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Best Practices for Implementing

Acute TelemedicinePaul Wright, MD, MBA

AVP Neuroscience Nuvance Health

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Disclosures

Dr. Paul Wright has no relevant financial or nonfinancial interest to disclose.

Disclosure will be made when a product is discussed for an unapproved use.

This continuing education activity is managed and accredited by AffinityCE in cooperation with SOC Telemed.

AffinityCE and SOC Telemed staff as well as Planners and Reviewers has no relevant financial or nonfinancial interest to disclose.

Commercial Support was not received for this activity.

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Learning Objectives

1. Discuss the common misconceptions regarding telehealth

2. Identify the proper implementation strategies and best practices to enable a smooth transition

3. How quality control is an integral part of implementing telehealth

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Overview

1. N

2. N

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Common Misconceptions

• We can’t do this

• Patients will not like this

• We are not ready for this

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Reality

• Patients do accept telemedicine, especially in an emergency situation

• Properly implemented, telemedicine will enhance patient care and quality

• Even small teams can implement telemedicine successfully

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Myth 1Patients Will Hate This

Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242. Published 2017 Aug 3. doi:10.1136/bmjopen-2017-016242

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Myth 2Physicians Will Hate This

1. Increased Access2. Retain new patients3. Improved work/life balance4. More efficient use of time5. Enhances doctor-patient relationship6. Increase recruitment

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Myth 3We Can’t Get Physicians Credentialed

• YES YOU CAN!!!!!

• However………….

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Myth 4The Technology Isn’t Good Enough

• Mobile/Available at Bedside• Long Hour Battery Life• SNF Friendly• Hydrolic Assist• Large WideScreen Display and Premium Sound• 1080P High Definition Camera with Zoom• Robust Platform

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Myth 5It Is Not Legal

• 1. Licensure: Most states require physicians to be licensed in the state where they are practicing and seeing the patient.

• 2. Physician-Patient Relationship: Many states prohibit use of telemedicine services before a physician-patient relationship is established through an in-person examination.

• 3. It is not private: Telemedicine heightens the risk of a data breach or other unauthorized disclosure. As such, for any telemedicine delivery system, a covered entity should ensure that it signs a business associate agreement with the vendor and ensure that the vendor is using fully encrypted data transmission, secure networks, and all other technical safeguards required under HIPAA.

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How Telemedicine Implementations Go Wrong

Leadership

• No direct involvement

• No goal setting

• No buy-in

• No change management savvy

Technical Planning

• IT not involved early enough

• Outdated Equipment/Redundant Equipment

• Lack of integration between systems

Clinical Planning

• Existing workflows ignored

• No emphasis on training

• Entrenched thinking about telemedicine

• Past poor experience with telemedicine

Communication

• Not early enough

• Not clear enough

• Not repeated enough (and repeated)

• No gate-check to see if understanding was achieved. Teachback

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• Driven by

Leadership

• Goals Developed

and Communicated

• Understanding of

change

management

• Get Buy-In

Leadership

How Telemedicine Implementations Go Right

What does Leadership look like?Positive attitudeEngagingSets the visionSees “the big picture”CompassionateBreaks down complexityStays positiveManages conflict and crisis with easeFocuses on results

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• IT involved from the

beginning

• Have a plan for

updates and

upgrades

• Don’t take

connections for

granted, i.e., Wi-Fi

Technical

How Telemedicine Implementations Go Right

What are the important technical considerations?

Is the Wi-Fi infrastructure adequateIT engagementNeed point personContingency plan

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• Integrate

telemedicine into

existing workflows

• 100% Training and

plan for continual

training

• Work to change

mindsets; listen

first, have the team

bring solutions

Clinical

How Telemedicine Implementations Go Right

What are the important clinical considerations?Have presence in roomPerform mock sessionsChange work processes from feedbackContingency plan

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• Routine meetings

• Develop metrics

• Set goals

• Performance

improvement

Quality

How Telemedicine Implementations Go Right

How is quality measured?

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• Know your why

• Communicate your

why

• Work not just to be

heard but to

achieve

understanding

• Communicate

failure and success

Communication

How Telemedicine Implementations Go Right

What does great communication sound like?Clear and conciseFriendlyNon verbal queuesTeach backProvide patient stories

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How quality control is an integral part of implementing telehealth

Create the workflow that is appropriate for your organization

Facets of Quality Control

• Time from Activation to on Screen

• Reporting time

• Audit reports

• Reporting on physical appearance

• Patient satisfaction

• Physician Satisfaction

• Nursing satisfaction

• Point 1

• Point 2

• Point 3

• Point 4

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Best Practices for Implementing Telemedicine

Summary

• Credential Staff

• Include everyone in your plan

• Have a fail safe plan for downtime

• Encourage local control

Picture of “Best Practice” on a file folder

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Questions

Paul Wright, MD, MBAAVP, NeuroscienceNuvance HealthEmail: Paul.Wright@NuvanceHealth.org

Thank you

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To Claim CE Credit

If you would like to receive continuing education credit for this activity, please visit:

https://soc.cds.pesgce.com

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OPENING REMARKSHammad Shah, CEO

Now: Networking Break

Next: Leadership Made Simple But Not Easy: Achieving Cultural Transformation in Healthcare

Dr. Michael Zappa, President, Highsmith-Rainey Specialty Hospital

Chief of Emergency Services & Assoc. Chief Medical Officer, Cape Fear Valley Health