Presentation on theme: "Joseph L. Ronzio, DHSc, CPHIMS, SMHIMSS VA Northwest Health Network"— Presentation transcript:
1VA Northwest Health Network Veteran Integrated Service Network (VISN) 20 Joseph L. Ronzio, DHSc, CPHIMS, SMHIMSSVA Northwest Health NetworkVISN Telehealth CoordinatorTracy Dekelboum, MSWSouthern Oregon Rehabilitation Center and ClinicsFacility Telehealth Coordinator
2What is Telehealth?The VHA Office of Telehealth Services states: Utilizing telehealth services supports “providing the right care in the right place at the right time through the effective, cost-effective and appropriate use of health information and telecommunications technologies”Utilizing Telehealth services:Increases access to care for services not normally available at a facility;Increases availability of and access to care for Veterans in rural locations;Reduces travel expenses to other VA sites for care which is replaced by telehealth services;Reduces non-VA expenses for specialty care
3Clinical Video Telehealth (CVT) A Process utilizing telehealth technologies to provide care and consultation between VA sites, VA sites and the home setting, and between VA and non-VA sites. This allows the patient to be examined or interviewed at a location different from the provider, via real-time interactive video images.The VA utilizes a national video telecommunications infrastructure to support CVT.
5VISN 20 CVT Services Telemental Health Pacemaker / ICD Nutrition and DieticianMoveTraumatic Brain InjuryRehabilitation and AmputeeDiabetesHepatologyPain Clinic
6Store and Forward (S&F) A process in which a trained imager or health technician takes digital images or captures digital data of a patients’ condition, downloads the images or data to VistA that are interpreted by a remote consulting provider.
7VISN 20 S&F ServicesFor teledermatology conditions a standard point and shoot camera is utilized.For teleretinal imaging a digital SLR camera is connected to a lens unit which can focus on and inside the eye.TeleradiologyEpilepsy EEG diagnostics
8Home Telehealth (HT)A process using Home Telehealth technologies to manage Veterans with chronic diseases at their home in order to improve clinical outcomes and access to care. This program supports and complements the care by our primary care teams.
10VISN 20 Description of Challenges of our Network Largest amount of land of any VA NetworkVery rural locations (Alaska, Southern & Eastern Oregon)Only two major tertiary care facilitiesHigh non-VA care and beneficiary travel costsBenefits of our NetworkVA Electronic Health Record – CPRSFrequent communication amongst sitesDecent collaboration and support amongst sitesPre-existing telehealth programsTelehealth is a natural addition to the healthcare provided
11VISN 20’s Telehealth Network Established a standardized VISN-wide Business StructureDesignation of Facility Telehealth Coordinators (FTHCs) to oversee each facility’s telehealth activitiesImplementation and use of Telehealth Clinical Technicians (TCTs) to provide technical support, training, and clinical supportImplementation of VISN wide and facility based telehealth committeesEstablishment of VISN Telehealth Technical Committee comprised of Office of Information and Technology staff, Bio Medical Engineering staff, and FTHCsAlthough VISN 19 has led in the development of CVT VISN wide, VISN 20 has been very proactive in implementing all elements of telehealth and a business structure
12VISN 20’s Telehealth Network Establishment of standardized documents proposing and facilitating all telehealth programsBusiness planTelehealth Service Agreement (TSA’s)Standard Operating Procedure (SOP’s)Establishment of standardized equipment use and purchase amongst all sites of care
13Developing a Network Wide Telehealth Program Rural location benefits greatly from telehealth ServicesDescription of demographics/idiosyncrasies of locationsDeveloping a Telehealth program requires a mix of aggressiveness and hand holdingShare transition of technology to make aware of actual use of technologyWhat is in it for them?Workload creditIncrease in Patient Access to careAbility to have more meaningful communication with patientsAbility to be in same room as other provider provides care
14Developing a Facility Program: SORCC Telehealth Program The Southern Oregon Rehabilitation Center & Clinics (SORCC):residential facility w/approximately 450 bedsprovides residential and outpatient mental health and substance use rehabilitation with primary care and limited specialty care availabilityapproximately 16,000 unique Veterans per yearRural Location:Medford, our main city is considered by VA to be urbanAll other areas are rural and highly ruralTreatment Sites: One Community Based Outpatient Clinic (CBOC) and one Outreach Clinic
15Developing a Facility Program: SORCC Telehealth Program cont’d Due to limited clinical services, telehealth is primarily “done unto us”Will expand SORCC services to our CBOC and Outreach Clinic in 2012
16SORCC Programs Clinical Video Telehealth Telemental Health Tele Pain ManagementVeterans CourtHome TelehealthStore & ForwardTeleretinal ImagingTeledermatologyImplement in 2012ArrhythmiaPace MakerHome Based TMH & PCExpansion of Diabetes Health ClinicPre & Post Op ClinicDiscuss hypocrisy of Arrnythmia & Pacemaker
17Involvement in a Network Telehealth Program Networking opportunity and support amongst FTHCsFrequent communicationBi-weekly organized callAs needed communicationEducation on “everything telehealth” by VISN Telehealth Coordinator and DirectorDiversity in skill amongst FTHCs – the whole is greater than the sum of its partsAbility to provide “the right care in the right place, at the right time”Providing care as “One VA”
18Experience - CVT FY 11 Data FY10 Data FY09 Data 5,747 patient encounters2,296 unique patients1,788,502 patient miles of travel savedFY10 Data3,358 patient encounters2,391 unique patientsJust over 1M patient miles of travel savedFY09 Data2,013 patient encounters1,690 unique patients
19Experience – Home Based CVT First VA to launch a successful Home Based Clinical Video Telehealth for Mental HealthPatient CenteredSaved over 20,000 miles of patient travel with just over 50 patients in 1.5 yearsHigher patient satisfaction than clinic based telehealth servicesSignificantly lower patient now show ratesLess than .5%Traditional mental health care is 12% to 24%Clinic based telemental health is 8% to 18%
20Experience – CVT Provider Empowered Telework is possible Patients are less stressed upon arrivalPatients with a history of violence
21Experience - S&F FY 11 Data FY10 Data FY09 Data 14,596 patient encountersFY10 Data9,950 patient encountersFY09 Data8,438 patient encounters
22Experience - S&F S&F for providers is a multiplier 1 hour face to face encounters = 5 to 15 minute image readsThere is a need for training to be accomplished by imagersThere is a need to constantly monitor imager qualityPatient follow-up can be extremely complicatedEspecially if you are imaging multiple body locations with suspected problems
23Benefits/Satisfaction/Challenges Increase in Patient Access to careAbility to have more meaningful communication with patientsAbility to be in same room as other provider provides careWorkload credit – telehealth is considered a face-to-face appointmentSatisfactionHigh Veteran satisfaction both in communication and in elimination of lengthy travelProvider satisfaction in communication success and ability to be present during the Veterans’ session with non-SORCC providers, skill buildingChallengesObtaining Clinical Champions to lead effortsObtaining buy-in for participationScheduling provider and room timeCoordination with providing sites
24Things to Never ForgetAssure purchase of sufficient bandwidth as there never seems to be enoughAssure all equipment is compatible and standardized where possible throughout the networkDevelop a systematic approach for Gaining Buy-inBenefit to patient accessBenefit to providersGet to play with cool shiny toys Importance of Clinical ChampionsTo lead innovationTo support followers