Designing an eVisit: Considerations for Virtual EncountersKathy Nieder, M.D.Baptist Health Medical Group

October 21, 2015

Agenda |Overall Considerations – Summary • Changing Care• Financial Considerations• Principles of Practice and Licensure• Process and Application of Technology• Patient Consent and Relationship• Evaluation and Treatment• Quality Management Provider Education and Guidelines• Case Studies

• Review the current landscape of telehealth• Assess the approach to using technology to provide care

in a virtual setting• Recognize the financial impacts and reasoning

associated with telehealth services

Learning Objectives

• Realizing the value of a virtual visit– Changing provider’s perspectives– Changing patient’s perspectives

• Understanding when a Virtual Visit is appropriate– Clinical needs – Past medical history and understanding how virtual relationships

should occur

Extending Care – Anytime, Anywhere

Financial Considerations

• Cost benefit– Soft ROI: Provider and patient satisfaction– Hard ROI: New business models; revenue generation

• Infrastructure needs for a Virtual Visit• Understanding patient demographics

– Medicare, Medicaid, pay per visit• Cost saving through improved outcomes• Chronic care management and pertinent/available CPT codes

Principles of Practice: Treat Telemedicine the Same

• Place the welfare of patients first;• Maintain acceptable and appropriate standards of practice;• Adhere to recognized ethical codes governing the medical profession;• Properly supervise non-physician clinicians; and• Protect patient confidentiality.• Licensure

Process and Technology

• Technology– Integration points with recordation

• Timing – 24/7 vs. scheduled

• Environment – Lighting and background– External audio sources

• Documentation • Support

– Staff to facilitate scheduling– Staff to facilitate medical encounter

• Online consultation guidelines – Tailor the approach for your organization

• From – MFA Video Consultation Operational Guidelines Document

Patient Consent and Relationship Process• Consent form should cover:

– Identifying information– Provider delivering service– Outline the limitations of service and patient rights or expectations– Check local laws

• Establishing a Relationship – Check applicable state laws– Verifying and authenticating the location and, to the extent possible,

identifying the requesting patient– Disclosing and validating the provider’s identity and applicable

credential(s)– Obtaining appropriate consents from requesting patients

Quality Management: Education, Guidelines and Operational Support• Personnel Training and Fellowships for Clinicians

– Online, in person, vs. “hi touch” experience• Program certification programs

– Online– Industry recognized– Relevant local laws and regulations

• Organizational Marketing and Collateral Development– Feedback from Patient – Payment

GWU ConnectER Program

• Targeted approach to reduce ER readmissions• Scheduling support and committed staff• Support and education for providers• Clear documentation and payment process• Patient feedback after eVisit

Other Case Studies

• Connected Health Case Study: Mobile PHR Improves Patient Engagement, Satisfaction and Care Children’s Medical Center Dallas teamed up with ONC on the “PHR Ignite!” pilot program, a personal health record (PHR) pilot program designed to engage patients, encourage active involvement in disease management, and provide medication reminders via an iPhone.

•  Connected Health Case Study: Montefiore Health System This case study highlights how Montefiore has built apps internally, and when necessary, partners with vendors and development firms. Patient focused apps undergo a marketing and branding review for continuity across platforms and use cases.

•  Connected Health Case Study: Geisinger - Reducing Patient No-Shows With its patient engagement initiative, Geisinger Health System implemented a platform to do text messaging and selected appointment reminders to help reduce patient "no shows".

Acknowledgements• George Washington University Medical Faculty Associates

– Neal SikkaAssociate Professor, George Washington UniversityDepartment of Emergency Medicine

– James BetzProgram ManagerDepartment of Emergency Medicine

– Nicholas ReedInnovative Practice Program CoordinatorDepartment of Emergency Medicine

• HIMSS Connected Health Community– Kathy Nieder M.D., Sri Bharadwaj MS, Brian Rothman M.D.

• HIMSS Staff LiaisonsTom Martin, David Collins, John Sharp

Questions?

• Kathy Nieder, M.D.• Baptist Health Medical Group

Thank You!