2014 ATA Presentation
- 1. Intermountain Healthcare’s “Build vs. Buy” Telehealth Implementation Strategy Kim Henrichsen, VP & CNO Intermountain Healthcare Crystal Jenkins, RN Blue Cirrus Consulting Dan Watterson, PMP Blue Cirrus Consulting
- 2. BIO Kim Henrichsen, RN, MSN • 30 years Nursing Practice • Graduate of Advanced Training Program, Institute of Delivery and Research Intermountain • Completed Wharton Nurse Executive Fellowship Program • 28 years staff and progressive leadership positions with Intermountain Healthcare 2 of 45
- 3. Hospitals Intermountain = 22 • State of Utah = 56 • (38% of the hospitals, 44% of the beds, 56% of the discharges) Physicians • Intermountain employs approx. 1,000 • Affiliated with an additional 4,000 • Operates approx. 185 clinics Health Plan • SelectHealth insures roughly 650,000 residents of UT and ID (25% of the UT market) • Initiated MA and Medicaid product in 2013 Employees Intermountain - approximately 35,000 Intermountain Healthcare
- 4. Intermountain Healthcare • Vision to be a “Model Healthcare System” • Overriding core value to deliver excellence in patient care • Known worldwide for clinical programs and innovative clinical IT solutions • History of self developed IT solutions 4 of 45
- 5. Teleservices Vision Provide Intermountain Healthcare patients, enrollees, families and employees access to a collaborative, efficient, and user friendly enterprise communication platform that eliminates barriers of place and time, improves safety, and contributes to “extraordinary care in all its dimensions.” 5 of 45
- 6. Teleservices Framework TeleDailyLiving use of technology to enable people to live independently in their own homes. TeleMedicine use of audio/video technologies to enable remote consultations between patients, physicians and healthcare professionals, as well as peer-to-peer consultations. TeleHealth use of monitoring equipment to a monitoring center. Monitored by qualified nurses to act on the information. TeleCoaching involves monitors and coaches who provide individual support to patients to help them more effectively manage their health conditions. 6 of 45
- 7. • Supports Intermountain’s vision of Shared Accountability • Care for more people through improved access and better utilization of physicians and other providers • Reduce delays in care delivery and improve clinical outcomes • Focus on patient engagement and wellness activities • Expand availability of information and communication for providers and patients Why Telehealth? 7 of 45
- 8. • Improves adherence to best practices • Supports clinicians in the complex in critical care areas • Improves clinical and financial outcomes • Improves ability to support patient management with chronic disease • Provide physicians and other providers tools that make practicing quality medicine efficient • Lower the need for future facilities • Keeps more patients closer to home • Provides clinical expertise and resource to rural hospitals • Creates opportunities for new referral patterns and partnerships Why Telehealth? 8 of 45
- 9. • Robust existing EMR • History of successful internal systems development • Teleservices strategy is planned across most service lines and many vendor systems are service specific. • Already established as an industry leader in automated clinical alerts • Restrictive vendor licensing limitations • Many vendor solutions not suitable for the Intermountain custom environment. • Cost Why Build vs. Buy? 9 of 45
- 10. Leadership / Operations • Telehealth business plan was developed with a conservative approach. • Hired a Telehealth Innovator to assist in creating direction to the program. • Hired a Telehealth Business Operations Director to coordinate efforts across departments and facilities. • Engaged Blue Cirrus Telehealth experts to assess readiness to implement. Laying the Groundwork (Key Decisions) 10 of 45
- 11. Technology • Develop stand alone AV platform independent of clinical systems. • First phase of Teleservices will use new AV platform and existing EMR “as is” • Cerner will be implemented system wide in 2014 and 2015 and will be integrated with self developed AV platform. Laying the Groundwork (Key Decisions) 11 of 45
- 12. • TeleCritical Care retreat was planned and executed with a project kick off approach. • Blue Cirrus Telehealth experts interviewed key project stakeholders and a Telehealth Readiness Assessment was developed and presented to Intermountain CMO, CNO and Telehealth Steering Committee. Getting Started 12 of 45
- 13. • Blue Cirrus Telehealth experts were engaged to provide Program/Project Management and Clinical Operations leadership for the project and act as advisors to the system CMO, CNO & Telehealth Oversight Committees. • Clinical project leadership hired and on-boarded • Initial telehealth clinical program (TeleCritical Care) rollout schedule was approved. Post Readiness Assessment 13 of 45
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- 15. Intermountain Teleservices Today and Beyond Dan Watterson, PMP Blue Cirrus Consulting 15 of 45
- 16. BIO Dan Watterson, PMP • 20+ years Clinical IT implementation experience • 10+ years Telehealth implementation experience working with over 35 health systems as a Project Executive or Project Manager • Critical Care Nurse 16 of 45
- 17. Customized AV platform… • Utilizes and integrates with Microsoft Lync. • Call routing and queuing based on service. • Xi3 PC serves as an “AV Server” • 32” or 42” TV for video display • Axis camera & Jabra mic-speaker combo • IR transmitter to control TV function • Remote agents use company standard PC/Laptop and webcam. What was Developed? 17 of 45
- 18. Video, audio, instant- message, screen-share, multi-party, call-routing Person To Person Connectivity Patient Room Connectivity Mobile Device Connectivity Home Connectivity Business To Business Multi- camera Views Recording Patient Education Medical Device Integration Cerner Integration Online eForms Teleservices Platform Capabilities 18 of 45
- 19. Video, audio, instant- message, screen-share, multi-party, call-routing Person To Person Connectivity Patient Room Connectivity Mobile Device Connectivity Home Connectivity Business To Business Multi-camera Views Recording Patient Education Medical Device Integration Cerner Integration Online eForms 19 of 45
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- 21. • TeleICU pilot live since December 3, 2013 testing clinical workflows and technology. • 12 facilities and 260 beds to be live on TeleICU by Fall of 2014. • Ongoing development and improvement of AV solution to include: family to patient room visits (Skype), high end microphone option, multi camera setup and integration with external service providers. • Numerous programs planned to implemented in 2014 to include: Current State and Future Plan 21 of 45
- 22. • Behavioral Health • Cardiovascular • Intensive Medicine • Oncology • Pediatric Specialty • Primary Care • Surgical Services • Women & Newborns • Care Process Models • Food and Nutrition • Imaging • Pathology • Pharmacy • Pain Management • Rehabilitation • Respiratory Care • Case Management • Interpretation Planned Telehealth Implementations Clinical Programs Clinical Support Services 22 of 45
- 23. Clinical Implementation Best Practices for Telehealth Crystal Jenkins, RN BSN MHI Blue Cirrus Consulting 23 of 45
- 24. BIO Crystal Jenkins RN BSN MHI (Masters of Health Innovation) • 18 years Critical Care Nursing Practice • 10 years Nursing Leadership Influence • 5 years Telehealth Operations/Implementation Expertise for large healthcare system, monitoring 500+ varied care level patients, in 5 Western States, from 4 remote locations, including Tel Aviv, Israel. • 6 years as Adjunct Faculty, Arizona State University-MHI/DNP programs 24 of 45
- 25. Readiness Assessment Performed via Interviews of Key Stakeholders Observations, Recommendations and Action Plans were categorized into the following topics: • Leadership • Culture • Clinical Operations • Technology Clinical Implementation Best Practices 25 of 45
- 26. • What problem are you trying to solve? • Identified Leadership to Support/Promote Telehealth • Executive Sponsor(s) • Physician • Nursing • Baseline data to support Telehealth Initiative • Outcome Measures/Goals of Program Clinical Implementation Best Practices Leadership 26 of 45
- 27. Is there Alignment Between: • Key stakeholders • Business Plan/Implementation Strategy • Clinical/Technical Leaders • Project Management • Organizational Initiatives R/T Telehealth Program Objectives Clinical Implementation Best Practices Leadership 27 of 45
- 28. Telehealth is NOT ‘Big Brother’ Eliminate Telehealth assumptions and ambiguity • Create Marketing/Communication Plans • Internal • External Create effective education plans • Initial • On going Clinical Implementation Best Practices Culture 28 of 45
- 29. • Align Telehealth with Organizational Initiatives/Strategy • Assess Current Organizational/ Specialty Area Goals • How will Telehealth contribute to these goals? • How will the Telehealth program be involved on a committee/planning level? Clinical Implementation Best Practices Culture 29 of 45
- 30. Assessment of current practices Identify inconsistencies that could impact outcomes • Use of Electronic Medical Record (EMR) • Use of Electronic/Enterprise Data Warehouse (EDW) • Data Collection/Reporting Practice • Policy/Procedure Clinical Implementation Best Practices Culture 30 of 45
- 31. Staffing Model • Type of Model/Hours of Operation • Continuous • Episodic • Responsive • Clinician Coverage • Expert • Specialist • Physician Extender Clinical Implementation Best Practices Clinical Operations 31 of 45
- 32. Staffing Model Impacts • Budget • Workflows • Technology • Quality Outcomes Clinical Implementation Best Practices Clinical Operations 32 of 45
- 33. • Are services reimbursable? • How will operating budget be funded? • Reimbursement • Grants • Allocating costs/charge per bed/patient • Insurance/vendor support • Skill set of remote clinicians • Impact on Organization Initiatives • Impact on Clinical Outcomes Clinical Implementation Best Practices Budget 33 of 45
- 34. • Dependent on staffing model • Hours of coverage • Clinical support type/skill • Designed to impact Telehealth Clinical Outcomes R/T Organizational Strategy • Dependent on Access to EMR, Data & Patient via Camera • Dependent on Engagement • Remote Clinicians • Bedside Clinicians • Supported by Executive Sponsor(s)/ Organization Executives Clinical Implementation Best Practices Workflows 34 of 45
- 35. Dependent on: • Available vs. Required to deliver appropriate and safe care • Capability to access clinical data remotely • State of Integration/Utilization • Remote Clinicians • Bedside Clinicians Clinical Implementation Best Practices Technology 35 of 45
- 36. Dependent on • Consistent practice throughout Organization • Policy/Procedure • Documentation • Data Collection • Utilization of the Telehealth program, clinical resources and associated technology • Relational Coordination between remote and bedside clinicians • Shared Goals • Shared Knowledge • Mutual Respect Clinical Implementation Best Practices Quality Outcomes 36 of 45
- 37. Program Management and Technical Implementation Best Practices for Telehealth Dan Watterson, PMP Blue Cirrus Consulting 37 of 45
- 38. • Define governance process for Telehealth initiatives. • Create a formal project with clearly defined senior executive sponsor, clinical business owner, IT business owner and a project manager. • Fully understand what you are implementing or building. i.e. technical standards (Hardware & Software), integration requirements, licensure restrictions, cost of ownership. • Ensure technology meets clinical or business need. Project/Program Prerequisites 38 of 45
- 39. • Do not move forward without clear defined project and business ownership. • Create a formal project charter (what, who, when and how) • Create a program specific implementation oversight / steering committee. • Conduct formal project kickoff meeting lead by senior executive sponsor. Why are we doing this!! • Ensure all IT functional departments are represented on project team. Project/Program Prerequisites 39 of 45
- 40. • Plan with end in mind! • Begin support and release management planning from the start. • Create a formal communication plan. Engage facility or corporate communications team from the start. • Clearly define technical implementation roles and obtain approval from IT leadership. • AV experts should plan technology placement with input from bedside clinicians. Planning 40 of 45
- 41. • Communicate, Communicate, Communicate… • Keep in scope! If changes are needed they should be vetted through the change management process (defined in project charter). • Evaluate effectiveness of all implementation components. Is this effective? Change what isn’t working. • Include support teams in equipment installation and configuration activities Execution and Control 41 of 45
- 42. • Communicate, communicate, communicate… • Create a formal activation plan. • OVER-staff for Go Live! • Include support teams in Go Live process. Activation 42 of 45
- 43. • Formal Transition to Support • Document Lesson’s Learned Intermountain Examples • Get multi-specialty feedback on AV requirements. • One size does not fit all! • Don’t implement technology unless there is a clinical need. • Be aware of other IT initiatives in relation to technology installation. Closure 43 of 45
- 44. Pro: You own it! • Customized for system’s specific needs • Minimal to no licensure limitations • Lower cost of ownership Pros and Cons Con: You own it! • Implementation of Telehealth is a complex CLINICAL initiative supported by technology. • Long term commitment to develop, implement and support. • Enhancement requests are system specific vs. multi system input. 44 of 45
Editor's Notes
- #4: Based in Salt Lake City, Utah, Intermountain Healthcare is a nonprofit healthcare system serving the healthcare needs of residents of the Intermountain West (primarily Utah and southeastern Idaho). Our mission is excellence in the provision of healthcare services. Our aspiration (which we express internally) is to provide “Extraordinary Care in All Its Dimensions.” This aspiration is expressed to external audiences in the form of our slogan or tagline: “Healing for Life.”
- #5: When Intermountain Healthcare was founded in 1975, our Board of Trustees challenged us to always aspire to be a model healthcare system. This challenge is always fresh, because the healthcare environment is always changing. In 2005, Intermountain again undertook in-depth research into the expectations of its patients and other stakeholder groups, to better meet the challenge of being a model healthcare system. The research showed our patients expect both clinical excellence and service excellence: They want their high-quality healthcare to be delivered with compassion by people who care about them as individuals. Based on this research, Intermountain Healthcare created a core aspiration that can be summed up in the phrase: “Extraordinary Care in All Its Dimensions.” We will always remain focused on clinical excellence and on achieving ever-better medical outcomes. In addition to focusing on clinical excellence, we will work to continually raise our standards of service excellence—the way we interact with patients. Our aspiration to provide Extraordinary Care is at the heart of our Vision (see Note 3).
- #8: Our Shared Accountability strategy (see Note 4) is helping Intermountain provide better care to patients, better health to the populations we serve, and better management of costs. Intermountain’s effectiveness in providing high-value care—clinically excellent care at a sustainable, relatively lower cost—has led many national experts to identify it as a model healthcare organization worthy of emulation.
- #9: Our Shared Accountability strategy (see Note 4) is helping Intermountain provide better care to patients, better health to the populations we serve, and better management of costs. Intermountain’s effectiveness in providing high-value care—clinically excellent care at a sustainable, relatively lower cost—has led many national experts to identify it as a model healthcare organization worthy of emulation.
- #26: ‘Setting the Table’ by identifying Key Stakeholders is essential for the preliminary assessment. Based on the interviews conducted, common themes were identified. Recommendations and action plans were categorized based on the following ‘common’ 4 themes.
- #27: Organizations want to implement telehealth to ‘stay competitive.’ Important to identify ‘why’ or ‘what problem you are trying to solve’ by implementing telehealth. Should be supported by specific/identified ‘organizational’ level leadership The ‘problem’ should be supported/justified with baseline data Start with the end in mind and identify outcome measures and goals of your telehealth program
- #28: Identify similarities/differences between business plan/strategy What are the strengths? Are there any concerns? Expected Outcomes Potential Obstacles Project management is essential for execution/implementation
- #29: Most common obstacle to implementing and or consistent use of telehealth is the ambiguity associated with it. Story about initial education Education occurring within the telehealth center Eliminating assumptions and ambiguity positive impact on utilization/buy in of program
- #30: What ever patient population you are connecting to through telehealth- Should be included in strategic planning, ongoing process performance committees, etc as an additional unit-just as if it were a new unit within a facility Telehealth units should not be silo’d When creating solutions to initiatives/process improvement-ask how can our telehealth colleagues assist in solving and/or improving this problem/process
- #31: Systemize the system Method for identifying inconsistencies Resolve the inconsistencies Ensure data is being collected and/or reported in a consistent manner-GARBAGE IN is GARBAGE OUT
- #32: Once you identify the problem that needs to be solved you’ll need to identify what type of staffing model -Continuous-like eICU -Episodic-involved in daily rounds -Responsive-like tele-stroke or tele-psych What type of clinician coverage will be needed
- #33: The type of model and clinician coverage will impact the following: -$$$ how much can you spend and how much can you bill for -what services can you offer- -what type of technology will you need to offer these services -how will your outcomes be impacted? Do you need to have an initial strategy and work towards a more progressive model?
- #34: When setting up a budget be sure to address the following : Again, to you set up an initial strategy to get started and move to a more progressive model?
- #35: Workflows are dependent upon what type of model you have chosen and who will be providing services. Also dependent upon what ‘problem’ you are trying to solve- if you are trying to impact number of hours psych patients are waiting in the ER, then you will probably want to ensure your model includes practitioners to assist with evals AND/OR you have created some sort of workflow that impacts psych pt wait times. Also ensure access to the correct technology and/or software is available
- #36: Access to technology AND Utilization of technology key to successful program outcomes Ensure proper access available-including login Ensure proper initial and on-going education takes place Monitor utilization
- #37: Your tele-health model Staffing Workflows & Technology Impact telehealth program outcomes Ensure all five are aligned and also support process improvement goals and organizational initiatives