1. eHealth and Tele-Medicine Operational Considerations Michele R. Lauria, MD, MS CMIO Eastern Maine Healthcare Systems

2. Together We’re Stronger Agenda Overview of eHealth Types of Telemedicine People/Process/Technology and Culture Successes Stumbles

3. Together We’re Stronger eHealth The provision of healthcare when participants are separated by distance and/or time.

4. Together We’re Stronger Goals The 3 R plus one –Right Care More immediate access to specialty services –Right Place Reduced travel time –Right Person f/u with specialist from acute care –Right Experience Provider Patient

5. Together We’re Stronger eHealth Scope Text based communications –Between patients and clinicians Email +/- images Texting Incorporating a Portal –Includes communications in the EMR –Communications between providers Store and forward image review Telephone: documented in the EMR Tele-Medicine: Real-time audio/visual exchanges between patients and providers

6. Together We’re Stronger Tele-Medicine Scheduled Tele-Video –Consults –Follow Up On Demand Tele-Video Store and Forward –Imaging –E-Visits Remote Monitoring Care Management

7. Together We’re Stronger Current TeleHealth-Enabled Initiatives EMMC / Acadia Telehealth Services 7

8. Together We’re Stronger People, Process, Technology & Culture Change Influences 8 Technology Process People Culture

9. Together We’re Stronger Barriers Technology –Broadband –Security Process –Licensure and credentials –Documentation –Billing People –Everyone already has a day job Culture –Defining ROI

10. Together We’re Stronger Considerations: Technology and Process Technology –Rock solid functioning like a telephone Once video doesn't work and phone is used, providers don’t go back. –When a problem happens you need to debrief the next day. Provider and staff training – Image transfer functionality Cardiology and MRI: high band width Process –Governance –How and where to document –Billing with a modifier –Tracking KPI –Defining best practice

11. Together We’re Stronger Program Staffing StaffResponsibilities Administrative Director Coordinate telemedicine initiatives Lead working group Identify expansion opportunities and potential partners Medical Director/Champion Advise new service line efforts Develop telemedicine workflows, products, best practice Nurse Coordinators Train staff at spoke sites on technology Assist with intake and triage Monitor incoming patient data, alert physicians as necessary May be dedicated or shared part-time with a service line IT Leader Coordinate IT staff dedicated to telemedicine Support telemedicine innovation efforts IT Staff Trouble shoot day-to-day technology problems Maintain data repositories and infrastructure Innovate on technology and interoperability Pull reports on outcomes data 11

12. Together We’re Stronger Considerations: People Governance Requires more office assistance not less –Registration – no change –Rooming and vitals – must be by support staff Where are they documented? How does the consulting provider see them? –Patient positioning –Initiating technology in rooms –Using remote stethoscopes and other items

13. Together We’re Stronger Considerations: Culture Non-traditional ROI –Reduced provider travel time opens more clinic time –Generates more revenue with in-system tests Exam room and office staff not required –Don’t get the facility charge –Useful if limited exam rooms Generate more revenue with in-system tests –How to validate? Provides a broader geographic scope for patient base –But requires more technology

14. Together We’re Stronger Successes WOW Program: Way to Optimal Weight –Multidisciplinary visits via WebEx One way invitation from provider’s office to patient MSW, clinician, nutritionist: take turns on same WebEx Lead physician is an early majority PICU: On demand consultation to providers –Video conferencing to see the patient & Tele- Stephony –Dedicated group of providers; consistent service

15. Together We’re Stronger Stumbles Lack of clear leadership –Innovators are not good leaders Early Majority are great Service inconsistency –Personnel: Referring providers demand a consistent service –Technology: one failure followed by the phone sinks the program –Lack of commitment by all providers. Billable Model –ICU consults: if admission same day as consult, can only bill one

16. Together We’re Stronger Even Great Tech Needs Translation 16

17. Together We’re Stronger Novel Ideas Increasing access to PCP –Pre-discharge consult between acute care provider and PCP. May reduce readmission rates? Window into the home environment –Nursing visits