1. Telehealth Implementation: Strategy for Measuring Impact on Quality, Access and Cost Kathleen Webster MD, FAAP Background Our Initial Goals Setting Program Goals Building on Success Telehealth: Use of telecommunication technology to deliver health care or education over a distance Provider/Provider Site: extend reach travel time/cost referrals Sustaining Change Program Implementation Measuring Outcomes Assembling the Team The temptation is to just get started, but it is important to consider key players in order to set up a successful program. Senior Leadership: helps to engage all stakeholders, mandate where needed Administrative Support: leader to coordinate team, support for data collection Clinical Champions: Each key group needs a champion to spark enthusiasm and get the program rolling. We identified physicians at both the attending and resident level as well as nurses. As remote sites were added, champions were needed at both ends of the connection. Technology Support: Decisions include to whether to provide onsite or obtain from vendor Legal: Ensuring compliance with HIPPAA, credentialing, EMTALA Coding & Billing: maximize revenue capture4, stay up to date with rapidly changing codes Choosing Technology The number of vendors supplying telehealth services grow every year. Key questions to consider: -Store and Forward vs Real Time -Audio, Video or Both? Connection on each end: wired or wireless? Is encryption needed? -What level of tech support is needed? -Do you anticipate growth? Is the system small enough for now and flexible enough to grow? -Costs: Hardware, Software, Connectivity, Support, Expected life of equipment -Where are you connecting and what are their capabilities? Many institutions either have a telehealth program or are planning to implement one within the next 5 years. Recent legislation focuses health care on the goals that are easily integrated with the main goals of telehealth, namely increased access, decreased cost and improved quality of care. Loyola University Health System (LUHS) implemented a clinical telehealth program in 2007. The initial program was internal to the organization. In pediatric critical care, facilitated after hours evaluation of high risk patients by pediatric intensivists, without the need for adding additional staff. In 2010 an external program was initiated, connecting the adult neurology team to outside Emergency Departments for evaluation and treatment of stroke patients. Access # of patients seen Quality Patient outcomes Cost Referrals to system Cost of alternatives Keep your champions involved Turn them into leaders Align program goals and system goals Keep collecting data – and sharing it Prove telehealth works Show how its better than in person Identify new quality goals reduce readmissions Identify new potential partners new sites (partner hospitals) new types of connections New internal and external champions Align with new partners Payors Legislators Currently only 12 states have laws requiring reimbursement for services provided via telemedicine Patient: access to specialists timeliness of care outcomes location of care Patient Site: compliance with quality # pts kept on site Program goals were designed around key stakeholders, with an assessment of how telehealth added value for each.