Home Telehospice: The Benefits and Barriers of Program Development

1. Home Telehospice: The Benefits and Barriers of Program Development Hosted by the Hospice & Palliative Care Association of New York State, May 23, 2006 Panel: Audrey Kinsella, Kim Anderson, Gina Banks, Micha Lee Post Contact: Audrey Kinsella, telehealthcare@lycos.com Kinsella and expert team, Home Telehospice

2. TELEHOSPICE First of all, what is telehospice and what can it do? • It’s the increased use of communications (the tele component) by the hospice team members to provide hospice services for end of life patients and their caregivers. Four essentials for effective program management: • 1. Telehospice service tracking and telehospice care planning • 2. Addressing legal issues/Obtaining informed consent • 3. Training staff and obtaining staff buy-in • 4. Assessing patients and caregivers as appropriate for assignment to telehospice Kinsella and expert team, Home Telehospice

3. TELEHOSPICE Why Do It? Let’s start with what we know… the barriers to providing plain vanilla or conventional hospice services. Kinsella and expert team, Home Telehospice

4. Barriers, in a nutshell: • Nursing shortages • Distances from hospice team to patient • Knowledge about hospice & ease of making a good fit with patients Bottom line: We need to overcome these barriers to provide comfort care services to dying patients and their in-home caregivers. Kinsella and expert team, Home Telehospice

5. Introduction to Telehealth Tools for Telehospice: A brief list…: • Telephone. Also telephone and telecommunication-ready blood pressure cuff, to track changes. • Full-scale telehealth workstation. As needed. • Videophones, for show-and-tell purposes. • Pre-programmed devices for clinical care– e.g., infusion pump for pain management and other needs. • Video/audiotapes for show and tell purposes, particularly for family caregivers to reinforce nurses’ in-person directives for providing needed comfort measures. • Not PERS but tools for clinical management and interaction Kinsella and expert team, Home Telehospice

6. Most familiar tool of telehealth:The telehealthcare workstation Kinsella and expert team, Home Telehospice

7. Range of Tools: We Must Match the Tools as Needed Kinsella and expert team, Home Telehospice

8. Lower Tech Tools Kinsella and expert team, Home Telehospice

9. Still Other Lower Tech Tools… Kinsella and expert team, Home Telehospice

10. We can Make quicker assessments as a result of reviewing telemonitored patient information Provide more timely interventions– for pain management, for example Provide more teaching opportunities for in-home caregivers Take note: We’re not choosing it over conventional care but using it to extend on that good work! Four essentials for effective program management: 1. Telehospice service tracking and telehospice care planning 2. Addressing legal issues/Obtaining informed consent 3. Training staff and obtaining staff buy-in 4. Assessing patients and caregivers as appropriate for assignment to telehospice Why Use Telehealth & What Should We Expect? Kinsella and expert team, Home Telehospice

11. Financing Telehospice: Reports from Two Program Builders • Kim Anderson, RN, CEO, Rural Health Care Advantage, Inc., Chariton, Iowa • Micha Lee Post, Telehealth Business Analyst, INTREGRIS Telehealth, Oklahoma City, Oklahoma Kinsella and expert team, Home Telehospice

12. “Telehospice: The Benefits and Barriers of Program Development” • Kim Anderson, RN, CEO • Rural Health Care Advantage, Inc. Hospice, Chariton Iowa Kinsella and expert team, Home Telehospice

13. Financing Programs & AchievingSustainability Building a program: Why are telehospice programs needed? Why should a telehospice program be implemented? How do I finance a program? Kinsella and expert team, Home Telehospice

14. Why is a Telehospice Program Needed? • Efficiency/ROI • Gives the primary caregiver a tool to evaluate symptom management in a more timely mannor • Can be there when needs to be there • Better outcomes at EOL • Increased nursing productivity R/T potential decreased visits, decreased mileage, and decreased drive time. and more reasons still… Kinsella and expert team, Home Telehospice

15. Why is a Telehospice Program Needed…. • Caregiver shortages • Rural areas not only have a shortage of caregivers on a professional level but a lay person level as well • Caregivers in the home cannot leave for support groups as no one to replace them, telehospice gives them a communication tool • Daily vital statistic to better careplan for your patient and family for better outcomes • Comfort measures/peace of mind Kinsella and expert team, Home Telehospice

16. Why Should a Telehospice Program Be Implemented? • Basic nursing care and symptom management is the cornerstone of Hospice, by receiving data on a daily basis, the nurse can careplan for better outcomes at end of life with the patient receiving dignity and respect with quality of life thruout the process. • Basic Telehealth: Phone Monitoring • Most basic type of telehealth. Phone monitoring is the scheduled remote care delivery or monitoring in which scheduled patient encounters via the telephone occur between a health care provider and a patient and/or caregiver. • Phone monitoring does not use electronic information processing technologies. Kinsella and expert team, Home Telehospice

17. Complex Telehealth: Telemonitoring/Vital Sign Measurement • Includes the collection of clinical data and the transmission of such data between a patient at a distant location and a health care provider through electronic information processing technologies. • Collection includes weight, blood pressure and heart rate… • The provider conducts a clinical review of the transferred data and provides a response relating to such data. Kinsella and expert team, Home Telehospice

18. Advantages of the Program • Decrease Health Care Costs • Consistent Routine Vital Statistic readings • Improve Medication Efficiency • Decrease Hospitalizations • Improve Individual Disease Management • HIPPA Compliant, FDA Approved Kinsella and expert team, Home Telehospice

19. How Do I Finance a Program? • The business considerations for a telehospice program can be explored by developing a business plan. • Need for telehospice services • Cost/reimbursement/expense reduction • Agency size and resources • Size and specifics of targeted population Kinsella and expert team, Home Telehospice

20. The Business Plan and Its Components: • Executive Summary-a brief and succinct summary of the entire plan • Program Description-including type of services, how they will be provided, and who will provide them as well as licensing, regulatory, and credentialing requirements • Strategic Plan-describing how telehospice fits within the agency’s mission, vision, and future plans • Financial Plan-including revenue, estimated expense reductions from face to face visits, profit and loss projections… • Management Plan-addressing the agency structure and support system for success and describing how the following occur: education, training, competency, and program evaluations as well as staff evaluation • Marketing Plan-addressing the needs of the local population and existing local competition, includingadvertising strategies Kinsella and expert team, Home Telehospice

21. Barriers of the Program • Technical-Lack of technical knowledge, fear of technology • Economic-Lack of third party reimbursment, agency financial obstacles • Behavioral-Lack of organizational support, inadequate workflow processess • Physician’s buy in • Nurse buy in • Patient buy in Kinsella and expert team, Home Telehospice

22. Benefits, include: Potential Support Interventions • Trended data show improvements or declines in health conditions • Trended data can be faxed to individuals, physicians, or team members • Alert readings offer chance for proactive care Kinsella and expert team, Home Telehospice

23. Benefits to the Program • Comfort peace of mind Cases from Rural Health Care Advantage, Hospice. Kinsella and expert team, Home Telehospice

24. Experiences of Barriers and Benefits at Integris Telehealth, with Grant Getting • Micha Lee Post on the roadblocks and successes Kinsella and expert team, Home Telehospice

25. Grants • Show me the money Kinsella and expert team, Home Telehospice

26. Barriers - It’s not the lottery • Very Competitive • Dedication to requirements • Extensive Paperwork • Matching Funds • Backup Plan for Sustainability • Make sure your company understands grants and what is required. Kinsella and expert team, Home Telehospice

27. Benefits - • Can help with start-up expenses. • Equipment • Salaries • Information & education opportunities. • Opportunity for testing what works. Kinsella and expert team, Home Telehospice

28. Introduction to Gina Banks, RN, NP, CWOCN, CDE, long-time user of telehealth & telehospice • Challenges of obtaining physician buy-in to telehospice…. Kinsella and expert team, Home Telehospice

29. Physician Participation:Leading the Horses to Water • How do you get them to drink? Kinsella and expert team, Home Telehospice

30. First Things First • Your agenda: • Importance of using telemedicine • Their agenda: • no time to learn something new, why change the current system You have to meet THEIR needs, NOT yours Kinsella and expert team, Home Telehospice

31. Before You Get to the Stream Do Your Homework! • Keep it Simple: Quick and easy forms, simple protocols, easy to use equipment • One Size Does NOT Fit All: Know their priorities & preferences, make your system work for them • Practice, Practice, Practice: If you aren’t absolutely comfortable and confident with your system and presentation, you’ll never convince them to use it Kinsella and expert team, Home Telehospice

32. The First Sip • Demo in non-patient situation first if you can • Choose test case carefully • “Problem” (time consuming for them) case • “Pet” (high priority, relative, friend) case • Ask for their feedback & impressions often • Make them your ‘champion’ for the service • Keep them in the information ‘loop’ Kinsella and expert team, Home Telehospice

33. Benefits of Comfort Care Measures Rendered Through Telehospice • A Panel Discussion…. Kinsella and expert team, Home Telehospice

34. Getting the Technology Right • The Challenges/Barriers of Working with Vendors…. • Presented by Micha Lee Post Kinsella and expert team, Home Telehospice

35. Allocating Nurses’ Resources to Time-To-Learn Telehospice, presented by Audrey Kinsella • Learning telehospice: It’s both a barrier– at first and a benefit – eventually We need to provide training to help nurses buy in to the idea of telehospice care. Kinsella and expert team, Home Telehospice

36. Brief Review of Tools • Includes…. • Telephone. Also telephone and telecommunication-ready blood pressure cuff, to track changes. • Full-scale telehealth workstation. As needed. • Videophones, for show-and-tell purposes. • Video/audiotapes for show and tell purposes… But we’re not teaching nurses how to do nursing! Kinsella and expert team, Home Telehospice

37. Teaching Nurses Telehospice • Some differences in learning home telehealth and telehospice. These matter. Kinsella and expert team, Home Telehospice

38. Telehospice Service Delivery Issues • We’re dealing with consumer items, like videophones, and using them for healthcare needs. • We’re using telehealth tools for hospice, not for other kinds of telecare service delivery. Kinsella and expert team, Home Telehospice

39. Videophone/Videocamera Technology Use in Hospice • Issues that require professional training: • Positioning of camera • Assessing pallor, facial expressions • Obtaining optimal lighting • Holding camera steadily…. All of this training takes time and requires experience. There aren’t any quick results. How can we measure any of the results…Draw up telehospice care plans for every patient, for one. Kinsella and expert team, Home Telehospice

40. Telehospice Care Plan Components • Frequency of contact (tele- and conventional) • Frequency of telemonitoring or other telecontact (e.g., instructional videoclips on syringe use) • Duration of contact per “visit” • Duration of use of telehealth equipment (per contact and per admission period) • Dated checkpoints Kinsella and expert team, Home Telehospice

41. The New Frontier of Hospice Care, Telehospice • We’re all finding out what is working with our patients and caregivers, it’s that new. • With telehospice contact, we have the opportunity to increase comfort levels of patients and caregivers, always an important goal in hospice, whatever it takes. • It will always be a challenge and never a fixed formula to find out what works– given the nature of hospice. As one industry commentator, Douglas Smith, notes, what’s certain about hospice is its unpredictability. • With telehospice, we have more tools to do our work better. Kinsella and expert team, Home Telehospice