Virtual Care – The Future of Healthcare Virtual Care – The Future of Healthcare? “We cannot solve our problems with the same thinking we used when we created them.” Albert Einstein

Disclosure(s): Rebecca Ohlinger– I have no actual or potential conflict of interest in relation to this program/presentation. Dr. McWilliams– I have no actual or potential conflict of interest in relation to this program/presentation.

Telehealth Overview

A Rose by Any Other Name… Telehealth Telemedicine Telepsychiatry Other definitions…

Telehealth Legislation 50 states = 50 policies Legal requirements for providers who provide telehealth services. Parity requirements for insurers. http://legacy.americantelemed.org/policy-page/state-policy-resource-center

Licensure Requirements Interstate Medical Licensure Compact

Prescribing Requirements DEA Registration Ryan Haight Act

Other Regulatory Issues HIPAA FERPA JCAHO

Location, Location, Location Clinic or Hospital School Correction Center Home

Physical Space Privacy Lighting Background noise Camera view

Policies and Procedures Referral process Scheduling Consent Telepresenter Documentation Emergency protocols Synchronous vs. Asynchronous?

A brief word about technology…

Children’s Telehealth

Why Telepsychiatry? We looked at the Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2017. Health Professional Shortage Area (HPSA) designations are used to identify areas and population groups within the United States that are experiencing a shortage of health professionals. There are three categories of HPSA designation based on the health discipline that is experiencing a shortage: 1) primary medical; 2) dental; and 3) mental health. The primary factor used to determine a HPSA designation is the number of health professionals relative to the population with consideration of high need. Federal regulations stipulate that, in order to be considered as having a shortage of providers, an area must have a population-to-provider ratio of a certain threshold. For mental health, the population to provider ratio must be at least 30,000 to 1 (20,000 to 1 if there are unusually high needs in the community). The number of mental health care HPSA designations includes HPSAs that are proposed for withdrawal and HPSAs that have no data. By statute, designations are not withdrawn until a Federal Register Notice is published, generally once a year on or around July 1. Definitions Percent of Need Met is computed by dividing the number of psychiatrists available to serve the population of the area, group, or facility by the number of psychiatrists that would be necessary to eliminate the mental health HPSA (based on a ratio of 30,000 to 1 (20,000 to 1 where high needs are indicated)). Practitioners Needed to Remove HPSA Designation is the number of additional psychiatrists needed to achieve a population-to-psychiatrist ratio of 30,000 to 1 (20,000 to 1 where high needs are indicated) in all designated mental health HPSAs, resulting in their removal from designation. While mental health HPSA designations can include core mental health providers in addition to psychiatrists, most mental health HPSA designations are currently based on the psychiatrists only to population ratio. HPSA designations based on psychiatrists only do not take into account the availability of additional mental health services provided by other mental health providers in the area, such as clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists.

Where Are We? Formed partnerships with: Primary care offices Hospital systems in rural communities Our own physician clinics Relationships with sites were formed in two ways: Word of mouth referrals: Established connections through past experiences and contacts Communities in need: Used zip codes to identify where existing psychiatry patients live General pediatric psychiatry visits, including: Evaluations Follow-up appointments Conditions very similar to outpatient clinics: Depression and Mood Disorders Anxiety Disorders Attention-Deficit/Hyperactivity Disorder Autism Behavior Disorders

Volumes are Increasing Comment briefly on No Show rates with this data

More Data - Telepsychiatry Primary care offices, hospital systems in rural communities, our own physician clinics. 50% reduction in no-show rates. Saved windshield time equated to around 26 hours per week. *Beatrice added 11/18.

Overall Patient/Family Satisfaction

Virtual Care at Children’s Hospital & Medical Center Currently Live Telepsychiatry, telepsychology, eating disorders program, post-op surgical visits, palliative care, telelactation, telemedicine visits at Lincoln SPC clinic (Pulm, Adult Congenital Cardiac), primary care f/u visits for ADHD, eConsults (BRYAN and St. Elizabeth’s). Piloting/Expanding Multidisciplinary virtual rounding at a long term care facility, Cardiothoracic Surgery post-op visits, virtual consults, established single vent patients f/u visits, specialty rounding at UNMC, eConsults, and the list goes on. We cares for more than 250,000 children each year. Mission: Improve the lives of children through dedication to exception clinical care, research, education and advocacy.