By Marc Newell, MD. A discussion about the rapidly evolving TeleHealth program at Minneapolis Heart Institute that promises to increase access to and timeliness of specialty care in communities across the region. “This is an innovative strategy that allows more patients to be seen closer to home, and have more access to subspecialty care. We need to transform how and where we deliver care so we can focus on prevention and chronic disease management.”

1. Marc Newell, MD, FACC, Minneapolis Heart Institute
TELEHEALTH

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Outline for today’s talk
•What is Telehealth about?
•Why do Telehealth?
• What does a visit look like/how does it work?
• What’s novel?
– Bedside ultrasound physical exam adjunct
• Where are we now in the program?
• Where is the program going?
• How does this fit into MHI’s Outreach?

3. Goals
• Increase patient satisfaction and outcomes,
and reduce health care costs.
• Partner with physicians and hospitals to
deliver telehealth services for patients in their
communities.
• Decrease inter-hospital transfers.
• Reduce the need for patients and their
families to travel long distances to see a
specialist.
• Improve continuity and convenience of routine
and post-hospital follow-up care.

4. Rationale: Why are we doing this?
• Our country’s economy is buckling under the
cost of health care.
• Rationing health care is not an option.
• We have to change---we need to transform
how and where we deliver health care.
- More emphasis on early prevention
- Focus on chronic disease
management
• Better access to specialty services for
complex patients (heart attack, stroke), and
for conditions, e.g. mental health, that are
undertreated and poorly resourced.

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Cardiac Telehealth (or Telecardiology) will improve
population health by providing tools and clinical
capabilities within and beyond the traditional health
care settings. We will do this by:
– Extending our world class expertise to all
communities and health care facilities
– Becoming a virtual health system integrating care
across the healthcare continuum and beyond
– Promoting the Triple Aim (quality care, positive
patient experience, at a reduced cost)
Vision

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Why Do Telehealth?
•Clear wins:
–Increased access to specialty care
• Care delivered more often
• Care delivered close to home, in a familiar environment
• Easier on the patient’s family and support system
–More “touches”
• You can literally be in two places at once!
• Huge implications from a group and system perspective
–Research possibilities
• Assess what benefits (and drawbacks) are present
• Become a leader in an expanding field
–A key to prepare for the new world of Affordable Care

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Telehealth and the Triple Aim
• Telehealth fits extremely well into the concept of
the IHI Triple Aim:
–Patient experience
• We will measure by patient satisfaction survey
• Less travel time, care provided closer to home
• Easier access to care
–Improve health of populations
• Increase timely access to specialty providers
• No need to increase the number of specialty providers
• More specialty care available in more locations
– Decrease cost of care
• Improved appropriate “triage” to tertiary care and further
testing (downstream testing)
• Less hospitalizations/ER visits due to increased access to
care

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• In our program, local or Allina-employed nurse
practitioners travel to rural communities to have
direct patient visits and then connect the cardiologist
with the patient via telehealth video equipment.
• This results in a real time, face-to-face visit, where all
patients can ask questions and interact, just as they
would in a traditional clinic appointment.
– Each patient’s medical history and test results are
available to the cardiologist in advance of the
appointment.
– The patient documentation appears in Electronic Medical
Record and formal dictations are still completed by the
cardiologist.
How does it work?
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• Currently slotted for 6 patients per day
• Goal is to see new patients or established
patients with new problems
– For programmatic development (and patient
convenience), all are welcome
• Logistics
– Information for patients and schedulers is key
– Fostering understanding and support from local
providers is essential
• Understanding this is a supplement and not a
replacement of services!
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How does it work?

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• Example template for workflow from the
clinic/patient perspective:
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Sample Workflow
Visit time Lab time Echo/Ultrasound
time
9 AM 7:45 AM 8:15 AM
10 AM 8:45 AM 9:15 AM
11 AM 9:45 AM 10:15 AM
1 PM 11:45 AM 11 AM
2 PM 12:45 PM 1 PM
3 PM 1:45 PM 2 PM

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• A rapidly evolving (and exciting) part of medicine
and cardiology is bedside ultrasound as an
adjunct to the physical exam
• Able to assess left ventricular function,
pericardium, do a limited valve review
• We will study this systematically, the hypothesis
is:
– Shorter time to diagnosis
– Less downstream testing
– More appropriate treatment, initiated sooner
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CardioVascular Ultrasound Physical
Exam (CVUPE)

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• One challenge of not being physically
present with the patient is the exam
– Some use nurses with audio-stethoscopes
– We chose an NP/PA face-to-face interaction
– Seeing the patient via ultrasound
• Gives the cardiologist a direct look above and beyond
the video monitor and reported exam
• Dramatic increase in diagnostic and prognostic
information to the remote provider
• Let’s be honest: our echo data far exceeds our
stethoscope findings!
Why CVUPE (Ultrasound)?
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Thank you!
• Marc Newell
– Cardiologist, Minneapolis Heart Institute
– Director of Telehealth and Telecardiology, Allina
Health
– Director of Outreach Services, MHI