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Methodology and Approaches to the Implementation of Telehealth ProgramsThe US and State of Hawaii Case Studies
Christina Higa, Co-Director, Pacific Basin Telehealth Resource Center, University of Hawaii at Manoa
0900-1030
@PTCouncil #PTC18
Health
Resources and
Service
Administration
@PTCouncil #PTC18
PRESENTATION OUTLINE
• Telehealth Definitions
• U.S. National Overview
• State of Hawaii
• Approaches & Methods: Department of HealthFamily Health/ Genetic Counseling (in-clinic) Early Intervention Services Model (in-home)School Based Clinic Model (in-school)
• Summary of Key Approaches
TELEHEALTH DEFINITIONS
US NATIONAL OVERVIEW
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TIPPING POINT FOR TELEHEALTH ADOPTIONIncrease in adoption & acceptance:
• Consumer: 64% willing to have a video consult with a doctor* (American Well/Harris Poll study)
• Providers: ~200 telehealth networks, 3500 telehealth services sites
* http://go.americanwell.com/rs/335-QLG-
882/images/American_Well_Telehealth_Index_2017_Consumer_Survey.pdf
Reasons for tipping point:
• Patient wait times: 24 days** to see a doctor in person, 3 mo for specialist in HI, < 3min online
• Direct to consumer concerns, encroaching on local markets
• Health Care Systems embracing TH: disruptive technologies & health care payment reform
• Telehealth cost efficient and improve quality of care
**Merritt Hawkins 2017 Study
* Source: www.cchpca.org
STATE TELEHEALTH LAWS AND POLICIES
STATE OF HAWAI`I
STATE OF HAWAI`ITelehealth Law - Act 226 (1/2017)• Requires Medicaid to cover services provided
through telehealth; • Lifts restrictions on originating site including patient
home or work;• Requires malpractice coverage for telehealth
equivalent to f2f coverage;• Specifically includes store and forward, remote
monitoring, live consultation & mhealth• Does not require presence of two providers and a
patient, appropriately;• Permits provider-patient relationship to be
established via telehealth by referral• (Provider must have Medical License in Hawai`i)• (Federal laws apply for prescription of controlled
substances)
Governor Ige Signs SB2395 into Law
Telehealth to improve health access
Plan: The State of Hawaii lacks
clear objectives regarding
telehealth, this despite recent increasing proliferation of cost-
effective technology and
supportive public policy. The DOH
will work with community to
establish governance and
accountability in assuring
telehealth as a sustainable, if not
preferred modality for specialty
provider shortages, long waitlists for specialists, geographic
barriers, improve access to certain
kinds of care, and to support
specialty consultation to primary
care practices. Community
Paramedics is a developing venue
for Telehealth.
STATE OF HAWAI`I DEPARTMENT OF HEALTH:
TELEHEALTH PRIORITY (2015-2018)
STATE OF HAWAI`I DEPARTMENT OF HEALTH INITIATIVES
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Sylvia Mann, M.S., C.G.C.Supervisor, Genomics [email protected]
Work Force
Development
Continuous
Evaluation
Infrastructure
Implementation
FAMILY HEALTH DIVISION
Overarching Goal: By July
2020, 100% of programs use
telehealth to provide services
and education for families and
providers.
Develop a framework for
Family Health Programs to
reach goal
Partner with PBTRC & others
Build on the successes &
experiences of tele-genetics
Family Healthservices for infant,
children, families,
including special
needs: newborn
screening, genetic
counseling, prenatal,
child development,
etc.
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Workforce Development: Telehealth Training
In Person:• Target: Administrators, Providers, IT Support
• 1-Day Training
• Protocols
• Policies
• Technology
• Telepresense
• Simulated Case Studies/ Practice
Online Modules:• Introduction to Telehealth and Telemedicine
• Clinical Applications Overview
• Telehealth Technology
• Facility Design
• Telepresenting Best Practices
• Telehealth Applications
• Telehealth Policy and Legal Issues
• Business Models in Telehealth
• Telehealth Project Planning
• Telehealth in Practice for Public Health Activities
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EARLY INTERVENTION SERVICES (EIS) PROGRAM
• EIS Population: Infant – 3 Years Old & Families
• Federal/ State Mandate
• Developmental Concerns
1. Physical (sits, walks)
2. Cognitive (pay attention, solve problems)
3. Communication (talks, understand)
4. Social or emotional (plays with others, has
confidence)
5. Adaptive (eats, dresses self)
• Services: Wide Range from audiology, nutrition,
physical therapy, speech therapy, to vision, focus on
building capacity of family members
Overarching Goal: Meet Federal
Office of Special Education, System
Improvement plan (quality and
access of services)
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Use Case• DOH Primary Service Provider(Home-Visits)
• Telehealth connection with Specialist
Approach• Attend Family Health Service initiated
telehealth training (online and in person)
• Establish a TH working group: program
manager, primary service providers, care
coordinators, specialists, TH SMEs (PBTRC) and
‘family advocate’ representative
• Develop Protocols
• Pilot & Evaluate
• Scale Up
Protocol Content:• Introduction to TH
• Sharing TH With Families
• TH in the Individualized Family Support Plan
(IFSP)
• Technical Requirement and Equipment
Needed
• Setting Up Zoom Video Telecon
• Guidelines for Primary Service Provider (PSP)
or Care Coordinator (CC) in the Family’s Home
• Guidelines for Therapist Providing “Remote”
Consultation
• Basic Trouble Shooting: At a Home Visit
• Basic Trouble Shooting: At the Program Office
• Securing the Device in the Field, HIPAA
EARLY INTERVENTION SERVICES (EIS) PROGRAM
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DOE/DOH/FQHC COLLABORATION
Hawaii Schools & Telehealth
• Nurse Aids – Not qualified to administer meds
• FQHC school based health centers (2 Waianae & 1 Kahuku)
• DOH Chronic Conditions, Family Health Framework for TH
Opportunity
• Expand to other uses: diabetes,
Individualized Education Plan
(IEP), etc.
Use CaseCurrent Asthma Situation: School is
cutting the grass today, causes Asthma
attack for child who uses her inhaler;
must report to the nurse aid office;
must be sent home; parent take off
work, child miss school
Telehealth: Teleconsult between
student and RN at a school based health
clinic; digital stethoscope, video
interview; student stays in school
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SUMMARY OF APPROACH TO IMPLEMENTATION OF
TELEHEALTH PROGRAMS• Buy-In at all levels (overarching vision &
workflow)
• Planning, Planning, Planning Wide Involvement
• Training – leverage, modify existing frameworks
• Partner within Department and outside (PBTRC)
• Pilot: infrastructure, administration, human
behavior
• Establish evaluation metrics during the planning
of the program and measure, evaluate, modify
• Then…Scale Up.
Mahalo for your time!