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Bringing healthcare
to the patient
Marsha WaindRegional Services &
Telemedicine
Altru Health System1 tertiary hospital11 regional clinics
50 % of
hospital
inpatients
are
discharged
back to
rural area
outside of
Grand
Forks &
EGF
Patient
services
depend on
connectivity
– FAST
connectivity.
Clinical
services are
impacted
when
connectivity
is disrupted
Altru supports the regional health care network
• Epic Affiliate for 8 regional Critical Access Hospitals (CAH)
• Epic Everywhere-health records for Epic network
• Pacs hosting & teleradiology---BIG FILES
• Telepharmacy for 9 regional CAH’s
• Telestroke care
• Regional Dialysis Centers: Roseau, Crookston and Devils Lake
• Home Health Care & Hospice
• Regional Therapy Services: 80 PT,OT, SLPs
• Remote Patient Monitoring
According to HIMSS Analytics:
Network reliability and availability are key contributors to success at rural healthcare organizations
Larger organizations looking to leverage remote examinations and consultations
Broadband is a social determinate of “Health”
Healthcare Information and Management Systems Society
Connectivity Advances the Quadruple Aim of Patient Care
Patient experiencePopulation HealthCare Team Well-BeingReducing Costs
Telemedicine specifically is driving organizational strategy to improve connectivity. Why? improve patient experience tap into previously unavailable
experts to drive an evidence-based approach to care
reduce costs
Patients have choices
Expanding telemedicine technologies is a future focus of connectivity for rural facilities and rural patients
Rural Mid-West Healthcare Realities
• Clinical shortages
• Misdistribution of providers
• Rural/urban underserved
• Aging Population
• Travel time, cost & hardships
• Delayed treatment = increased healthcare costs
BARRIER TO SERVICES
Primary obstacles to overcome to improve network connectivity
1. Implementation cost
2. Lack of services to the area
Bring Healthcare to Patient?
Kittson 66%
Roseau 62%
Marshall 34%
Norman 37%
What is Telemedicine?
• The use of interactive audio, video, or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site
• Is delivered over a secure connection that complies with the requirements of state and federal laws
North Dakota State Law SB 2052 Telemedicine Parity
Altru Telemedicine Strategy
• Patient care strategy is to efficiently provide services using the technology available to increase access and improve health
• 2018: will keep smaller community clinics in Fertile, Red Lake Falls and Erskine open using Telemedicine
Strong Broadband is essential to this strategy
Altru Telemedicine sites
• Hospitals
• Rural Clinics
• FQHC’s
• Skilled nursing homes
• Residential centers
• County Jail
• Patient’s homes
0
2000
4000
6000
8000
10000
12000
14000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Altru Telemedicine Encounters by Year
23,520 encounters since 2008
Bring care to the patient
Pocket-sized smartphone connected ECG Patients outfitted with
point of care medical devices referred for care and experience less hospitalization or death
JACC: Cardiovascular Imaging
September 2017 DOI: 10.1016/j.jcmg.2017.06.019
Economics
Increased physician utilization by eliminating more than 400 hours of travel time per year for specialist consultations that can be accomplished remotely
Decreased the need to transfer patients from regional hospitals to tertiary centers with telemedicine inpatient consultations
Reduced patient wait times for specialist appointments and outpatient services
The ROI of Telemed for 1 Clinic
Revenue 1223 encounters Revenue related to Telemedicine encounters
Facility fee $28.00 x 1223 encounters
$34,244.00/ yr
Lab fees kept local as ordered by Telemed*
$5,808/month $69,696.00/yr
Imaging 48 Ortho patients /yr ?
Total $103,940.00/ yr
*only accounts for labs same day as telemedicine encounter
Revenue 3087 Altru Clinic encounters in 2016*
Revenue related to Telemedicine encounters
Facility fee $28.00 x 3087 encounters
$86,436.00/ yr
Lab fees kept local as ordered by Telemed for 1 month April 2016 for 10 clinics*
$5808.00/month $333,352.00/yr
Imaging 48 Ortho patients /yr ?
Total $419.968.00/ yr
ROI for 10 Clinics over 1 year
*5223 total encounters at all locations in 2016
Cost Savings $$$$$$
1 less van ride Van driver; aide; gas/wear
86 yr old transported 2.5 hrs dx: Dementia and anxiety for 15 min visit med check
1 less ambulance ride Driver, aide or 2 What does it cost hospital when they lose out on admit because ambulance is out of town?
Professional Networking and care planning
Invaluable Rural care team and FAMILY is involved in reviewing the behavioral logs, med logs, developing a care plan
Revenue by keeping 1 patient at home in LTC?
$$$$$ Omitting the inpt admit and the med changes and re-acclimated to LTC routine
ROI for SNF or CAH???
Broadband is a “life and death issue for rural America”
“Rural communities that encounter a severe shortage of doctors, aging
populations, and a greater distance to medical experts are in dire need of
easily accessible telemedicine services,” John Windhausen, Jr., executive
director of the Schools, Health & Libraries Broadband (SHLB) Coalition, said
in a letter to U.S. Reps. Greg Walden and Frank Pallone, the chairman and
ranking member of the House Energy and Commerce Committee. “The RHC
program has the power to elevate the health of these communities, but
only if the program is revamped to promote rural broadband.”
SHLB (Broadband Coalition to US House Energy and Commerce Committee
