Richard Strozewski

SCI/D Telehealth Program Specialist/Telehealth Master Preceptor

Louis Stokes Cleveland VA Medical Center

 Spinal Cord Injury/Disorders (SCI/D) Service

BUILDING A SYSTEM FOR

RAPID DEPLOYMENT OF

FISCALLY SOUND TELEHEALTH TECHNOLOGIES

FOR ALS PATIENTS

Contact Information

 

Phone: (216) 791-3800 ext. 4702

E-Mail: Richard.Strozewski@va.gov

Alternative E-Mail: ALS-Veteran-Assist@technologist.com

Disclosures

• Commercial Support was not received for this activity.

• Richard Strozewski has no financial interest to disclose

 Presentation Learning Objectives

• Definitions of Telehealth/Telemedicine.

• Making a Business Case – The Financials behind using Telehealth for ALS Patients.

• Developing a Telehealth Technology Matrix - The different telehealth technologies and deciding which technology will work best.

• Building a working Telehealth System – Installation, security and support issues.

• Making Your Telehealth System Work – For your patients and for your practice.

Question (Raise your Hands)

How many are VA Employees?

How many are Non-VA Hospital Employees?

How many are in Private practice?

Telehealth/TelemedicineDefinitions and

Distinctions

Telehealth

The use of electronic information and telecommunications technologies (ICT or E/ICT) to support long-distance clinical health care, patient and professional health-related education, public health and health administration, all in the interests of advancing the health of individuals and their communities”

Telemedicine

• Term coined in the 1970’s

• Literally “HEALING AT A DISTANCE”

• The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (WHO Definition)

4 Elements

• Its purpose is to a provide clinical service.

• Overcome geographical barriers, connecting users who are not in the same physical location as their provider.

• It involves the use of various types of ICT.

• Its goal is to improve health outcomes and/or Quality of Life.

The Financials behind using Telehealth for ALS

Patients

50 states - 90 sets of rules

What are telehealth parity statutes ?

Laws that require private insurers to cover telemedicine services if those same services are covered when provided in-person.

Current Status of Telemedicine Parity Statutes.

• Currently, 17 states have telemedicine parity statutes in place,

• 13 states have legislation pending regarding telemedicine parity for private insurers.

• The vast majority of Medicaid programs (47 states) do cover telemedicine services for their beneficiaries, although coverage is usually limited to those services provided via live interactive communication and/or have geographical limitations. 

• Other Medicaid programs expressly cover remote monitoring services (Telehealth). (While these statutes require coverage, many don’t mandate the same level of reimbursement for telehealth as those services provided  face-to-face.)

Making a Business Case

• Reduced costs

• Reimbursements from Medicare; Medicaid; the Children's Health Insurance Program; TRICARE and Private Insurance companies regulated by the Affordable Care Act.

• Improved Customer Communications and Customer Service

• Increased Throughput

• Additional Services

• Inter-State Licensing

• Plan on a long term ROI

Developing a Telehealth Technology Matrix:

The different telehealth technologies and deciding which

technology will work best.

The Basics

Synchronous – Live and Interactive

Asynchronous – Delayed Interaction

Synchronous

ExamplesVideo Visits

Telephone

Online Interactive communications

AsynchronousExamples

Store and Forward technologies

Electronic Medical Records

Readings from home biosensor instruments connected to a personal computer transferring data to a home telemedicine web site.

Building a working Telehealth System –

Installation, security and support issues.

• HIPAA Requirements are the same as “in-Person” visits

• Telemedicine clinicians have the same duty to safeguard a patient’s medical records and keep their treatments confidential.

• Use common sense.

• Storage of electronic files, images, audio/video tapes etc., needs to be done with the same precaution and care ascribed to paper documents.

• Set your protocols to be compliant

• Follow your protocols

• Document that the protocols have been followed

• Never, Never use open Internet connections.

• Ask the question “Is my carrier HIPAA Compliant”

• Do they have documentation to prove it

• CYA yourself with Patient Informed Consent

Rules – Security

•Don’t fret the Tech

•Work with a technologist who understands Clinical Processes, Clinicians and Patients.

• Schedule internal installation during off.

• Test, Test, Test before you bring patients online

Rules – Implementation

• Stick with a single Vendor for supporting you entire telehealth operation

• Your office, your network, your software and your patients

• Have a single point of contact.

• Have a tight, well defined Service Level Agreement.

• Have a Plan B.

Rules – Support

Making Your Telehealth System Work

For your patients and for your practice.

• Be confident in the technology – do not try to out-think it

• Be confident in your support structure

• Consider your support staff your partners in success.

• Use it in appropriate circumstances when there is a benefit to the patient

• Not just because it is there

• If using video , Learn how to talk in front of a camera.

• Do not make is stressful for patients.

• Don’t Fret the Tech

Telemedicine and Telehealth

are A Means to an End

And Now The Commercial

Ask your patient if he or she is a Veteran,

If they are,Referring them the local

Veterans Health Administration facility

could be one of the best services you could provide to them…

Richard StrozewskiLouis Stokes Cleveland VA Medical Center

 Phone: 216-791-3800 Ext: 4702

VA-Email: Richard.Strozewski@va.govAlt. Email: ALS-Veteran-Assist@technologist.com

Questions?