Transcript M3 Product with Advice Engine Enhancement

Collaboration for an Effective
TeleHealth Project
Catherine Bruno, FACHE
January 2001
Catherine Bruno, FACHE
Current position (4 months)
Vice President
Medicalis Corporation, Boston, MA
Software company connecting radiologists to ordering
physicians
Funded by Brigham & Women’s Hospital
Prior position (11 years)
Chief Information Officer
The Ohio State University Medical Center, Columbus, OH
1,000-bed academic medical center
Agenda
TeleHealth Landscape
Technology
Regulations
Scenario for Collaboration – a TeleHealth Project
Framework
Case Studies
The Ohio State University Medical Center Telemedicine
Program
Radiology at Brigham & Women’s Hospital
TeleHealth Landscape - Technology
The Internet - Connectivity
Worldwide connection
Browser
Wireless
Computer Hardware
Smaller, faster, lighter, less expensive
Video
Handhelds
Software Frontiers
Voice Recognition
Character Recognition
Data Mining
TeleHealth Landscape - Regulations
New Telemedicine Legislation
that expands reimbursement
HIPAA - Clinton Administration
Issues Regulations on Medical
Record Security
Canada strengthens Internet
privacy
New Telemedicine Legislation
Substantially improves existing Medicare coverage of
telemedicine effective October 1, 2001
HCFA will issue rules early in 2001
Serves as a major step forward in expanding services
throughout the U.S.
HIPAA - Medical Record Security
Effective Feb 26, 2003
Covers all medical records and identifiable health
information: electronic, paper, & oral
Provisions:
Consumer Control Over Health Information
Boundaries on Medical Record Use and Release
Ensure the Security of Personal Health Information
Establish Accountability for Medical Records Use and Release
Balancing Public Responsibility with Privacy Protections
Special protection for psychotherapy notes
Equivalent treatment of public and private sector health
plans and providers
Source: HHS Fact Sheet, Dec 20, 2000
Canadian Internet Privacy
Protects personal information disclosed through
electronic transactions
Jan 1, 2001 for companies that are federally regulated
By 2004, anyone doing business in Canada must comply
Consent of consumers is required if their personal
information is used commercially
Consumers have the right to review any information
about them that is on file
A privacy commission is being set up to investigate
violations
Companies must name someone responsible for privacy
matters
European companies already operate under similar rules
Source: New York Times, Dec 23, 2000
Agenda
TeleHealth Landscape
Technology
Regulations
Scenario for Collaboration – a TeleHealth Project
Framework
Case Studies
The Ohio State University Medical Center Telemedicine
Program
Radiology at Brigham & Women’s Hospital
Overview
Effective TeleHealth Projects provide
ongoing support for
improved health
using telecommunications tools
Many TeleHealth projects are initiated as
independent projects that are grant-funded
have a limited scale
often not part of the health care organization’s technical
plan
TeleHealth is not an “Island;” it requires significant
integration into the organization and operations for
success
Scenario for Collaboration –
a TeleHealth Project Framework
Three Keys to Success
People
Processes
Effective
TeleHealth
Project
Technology
Scenario for Collaboration – a
TeleHealth Project Framework
People
Support of key medical staff, administrative, project, and IT
staff
Sufficient resources
Collaborate throughout the process
Communicate, communicate, communicate
Strict patient confidentiality
Processes
Change Management
Organize and structure the project
Ensure fit with operations
Technology
Integration into the organization’s systems
Systems & Technical infrastructure
People: Support of key medical
staff, administrative, project,
and IT staff
Medical Staff involvement and leadership
Administrative support
Project executive sponsor or committee to remove
roadblocks
Fit with the health care organization’s strategic
direction and market
Consensus on clear project goals and expectations
Identify key end users who can be trusted to shape the
project
Vendor involvement
People: Sufficient resources
Money for equipment, systems, connectivity, etc
Staff with technical and clinical operational expertise
Large projects require a dedicated project manager
People: Collaborate throughout
the process
Starting in the planning phases
Continuing through design, development or selection,
testing, implementation, and support
Regular meetings to track progress and remove
roadblocks
People: Communicate,
communicate, communicate
Communicate often
Use multiple methods
Project meetings
Leadership meetings
Organizational communications (regular staff meetings, grand
rounds, etc.)
Pizza lunches
Newsletters
Internet
Etc.
People: Strict patient
confidentiality
In the United States
Medicare regulations
Newly created HIPAA privacy rules
State laws on privacy – especially for psychiatric and AIDS
information
Regulatory agencies, e.g., JCAHO, CARF
In Canada – new internet privacy regulations
Organizational Policies
E.g., Research oversight, e.g. Human Subjects Committees
Scenario for Collaboration – a
TeleHealth Project Framework
People
Support of key medical staff, administrative, project, and IT
staff
Sufficient resources
Collaborate throughout the process
Communicate, communicate, communicate
Strict patient confidentiality
Processes
Change Management
Organize and structure the project
Ensure fit with operations
Technology
Integration into the organization’s systems
Systems & Technical infrastructure
Processes: Change Management
Build a shared vision
Document current processes and operations - “An accurate,
insightful view of current reality is as important as a clear
vision.”
“Use the gap between the vision and current reality to
generate energy for change.” Collaborate to develop new
operational procedures to accommodate the new
functionality/system
Consider the interconnectedness with the rest of the
organization
Prototype the new processes and system
Level of testing depends on the newness and criticality of the
system
Measure and communicate the results
Source: The Fifth Discipline by Peter Senge
Processes: Organize and structure
the project
Assemble and structure the team with the needed skills
and knowledge
Define clear roles
Develop a reasonable schedule
Track status; Measure and report project performance
Manage Vendor to deliverables and dates
Implement the technology in phases
Iterative changes to operations
Opportunity for the system to evolve from feedback &
experience
Typical Planning Process
WHERE ARE WE NOW?
TASK 1
Project
Organization
TASK 2
Goals and
Objectives
TASK 3
Inventory of Current
Environment
TASK 4
Environmental
Assessment
Status Update
WHERE ARE WE GOING?
TASK 5
Needs Analysis
HOW DO WE GET THERE?
TASK 7
Alternate Strategy
Assessment
TASK 6
Identify/Prioritize
Projects
TASK 8
Strategy Selection
and Plan
Status Update
Status Update
Processes: Ensure Fit with the
Operations
Analysis of current operations
Work with people who do the work every day to
redesign the processes to fit the new system
Monitor implementation and change where needed
Operational considerations:
Convenience/accessibility of location
Physician scheduling
Who do you call with questions or issues?
Scenario for Collaboration – a
TeleHealth Project Framework
People
Support of key medical staff, administrative, project, and IT
staff
Sufficient resources
Collaborate throughout the process
Communicate, communicate, communicate
Strict patient confidentiality
Processes
Change Management
Organize and structure the project
Ensure fit with operations
Technology
Integration into the organization’s systems
Systems & Technical infrastructure
Technology: Integration into the
organization’s systems, where
practical
Conformance with standards
Sets the stage for current and future integration of
information with other systems and processes
Allows integration with support services
Makes ongoing support and updates easier
Technology: Systems and Technical
Infrastructure
Technical standards
Vendor support
Planning
Support services such as
the help desk
Connectivity
Information integration
Bandwidth
Obstacles
Obstacles can arise in any area and at any step of the
project
With collaboration and consensus on goals, the team can
work through all the other obstacles
For example
If resources are scarce, the leadership group can figure out
how to get what’s needed
If the technology is too immature, you can work out an
appropriate exit strategy
Agenda
TeleHealth Landscape
Technology
Regulations
Scenario for Collaboration – a TeleHealth Project
Framework
Case Studies
The Ohio State University Medical Center Telemedicine
Program
Radiology at Brigham & Women’s Hospital
Examples of Effective Collaboration
Massachusetts General Hospital
Teleradiology using electronic images
Source: “Medical Imaging over the Internet” by Keith
Dreyer, DO, PhD, Corporate Director, Partners Healthcare
System, presented at eHealthcareWorld, Dec 2000
Real-time stroke intervention, including scoring the deficits
and collaborative patient management
Source: “Telemedicine-enabled patient care: New
Approaches to healthcare delivery” by Lee Schwamm, MD,
MGH, presented at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration
DOD Walter Reed Army Medical Center: telemedicine
web-based clinical applications to enhance access to
subspecialty medical consultation: dermatology,
dentistry, echocardiography, sleep medicine, podiatry,
and ophthalmology
Source: “Medical Imaging over the Internet” by Colonel Ron
Poropatich, MD, Walter Reed Army Medical Center, presented
at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration –
Case Studies
The Ohio State University Medical Center telemedicine
program
Radiology at Brigham & Women’s Hospital
Case Study: The Ohio State
University Medical Center
(OSUMC) Telemedicine Program
OSUMC – Telemedicine Program
Description
Overview
Began in 1996
6,000 consults per year
12 specialties with highest use in internal medicine,
pulmonary care, and dermatology
32 sites, dedicated half-T1 connections
Administration shared between OSUMC and Ohio Department
of Rehabilitation and Corrections (ODRC)
Cost $2.5 million
Cut the transport of prisoners by 30%
High physician satisfaction
Easy to use
Readily met their clinical needs
Three Keys to Success
People
Processes
Effective
TeleHealth
Project
Technology
OSUMC – People
Key OSUMC and ODRC Medical Staff, administrative, and
IT leadership
Sufficient resources – Funded by ODRC and a grant from
Ameritech
Full time OSUMC project leader
Full time technical coordinator
Significant involvement by Ameritech and OSUMC IT network
staff
Close working collaboration between OSUMC and ODRC
throughout the process
Frequent communication via meetings, phone, etc.
Strict patient confidentiality
Behind the OSUMC firewall
Physical security
OSUMC - Processes
Shared vision to improve quality and timeliness of care
and reduce cost by minimizing patient transports for care
Started with a prototype in internal medicine
Full time project leader assigned by OSUMC to organize
and manage the implementation and ongoing operations
Ensure fit with operations
Technical coordinator for scheduling the physician time and
technical resources
Convenient/ accessible location at OSUMC
OSUMC - Technology
Systems and technical infrastructure
Conformance with network standards
Support by OSUMC network staff
Vendor support
Case Study: Radiology at
Brigham & Women’s Hospital
(BWH)
BWH – Radiology Information
Management System (RIMS)
Improve the quality and efficiency of health care
services by
Facilitating the integration and flow of information among
health care providers
Providing evidence-based clinical knowledge at the point the
physician is placing the order
Improving access to billing code information
Mining a data warehouse of indications and results to create
evidence-based clinical guidelines
Over 100 radiologists, ordering physicians, and physician
office staff using the system for the past 2 years
Radiology: Historical
with the Internet
Consult favorite radiologist
MD sees
Patient
Consultation and Advice Engine
MD Receives Report Text: Call, Fax, US-Mail
Risk Management
Work lists
Patient letters
Bill
Generated
Web Result Delivery
Manual Billing Coding
ICD & CPT Mapping, ABN’s
Consensus Wisdom
Future Ordering
Data
Indications & Results Analysis
Warehouse
Generate Req
Structured
Ordering &
Scheduling
A
N
A
L
O
G
PACS
Image
Enhancement
Report Dictation/
Transcription
Report
Generation
Three Keys to Success
People
Processes
Effective
TeleHealth
Project
Technology
BWH – People
Support of key medical staff, administrative, project,
and IT staff – Medical Staff Leadership
Initiated by a Radiologist
Significant time commitment of the Radiologist
Supported by Chair of Radiology
Support from the Hospital COO and CIO
Sufficient resources - Staff to support the system funded
by the Hospital
System Development
Implementation
Training
Dedicated System Support Staff
BWH – People
Collaborate throughout the process
Radiology leadership
BWH Information Systems and BWH Operations Staff
Communicate, communicate, communicate
Regular meetings
Close communication with people using the system during
implementation and on an ongoing basis
Strict patient confidentiality
Conformance to BWH strict patient confidentiality policies
Conformance with BWH security: standard login
authentication
Behind the BWH firewall
Physical Security of the data center
Privacy/security standards
BWH - Processes
Change Management
Shared vision to improve quality and efficiency
Prototyped the system in a primary care office with a
supportive physician
Designed the system to improve efficiency in the
physicians office; added features based on feedback
Scheduling
Risk management
Ensure fit with operations
Close working relationship with each physician office
and the radiology department
BWH - Technology
Integration into the organization’s systems and
technical infrastructure
Information sharing with Partners’ systems: EMPI, radiology
and PACS
Standard workstations and network connections
Standard login authentication
Standard fax server connectivity
Standard paging server connectivity
Central organizational support for Network, Workstation,
Login
Further contact:
Catherine J. Bruno, FACHE
Vice President
Medicalis Corporation
850 Boylston St, Suite 312
Chestnut Hill, MA 02467
Phone: 617-734-1702
Email: [email protected]