powerpoint presentation tbi evaluation teleconsultation_09...• provide education on symptom...
TRANSCRIPT
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Recording: 9/26/13 VANTS: 1-800-767-1750 Access Code #43515
Adobe Connect (U Pitt Guest invite)
Housekeeping
• Please mute your computer microphone and use the VANTS line for the audio.
• This call will be recorded for future training.
• All documents (handouts) are available to download from the Files ‘pod’
during conference.
• After the conference, the documents may be downloaded from:
a) PM&R SharePoint/TBI Teleconsultation:
http://vaww.infoshare.va.gov/sites/rehab/pmrs/Special%20Projects/For
ms/AllItems.aspx
b) University of Pittsburgh External Site:
http://www.rstce.pitt.edu/VA_TBI/VATBI.html
• Questions:
a) May be typed using the ‘chat’ pod
b) Audio using the VANTS conference call line
Housekeeping
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Special Thanks to:
Host for Adobe Connect and Training Modules University of Pittsburgh = “Pitt Crew” Mark R. Schmeler Richard M. Schein Andi Saptono Joseph Ruffing Bambang Parmanto
Faculty and Advisors:
Joel Scholten, MD TBI Specialist and Special Projects Manager Rehabilitation and Prosthetics Services VHCO Washington, DC Ron Riechers, MD Neurologist and TBI Specialist Cleveland VAMC Doug Bidelspach Rehab Planning Specialist and Data Manager Rehabilitation and Prosthetics Service VACO Lebanon VAMC
Telehealth Services
Pat Ryan Associate Chief Consultant VISN 8, Bay Pines, FL John Peters Clinical Video Telehealth Program Manager/Analyst Washington DC Rhonda Johnston Director, Clinical Video Telehealth National Training Center, Denver
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Background
Comprehensive TBI Evaluation
via Telehealth Technology
Primary Goals: Comprehensive TBI Evaluation
Teleconsultation Pilot
• Develop a standardized procedure for completing a Comprehensive TBI Evaluation utilizing telehealth technologies
• Improve access to care for Veterans in rural settings
• Increase overall percentage of Comprehensive TBI Evaluation completion
• Increase the number of telehealth visits
This pilot project is possible due to:
- Funding from the Office of Health Care Transformation
- Support by Specialty Care Transformation
- Coordination by Rehabilitation and Prosthetics Services
- Collaboration with Telehealth Service
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Advisory Board
Nan Musson, Project Lead
Joel Scholten, MD Lead
Doug Bidelspach, PM&R Office
David Cifu, Director PM&R
Ronald Riechers, Neurologist
Bryan Merritt, Physiatrist
Lisa McPeak, Physiatrist
Belisla Vasquez, Physiatrist
Jack Dryden, PM&R FAB
Patricia Ryan, Telehealth Services
John Peters, CVT Program Manager
Michelle Winslow, CVT Telehealth Lead
Rod Miles, FTC
Bridget Smith, TBI Queri
Robin Hurley, ACOS Research & Ed
Kathy Walker, PNS and Telerehab Lead
Brian Shenal, Neuropsychologist
Betty Dameron, OEF/OIF
In May 2012, the Advisory Board met at the Bay Pines VAMC Hosted by VISN 8 Telehealth staff
Objectives included: Develop a consensus standardized Comprehensive TBI Evaluation to be
delivered via Telehealth (including the TBI Specialist and TCT Roles) Review and Select Telehealth Equipment Recommend Training Modules Identify Outcomes for the Project Develop an Application Process for Potential Pilot Sites
TBI Telehealth Pilot Sites
In FY12, 16 Pilot Sites were selected
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TBI Telehealth Pilot Sites
In FY13, 15 additional Pilot Sites were selected and 10 PRC/PNS sites will be joining the project
to expand the network across all VISNs
Education/Training
Knowledge/Skills
Need to Know
Objectives for Today
Introduction and Overview:
• Background
• Business/Administrative Issues
• Telehealth equipment, forms, and supplies
• Documentation
• Outcomes and Reports
• Training
• Communication and Contact Information
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It Takes a Team: Telehealth + TBI Facility Leadership
TBI Specialist
“Clinical Champion”
Facility
Telehealth Coordinator
“FTC”
TelePresenter
“TCT”
IT/BioMed
CBOC Managers and Personnel
Decision Support Team
(DSS)
VISN Leadership
Support
Staff
PM&R
Administrative
Sfaff
The FTC to assist with ….
- Identification of Clinic Space and Time for Clinic
- Recommendations for Clinic Profile Titles
- Assist with Equipment Inventory
- All Telehealth Services Documents including:
A Memorandum of Understanding Credentialing and Privileging The Telehealth Service Agreement Telehealth Clinical Protocol Development Tool HT Enrollment Agreement
Preparation
Clinic Profiles Space and Furniture
Telehealth Equipment Office Equipment
Supplies
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Clinic Appointments and Profiles
Clinical Video Telehealth Clinics are set-up in pairs.
2 Clinic Profiles/Appointments
1) Patient site (20 – 30 min. early to complete screening forms)
2) Provider site (actual appointment time)
Example:
• Tallahassee CVT TBI Consultation - 8:30 a.m. (Patient site/90 min.)
• Gainesville CVT TBI Consultation - 9:00 a.m. (Provider Site/60 min.)
Stop Codes and 4CHAR Codes
Primary Stop Code/Polytrauma: 197
Secondary Stop Code/Telehealth: 690 or 692/693
4CHAR Code: PLVT
Example:
Patient Site: 197690 PLVT
Provider site: 197692 PLVT
Emergency Procedures:
- Provider telephone numbers
- Telepresenter telephone numbers
- OPC/CBOC telephone numbers
- Medical Emergency procedures
- Crisis procedures
- Patient/Family contact information
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Recommended Equipment
Provider - Desk Top EX90 - Document Reader - VA Desktop Computer - CPRS
- My Healthe Vet - PM&R SharePoint
- Telephone or Cell Phone
Telepresenter - Education or Global Med Cart - Document Reader or Fax - VA Desktop Computer - CPRS
- My Healthe Vet - PM&R SharePoint
- Telephone or Cell Phone - Chair (no rolling chairs) - Table or Desk space
Provider: Space and Telehealth Equipment
Telepresenter (patient site): Room, Telehealth Equipment, Table/Chair
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Peripheral Telehealth Equipment
Document Reader
Equipment Contract
Eric Silvernail, Iron Bow
Deliveries and Tracking Numbers
Supplies to support Teleconsultation (Telepresenter Side)
*plus safety pin!
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Supplies for the Telepresenter
1) Screening Forms (PDF, clip board, pen) – Neurobehavioral Symptom Inventory (NSI) – Post-Traumatic Stress Disorder Checklist-Military (PCL-M) – Patient Health Questionnaire (PHQ)
2) Montreal Cognitive Screening (MoCA) 3) *Brief Identification Smell Test - A and #2 pencil 4) *Reflex Hammer and sharp/pin 5) Education Handouts (link, PDF or SharePoint) 6) Telehealth Patient Satisfaction * Sent by snail mail to the TBI Specialist
Comprehensive TBI Evaluation Standardized Teleconsultation
Provider and Telepresenter Responsibilities: - Before the Teleconsultation - During the Teleconsultation - After the Teleconsultation
Prior to this October 3, 2013 The following training Modules were recommended:
• PITT RSTCE TBI Modules (http://www.rstce.pitt.edu/VA_TBI/VATBI.html )
– Overview of TBI Diagnosis and Co-Morbidities (Ron)
– Demonstration of MoCA Administration (Ron)
– Demonstration of Brief Smell Test A
– Demonstration of Pain Module
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Before the Teleconsultation
Telepresenter • Provide the patient with Screening Tools to be completed in the waiting
area (clip board and pen): – Neurobehavioral Symptom Inventory (NSI) – Post-Traumatic Stress Disorder Checklist-Military (PCL-M) – Patient Health Questionnaire (PHQ)
• Prep room if necessary (set-up of telehealth equipment and peripherals) • Verbal consent for telehealth visit • Obtain Pt.’s main complaint • Vitals (i.e. height, weight, pain level) TBI Specialist • Review history in CPRS • Ensure that Veteran had + TBI screen if using Comprehensive TBI
Evaluation (CTBIE) template • Check telehealth equipment and peripherals
Screening Tools (PDF)
PTSD CHECKLIST – MILITARY VERSION (PCL-M)
Administration and Scoring
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PCL-M Case Example
NEUROBEHAVIORAL SYMPTOM INVENTORY (NSI)
Administration and Scoring
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NSI Case Example
PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
TBI Tele-training - Administration and Scoring
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PHQ-9 Case Example
DURING TELECONSULTATION
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During the Teleconsultation Telepresenter Assistance • Review of Screening Results and Vitals with the provider • Olfactory Testing • Montreal Cognitive Assessment (MoCA) • Pain/Musculoskeletal Module (if needed at the end of the evaluation) • Tandem Romberg • Assists with the handouts and brochures (as needed at the end of the session)
TBI Specialist
• Review of telehealth ‘consent’ • Complete Interview and record responses in CTBIE template • Complete Telehealth Examination
– General Appearance and Observation (speech, distractibility/attention, thought process) – Cranial Nerves (EOM, grimace, tongue protrusion, hearing intact to conversational volume) – Motor and Coordination (finger to nose, Luria motor sequencing, Rapid Alternating
movements, seated heel to shin, pronator drift) – Gait AND completes Pain /Musculoskeletal module if warranted
• Determine treatment plan and discuss recommendations with Veteran • Provide Education on symptom management and prognosis
MONTREAL COGNITIVE ASSESSMENT (MOCA)
TBI Tele-training - Administration and Scoring
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BRIEF IDENTIFICATION SMELL TEST – VERSION A
Author: Richard L. Doty, Ph.D.
Vendor: Sensonics, Inc
Brief Smell Identification Test - A
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PAIN MODULE
After the Teleconsultation
Telepresenter • Patient Satisfaction (national form) • Progress Note (templates are available if requested): Veteran consents to participate in a Telehealth Visit Vitals and other observations • Completes the Encounter TBI Specialist: • Complete CTBIE template (include NSI, PCL-M, PHQ) • Complete the Encounter • TBI (Community Reintegration) Care Plan • Enter appropriate orders/consults
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Fill out VISN
Fill Out Facility
Fill Out Date
Inform the Veteran to fill in bubbles. Tell them that checkmarks, x’s, circling the answer, etc. are not acceptable.
Inform the Veteran to only write in comments inside of the box. Any answers outside do not scan!
Specialty Clinic: TeleRehabilitation
How to Properly Fill Out ‘Telehealth Satisfaction’ Form
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Example: Diagnostic and Procedure Codes Don’t Forget - Encounters need to be completed for both appointments.
Helpful Hint: Attach the note to the correct appointment.
Provider example:
Diagnostic Code:
854.01
Procedure Code:
99204
Telepresenter example:
Diagnostic Code:
854.01
Procedure Code:
Q3014
INTERDISCIPLINARY REHABILITATION AND COMMUNITY REINTEGRATION (IRCR) CARE PLAN
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Rehabilitation/Reintegration Care Plan The Individualized Rehabilitation and Community Reintegration (IRCR) Care Plan should
be completed for EVERY individual who is being discharged from inpatient rehabilitation or receives outpatient rehabilitation services and meets the all of the following criteria:
Is diagnosed with TBI/Polytrauma;
Referred to the TBI/Polytrauma team for assessment and treatment;
Required and received interdisciplinary rehabilitation assessment including medical, case management PLUS at least one of the following; PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab;
Determined to benefit from rehabilitation treatments for functional disabilities related to TBI/polytrauma;
Rehabilitation treatments require intervention by interdisciplinary specialists including medical, case management PLUS at least one of the following: PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab.
Rehabilitation/Reintegration Care Plan
Revised Care Plan – Additional point/click
selections and specific free text areas
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Revised Care Plan – When all fields are completed, either ‘Save Draft’ or ‘Save and
Prepare Note’ to send to CPRS
PATIENT EDUCATION MATERIALS HTTP://WWW.MIRECC.VA.GOV/VISN16/PROVIDERS/TUFF.ASP
MIRECC, HOUSTON VAMC
Pilot Project Outcomes Data (Spread Sheet)
• Provider Location (Text) • Provider Zip Code (5 digit number) • TCT Location (Text) • TCT Zip Code (5 digit number) • Positive TBI Screen (MM/DD/YYYY) • TBI Teleconsultation (MM/DD/YYYY) • Did the TBI Specialist recommend a face-to-face visit to complete the
exam (Yes/No) • Referrals after the TBI evaluation: • OT (Yes/No) • PT (Yes/No) • Speech Pathology (Yes/No) • Neuropsychology (Yes/No) • Interdisciplinary Care Plan initiated (Yes/No) • Comment (open text)
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During monthly calls (4th Tues of the month at 3:00 p.m. EST)
In FY14, each site will be asked to provide two updates: • Slide #1 TBI Specialist, Facility Telehealth Coordinator, Telehealth Clinical
Technician • Slide #2 Start Date, Clinic Name and Stop Codes, Number of TBI
Teleconsultations completed • Slide #3 Lessons Learned, Suggestions, Challenges, Additional Comments
Research Project: “Examining Telehealth Applications for Evaluation of
Mild Traumatic Brain Injury”
Bridget Smith, Primary Investigator
• Aim 1: Characterize approaches to using telehealth to provide CTBIEs.
• Aim 2: Examine the association between patient characteristics and use of telehealth to perform the CTBIE and outcomes associated with telehealth.
• Aim 3: Convene an expert panel and develop recommendations to facilitate the implementation of telehealth strategies to provide comprehensive TBI evaluations.
• Aim 4: Conduct a preliminary cost analysis.
Comprehensive TBI Evaluation Teleconsultation Project Contact information…
• Nan Musson
e-mail: [email protected]
telephone: 352-376-1611 x5607
• Joel Scholten at [email protected]
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Telehealth Services Links
VHA Telehealth Services Intranet - http://vaww.telehealth.va.gov/
VHA Telehealth Services Share Point - http://vaww.infoshare.va.gov/sites/telehealth/default.aspx
Traumatic Brain Injury Training
Please download the list of training available.
Concluding Remarks
Questions and Answers:
Adobe Connect ‘Chat’ Box or
VANTS line 1-800-767-1750 Access Code 43515#
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