Blue Cirrus/Intermountain Healthcare ATA 2014 PowerPoint 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
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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
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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.”
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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.
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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?
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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?
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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?
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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)
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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)
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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
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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
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15. Intermountain Teleservices
Today and Beyond
Dan Watterson, PMP Blue Cirrus Consulting
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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
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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?
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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
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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
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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
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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
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23. Clinical Implementation
Best Practices for Telehealth
Crystal Jenkins, RN BSN MHI
Blue Cirrus Consulting
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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
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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
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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
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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
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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
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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
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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
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31. Staffing Model
• Type of Model/Hours of Operation
• Continuous
• Episodic
• Responsive
• Clinician Coverage
• Expert
• Specialist
• Physician Extender
Clinical Implementation Best Practices
Clinical Operations
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32. Staffing Model Impacts
• Budget
• Workflows
• Technology
• Quality Outcomes
Clinical Implementation Best Practices
Clinical Operations
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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
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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
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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
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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
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37. Program Management and Technical
Implementation Best Practices
for Telehealth
Dan Watterson, PMP Blue Cirrus Consulting
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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
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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
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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
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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
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42. • Communicate, communicate, communicate…
• Create a formal activation plan.
• OVER-staff for Go Live!
• Include support teams in Go Live process.
Activation
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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
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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.
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45. www.blue-cirrus.com www.intermountainhealthcare.org
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