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NRTRC 2018 Telehealth Conference

Conference Information

2018 Conference Sessions

 

A New Model: The Frontier Community Health Integration Project Demonstration (FCHIP)

A New Model: The Frontier Community Health Integration Project Demonstration (FCHIP)


LEARNING OBJECTIVES:

DESCRIPTION: 

The FCHIP demonstration aims to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties in three states with the goal of improving health outcomes and reducing Medicare expenditures. Under a cooperative agreement funded by FORHP, MHREF provides technical assistance to the participating CAHs to assist in achieving the goals of the Demonstration, including creating linkages with tertiary providers, supporting strategic planning to integrate and coordinate services, and lowering overall costs while maintaining or improving quality of care.

The Demonstration is currently in its third and final year. During the first two years, the Critical Access Hospitals participating in the Demonstration faced similar challenges as they worked to develop their Telemedicine programs. This presentation will discuss these challenges and what can be done to address concerns around implementation, integration, and capability when building your own Telemedicine program. There are a number of challenges and hurdles in the early stages of incorporating such technology into every day patient care. Examples of implementation success will be provided as well as key observations and lessons learned throughout the life of the FCHIP Demonstration. 

Speaker:

Kimberly Seligman
FCHIP Technical Assistance Coordinator
Montana Hospital Association

The Application of Telehealth in Education, Clinical Practice and Research

Since 2013, the University of Utah College of Nursing (CON) has been employing telehealth concepts and technology to provide interprofessional education (IPE) to health science students, deliver distant health care to clients in rural Utah, and study the effectiveness of telehealth and tele video conferencing (TVC) in the delivery of health care to rural clients. The purpose of this panel is to present the different utilizations of telehealth at the CON to provide education, patient care and research. 

The first utilization of telehealth and tele videoconferencing (TVC) was to introduce IPE to health science students enrolled at the University of Utah. The students were from nursing, medicine, social work,nutrition, and wellness coaching. Partnership with Utah Telehealth Network (UTN) and utilization of TVC allowed the CON to teach the students and allow them to apply telehealth concepts and etiquette, interprofessional practice competencies, and the quadruple aim model. Students then applied the knowledge by role playing professionals using a case study via TVC. During the simulated case, students were able to apply IPE and telehealth concepts in a safe environment. 

A second utilization of telehealth and TVC occurred when the CON collaborator with Utah Area Education Health Center and UTN to investigate teaching interprofessional health care to health science students enrolled at multiple different state support universities and colleges in one session using Telehealth concepts and TVC. Four students from three different state universities and colleges participated in an interprofessional team to create a plan of care for a simulated case. The students appreciated participating in an interprofessional team utilizing TVC to care for a patient. 

A third utilization was the development, implementation and evaluation of telehealth distant technology to provide grief support group program for grieving persons in underserved rural/frontier communities in Utah.  Caring Connections partnered with Utah Telehealth Network and several hospice organizations serving underserved rural/frontier communities to assist with a web-based platform and multi-point bridge in live synchronous groups sessions bringing together a lead facilitator and group members joining from home (using iPad and appropriate “hot spot” cellular internet devices). This technology benefited remotely located caregivers by increasing access to care and eliminating travel burden. Research is currently begin conducted on the effectiveness of providing support group program for grieving persons in underserved rural/frontier communities in Utah.

The fourth utilization was the development and evaluation of implementing an 8-week facilitated group videoconference intervention and mindfulness-based cognitive behavioral therapy (VCI-MBCBT) on perinatal depression (PD) and anxiety to women with limited access to health care in Utah. The Certified Nurse Midwifes group partnered with Utah Telehealth Network and several behavioral health faculty to provide group VCI-MBCBT one hour, once weekly, for 8 weeks. The women expressed enthusiasm for the group VCI-MBCBT and would highly recommend the program to other perinatal women in need of support.

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Speaker:

Sue Chase-Cantarini, DNP RN CHSE
Assistant Professor (Clinical)
University of Utah, College of Nursing

Susan Hall, DNP, APRN, FNP-C, WHNP-C
Track Director of Primary Care DNP Family Nurse Practitioner
University of Utah, College of Nursing

Avoiding Transfers and Improving Care: TeleHealth Newborn Resuscitations in Community and Rural Hospitals

LEARNING OBJECTIVES:

DESCRIPTION: A panel discussion assessing the use of telehealth technology to improve the delivery of neonatology services to community and rural hospitals throughout Utah, Idaho, Nevada, and Wyoming. Four panelists bring a diverse set of perspectives to the discussion. 

In 2013, a small group of neonatologists, nurses, and respiratory therapists in neonatal intensive care units (NICUs) at Intermountain Healthcare began using webcam-based, secure video connections to augment neonatology consults with newborn bedside teams at level 1 and 2 nurseries. This enabled NICU teams to conduct visual newborn assessments, view live treatments and procedures, and make recommendations to onsite clinical teams. 

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Speaker:

Jordan Albritton, PhD, MPH
Sr. Statistical Data Analyst
Intermountain Healthcare

Taunya Cook, BSN, RNC-LRN
Unit Education Consultant for Newborn Intermediate Care
Intermountain Healthcare

Lory J. Maddox, MSN, MBA, RN
Clinical Manager for Connect Care Pro: Pediatrics
Intermountain Healthcare

Stephanie Merrell MSN, RN
Nurse Manager
Uintah Basin Medical Center

Stephen D. Minton, MD, FAAP
Chief of Neonatology and Medical Director of the Newborn Intensive Care
Utah Valley Hospital

Beginners Guide to Reimbursement & Billing

This workshop will provide an introduction to getting paid for delivering care via telehealth. First, there will be an overview of policies and challenges for telehealth reimbursement by Medicare, Medicaid and commercial payers, including a discussion of the emergence of payer parity laws in several states. This will be followed by the fundamentals of billing for telehealth, including system setup, workflow, completing a HCFA 1500 form, and best practices. Q & A will be encouraged through the session.

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Speakers:

Catherine Britain
Executive Director
Telehealth Alliance of Oregon, CSBritain Consulting

Katie Brown, MBA, CPC, CPC-I
Manager Revenue Integrity and University Medical Billing
University of Utah

Cultivating Physician Engagement while Transforming Rural Healthcare Through Telehealth

LEARNING OBJECTIVES:

DESCRIPTION:

Physician engagement is critical to successful programs in health care, and telemedicine is no exception. According to The Advisory Board Company’s Annual Health Care CEO Survey, hospital and health system CEOs were twice as likely to rate physician engagement as their best opportunity to improve performance compared with other options.  Physician engagement has been proven to improve quality, lower costs and better performance overall, but how exactly does a facility achieve this? 

Setting up a telemedicine program is complex; leaders have to consider technology, reimbursement, compliance, staffing, and much more. Too often the change management or people component of launching programs are pushed to the bottom of a long implementation task list.  New ideas and technologies can create uncertainty and challenge the most innovative and flexible health care organizations.  

In telemedicine, particularly Emergency Room or hospital-based telemedicine, the stakes can be twice as high as there are physicians to engage at both the spoke/originating site and the hub/distant site.  Spoke physicians must have comfort with the technology, see how it benefits their patients and practice, learn to fit telemedicine into their work day, and have confidence that their patients will receive high quality care. Likewise, hub providers must adapt their practice to work effectively with remote colleagues. Managing the change, building trust and demonstrating the mutual benefits of telemedicine are core strategies to gaining physician buy-in.  

Telehealth has proven to be a crucial lifeline in communities served, helping to address workforce shortages, reducing the burden on patients who travel for specialty care, lowering costs and improving patient outcomes. 

Telemedicine redefines healthcare by focusing on new models of care and collaborative relationships. Such strategies have the potential to reshape the health care delivery system to better meet the needs of the nation’s sickest and most vulnerable patients.   

Bedside clinicians are supported in telehealth through the delivery of high-quality care, resulting in earlier patient interventions and improved use of evidence-based medicine. Quality initiatives such as intubation, chest pain, sepsis and antimicrobial stewardship are specific performance improvement (PI) projects that can be monitored through a telehealth program.  

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Speaker:

Darcy Litzen, MS, BSN
Business Development Officer
Avera eCARE

Kelly Rhone, MD, FACEP
Medical Director of Outreach and Innovation
Avera eCARE

Delivering Convenient Care to the Community: Remote Patient Monitoring (RPM) Programs

LEARNING OBJECTIVES:

DESCRIPTION:

Advances in predictive analytics and remote patient monitoring technology enable healthcare provider’s opportunities to better identify patients at risk of hospitalization and proactively manage the health of patients with chronic conditions. This telehealth solution can help reduce costs by better engaging and educating patients, promoting adherence to treatment, and facilitating early intervention to reduce the need for emergency department visits and hospital readmissions. Advances in reimbursement for these services are on the rise which enables these programs to be used throughout a variety of patient populations. The benefits of strong RPM programs are vast and directly impact patient and provider satisfaction, clinical outcomes and access to care. There are a variety of obstacles health system should be aware of when planning for and implementing these programs in order to ensure a sustainable and successful program. This presentation will provide an overview of an existing RPM program detailing outcomes, obstacles and high level workflow design considerations. In addition, value proposition and reimbursement models will be reviewed in order to assist the audience with the development of business cases for RPM.

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Speaker:

Krista Stadler, RN, BSN
Senior Director
Telehealth Services, St. Luke’s Health System


Developing Telehealth Services within a Pediatric Feeding Program at Seattle Children's Hospital to Reach Children and Families with Special Health Care Needs in Their Communities

LEARNING OBJECTIVES:

DESCRIPTION:


The Pediatric Feeding Program delivers interdisciplinary assessment and intervention to children with ASD and related disorders who have avoidant restrictive food intake disorders. Unfortunately, there are various obstacles in delivering services across the state, which result in disparities in access to care. The goals of this telehealth project were 1) to increase access and minimize disparities, 2) to embed telehealth within the continuum of care, and 3) to provide interdisciplinary trainings and support to community providers. We will review outcomes and process.

Speaker:

Danielle N. Dolezal, Ph.D., BCBA-D
Certified Special Education and Early Education Teacher, Child Psychologist, and Board Certified Behavior Analyst at the Doctoral Level
Program Director, The Pediatric Feeding Program at Seattle Children’s Autism Center

Seattle Children’s Hospital

Direct-to-Patient Telemedicine Legal and Regulatory Considerations

LEARNING OBJECTIVES:

DESCRIPTION:

This session will provide attendees with an understanding of the legal and regulatory issues providers must know when engaging in direct-to-consumer telemedicine services. Explore state and federal prescribing laws, fraud and abuse considerations, and online privacy and e-commerce rules essential to compliant direct-to-consumer telemedicine services. Join me to learn about key legal and regulatory issues, ask the questions you’ve been eager to have answered, and walk away with sound compliance strategies and insights regarding implementation.

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Speaker:

Kyle Y. Faget, J.D.
Special Counsel and Business Lawyer
Foley & Lardner LLP

Direct-to-Patient Virtual Follow up Care

LEARNING OBJECTIVES:

DESCRIPTION:

Consumer technology has changed how we communicate, access programs and receive services. Virtual care has become a reality, as patients are now able to access healthcare providers via their personal devices. Offering direct-to-patient services provides new opportunities and challenges on how best to extend care when and where it is needed. This session will explore decision points for implementing a direct-to-patient program, review workflow for follow-up care in a primary care setting, discuss technology requirements and HIPAA concerns, and consider the value of certifying patient technology prior to receiving virtual care.

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Speaker:

Tammy Arndt
Director
Northwest TeleHealth (NWTH)

Federal & State Telehealth Policy Trends in the NRTRC Region: Reimbursement, State Compacts, and other legal and regulatory topics

LEARNING OBJECTIVES:

DESCRIPTION:

This presentation will provide attendees with the latest information on federal and state telehealth policy, including reimbursement, legal issues, and substance use disorder policies.  A special focus will be paid the states in the NRTRC region with specific information related to those states’ individual telehealth laws, regulations and policies.

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Speaker:

Mei Wa Kwong, JD
Executive Director
Center for Connected Health Policy Brief

Funding Broadband and Telehealth: An Introduction to Federal Funding Programs

This workshop will review the most common funding opportunities for the telehealth community. We’ll take a close look at three programs: USAC Rural Health Care programs for broadband discounts, USDA RUS Distance Learning & Telemedicine grants for equipment, and HRSA Office for the Advancement of Telehealth for program grants. Other funding sources exist but remain a little more hidden. Tips for submitting successful applications and links to resources will be provided.

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Speakers:

Deb LaMarche
Program Director and Principal Investigator
Northwest Regional Telehealth Resource Center
Associate Director
Utah Telehealth Network (UTN), a service of the Utah Education and Telehealth Network (UETN)

B. Keith Price
Director, Community Programs Rural Development
U.S. Department of Agriculture (USDA)

Guiding Your Organization Telehealth Change: The Intermountain Healthcare Experience

LEARNING OBJECTIVES:

DESCRIPTION:

Telehealth programs have the potential to help providers and healthcare organizations improve patient access, lower healthcare costs, and improve provider satisfaction and productivity.  However, implementing a telehealth program requires more than a business plan and a slick technology.  Intermountain Healthcare has implemented numerous successful inpatient and outpatient telehealth programs.  In this presentation, we will review the business and clinical motivations for developing telehealth capabilities.  We will review clinical, operational, and cultural changes providers and organizations must go through to help telehealth programs succeed.  We will review how telehealth program development specifics, including how to define and measures success, how to translate high quality in-person care to the telehealth environment, and how to engage providers in telehealth delivery. We will review how Intermountain prioritizes telehealth programs and links telehealth care with in-person care. Finally, we will review how telehealth leaders can incite, drive, and lead change efforts within their organizations.

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Speaker:

William Daines, MD
Medical Director, Intermountain Connect Care
Intermountain Healthcare

How to Find the Perfect Telehealth Specialty Service Provider

This presentation illuminates a series of questions (up to 18 now) that primary care clinics should ask specialty service providers before signing a service agreement.  Finding a provider that can meet the needs of your patients and providers and has a business model that meets the needs of your organization is the key to success. Contracting with specialty service providers is more than just asking “how much do you charge” and “are you board certified in your specialty”.  When we add telemedicine into the mix, we need to think of the other questions, such as “what level of provider is required to be in the room during the consult”, “what is your no-show policy”, “what type of equipment do I need in the exam room to accommodate your specialty”  “can you teach my staff the proper patient presentation techniques required by your specialty”, “how will medications be handled” “is your model direct care or consult only”, etc. All of these questions and more will be presented along with the logic behind asking each question.

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Speakers:

Kathy J. Chorba
Executive Director
California Telehealth Resource Center

Maximizing Clinical Effectiveness Over Live Video

Using live video effectively requires a basic knowledge of the elements that go into creating high quality audio and video, the fundamentals of video etiquette, and simple ways clinicians and others can maximize their professional image and the clinical effectiveness of their video presence.  This presentation will provide interactive demonstrations and clinical vignettes to help participants understand and experience some of these elements first-hand in ways that will help them increase the effectiveness of live video work of all kinds.

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Speaker:

Jonathan Neufeld, PhD
Program Director
Great Plains Telehealth Resource Center

Quality, Technology and Rural Health: Lana'i Community Health Center Experience

LEARNING OBJECTIVES:

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Speaker:

Joseph Humphry, MD FACP CPHIMS
Medical Director and Director of Quality
Lana’i Community Health Center

Rural Support Groups Using Telehealth

Since 2013, the University of Utah College of Nursing (CON) has been employing telehealth concepts and technology to provide interprofessional education (IPE) to health science students, deliver distant health care to clients in rural Utah, and study the effectiveness of telehealth and tele video conferencing (TVC) in the delivery of health care to rural clients. The purpose of this panel is to present the different utilizations of telehealth at the CON to provide education, patient care and research. 

The first utilization of telehealth and tele videoconferencing (TVC) was to introduce IPE to health science students enrolled atthe University of Utah. The students were from nursing, medicine, social work, nutrition, and wellness coaching. Partnership with Utah Telehealth Network (UTN) and utilization of TVC allowed the CON to teach the students and allow them to apply telehealth concepts and etiquette, interprofessional practice competencies, and the quadruple aim model. Students then applied the knowledge by role playing professionals using a case study via TVC. During the simulated case, students were able to apply IPE and telehealth concepts in a safe environment. 

A second utilization of telehealth and TVC occurred when the CON collaborator with Utah Area Education Health Center and UTN to investigate teaching interprofessional health care to health science students enrolled at multiple different state support universities and colleges in one session using Telehealth concepts and TVC. Four students from three different state universities and colleges participated in an interprofessional team to create a plan of care for a simulated case. The students appreciated participating in an interprofessional team utilizing TVC to care for a patient.

A third utilization was the development, implementation and evaluation of telehealth distant technology to provide grief support group program for grieving persons in underserved rural/frontier communities in Utah. Caring Connections partnered with Utah Telehealth Network and several hospice organizations serving underserved/rural-frontier communities to assist with a web-based platform and multi-point bridge in live synchronous groups sessions bringing together a lead facilitator and group members joining from home (using iPad and appropriate “hot spot” cellular internet devices). This technology benefited remotely located caregivers by increasing access to care and eliminating travel burden. Research is currently begin conducted on the effectiveness of providing support group program for grieving persons in underserved rural/frontier communities in Utah.

The fourth utilization was the development and evaluation of implementing an 8-week facilitated group videoconference intervention and mindfulness-based cognitive behavioral therapy (VCI-MBCBT) on perinatal depression (PD) and anxiety to women with limited access to health care in Utah. The Certified Nurse Midwifes group partnered with Utah Telehealth Network and several behavioral health faculty to provide group VCI-MBCBT one hour, once weekly, for 8 weeks. The women expressed enthusiasm for the group VCI-MBCBT and would highly recommend the program to other perinatal women in need of support.

The CON has utilized telehealth and TVC to education, provide patient care and evaluate the care. The work has been done to improve the knowledge and health of the citizens of Utah.  

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Speaker:

Gwen Latendresse, PhD, CNM, FACNM
Associate Professor and Assistant Dean for the Master and DNP Programs
College of Nursing, University of Utah

Kathie Supiano, PhD, LCSW, F-GSA, FT
Associate Professor, Director: Caring Connections: A Hope and Comfort in Grief Program
College of Nursing, University of Utah

Stand and Deliver: Standardization of Telemedicine Training for Acute Stroke Care

LEARNING OBJECTIVES:


DESCRIPTION:

For almost 20 years, telestroke has been implemented to address the many barriers in providing optimal acute stroke treatment to rural and underserved populations. Despite widespread utilization, there are very few training guidelines to ensure providers are up to the task of delivering timely and personalized acute stroke treatment. Although the number of neurologists involved in telemedicine is increasing, many training programs still offer little exposure to the skillsets necessary for clinical care via telemedicine, and telemedicine experience is not required by the ACGME in neurology residencies and fellowships. Telestroke is among the oldest uses for neurological care via telemedicine, yet little is known about the efficacy or standardization of current training methods for telestroke providers.  Furthermore, the number of providers at spoke hospitals with telestroke coverage is increasing, yet there are no training standards for staff on how to facilitate a telestroke encounter. The University of Utah has been conducting training throughout its telestroke network since 2003, which now includes 26 sites over 6 states throughout the Western region. In this presentation we will discuss the importance of utilizing multi-modality training tailored for both the hub and spoke site providers. Our program includes formalized telestroke provider training within our vascular neurology fellowship. For our spoke sites, we offer a program that includes standardized stroke protocols, on-site and remote simulations, formalized encounter feedback, technical training, online learning modules, and the Project ECHO tele-mentorship program. Through this multi-modal approach we have seen both utilization and process metric improvement in our telestroke network, and this approach could serve as a model for moving towards formal training standards among telemedicine providers.

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Speaker:

Lee S. Chung, MD
Assistant Professor of Neurology
School of Medicine, University of Utah

Team Telemedicine: Implementing and Running a Collaborative General Tele-Neurology Clinic in Rural Southern Utah

LEARNING OBJECTIVES:

DESCRIPTION:

This presentation will describe the design and implementation of a collaborative tele-neurology clinic in rural Utah, barriers we’ve overcome and lessons we’ve learned along the process. 

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Speaker:

Sarah Dehoney, PharmD, BCPS
Neurology Clinic Pharmacist
University of Utah, Clinical Neurosciences Center

Peter Hannon, MD
Assistant Professor
Division of Vascular Neurology, Department of Neurology, University of Utah

Russell Pincock DNP, APRN, NP-C
Primary Care Provider
Utah Navajo Health System (UNHS)

Telehealth 101: Getting Started

This session will provide information on how to create and/or grow telehealth programs. Tools, tips and lessons learned will be incorporated into a discussion of the various components of setting up a telemedicine program. Components include needs assessment, patient services plan, determining organizational capacity, choosing technology, regulatory & funding environments, outcome measurement, operational planning and training considerations.

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Speaker:

Cindy Roleff, MS, BSN, RN-BC
Telehealth Program Development Manager
ANTHC Alaska Federal Health Care Access Network (AFHCAN)


Telepsychiatry 101

LEARNING OBJECTIVES:

DESCRIPTION:
Telepsychiatry is an innovative solution in behavioral health care that has the potential to give underserved clients, communities and organizations access to high quality care by breaking down geographical barriers. However, it can often seem like an overwhelming initiative – where do you even begin when deciding to use telepsychiatry? This presentation will be about telepsychiatry in general, not about IrisTelehealth, our providers, our partners or our solutions. It will give a bird’s eye view of what telepsychiatry is and how to build a successful telepsychiatry program. We will not discuss or recommend any brands, rather identify the type of IT equipment needed e.g. a monitor, a computer, a webcam and a video-conferencing software. We will not discuss our providers or how we work with (workflow) with our partners, rather provide general best practices for hiring a telepsychiatry provider and for integrating a telepsychiatry provider into an existing workflow. Our goal is to provide unbiased and unbranded education to attendees that they can use to build their own telepsychiatry program, regardless of partnerships with telepsychiatry vendors or provider groups.

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Speaker:

Krysten Cosway
Account Executive
Iris Telehealth

Telestroke: Staying Relevant in a Competitive Market

LEARNING OBJECTIVES:

DESCRIPTION:

The University of Utah is in its 15th year providing Telestroke services, and has expanded to over 20 sites in six states.  During this time, The University Telestroke Program has seen vast changes in the services provided, and market for such a program. Program growth no longer is coming from huge increases in the number of spoke sites.   In the mature market of Telestroke, it is not enough to simply “provide” the service any longer. 

The University of Utah’s Telestroke program has looked to keep a competitive edge through focusing on outreach, education, and quality opportunities. The work that has been done in each of these three areas has given us a better understanding of our spoke site needs, and allowed us to engage them as active members in our network. 

The University has been successful in strengthening the TeleStroke network and deepening those relationships.  This has directly translated into growth in consult volumes despite few expansion opportunities.  Staying relevant has been key to the success of the University of Utah’s Telestroke program in the current market.

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Speaker:

Jaleen Smith, BS
TeleStroke Program Coordinator
University of Utah Hospital

Using Telemedicine to Keep Care Closer to Home in Oregon: A Critical Access Hospital Case Study

LEARNING OBJECTIVES:

DESCRIPTION:

The value equation telemedicine offers—the ability to admit more patients and keep them in local community hospitals—never fails to resonate with administrators and clinicians concerned with keeping critical access hospitals economically viable. By helping them adopt new staffing models that address the worsening physician shortage in a cost-effective and sustainable fashion, telemedicine offers value that is increasingly critical to these facilities nationwide. In addition to solving staffing needs, telemedicine offers other big-picture benefits for critical access hospitals, among them, helping Nurse Practitioners (NPs) and Physician Assistants (PAs) move into leadership roles in clinical settings where physicians might be hard to find and reducing the number of patient transfers to tertiary facilities.

A real-life case study involving Grande Ronde Hospital will be presented and discussed. Grande Ronde Hospital is a 25-bed critical access hospital in La Grande, Ore. Neurologists, cardiologists, and other specialists working in 10 hospital-operated clinics were available to treat patients, but nocturnist coverage and ER support were ongoing challenges as was physician burnout. In 2015, the Hospital implemented a new approach to clinical care using two teams―each consisting of a hospitalist and a nurse practitioner―who would provide daytime coverage on alternating weeks at the hospital. At night, from 5 p.m. to 5 a.m., a telemedicine team consisting of six telehospitalists and onsite nursing staff would be on duty. Key outcomes from the telemedicine program include improved throughput, newfound ER cross-coverage support, reduced stress among ER physicians, and higher patient satisfaction scores. 

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Speaker:

Talbot “Mac” McCormick, MD
President and CEO
Eagle Telemedicine

Doug Romer, RN, BS
Executive Director Patient Care Services
Grande Ronde Hospital

Welcome to Utah – Improving Community Health Through Telehealth

Speaker:

Sarah Woolsey, MD, MPH, FAAFP
Medical Director
HealthInsight Utah

 

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