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Telehealth and Emerging Technology: Practical Applications, Challenges, and Considerations for Rural Hospitals

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Telehealth and Emerging Technology: Practical Applications, Challenges, and Considerations for Rural Hospitals Telehealth and Emerging Technology: Practical Applications, Challenges, and Considerations for Rural Hospitals CINDY JACOBS, RN, JD PARTNER, JACOBS RIGGS AFFILIATE FACULTY, UW SCHOOL OF LAW LEAH ROSENGAUS, MSC INTERIM DIRECTOR, TELEHEALTH SERVICES UW MEDICINE June 25, 2019 OBJECTIVES • Identify high‐value telehealth applications and use cases for rural medicine • Discuss the reimbursement landscape, regulatory considerations and challenges for telehealth • Connect to available resources in WA State 4 Notable Technology Trends Impact 1. Maturation of Mobile Technology We must distill the flood of data & strategically think how to best apply. Telehealth a component of 2. The Age of Data & Intelligent Computing a broader ecosystem. 3. Telehealth Industry Maturation & Evolution Telehealth is primed for growth 4. 5G Wireless Expansion 3 Technology Innovation – An Ever‐Evolving Landscape Standard Use Cases Emerging Trends On the Horizon Patients access health Remote monitoring of AI increases provider efficacy information at their fingertips ‐ chronically ill or isolated (i.e. virtual assistant) My Chart, virtual symptom patients at home or other Bots for symptom tracking & checker, etc. locations healthcare delivery Self‐service tools to streamline Smart glasses revolutionize interactions – mobile Artificial intelligence used for care delivery, training & scheduling, personalized patient triage & diagnosis patient safety education Wearables enable self‐ Augmented reality enhances 24x7 virtual diagnosis & management & give clinicians care delivery & experience treatment via phone, video or access to real‐time patient and supports provider online chat information education Virtual provider‐to‐provider Drones increase access & Digital communities facilitate consultations via phone, video augment healthcare supply social support & education or store‐and‐forward chain Waiting rooms & clinics Body scanners gather vital Virtual provider education & revolutionized by “smart” signs like temperature, pulse training technology” & patient oximetry, etc. engagement tools 4 UW Medicine Telehealth Program 5 UW Medicine Telehealth Turn‐key 20+ Specialties Programs and Supports 19,000 Virtual Consults per Year Over 100 19 Programs Partner Sites Advocacy: Chair of the WA State 5‐State Region Telehealth Collaborative 6 Active Programs Highlights » eConsult improves access by 30%+ measured by the % of patients seen ≤ 30 days for pilot specialties Provider toProvider Providerto Patient » UW Medicine Hep C ECHO > 89% cure rate » UW Medicine’s TeleStroke program completes » Project ECHO: 8 specialties » Virtual Urgent Care: ACN & public > 270 consults per quarter » eConsult : 14 specialties including » TelePrimary Care psychiatry » TeleMaternal Fetal Medicine » TeleAntimicrobial Stewardship » TeleBurn Our Goals » TelePsychiatry » TelePsychiatry » Expand existing programs & launch new offerings, enhancing relationships with patients » TelePain » TeleAmputee & our physician community. » TeleStroke » TeleJail » Continue advocating to alleviate challenges & growth barriers such as reimbursement. » TelePost‐Acute Care » TeleNutrition » Drive innovation through development & » Grand Rounds » TeleUrology assessment of new ideas. 7 Programs of Particular Interest to Rural Providers 8 Project ECHO® Multidisciplinary education and case consultations help clinicians care for patients in their own community Program Overview Available Specialties » UW Medicine was the second » HIV ECHO program in the United » Hepatitis‐C States » Tuberculosis » ECHO is now live in 23+ » Geriatrics counties including 80+ U.S. » Antibiotic Stewardship sites and 50+ global partnerships » Dialectal Behavioral Health » Transgender Health » Pain Virtual ECHO Sessions » 1 session/week, on average, per discipline » 10‐15 min educational session, CME credit available » Physicians present de‐identified cases, sent to UW Medicine in advance » Multi‐disciplinary case consultation & treatment plan development » Session materials made available 9 TeleAntimicrobial Stewardship (TASP) Helping establish and strengthen antimicrobial stewardship programs at 41 partner institutions Benefits Services Provided Lower costs by reducing inappropriate antimicrobial • Weekly didactic video conferences covering case use in hospitals discussions with a focus on your institution Improve patient safety through appropriate dosing • Curriculum that keeps staff up‐to‐date on anticipated and use of antimicrobials at your institution federal regulations and accrediting organization Prepare for current TJC and expected CMS mandates requirements • Learn quality improvement techniques Continuing education credits for physicians, nurses and pharmacists Share best practices among participating organizations • Access to protocols and procedures • Regular access to infectious disease experts who have written IDSA guidelines and won awards for their own programs 10 TeleStroke Connect directly to the certified comprehensive stroke program at Harborview Medical Center Consultations Expertise • Enter live video consultation with a vascular neurologist within 5 minutes • 15 years of TeleStroke experience • All aspects of consultation are • UW Medicine physicians complete >270 automatically documented and telestroke consultations per quarter available for review • Washington’s first Joint Commission • Access to UW Medicine’s Transfer certified comprehensive stroke program Center and Airlift Northwest at Harborview Medical Center Education • Access to training in cutting‐edge Platform stroke treatments and protocols • High‐quality platform successfully in use • Initial on‐site training and annual at hospitals nationwide site visits • Integrated diagnostics, imaging, • Weekly online lectures documentation & quality reporting • Quarterly teleconferences and • Cloud based, HIPAA secure CEU opportunities 11 UW Medicine Grand Rounds • The latest in innovation and clinical best practice, Join us! provided by Department of Medicine faculty Thursdays • All are welcome to stream live 8am‐9am ─ Zoom webinar ID: 812 197 730 ─ Or download the Zoom app (select "join a meeting" and enter ID 812 197 730) • CME credit available ─ https://medicine.uw.edu/grand‐rounds • YouTube Channel with 200+ recorded lectures: ─ https://www.youtube.com/user/UWDeptMedicine/videos 12 CJ1 TelePsychiatry Access to mental health care professionals with expertise in a wide‐range of disorders Areas of Expertise • Our team completes more than 10,000 consultations per year in over 150 regional inpatient and outpatient settings. • Anxiety disorders • Neurocognitive disorders • Substance abuse disorders • Bipolar disorder • Perinatal mental health • Psycho‐oncology • Depressive orders • Psychopharmacology • Delirium • Obsessive‐compulsive disorder • Psychotic disorders • Trauma‐related disorders Direct Patient Care Services • Inpatient telepsychiatry consultations • Outpatient consults and implementation of Collaborative Care with primary care team Provider to Provider Services • Outpatient case reviews • Inter‐specialty case consultation for inpatients • Weekly psychiatry & addictions case conference series • Perinatal psychiatry consultation line • Child psychiatry consultation line 13 Slide 13 CJ1 Leah, should we provide information about the new DOH funding for telepsych? I added 2 slides with the information from the biennium budget. Cindy Jacobs, 6/7/2019 HB 1109—2019‐2021 Biennial Budget (enacted) Funding for TelePsychiatry Services • To create and operate a tele‐behavioral health video call center staffed by UW School of Medicine’s Department of Psychiatry and Behavioral Sciences • The center must provide emergency department providers, primary care providers, and county and municipal correctional facility providers with on‐demand access to psychiatric and substance use disorder clinical consultation • Clinical consultation may also involve direct assessment of patients using video technology • The center must be available from 8 a.m. to 5 p.m. in fiscal year 2020 and twenty‐four hours a day in fiscal year 2021 14 Considerations for Rural Hospitals and Providers • Extreme variation in policies by payer and state, with piecemeal exceptions that chip away at restrictions • While rural providers have more flexibility with Medicare, requirements are still fractured and nuanced Reimbursement • The lead time for reimbursement is long • Some platforms are designed to work in low‐bandwidth, but internet speed can still be an issue overall • Proxy credentialing may require a change in hospital bylaws Implementation 15 • Digital health solutions create opportunities for competition in new markets; national health systems and vendors are beginning to move into the WWAMI region • Forward‐thinkers are not necessarily traditional payers and providers, but technology companies Industry Pace • All modalities of telehealth, including mHealth and digital health, are rapidly evolving • Regulations lag behind technology—particularly at federal level • Inconsistent patchwork at state level Legal/Regulatory Arena 16 Reimbursement and Regulatory Landscape 17 Medicare Reimbursement—most restrictive Historic problem—may affect some rural areas that do not meet the definitions • Medicare beneficiaries eligible for telehealth services only if they are presented from an originating site located in: ─ A rural Health Professional Shortage Area (HPSA) located either outside a Metropolitan Statistical Area (MSA) or in a rural census tract; or ─ A county outside an MSA. 18 Other restrictions
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