Advisory Panel: Telehealth Projects

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Is your organization running or planning telehealth projects?

Assuming the term telehealth includes scope of technologies included in the HRSA definition, we run remote ICU monitoring across our WAN. In addition, we continue to expand the use of mobile clinics that roam around our geography. These clinics include videoconferencing between clinic providers, patients, and remote specialists. We are planning additional work with a national telehealth provider.

No, my organization is still struggling to implement CPOE, keep the beds full, reduce readmissions, etc., etc., and we have not got that far yet.

This shows up in our annual strategic plan every year and it’s there this year too. But I haven’t been able to generate much interest among my medical staff, even the members who travel hundreds of miles for outreach clinics. We run a telemedicine epilepsy clinic and we have the usual teleconferences, but that’s about it. So I’ve retained some consultants to explore options like e-visits, home monitoring, and video visits using webcams with the med staff.

We have a few telehealth services we consume for a couple of specialties. For example, we have a small pediatric hospital and will perform remote echoes with specialists at a leading children’s facility for special patient cases. We do not have any plans to provide any additional telehealth services within our organization or service areas at this time.  

Multiple coordinated efforts related to telehealth as we are approaching from a number of perspectives. More traditional eICU, using remote monitoring of multiple ICUs from a centralized location where critical care physicians and other clinicians are monitoring beds across multiple hospitals. Tele-psych consults in our emergency departments. Developing newer capabilities for virtual ambulatory visits, more acute or urgent care conditions where audio/video is effective in connecting a patient and a provider. Our EMR is really helping with efficiency in this service area and also with tele-psych and ICU areas. The key being that tele-X software, hardware can help best facilitate the patient encounter but it’s important to realize our EMR is needed for order entry, documentation, communication with the local hospital pharmacy, etc.

We currently have a monitoring station set up in our ICU for pediatrics so that our patients can be “seen” by a specialist at a large teaching hospital in the state.  We are currently proposing to provide healthcare services to our local detention centers. If accepted, we’ll go the telehealth route.

ANGELS – Antenatal & Neonatal Guidelines, Education, and Learning System – consists of 23 hospitals and clinics who receive clinical services from us, as well as 18 hospitals who participate in a tele-nursery with us as the hub. Neonatal mortality rates for Medicaid declined from 4.5 per thousand to 3.3 per thousand. ANGEL EYE – one-way video from NICU to authorized family members. AR SAVES – Stroke Assistance Through Virtual Emergency Support – consists of emergency support for 42 hospitals across the state. Increase delivery of TPA from <1 percent to 29 percent in participating hospitals. Other telemedicine services – psychiatry, pediatrics, geriatrics, rehab medicine, cardiology, internal medicine, burn, trauma, genetic counseling.

We’re doing projects with telehealth, telepsych, home health monitoring, remote hospitalist consulting, and have others we’re thinking about. While telemedicine has been around for decades now, it seems to be really heating up lately.

[from a vendor member] We are working with several organizations who are planning telehealth projects. However, it is like NLP at this point – all talk, no action.

We are on the receiving end in that we use a telehealth service (neurology consults) in our ED. It works well, although the service and support has proved problematic. The cart contains all the video components, but when there was a problem, they had no local service techs. This left it to our staff to troubleshoot – if we were a smaller very rural hospital we may not have had the expertise to troubleshoot their equipment on our end. Overall the service has been a benefit to the hospital in that we have a shortage of these specialists to take call.

We actually do a lot of telemedicine, both inside our health system and with external partners and that program is continually expanding. Our main service lines at this point are Neuro, Pediatrics, and Psychiatry. The primary locations served tend to be emergency departments in order to deliver otherwise unavailable specialty care to patients.

Yes, for various disease states and ethnically diverse populations.

A year and a half ago, we agreed to work with a vendor on a case study to determine if telehealth would positively impact outcomes. Telehealth was new to them and they struggled to develop a website for data collection and patient interaction. For the research study we needed IRB approval and a contract with us. Once the attorneys got involved, everything came to screeching halt. A year later, we have a contract and pending IRB approval. Perhaps in the near future we can begin the study with our diabetes and CHF patients.

We have long offered telehealth via phone and web visits for mild, acute problems (e.g. URI, UTI), and we charge a separate fee for those. We are also now looking at using telehealth technology to do remote care at corporate clients.

Vague talk only about telepsychiatry to local ERs and jails.

Telehealth in use for burn, stroke, and psych consults. All working very well with different technology solutions including iPad and a mobile robot looking device.

To meet requirements for Level 1 nursery, we have neonatology sub-specialists on tap, credentialed and available. This is a great solution to consultations that would otherwise require transfers. It is another question entirely whether early transfers are in the baby’s best interest; it may be that telehealth consultations get an actual consultation in the odd hours, where if the baby were in the actual institution providing the consultants, there would be more of the "I’ll see them in the morning" mentality. Of course, in that setting, the consultant is probably more comfortable with the nursing and ancillary staff, so it may be about the same outcome. Still, it feels good to have an actual clinician to clinician discussion about a specific case.

We’re doing a lot of tele-stroke work. A real smart stroke neurologist with an interest in the technology. He’s serving other organizations and when not on site, he starts care using his tablet and the stroke robot in the ED supported by a stroke nurse-practitioner or neurosurgery PA.

Virtual visits are part of our future plans, none running yet.

We are rolling out telemedicine to support our network of six rural health clinics. This will be essentially to push the access to our specialists. Rollout is over next three months.

Radiology uses NightHawk services from the other side of the globe for night preliminary reads, but that’s it.