11/30/22, 1:49 AM Final: Telehealth Strategic Planning

https://sju.instructure.com/courses/32739/assignments/414491?module_item_id=1192867 1/2

Total Points: 36

Final 561 Rubric

Criteria Ratings Pts

10 pts

10 pts

4 pts

4 pts

4 pts

4 pts

Coherent Concise and Organized 10 pts Exceeds Expectations

6 pts Meets Expectations

0 pts Does Not Meet Expectations

Spelling and Grammar 10 pts No Errors

7.5 pts Minimal Errors

0 pts Three or More Errors

F1 History and Goals (SLO 1) Graduates will understand the history, goals, methods (including data and information used and produced), and current challenges of the major health science fields. (SLO 1) threshold: 3.0 pts

4 pts Exceeds Expectations

3 pts Meets Expectations

2 pts Near Mastery

1 pts Does Not Meet Expectations

F9 Interprofessional Roles (SLO 5) Graduates will define and discuss the scope of practice and roles of different health professionals and stakeholders including patients, as well as the principles of team science and team dynamics to solve complex health and health information problems. (SLO 5) threshold: 3.0 pts

4 pts Exceeds Expectations

3 pts Meets Expectations

2 pts Near Mastery

1 pts Does Not Meet Expectations

F6 Population Behavior (SLO 1) Students will identify theories or models that explain and modify patient or population behaviors related to health and health outcome. (SLO 1) threshold: 3.0 pts

4 pts Exceeds Expectations

3 pts Meets Expectations

2 pts Near Mastery

1 pts Does Not Meet Expectations

F7 Design and Implementation (SLO 2) Students will identify the theories, models, and tools from social, business, human factors, behavioral, and information sciences and technologies for designing, implementing, and evaluating health informatics solutions. (SLO 2) threshold: 3.0 pts

4 pts Exceeds Expectations

3 pts Meets Expectations

2 pts Near Mastery

1 pts Does Not Meet Expectations

11/30/22, 1:38 AM Telehealth – Defining the Field: XLST Digital and Connected Health (TUESDAY) Fall 2022

https://sju.instructure.com/courses/32739/pages/telehealth-defining-the-field?module_item_id=1192864 1/1

Telehealth – Defining the Field According to the Office for the Advancement of Telehealth (OAT), Telehealth is defined as: “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration”. Telehealth can be delivered synchronously (using real time technologies) or a synchronously (using other methods discussed at length in this course).

Store-and-forward Images or videos are saved and sent later. As an example, a primary care physician takes a picture of a rash with a digital camera and forwards it to a dermatologist to view when time permits. This method is commonly used for specialties such as dermatology and radiology. This could also be referred to as asynchronous communication. Real time A specialist at a medical center views video images transmitted from a remote site and discusses the case with a physician. This requires more sophisticated equipment to send images real time and often involves two way interactive telemonitors. The specialist can see the patient and ask questions. Telemedicine also enables the sharing of images from peripheral devices such as electronic stethoscopes, otoscopes, etc. This would be an example of synchronous communication. Remote monitoring. A technique to monitor patients at home, in a nursing home or in a hospital for personal health information or disease management.

Recently, telemedicine has been adopted by many major US healthcare delivery systems, such as Saint Joseph’s Healthcare, Geisenger and Sentara, to improve access to medical care and hopefully reduce spiraling costs. Given a move to bundled and alternative payments, telemedicine remains a potentially useful tool for the informatician. Increasingly payment models are either implicitly or explicitly calling for their use. The Merit Based Incentive Payment System (MIPS) provides opportunities for the use of telehealth services to increase access to care and provide population health outreach. In addition, CMS continues to evaluate waivers for the delployment of telemedicine services as outlined in updates to the comprehensive joint replacement (CJR) bundled payment.

The readings this week are designed to foster greater awareness of a few key items. The first reading by Chan et al is highlighted to convey that the practice of telehealth is by no means a physician only practice. Increasingly many members of a care team are participating in virtual visits with patients. These include OTs, PTs, mental health professionals and social workers. The article also highlights a need for newer methods to investigate "mixed" digital health engagement with patients and those in need of care. The second article by Cason conveys with it the approval of the American Occupational Therapy Association for members to actively engage and utilize telehealth services. The article lays out ethical responsibilities of practitioners and to a certain extent embraces certain types of platforms already created and used by therapists at leading academic institutions. The broad question I have for everyone in the course (and given your diverse backgrounds) is whether or not your own professional home has provided clear guidance on the use of telehealth services. Finally in the article by Eric Wicklund the following statement is especially profound as we look back across the previous modules – "For example, in a simplistic sense, a consumer may consider an mHealth or telehealth program to be effective if it proves more convenient than in-person care, while a doctor might measure its value in whether clinical outcomes are improved and a health plan might prefer a program that reduces cost and waste. In another case, a consumer might embrace a program that makes him or her feel better, while a provider values that platform’s ability to protect patient data."

6-8

Now part of the

UPMC Telehealth Adoption Model – A HIMSS Case Study November 10, 2015

Natasa Sokolovich JD, MSHCPM, Executive Director, Telehealth at UPMC & Senior Director, Affiliated Physician Services

Dr. Bill Fera, Principal at EY

• Natasa Sokolovich, JD, MSHCPM

• Salary: N/A

• Royalty: N/A

• Receipt of Intellectual Property Rights/Patent Holder: N/A

• Consulting Fees (e.g., advisory boards): COVIDIEN

ADVISORY BOARD

• Fees for Non-CME Services Received Directly from a

Commercial Interest or their Agents (e.g., speakers’ bureau):

N/A

• Contracted Research: N/A

• Ownership Interest (stocks, stock options or other ownership

interest excluding diversified mutual funds): N/A

• Other: None

Conflict of Interest

• Bill Fera, MD

• Has no real or apparent conflicts of interest to report

Conflict of Interest

Describe the approach employed for developing the telemedicine adoption

model

Select the maturity level that best describes telemedicine services within

your organization

Identify two ways in which your organization can apply this adoption model

1

2

3

Learning objectives

The use of technology to exchange health information, provide health

education and enable care delivery at a distance or between two remote

sites

TELEMEDICINE

Often used as a broader definition that includes the use of tools which

enhance patient health such as remote monitoring devices, wearables

and mobile health apps

TELEHEALTH

Types of Services

Specialties

Care Continuum

What do we mean by telemedicine and telehealth?

Factors driving interest

Telemedicine

/ Telehealth

Volume to value

Expanding coverage

Physician shortages Triple aim

Population health

Consumerism

Project background

Challenge

Opportunity

Solution

The industry lacks a standardized framework for

assessing the maturity of a telemedicine program and

readiness to expand

Define a standard industry process for developing

telemedicine programs and strengthen the healthcare

community

Develop the first market research based adoption

framework

Benefits of an adoption model

Enable evaluation and systematic planning

Establish a process that enables scalability

Determine the appropriate level of investment

Provide a mechanism for assessing progress

Promote transparency with telemedicine services

Enhance the community of telemedicine providers

Scope

Research

Advisory Council formation

Survey* and model construction

Vetting and socialization

Adoption Model

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Advisory Council membership

Name Organization

Matt Cox Duke University Health System

Bill Gable Duke University Health System

Karen Jackson The Ohio State University Wexner Medical Center

Kyle Sharp The Ohio State University Wexner Medical Center

Mark Moseley The Ohio State University Wexner Medical Center

David Nash Jefferson School of Population Health

Alexis Skoufalos Jefferson School of Population Health

Frank Maguire TriWest Healthcare Alliance

Natasa Sokolovich University of Pittsburgh Medical Center

Nate Gladwell The University of Utah

Amalia Cochran The University of Utah

Ted Kimball The University of Utah

Brian Carlson Vanderbilt University Medical Center

Paul Sternberg Vanderbilt University Medical Center

Challenges

New industry model

Relevance and applicability

Data collection and analysis

A d

o p

ti o

n M

o d

e l

Variability in terminology

Approach

1 • Concept research and validation

2 • Survey* development and administration

3 • Analysis and validation of findings

4 • Adoption model socialization

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Key hypotheses

• Providers started by adopting phone consults with other providers

and patients

• Telemedicine programs started providing asynchronous services

before synchronous services

• Initial telemedicine programs often involve a single provider or group

of providers from related specialties

• Providers with highly mature telemedicine programs have:

– A centralized governance model

– Standardized workflows and processes

– Standardized policies and procedures

– A high level of interoperability

• Respondent information

• Organizational profile

• Primary objectives

• Regulatory and reimbursement

• Utilization of technologies

• Duration of implementation

• Technology enablement

• Telemedicine partnerships

• Telemedicine adoption levels

• Program governance

• Clinician engagement

• Future plans

“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Survey topics

Survey respondents

ORGANIZATION TYPE

Academic Medical Center 56.3%

Health System 16.7%

Hospital 12.5%

Other 14.6%

NUMBER OF BEDS

1 to 100 4.3%

101 to 500 19.1%

501 to 1,000 29.8%

1,001 to 3,000 14.9%

More than 3,000 8.5%

Unsure 8.5%

N/A 14.9%

8

3

8 8

3

1

1

3

5

1

3

1

3

0

2

4

6

8

10

12

14

16

18

Midwest Northeast South West

AMC Health System Hospital Other

Distribution by Region

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Telemedicine utilization

Video

conferencing

Remote

monitoring

Store and

forward

Robotic

services

91.7%

72.9%

64.6%

33.3%

TOP USE CASES

1. Psychiatry / Behavioral Health

2. Stroke

3. Radiology

4. Neurology

5. Pediatrics

6. Maternal Fetal Medicine

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Investment

28.9%

22.2%22.2%

6.7%

4.4%

8.9%

6.7%

< $1M $1.1M – $5M $5.1M – $10M

$10.1M – $15M $15.1M – $20M > $20.1M

Unsure

The majority of

providers have

invested < $1.1M

Three of the four AMCs

that invested > $20.1M

are currently using

grants

Providers with

investments between

$10.1M – $15M are

academic medical

centers

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Objectives

42.2% 42.2%

15.6%

95.6%

84.4%

66.7%

46.7%

8.9%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Availability of grant(s)

Consumer engagement

Financial incentives

Improve access Improved patient

outcomes

Physician shortage

Streamlined workflow

Other

* “eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Reimbursement sources

52.3%

61.4%

61.4%

72.7%

6.8%

18.2%

Medicare

Medicaid

Commercial payers

Direct contract

Unsure

Other

“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Key findings

• Over 55% of healthcare providers deploy Telemedicine by

service line or department

• Synchronous (live interactive virtual consults) were the most

common form of telemedicine visit implemented

• Most organizations indicate starting with high acuity clinical

services

• Organizations with complex services did not necessarily have:

– Centralized governance model

– Standardized workflows

– High level of interoperability

“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

External challenges

Challenges Immature Mature

Cross-state licensure impedes delivery of

services

50% 58%

One or fewer forms of reimbursement 35% 17%

No state reimbursement 29% 33%

One or fewer commercial payers that

reimburse for services

32% 17%

“eHealth Initiative's 2014 Telemedicine Survey". https://www.surveymonkey.com/s/H7P73ZD. eHealth Initiative, 30 October 2014.

Adoption level conceptual approach

Level 0

Governance Level 1

Providers

Level 2

Patients

Level 3

Simple

Level 4

Complex Level 5

Complete

Level 6

Expanded

Level 7

Integrated

Alignment and

engagement

Enabling

technologies

Care across

the

continuum

Interoperability

Adoption levels

Level Capabilities

7 Full interoperability to include patient generated data

6 Services across the care continuum for multiple specialties

5 Remote monitoring

4 Complex synchronous and asynchronous services

3 Simple synchronous and asynchronous services

2 Patient health portal

1 Provider education and e-consults

0 Centralized governance, standardization and scalability

Centralized governance model

24% describe the governance of their

telemedicine organization as “managed

centrally across the enterprise”

25% centrally developed and

standardized workflows, policies

and procedures and protocols

• Scalable IT strategy that accounts for a high level of interoperability

with EHR, CIS, devices and medical equipment

• Workflows, processes, policies and procedures designed for

telemedicine and standardized across the enterprise

• Policies defined for security and regulatory compliance

0

Provider education and e-consults

67% currently do or will support provider

education through telemedicine

technologies

92% have VTC capabilities; of those,

81% use VTC technology for

educational purposes

• The use of telemedicine technologies, including video conferencing,

to support clinician / provider consults and education (GME, CME)

77% have secure, high-speed, wireless

internet access to support voice, video

and data capabilities

1

Patient health portal

• Dedicated patient health portal that may include customized health,

wellness or disease management content based on EHR data, if

applicable

• Capabilities may exist for patients to integrate data from mobile

applications into the EMR

35% offer internet sites to support wellness /

disease management

58% offer patient education through

telemedicine with a total of 74%

offering in the next three years

51% of patient education programs are

customized for individual patients

2

Simple synchronous and asynchronous services

• Virtual consults with patients, second opinions, pre- and post-

operative visits, etc.

• Relatively simple patient exam cameras and viewing monitors

• Simple store and forward capabilities that do not require a high level

of technical requirements or infrastructure within a few clinical

specialties

70% have patient rooms equipped with

cameras and other devices that can be

accessed or viewed remotely

67% have exam equipment for remote

patient consults / evaluations

58% use digital cameras to support

telemedicine service

3

54% have viewing monitors for images

and / or video streaming (i.e., technologies

to support synchronous services)

35% have remote presence technologies associated

with independent workflow from a different

location (portable cameras / modules)

• Multiple asynchronous and synchronous services across several

specialties / sites to support care for various levels of patient acuity

• Specialized cameras with remote capabilities (PTZ features)

• Integration with numerous medical equipment/devices

• Two or more complex synchronous services (e.g., telestroke, eICU

or trauma consults)

Complex synchronous and asynchronous services 4

Remote monitoring

54% have remote monitoring or mobile

devices for patient use

37% use patient supported remote monitoring

through telemedicine with a total of 51%

offering in the next three years

• Remote monitoring of patients at home

• Home medical equipment capable of transmitting basic clinical

data; may include messaging and webcam to support patient to

clinician visits

• Medical equipment dispensed by the provider as part of the care

treatment plan

61% use telemedicine to provide ongoing care

to avoid a hospitalization or re-

admissions for a chronic illness

5

Services across the care continuum for multiple specialties

30% deliver care through telemedicine

at all points on the care continuum

14% offer telemedicine services

across 60% of clinical specialties

• Portfolio of telemedicine services across the entire care continuum

• Telemedicine services offered by at least 60% of clinical

departments

• Highly integrated care delivery approach that is regularly used for

ongoing patient management (e.g., psych / behavioral health)

7% Offer real time intra-procedure or

operative consults

6

Full interoperability to include patient generated data

• All medical device data is transmitted, analyzed and accepted into

the EHR (internal)

• Ability to exchange data with external organizations such that it

appears as primary data

• EHR and ancillary clinical systems interoperability to support

multiple sources of patient data

• Ability for patients to self-report and track health or lifestyle data to

support customized programs; data is analyzed and contained

within the EHR as primary data

7

Where do you begin or re-start?

Gather intelligence

Innovate and define strategy

Design the program

Stage and sequence

1

2

3

4

Limitations

• Not a formal certification or assessment of the quality or outcomes of a

telemedicine program

• Not an accreditation or credentialing process for telemedicine related to

quality in care delivery

• A high level of maturity is not a guarantee for meeting a certain clinical

quality and outcome standards

• Does not incorporate external factors such as reimbursement, legal and

regulatory federal and state policy as an indicator of maturity

Questions

Contact Information

• Natasa Sokolovich • UPMC

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