Describe in detail how to strategically plan a Telehealth as a scope of digital health.
frankcozy
TelehealthAdoptionModel.pdf
Now part of the
UPMC Telehealth Adoption Model - A HIMSS Case Study November 10, 2015
Natasa Sokolovich JD, MSHCPM, Executive Director, Telehealth at UPMC & Senior Director, Affiliated Physician Services
Dr. Bill Fera, Principal at EY
• Natasa Sokolovich, JD, MSHCPM
• Salary: N/A
• Royalty: N/A
• Receipt of Intellectual Property Rights/Patent Holder: N/A
• Consulting Fees (e.g., advisory boards): COVIDIEN
ADVISORY BOARD
• Fees for Non-CME Services Received Directly from a
Commercial Interest or their Agents (e.g., speakers’ bureau):
N/A
• Contracted Research: N/A
• Ownership Interest (stocks, stock options or other ownership
interest excluding diversified mutual funds): N/A
• Other: None
Conflict of Interest
• Bill Fera, MD
• Has no real or apparent conflicts of interest to report
Conflict of Interest
Describe the approach employed for developing the telemedicine adoption
model
Select the maturity level that best describes telemedicine services within
your organization
Identify two ways in which your organization can apply this adoption model
1
2
3
Learning objectives
The use of technology to exchange health information, provide health
education and enable care delivery at a distance or between two remote
sites
TELEMEDICINE
Often used as a broader definition that includes the use of tools which
enhance patient health such as remote monitoring devices, wearables
and mobile health apps
TELEHEALTH
Types of Services
Specialties
Care Continuum
What do we mean by telemedicine and telehealth?
Factors driving interest
Telemedicine
/ Telehealth
Volume to value
Expanding coverage
Physician shortages Triple aim
Population health
Consumerism
Project background
Challenge
Opportunity
Solution
The industry lacks a standardized framework for
assessing the maturity of a telemedicine program and
readiness to expand
Define a standard industry process for developing
telemedicine programs and strengthen the healthcare
community
Develop the first market research based adoption
framework
Benefits of an adoption model
Enable evaluation and systematic planning
Establish a process that enables scalability
Determine the appropriate level of investment
Provide a mechanism for assessing progress
Promote transparency with telemedicine services
Enhance the community of telemedicine providers
Scope
Research
Advisory Council formation
Survey* and model construction
Vetting and socialization
Adoption Model
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Advisory Council membership
Name Organization
Matt Cox Duke University Health System
Bill Gable Duke University Health System
Karen Jackson The Ohio State University Wexner Medical Center
Kyle Sharp The Ohio State University Wexner Medical Center
Mark Moseley The Ohio State University Wexner Medical Center
David Nash Jefferson School of Population Health
Alexis Skoufalos Jefferson School of Population Health
Frank Maguire TriWest Healthcare Alliance
Natasa Sokolovich University of Pittsburgh Medical Center
Nate Gladwell The University of Utah
Amalia Cochran The University of Utah
Ted Kimball The University of Utah
Brian Carlson Vanderbilt University Medical Center
Paul Sternberg Vanderbilt University Medical Center
Challenges
New industry model
Relevance and applicability
Data collection and analysis
A d
o p
ti o
n M
o d
e l
Variability in terminology
Approach
1 • Concept research and validation
2 • Survey* development and administration
3 • Analysis and validation of findings
4 • Adoption model socialization
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Key hypotheses
• Providers started by adopting phone consults with other providers
and patients
• Telemedicine programs started providing asynchronous services
before synchronous services
• Initial telemedicine programs often involve a single provider or group
of providers from related specialties
• Providers with highly mature telemedicine programs have:
– A centralized governance model
– Standardized workflows and processes
– Standardized policies and procedures
– A high level of interoperability
• Respondent information
• Organizational profile
• Primary objectives
• Regulatory and reimbursement
• Utilization of technologies
• Duration of implementation
• Technology enablement
• Telemedicine partnerships
• Telemedicine adoption levels
• Program governance
• Clinician engagement
• Future plans
“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Survey topics
Survey respondents
ORGANIZATION TYPE
Academic Medical Center 56.3%
Health System 16.7%
Hospital 12.5%
Other 14.6%
NUMBER OF BEDS
1 to 100 4.3%
101 to 500 19.1%
501 to 1,000 29.8%
1,001 to 3,000 14.9%
More than 3,000 8.5%
Unsure 8.5%
N/A 14.9%
8
3
8 8
3
1
1
3
5
1
3
1
3
0
2
4
6
8
10
12
14
16
18
Midwest Northeast South West
AMC Health System Hospital Other
Distribution by Region
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Telemedicine utilization
Video
conferencing
Remote
monitoring
Store and
forward
Robotic
services
91.7%
72.9%
64.6%
33.3%
TOP USE CASES
1. Psychiatry / Behavioral Health
2. Stroke
3. Radiology
4. Neurology
5. Pediatrics
6. Maternal Fetal Medicine
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Investment
28.9%
22.2%22.2%
6.7%
4.4%
8.9%
6.7%
< $1M $1.1M - $5M $5.1M - $10M
$10.1M - $15M $15.1M - $20M > $20.1M
Unsure
The majority of
providers have
invested < $1.1M
Three of the four AMCs
that invested > $20.1M
are currently using
grants
Providers with
investments between
$10.1M - $15M are
academic medical
centers
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Objectives
42.2% 42.2%
15.6%
95.6%
84.4%
66.7%
46.7%
8.9%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Availability of grant(s)
Consumer engagement
Financial incentives
Improve access Improved patient
outcomes
Physician shortage
Streamlined workflow
Other
* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Reimbursement sources
52.3%
61.4%
61.4%
72.7%
6.8%
18.2%
Medicare
Medicaid
Commercial payers
Direct contract
Unsure
Other
“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Key findings
• Over 55% of healthcare providers deploy Telemedicine by
service line or department
• Synchronous (live interactive virtual consults) were the most
common form of telemedicine visit implemented
• Most organizations indicate starting with high acuity clinical
services
• Organizations with complex services did not necessarily have:
– Centralized governance model
– Standardized workflows
– High level of interoperability
“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
External challenges
Challenges Immature Mature
Cross-state licensure impedes delivery of
services
50% 58%
One or fewer forms of reimbursement 35% 17%
No state reimbursement 29% 33%
One or fewer commercial payers that
reimburse for services
32% 17%
“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.
Adoption level conceptual approach
Level 0
Governance Level 1
Providers
Level 2
Patients
Level 3
Simple
Level 4
Complex Level 5
Complete
Level 6
Expanded
Level 7
Integrated
Alignment and
engagement
Enabling
technologies
Care across
the
continuum
Interoperability
Adoption levels
Level Capabilities
7 Full interoperability to include patient generated data
6 Services across the care continuum for multiple specialties
5 Remote monitoring
4 Complex synchronous and asynchronous services
3 Simple synchronous and asynchronous services
2 Patient health portal
1 Provider education and e-consults
0 Centralized governance, standardization and scalability
Centralized governance model
24% describe the governance of their
telemedicine organization as “managed
centrally across the enterprise”
25% centrally developed and
standardized workflows, policies
and procedures and protocols
• Scalable IT strategy that accounts for a high level of interoperability
with EHR, CIS, devices and medical equipment
• Workflows, processes, policies and procedures designed for
telemedicine and standardized across the enterprise
• Policies defined for security and regulatory compliance
0
Provider education and e-consults
67% currently do or will support provider
education through telemedicine
technologies
92% have VTC capabilities; of those,
81% use VTC technology for
educational purposes
• The use of telemedicine technologies, including video conferencing,
to support clinician / provider consults and education (GME, CME)
77% have secure, high-speed, wireless
internet access to support voice, video
and data capabilities
1
Patient health portal
• Dedicated patient health portal that may include customized health,
wellness or disease management content based on EHR data, if
applicable
• Capabilities may exist for patients to integrate data from mobile
applications into the EMR
35% offer internet sites to support wellness /
disease management
58% offer patient education through
telemedicine with a total of 74%
offering in the next three years
51% of patient education programs are
customized for individual patients
2
Simple synchronous and asynchronous services
• Virtual consults with patients, second opinions, pre- and post-
operative visits, etc.
• Relatively simple patient exam cameras and viewing monitors
• Simple store and forward capabilities that do not require a high level
of technical requirements or infrastructure within a few clinical
specialties
70% have patient rooms equipped with
cameras and other devices that can be
accessed or viewed remotely
67% have exam equipment for remote
patient consults / evaluations
58% use digital cameras to support
telemedicine service
3
54% have viewing monitors for images
and / or video streaming (i.e., technologies
to support synchronous services)
35% have remote presence technologies associated
with independent workflow from a different
location (portable cameras / modules)
• Multiple asynchronous and synchronous services across several
specialties / sites to support care for various levels of patient acuity
• Specialized cameras with remote capabilities (PTZ features)
• Integration with numerous medical equipment/devices
• Two or more complex synchronous services (e.g., telestroke, eICU
or trauma consults)
Complex synchronous and asynchronous services 4
Remote monitoring
54% have remote monitoring or mobile
devices for patient use
37% use patient supported remote monitoring
through telemedicine with a total of 51%
offering in the next three years
• Remote monitoring of patients at home
• Home medical equipment capable of transmitting basic clinical
data; may include messaging and webcam to support patient to
clinician visits
• Medical equipment dispensed by the provider as part of the care
treatment plan
61% use telemedicine to provide ongoing care
to avoid a hospitalization or re-
admissions for a chronic illness
5
Services across the care continuum for multiple specialties
30% deliver care through telemedicine
at all points on the care continuum
14% offer telemedicine services
across 60% of clinical specialties
• Portfolio of telemedicine services across the entire care continuum
• Telemedicine services offered by at least 60% of clinical
departments
• Highly integrated care delivery approach that is regularly used for
ongoing patient management (e.g., psych / behavioral health)
7% Offer real time intra-procedure or
operative consults
6
Full interoperability to include patient generated data
• All medical device data is transmitted, analyzed and accepted into
the EHR (internal)
• Ability to exchange data with external organizations such that it
appears as primary data
• EHR and ancillary clinical systems interoperability to support
multiple sources of patient data
• Ability for patients to self-report and track health or lifestyle data to
support customized programs; data is analyzed and contained
within the EHR as primary data
7
Where do you begin or re-start?
Gather intelligence
Innovate and define strategy
Design the program
Stage and sequence
1
2
3
4
Limitations
• Not a formal certification or assessment of the quality or outcomes of a
telemedicine program
• Not an accreditation or credentialing process for telemedicine related to
quality in care delivery
• A high level of maturity is not a guarantee for meeting a certain clinical
quality and outcome standards
• Does not incorporate external factors such as reimbursement, legal and
regulatory federal and state policy as an indicator of maturity
Questions
Contact Information
• Natasa Sokolovich • UPMC • [email protected]
• Bill Fera
• EY
• @BillFeraEY
