Telehealth

A New Way to Look at the Business of Healthcare

Nancy NahlikMissouri Baptist Medical Center

BJC HealthCare

March, 2014

BackgroundMissouri Baptist Medical Center is a Community Hospital in a large metropolitan market

What could we do to set ourselves apart?• Developed relationships with rural hospitals

• Educated Medical Staff on value of outreach

• Created a hospital philosophy dedicated to rural markets

• Started working on program development specifically for rural hospitals and patients• CME programs• Missouri Heart Network• Affiliation Agreements

Then……..2002 – 82 specialty outreach clinics in…

13 rural markets by …..45 different physicians

2006 – Rural markets represented 31% of total MoBap “cases”

110 outreach clinics in … 17 markets by …. 63 different physicians

And Now

2013 – Rural markets represented 28% of total MoBap “cases”

90 clinics in…15 markets by….50 different physicians

Other Outreach Programs

– Access to Purchasing Contracts through BJC

– Heart Life Line Alliance (STEMI)

– ED to ED Transfer Program

Why Telehealth?

• Economy

• Physician retirement

• Younger physicians looking for quality of life and work/life balance

What is Telehealth?

Telehealth: The use of medical information exchanged from one site to another via electronic communications to improve a

patient’s clinical health status.

Telehealth is…..

NOT SKYPE

NOT Texting pictures from phones

Telehealth must be:

- HIPAA compliant

Who is Using Telehealth Across the Country & World?

Cleveland ClinicMayo Clinic

Johns HopkinsUniversity of Michigan

EmoryUniversity of Missouri

Missouri Baptist Medical Center

• many more

How Are They Using Telehealth?

• ICU Coverage

• Hospitalist Services

• Stroke Coverage

• Consulting Services

• Surgical Assistance

• Physician “Office” Visits

And….

• Pharmacy Support

• School Nurse programs

• In-home monitoring

• Long Term Care Assistance

• Chaplain Assistance – patient and family education

What Does Telehealth Look Like?

At the outlying site, it is this…

And this

And this

At MoBap, It Is This…

Telehealth at Missouri Baptist Medical Center

• Mo Bap can beam into 4 rural robots

• Specialty physician visits

• ED transfers

• Working with a Long Term Care Company to put a robot in one of their skilled and rehab units

Specialty Clinics

• Cardiology • Oncology• Pulmonology

• ENT – discussed, but not implemented

• Neurology – within 3 months

Specialty Clinic

• Seeing 60 – 70 patients a month in two rural locations

• Both new patients and followups• Patient satisfaction is HIGH• Physician satisfaction is HIGH• MoBap satisfaction is HIGH

Emergency Services

• Robots in 4 rural CAHs• Available 52 hours a week • In a 5-month period in 2013:– 86 encounters an average of 20 min. each– 64 were direct admits to a floor– 12 admitted to ICU– 4 were recommended for a higher level of care– 2 came to our ED – 1 discharged from rural hospital

Emergency Services in 2014

• Averaging 4 calls a day

• 3 physicians providing service

• Will be starting 24 hour 7 day a week “Consulting Services” through the ED within the next 3 months

Emergency Room Telehealth in Action–

• ER Physician in a rural ER determines that a patient needs to be transferred to MoBap. He calls Dr. Winer’s cell phone.

• Through Telehealth - on an IPAD - Dr. Winer is able to “beam into” the rural ER.

• Robot taken into the patients’ room.

• Dr. Winer introduces himself to the patient and through telehealth is able to confirm the condition of the patient – and reassure them about the transfer.

• Dr. Winer calls the MoBap ICU and arranges for a bed. The patient becomes a direct admit.

What Does This Accomplish?

1. With “eyes on” – the MoBap physician can be reassured about the condition of the patient

2. MoBap can make recommendations on method of transportation – Ground vs. Air

3. Keeps patient from being in 2 EDs

4. Patient and family satisfaction

Telehealth in Nursing Homes

• In the beginning phases

• Working with one group within Metropolitan Service Area

• Consults will NOT be billable

• Patients will have a record at MoBap whether the patient is admitted here or not

Advantages to Nursing Home

• A resource for staff during “off hours” to help determine whether a resident needs to go to the Emergency Department.

• Reduces the number of residents sent to Emergency Departments

• Reduces hospital re-admissions• Makes nursing home a choice referral source for

discharges from MoBap, knowing that they are involved in keeping the resident out of the hospital

• Clinical training/education supporting our staff

Advantages to Hospital• A reduction in non-Emergency visits to the

Emergency Department

• A potential increase in true Emergency Department admissions

• A reduction in re-admissions

• A collaborative partner on the clinical care of patients

 

Why Telehealth?

• Efficient patient care• The technology is dependable• It is reimbursed by most insurance

plans• Strengthens rural providers• Provides a platform to grow

marketshare• Consistent with our Mission:

To improve the health of the people and communities we

serve

Let’s look……