1. Convenient Care Anywhere
Healthcare Horizons 2017
Marsha Waind
Jessica Piseno

2. Goals Today Define: What is Telemedicine? Survey:
What is available now for our patients?
What could we build for more efficient and patient centered care?

3. 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 Telemedicine Parity

4. What is Telemedicine?
Includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real time or through the use of store-and-forward technology
Does not include the use of audio-only telephone, electronic mail, or facsimile transmissions
North Dakota State Law SB Telemedicine Parity

5. Telemedicine Parity
An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in - person means.
Both North Dakota and Minnesota have Telemedicine Parity laws

6. What is currently used in our Region?
Teleradiology
Outpatient encounters
eEmergency
Inpatient encounters: telestroke care
Remote Patient Monitoring
eVisits
Video visits

7. Where is the Patient? Clinic Hospital Skilled Care Facility
Residential care facility
***Medicare patients in a rural location ***

8. Altru Telemed Patient Locations

9. Patient Volumes at Location type 2016

10. Altru Telemedicine Growth
Total encounters to = 15,520

11. Altru Telemedicine Rural Locations
» Allergy
» Cardiology
» Dermatology
» Diabetes Care
» Gastroenterology
» Genetic Counseling
» Infectious Disease
» Dietitian Services
» Nephrology
» Neurology
» Oncology
» Orthopedics
» Pain Management
» Palliative Care
» Pediatrics
» Podiatry
» Prosthetics
» Psychiatry & Mental Health Counseling
Altru Telemedicine Rural Locations
» Pulmonology
» Renal Dialysis Care
» Speech Therapy
» Sports Nutrition
» Surgical consult/follow-up
» Urology
» Weight Management & Health Coaching
» Wound Care
Newest Service: Teleprimary Care
Primary care coverage of small rural
Clinics to increase access and avoid closure

12. Telemedicine Services at Altru

13. Why connect? Professional Shortage areas Underserved populations
FQHC, Detention Centers, Group homes
Providing more efficient, higher quality, cost-effective care
Teleradiology, e-ICU model, Home monitoring services for fragile patients can reduce ED utilization and unnecessary hospital readmissions

15. Improved outcomes with telehealth
45% reduction in mortality2
25% reduction in bed days1
20% reduction in ER admissions2
19% decrease in hospital admissions1
15% reduction in ER visits2
Telehealth Services in the Department of Veterans Affairs, Darkins 2008
Whole Systems Demonstrators; An Overview of Telecare and Telehealth, BMJ / UK Department of Health 2009

16. COME EXPERIENCE THE TECHNOLOGY
DEMONSTRATION
COME EXPERIENCE THE TECHNOLOGY

17. New Opportunities? Schools Jails Workplace Cell Phone:
Home
Boat
Camper
Dorm Room
Assisted Living Apartment

18. Provider to Provider E-Consults

20. Patient Engagement in Health
98% of outcomes are based on what happens outside the physician’s office—and, therefore, outside the physician’s control
Success of ACOs will hinge upon their ability to increase their use of connected health technologies and convert that information into action.

21. Bring care to the patient
Pocket-sized smartphone connected ECG
mHealth = portability, lower cost and simple to use
Journal of American College of Cardiology: Patients outfitted with point of care medical devices referred for care and experience less hospitalization or death
JACC: Cardiovascular Imaging
September 2017 DOI: /j.jcmg

22. eVisits

23. Video Visit Completed from mobile device Scheduled visit
Average age of participant: 53% over 40+
More often Female 64% to 77%
Most often seen for Upper respiratory infections, UTI, Rashes

24. Telemedicine Rules Encounter occurs where the patient is located
Provider must be licensed and follow rules of the State where patient is located
Provider must follow credentialing rules of patient site
Be HIPAA compliant: private and secure
Provide same quality as in person encounter
Document encounter as telemedicine encounter
Yes, Initial encounters and consults are allowed

26. Bringing healthcare to the patient

27. Marsha Waind Jessica Piseno
Telemedicine Manager Telemedicine Coordinator