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Innovative Uses of Telehealth

Session 264 Date of Session March 5, 2018

Michael Adcock, Executive Director, UMMC Center for Telehealth

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Michael P. Adcock, FACHE

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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Agenda• UMMC Center for Telehealth History

• TelEmergency

• Remote Patient Monitoring

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Learning Objectives• Discuss the benefits and challenges associated with having a

remote patient monitoring program

• Outline how to develop a TelEmergency room program

• Describe how telehealth can be used effectively in rural areas

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UMMC Center for Telehealth History

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What is Telehealth?• Telehealth lets providers examine and treat patients remotely, in real

time, using online streaming video technology and interactive tools.

PATIENT & LOCAL CLINICIAN

USING UMMC’S

ONLINE TELEHEALTH TOOLS

UMMC SPECIALISTS

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Why is telehealth important?Currently, 53 of Mississippi’s 82 counties are more than a 40-minute drive from specialty care.

UMMC CENTER FOR TELEHEALTH

Provides specialty

care that is

convenient for

patients

Offers vital

support for

primary care

physicians

Helps decrease

the cost of

care and

improve patient

outcomes

Supports

population health

in underserved

areas

Provides

interactive

distance

education

for providers

to improve quality

of care

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UMMC Telehealth Timeline• 1990s: Diagnostic test interpretation; Adult and Pediatric Cardiology

• 2003: First videoconferencing of telemedicine; Emergency Medicine

• 2008: First new specialty added - Psychiatry

• 2011: Full- time staff assigned to Telehealth

• 2013: Center for Telehealth formed

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Comprehensive Telehealth ProgramTelemedicine: Live (Audio-Video) Interaction

• Scheduled and unscheduled

• Specialty consults, Primary Care, Employee & Student Health,

• Prison Health

• Ancillary health and wellness services

Store & Forward & Diagnostic Tests Interpretation

• Cardiology, Radiology, Neurology, Audiology

• Dermatology, Pathology, Ophthalmology

Remote Patient Monitoring

• Chronic disease management

• Hospitals- at risk population, cost avoidance/reduction

• Clinics-Chronic disease management

• Post Acute monitoring

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UMMC Telehealth by the numbers• 500,000 encounters since 2003

• 200+ UMMC available specialists

• 35+ specialty services and growing

• 200+ locations

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UMMC Center for Telehealth locations

• Community Hospitals & Clinics

• Mental Health Clinics

• FQHC’s

• Schools & Colleges

• Mobile Health Vans

• Corporations

• Prisons

• Patient’s Homes

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Clinical Quality• Maintain SAME STANDARD as in-person care

• If the technology can not replicate the exam you would do in-person then the visit is not appropriate for telehealth. Do not cut corners

• Study clinical outcomes and compare to in-person outcomes.

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TelEmergency

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TelEmergency • Catalyst to start the program:

– Health care climate-workforce shortage

– ED overcrowding/ diversion

– Financial burden of community hospitals

• Staffing cost excessive with locum tenens

• Declining admissions

• Declining reimbursement

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TelEmergency Outcomes Evaluation

• Access to Care

• 15 rural MS hospitals

• >500,000 patients treated

• Multidisciplinary Team

• NP & Board Certified EM physician

• Cost Effective Staffing

• 25% reduction in staffing costs

• Rural Communities Benefit

• 20% admissions locally

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TelEmergency Outcomes Evaluation

New Site Satisfaction Survey

Community Hospital (Q1 2014)

• 100% Satisfaction

• Total patients seen with TelEmergency: 884

• Total admission to that facility: 208

• Total transfers from the facility: 68

• Total discharges: 608

Total admission to this facility increased by

101 patients in Q1 of program

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TelEmergency

• Connects 15 emergency departments in rural hospitals with UMMC’s Level One Trauma Center

• Uses real-time video and audio connections

• 25% reduction in rural emergency room staffing costs

• 20% reduction in unnecessary transfers

• Produced patient outcomes in rural hospitals that are on par with those of the academic medical center

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TelEmergency

PATIENT SATISFACTION

• 96.3% of patients were comfortable or very comfortable with system

• 98.7% never had difficulty seeing or hearing the UMMC physician

• 87.3% felt their care was as good or better than with an MD alone

• 91.2% of patients are more likely to come back to rural ED because of TelEmergency

• 85.6% rated their overall care as good or excellent

ADMINSTRATOR SATISFACTION

• 100% feel level of care in their ED has increased or remained the same

• 87.5% feel it cost less or about the same

• 85.7% feel that their overall ED volume has increased

• 87.5% are not concerned about a technical failure of the system

• 87.5% have an overall good or excellent opinion of TelEmergency

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Remote Patient Monitoring

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Sustainable Change: The Three E’s

EducationPhase 1

EngagementPhase 2

Behavior

ChangePhase 3

Personal

EmpowermentPhase 4

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Remote Patient Monitoring

Daily Health Sessions

Personalized Interventions

Targeted Education

Health Coach

Behavior Modification

Patient Empowerment

Chronic disease management in the patient’s home including:

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MS Diabetes Telehealth Network

HbA1c

1.7%

Medication

Compliance

96%

Health Session

Compliance

83%

Retinopathy

Found

9 cases

Weight Loss

71 pounds

Miles Saved

9,454.11

No Hospitalizations or ER visits for DMPreliminary results on first 100 patients

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MS Diabetes Telehealth Network

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SB 2646 (2104)- SAF; RPMSENATE BILL NO. 2646

(As Sent to Governor)

AN ACT TO CREATE NEW SECTION 83-9-353, MISSISSIPPI CODE OF 1 1972, TO REQUIRE

HEALTH INSURANCE AND EMPLOYEE BENEFIT PLANS IN 2 THIS STATE TO PROVIDE COVERAGE

AND REIMBURSEMENT FOR 3 "STORE-AND-FORWARD TELEMEDICINE SERVICES" AND

"REMOTE PATIENT 4 MONITORING SERVICES" TO THE SAME EXTENT THAT THE SERVICES

WOULD BE 5 COVERED AND REIMBURSED IF THEY WERE PROVIDED THROUGH IN-PERSON 6

CONSULTATION; TO DEFINE "STORE-AND-FORWARD TELEMEDICINE" AND 7 "REMOTE PATIENT

MONITORING"; TO AMEND SECTION 83-9-351, 8 MISSISSIPPI CODE OF 1972, TO INCLUDE

EMPLOYEE BENEFIT PLANS IN THE 9 REQUIREMENT FOR INSURANCE REIMBURSEMENT FOR

TELEMEDICINE SERVICES; 10 AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI

http://billstatus.ls.state.ms.us/documents/2014/pdf/SB/2600-2699/SB2646SG.pdf

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Lessons Learned

• Smaller Tablet

– Patients need tablets that are more

mobile

• No tethered devices

– Cords and cables cause confusion and

increased technical issues

• Affordable options

– Blood glucose strips were not affordable

• Connectivity

– Wireless connectivity limited

– Provide patients with cellular network

connectivity

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Future Research

• Larger sample size

• Random assignment of treatment

• Patient and provider satisfaction

• Analysis of cost effectiveness

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UMMC’s RPM Plan

• Monitoring for patients across multiple chronic diseases

• Extend to pediatric population

• Significant cost savings

• Extend outside of Mississippi’s borders

• Continue innovative approach to bringing healthcare resources into the patient’s home

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Patient Feedback

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97%Strongly Agree

/Agree

I would recommend

this program to others.

If I had a problem, someone

was available to help me.

99%

I feel this is an

important step in my

care.

93%

The equipment was

easy to use.

93%Strongly Agree

/Agree

Strongly Agree

/Agree

Strongly Agree

/Agree

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Excellent Medication Compliance

98%

“Yes”

Did you take all of your

medications in the past 24

hours? 53%

Another

Reason

29%

I Forgot

15%I Ran Out

3% Side Effects

Please tell us why.

2% “Missed”

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Remote Patient Monitoring

Current RPM Programs

• Employer based program

• Chronic disease

– Diabetes (Adult and Peds)

– Congestive Heart Failure

– COPD

– Hypertension

– Bone Marrow Transplant

– Kidney Transplant

• High Risk Pregnancy

Future RPM Programs

• Asthma (Adults and Peds)

• Congenital Heart

• Medical Weight Loss

• Neonatal

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QuestionsMichael Adcock, FACHE

Executive Director, Center for Telehealth

University of Mississippi Medical Center

madcock@umc.edu

@ummctelehealth

601.815.2048

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