Maximizing Provider Time Using Distance Learning Telemedicine Technology

1. Maximizing Provider Time Using Distance Learning Telemedicine Technology Charles Clark, Jr. MD Jennifer Baron, BS Rita Riddle Adam Bonaventura, MHA

3. Mission Consistent with the mission of the Indiana University School of Medicine, the mission of the Division of Continuing Medical Education (CME) is to implement and evaluate a variety of learning programs to physicians and other health care professionals in Indiana and beyond, utilizing activities and materials that implement sound educational practices that enhance performance in medical practice and improve healthcare outcomes.

4. FY08-FY09 Goals • Develop strategic partnerships within the IUSM practice community and with outside agencies, such as Indiana Health Information Exchange (IHIE), Anthem and Excel, regarding Performance Improvement initiatives to improve patient outcomes and promote high quality care in Indiana using actual physician practice data. • Identify methods to assess changes in outcomes measurements using benchmarked baseline and ongoing performance data. • Incorporate practice and epidemiologic data within CME course content to enhance our ability to meet the needs of practicing physicians. • Expand web-based distance learning opportunities so that physicians can access our programs locally, nationally and internationally. • Foster relationships with pharmaceutical and medical device companies, and state and federal public health sources to advance our educational and educational research activities, increase grant funding and diversify revenue sources. • Develop and implement a more robust web site and marketing presence.

6. Education Process IDENTIFIED NEEDS PURPOSE OR OBJECTIVES DESIRED RESULTS INSTRUCTIONAL DESIGN

8. Levels of Outcome MeasurementNew Model • Level 1 – measures participants’ initial reactions and satisfaction with the program. • Level 2 – measures participants’ perceptions as to meeting objectives, acquiring skills, intentions to make practice/behavioral change. • Level 3 – participants acquire necessary information to make appropriate practice/behavioral change as evidenced through and post testing learning gains. Participants make actual changes in practice/behaviors that can be linked directly to the program. • Level 4 – patient health improves, practice-by-practice, as evidenced by chart reviews and measurable improvements in patient health data. • Level 5 – patient populations’ health and outcomes improve unilaterally throughout a broadly measured patient population.

9. Summary • Work collaboratively with others involved in training physicians such as: - other educators - professional leaders - medical societies - State Department of Health • Move away from information transmission to other design options such as: - Performance Improvement (PI) - Point of Care (POC) - Skill workshops - OSCE (Objective Structured Clinical Examination)

10. Summary (cont.) • Understand the relationship between CME and CQI - Train physicians in the principles of CQI - Maintain close contact with health systems with regard to QI initiatives - Use CQI techniques. CME needs assessment, evaluation and outcome measurement - Access clinical guidelines from AME & AHRQ - Make CME content responsive to competencies

11. Breaking Down Barriers Distance learning is a cost effective way for health care providers to participate in educational conferences

12. Building a Bridge In 2008 Clarian Telemedicine broadcast 289 educational events Drive miles saved by Indiana physicians: > 68,000 drive miles Approximate cost savings at the pump: $30,672

13. Pluses Live and interactive two way communication Promotes group interaction CME credit for attending Minuses Have to arrange schedule to attend at a certain time Room and equipment scheduling High level of IT support Point to Point Video

14. Web Meetings • Allow for ease of slide sharing from desk top to desk top • Web based- easily accessed • Can have a combination of technology for two way exchange • Tumor Board – live video & web (PACS) • Child Abuse Case Conference- Audio & web

15. Continuing to Build through Web Streaming • Media (video, powerpoint, ect) delivered over the internet. Synchronized video and slides. • Generally, a website is provided that when clicked on, starts the stream in Windows Media Player. • Web streams can be viewed live during an actual presentation or after the presentation is over as an archive.

16. What will Web Streaming Do? It will allow physicians, nurses and other healthcare professionals (as well as patients and employees) to easily access education/information from IU School of Medicine or Clarian at any time from a location that is convenient to them.

17. Allows events such as grand rounds, weekly conferences and physician group meetings to be viewed on demand from any computer with internet access. Provides full tracking capabilities including the ability to track student/viewer progress thru the content. Will interface with eLMS as well as CME Tracker for comprehensive tracking of CME and CEU credits for providers. Has (optional)pay-per-view capabilities allowing a care provider to be charged for CME or CEU credits if required. Can add quizzes and surveys to presentations and track participant scores. Full editing capabilities allow for editing of any section of a presentation and even allows for PP slide replacement that is seamless. Functionality Assessment

18. Making it happen Manage Expectations • Scheduling guidelines • Prioritize requests • Communication plan • Pilot planning

19. Making it happen, cont. Behind the scenes • Editing • Branding • Quizzes • Reporting

20. Making it happen, cont. Three Phase Process Pilot Phase Phase 1 Phase 2

21. The User Experience • Clarian Users • IU CME Users • Includes all health professionals • Public Users

22. The User Experience From spider web to web friendly experience

23. The User Experience

24. Questions and Answers