telehealth should be provided to the community in order to make individuals more aware of what to expect during a telehealth consultation? What steps should be taken by the healthcare provider to ensure patient confidentiality during telehealth exams? Another ethical dilemma is in the fact that the patient could see/hear the students and other people on the screen, therefor the screen that the physician was looking at and able to see the patient on was not in a private area. It is a breach of confidentiality to have the screen in an area that is not private. There were other people that would be able to hear their conversations and also to see her exposed body when she had to undress to be examined. And the patient had not given consent for anyone other than the physician permission to do so. With the move to telecommunications in healthcare these issues are just a few that need to be addressed before patients are going to be willing to participate. They need to be assured that their rights to privacy and informed consent will be taken into consideration and made a priority by the physician. It is our duty as healthcare providers to ensure that our patients are protected as the use of technology in the healthcare system continues. What concerns or questions do you have regarding the use of telehealth for consultations with your healthcare provider? Christian vs Secular Worldview In Romans 12:10, Paul writes, “Honor one another above yourselves” (New International Version). Peter echoes this in 1 Peter 2:17, “Honor everyone” (New International Version). Scripture commands all Christians to honor others above themselves no matter their profession, even if it is an inconvenience. This includes showing respect to patients who might have more need for modesty than others. 1 Peter 5:2 states, “Be shepherds of God’s flock that is under your care, watching over them- not because you must, but because you are willing, as God wants you to be; not pursuing dishonest gain, but eager to serve” (New International Version). The Christian healthcare professional can, in one sense, view the flock that God has given them as their patients. Is this physician treating this telehealth patient with care, honesty, and eagerness to serve? It does not appear so, and the patient does not seem to feel like she has been honestly cared for. Because of these reasons discussed, the Christian provider would most likely navigate this ethical dilemma much differently. By: Brandy Bartholomew, Andrea Bazzell, Charlene Bonner, Kristen Hunt, James Lee and MaryBeth Mungle What steps should the healthcare provider taht to assure the patient is comfortable? Question 6 Question 1 Reflective Statement Because of Union University... Where any HIPAA violations committed during this consultation? If so, what could have been done to prevent them? As Union University nurse practitioner graduates, we pray that our practice reflects Christ and influences our patient care in a way that is obviously different from providers prepared with a non-Christian education. In light of these scriptures, we hope to honor and respect our patient’s needs,
Transcript: The Non-Clinical Use Universities /Colleges ..ex..Navarro OTA Program distance learning of patient and medical education Patient accessibility to medical records Health data management and online information What is Teleheath cont. Telehealth is the use of technology to deliver health care, health information or health education at a distance. As our medical Technology continues to advance and grow, the distance between our health care professionals does also. The demand for this modern healthcare is growing just as fast. What is Telehealth & why is it important? Pro's of Telehealth Telehealth Presentation Presented by Tosha Putz, OTAS Principles of Occupational Therapy September 17, 2013 The Clinical Use Hospitals exchanging health education or services through video conferencing, medical image transmission for diagnostic reasons Pediatrician's office medical data transmission for diagnosis. Montreal to United States Hospitals Doctor and a nurse having a discussion over the telephone Performing robotic surgery from two different remote locations in the world e.g DaVinci, a widely used surgical robot that can be controlled by surgeons from remote locations, along side of McSleepy, appropriately known as the anesthesia bot. Doctors go online Implementing tools like emails to communicate with their potential patients, to offer various health services and even order drug prescriptions. Con's of Telehealth What type of setting is Telehealth used in? Telehealth Presentation Reimbursement Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a rural Health Professional Shortage Area or in a county outside of a Metropolitan Statistical Area. The originating sites authorized by law are: The offices of physicians or practitioners; Hospitals; Critical Access Hospitals (CAH); Rural Health Clinics (RHC); Federally Qualified Health Centers (FQHC); The Non-Clinical Use Universities /Colleges distance learning of patient and medical education Patient accessibility to medical records from home MyChart from Mother Francis Trinity Clinic Health data management and online information people from remote areas are now able to communicate via live video or email with qualified medical professionals from different parts of the world.telehealth consultation is an effective tool for eliminating a few of the barriers to better health care services in various parts of the world. Telehealth also improves the way the health care providers access information and deliver care. It can bring additional expertise to consult on a case, reach out to patients when they're at home or save travel time and expense for both practitioners and patients. Telehealth consultation is not fully effective and appropriate in some medical issues like mental illness. In this case, a physician doesn’t have the ability to examine the patient accordingly. Therefore, under these circumstances, a face-to-face consultation is necessary. • Some areas of the world don’t have access to the internet or telephones, so they are left out. In some cases people may go to sites like Web Md to self diagnose when professional treatment is needed.
Transcript: Usage Trends Introduction to Telehealth The Evolving Role of Telehealth in Healthcare Delivery Ben Nissim February 4th, 2022 What is Telehealth? The use of digital information and communication technologies (i.e. computers and mobile devices) to access health care services remotely and manage an individual's health care. Source: Mayo Clinic Forms of Telehealth: Synchronous vs. Asynchronous First Radiological Images Sent Via Telephone History of Telehealth 2000 - Present Supporting Telehealth growth: HITECH Act, HRSA funding, etc. 1973 - 1977 Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) 1959 Transmission of Neurological Examinations Using Interactive Video Communications 1948 1990's: Introduction of the Internet Examples of Telehealth Services Phone/Video Consultation with Provider Remote Patient Monitoring Mobile Apps to view lab test results, refill prescriptions, etc. Patient Education Healthcare Staff Training Trends in Telehealth Use During Beginning Stages of Covid Source: Centers for Disease Control and Prevention (CDC) Increase in Telehealth Claims Volumes Source: McKinsey & Company Top Users of Telehealth Psychiatry 50% 30% Substance Use Disorder Treatment % of Telehealth outpatient and office visit claims 17% Endocrinology Rheumatology 17% Gastroenterology 13% Source: McKinsey & Company Cost Effectiveness Can Telehealth Lead to Savings for Health Systems? Reasons for Yes Reasons for No Telehealth services can be delivered at a lower cost than the cost for in-person services (i.e. less space and staff support needed) Increases follow-up care costs needed by patients who are unable to resolve their medical issues via telehealth Increased costs for the necessary technology and electronic platforms Improves efficiency and provider productivity Additional resources and associated costs needed to help with the transition to digital care Prevents cases in higher cost areas (i.e. Emergency Department) Reimbursement for Telehealth Services Throughout the Covid-19 public health emergency, the federal government, state Medicaid programs, and private insurers have expanded coverage for telehealth services Coverage Parity: Requires the same services be covered via telehealth as would be covered if delivered in-person *As of October 2021, 42 states and D.C. require private insurance providers to reimburse for telehealth services. Payment Parity: Requires insurers to reimburse for telehealth and in-person services at equal rates (less common among states) Medicare Policy Change: Any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. *There is a list of telehealth services payable under the Medicare Physician Fee Schedule Physician and Patient Satisfaction Increases flexibility and control over patient care activities Improves the timeliness of care for patients Easier to provide care for rural and vulnerable communities Does not improve work-life balance/burnout symptoms Lack of integration with EHRs Confused by insurance coverage/frustrated by low payments Takeaways from Physician Survey Results Improves access to care/appointment convenience Helps maintain patient-provider communication Crucial for chronic disease management Difficulty explaining their concerns to doctor Experience technology issues Less likely to trust a diagnosis compared to an in-person visit Takeaways from Patient Survey Results Looking Ahead Key Questions How can the healthcare supply chain adapt to a healthcare system that sees a greater mix between treating patients in-person and in virtual settings? What are some key barriers hospitals face to providing telehealth services? Looking ahead, which type of telehealth services can be the most impactful and how should they be delivered? Thank You! Works Cited Works Cited Nesbitt TS, Katz-Bell J. History of Telehealth. In: Rheuban K, Krupinski EA. eds. Understanding Telehealth. McGraw Hill; 2018. Koonin LM, Hoots B, Tsang CA, et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep; October 2020; 69:1595–1599. Bestsennyy O, Gilbert G, Harris A, Rost J. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company; July 2021. Ravitz N, Looby S, Jordan C, Kanoff A. The economics of a telehealth visit: A time-based study at Penn Medicine. Healthcare Financial Management Association; April 2021. Nelson H. COVID-19 Telehealth Delivery Reaps High Patient Satisfaction. mHealth Intelligence; April 2021.
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