Best Practices for Telehealth in Palliative Care

1. National Hospice and Palliative Care Organization’sPalliative Care Resource SeriesBest Practices for Using Telehealth in Palliative CareVicki Wildman, MSN, EduTammy Flick, RN, BS, CPEHR, CTCLori Bishop, RN, CHPN

2. Objectives • Define Telehealth • Understand principles for implementing a telehealth program • Describe benefits and challenges of telehealth programs • Identify steps for implementation for various teams

3. What is Telehealth? • Uses medical information exchanged via electronic communications to improve patient’s health status. • Two-way video • Email • Smart phones • Wireless tools

4. What is Telehealth? • Broad range of services includes telemedicine and remotely provided services • Clinical education programs • Patient support and education • Health information exchange • Clinical decision support • Electronic health records and laboratory systems • Disaster response support

5. Telehealth Program: Guiding Principles • Ease of use • Is it intuitive for use by physicians, staff and patients? • Compatibility • Can it interface between multiple end users and facilities, both technically and operationally? • Ability to drive access • Does it increase use of telehealth and utilization of services?

6. Telehealth Program: Guiding Principles • Conforms to industry standards • Does it comply with industry protocols and federal regulations? • Promotes sustainability • Is it cost effective? • Does it contribute to increased revenues or cost avoidance?

7. Telehealth Program: Guiding Principles • Connectivity considerations • Locations • Home/community • Outreach clinics • Emergency departments • Long-term care • Types of Connections • Web-based applications • Remote patient monitoring • Store and forward

8. Telehealth Program: Benefits and Challenges • Expected benefits • Improved access • Real-time • Increase in access to specialists for rural practitioners • Increase in provision of services for rural and remote patients • Cost efficiencies • Reduces cost of care • Timely access to providers • Reduces or eliminates travel time • Improved quality • Timely interventions improve clinical outcomes and patient satisfaction

9. Telehealth Program: Benefits and Challenges • Challenges • Resource capacity to support telehealth • Availability of clinical staff and telehealth support staff • Difficulties using the technology • Demands on clinical time • Integration of clinical information systems • Lack of reimbursement • Physicians reimbursed as if seeing patient in office • Expanded Medicare/Medicaid reimbursement needed

10. Telehealth Program: Benefits and Challenges • Challenges • Lack of funding • Grant funding limited • Access to technology/staff can be costly • Lack of standardized guidelines, management and training • Availability of guidelines, training programs, standardized procedures lacking

11. Steps for Implementing a Telehealth Program:Administrative • Form steering committee • Form core project team • Confirm scope of project • Determine locations for use • Add physician/provider leaders • Develop documentation standards

12. Steps for Implementing a Telehealth Program:Administrative • Determine quality reporting metrics • Set short and long term project goals • Confirm risk management, compliance, licensure issues • Patient consent form • Policy and procedures • Develop patient and staff feedback

13. Steps for Implementing Telehealth Program: Clinical • Determine providers of care and care attendant • Determine set of acceptable diagnosis/visit reasons • Develop workflow for conducting visit • Develop triage protocols • Develop telehealth treatment protocols

14. Steps for Implementing Telehealth Program: Clinical • Develop follow up protocols • Scheduling • Infection control and cleaning of equipment • Engage patients and families in the care process • Compliance with Joint Commission

15. Steps for Implementing a Telehealth Program: Information Technology • Purchase and install all necessary equipment • Ensure necessary software is installed • Set up end user devices • Internal IS/IT resource • Determine wireless needs and settings

16. Steps for Implementing a Telehealth Program: Information Technology • Establish privacy and security protocols • Ensure HIPPA and MOU • Build or align with Help Desk • Test in true end user settings

17. Steps for Implementing a Telehealth Program: Financial • Determine ROI • Secure funding • Establish long term and monthly budgets • Capital expenses • Equipment maintenance • Software licensing • Supplies

18. Steps for Implementing a Telehealth Program: Training and Education  • Develop training module/program • Select ‘super users’ • Schedule and conduct trainings • Perform mock trial sessions • Perform periodic refresher sessions

19. Steps for Implementing a Telehealth Program: Marketing  • Website integration • Community kiosks

20. Resources • 2015 Medicare Covered Telehealth Services: • http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html • American Telemedicine tracks Legislation and Policies for each state • Varies per state • Many bills in play for 2015 for Telehealth Coverage • http://www.americantelemed.org/docs/default-source/policy/state-telemedicine-policy-matrix.pdf?sfvrsn=56

21. Resources • ATA provided gap analysis and grades for each state regarding Telehealth • Grades Include • Coverage and Reimbursement • Physician Practice Standards and Licensure • http://www.americantelemed.org/policy/state-telemedicine-policy#.VJIGsE10xjo