Reaching Out With Telehealth

Lloyd SirmonsExecutive Director

Alabama Partnership for Telehealth

Can you imagine what healthcare would be like if…• Clinical care was available anytime and anywhere• Clinicians could obtain consultations with medical

centers of excellence anytime and anywhere• Home bound patients could be monitored

remotely anytime and anywhere• Medical education programs were available

anytime and anywhere

This is the potential of Telehealth!!!

What is Telehealth

Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.

APT

Alabama Partnership for TeleHealth, Inc. (ATP), is a 501(c)3, nonprofit corporation, with a focus on increasing access to healthcare through the innovative use of technology.

Business Model

• 501(c)3 – Not for Profit

• Network of Partners

• Services Provided:• Field-Based Telehealth Liaisons

• Support for Credentialing

• Scheduling System• Centralized PACS System• 24/7 support for network partners

The Need for Telehealth

• Clinician shortages• Rural/Urban underserved• Aging population• Administrative meetings• Clinical education programs• Travel time• Delayed treatment

The Need for Telehealth• Healthcare providers are coming under increasing

pressure to improve the quality of care delivered to patients while decreasing the cost to provide this improved care.

• As the population ages and chronic disease explodes, the healthcare delivery system will be forced to treat larger numbers of patients with fewer and limited resources.

• The main DRIVERS behind the expanding application of telehealth:1. the desire to improve healthcare services for all, especially

in rural areas and 2. the need to decrease costs and increase efficiencies while

improving workflow.

Telehealth Applications

• Hospitals• SNF (Skilled Nursing Facilities)• Clinics• Schools• Corrections• Physician’s Office• Remote Patient Monitoring• Pharmacies

Barriers to Telemedicine

• Reimbursement• Physician buy-in• Infrastructure and Hardware costs• Limited bandwidth• Program Sustainability• Resistance to new technology• Political agendas that can derail

progress and health system reform

Telehealth ReimbursementMedicaid and private insurance coverage

Medicaid

Private insurance

No required coverage

Ethics in Telemedicine

• Security & Confidentiality• Diminished level of care• Overuse or Abuse

– Doctor shopping

Not For Everyone/Everything

Telepharmacy Services

• drug review/monitoring• oral and sterile compounding verification • medication therapy management (MTM)• patient assessment• patient counseling

Evaluating The Impact of Telepharmacy byPhilip J. Schneider, looked at the Impact of remote pharmacist review of medication orders in three small community hospitals

A longitudinal study was conducted in three community hospitals without 24-hour pharmacy services before and after the implementation of telepharmacy services. Override reports from automated dispensing cabinets were reviewed. Charts were reviewed for errors and potential adverse drug events. Pharmacist interventions during times when the pharmacy was closed were evaluated. Cost estimates were based on a proprietary intervention tracking program. Surveys were administered to staff nurses and pharmacists to assess concerns about medication-use, safety and job satisfaction.

The number of times that nurses obtained and administered medications without pharmacist review declined by 35.3% after implementation of the telepharmacy service. There was a significant reduction in the percentage of high-risk medications obtained without a pharmacist review. Three potential adverse drug events were discovered before implementing remote order review versus none in the postimplementation period. The number of pharmacist interventions increased from 15 to 98 per week after implementing remote order review by pharmacists. Estimated cost savings resulting from preventing, identifying, and resolving medication-related problems were $261,109 per hospital in total cost saved or avoided. Nurses’ survey scores reflected increased comfort with the medication-use system, patient safety, and job satisfaction.

Remote review of medication orders by pharmacists when the hospital pharmacy was closed decreased the number of potential adverse drug events reported and improved job satisfaction among nurses.

http://www.ajhp.org/content/70/23/2130

“The best cure for a sluggish mind is to disturb its routine.”

William H. Danforth

Lloyd SirmonsExecutive Director

912-337-6183lloyd.sirmons@alabamatelehealth.org