Telehealth Project Management: Unique Challenges And Critical Success .
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsHIMSS InnovationCommunity Webinar: aProject Management Series The event will begin at the top of the hour. Visit the HIMSS Innovation Community atwww.himss.org/innovationMay 28, 20201
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsTelehealth Project Management:Unique Challenges and Critical SuccessFactorsPatrick Mattis, DNP, MSN, MSCS, RN-BC,CPHIMS, CNEChair and Professor at Lincoln University, and theChief Nurse Administrator2
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsWelcome3
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsAgenda Welcome HIMSS Innovation Community Updates / Announcements A word from the Project Management Work Group Chairs Presentation: Telehealth Project Management: Unique Challenges and Critical Success Factors Live Q&A Wrap-Up / Next Steps4
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsUpdates and Announcements5
Telehealth Project Management: Unique Challenges and CriticalSuccess Factorswww.himss.org/h20digital6
Telehealth Project Management: Unique Challenges and CriticalSuccess Factors7
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsShare. Have a COVID-19 related process or solution that's working well in your organization?Submit it.Learn. Looking for ways to better manage COVID-19? Explore solutions from fellowhealthcare professionals.Ask. Have questions about a solution? Comment on it and engage in the discussion.Visit the HIMSS COVID-19 Digital Tank8
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsProjectManagementWork GroupCo-ChairsNiha GoyalMichele MillsSr. Program Manager, Perspectaniharika.goyal@uspsector.comDirector, ITS ProgramManagement OfficeUniversity of Utah Healthmichele.mills@hsc.utah.edu9
andTelehealthProjectManagement:Challengesand CriticalSuccess FactorsCritical Success FactorsWelcomePatrick Mattis, DNP, MSN,MSCS, RN-BC, CPHIMS, CNEChair and Professor at LincolnUniversity, and the Chief NurseAdministrator10
Project Management ofTelehealth: Unique Challengesand Critical Success FactorsPatrick Mattis, DNP, MSN, MSCS, RN-BC, CPHIMS, CNEDirector & Chair /Professor Lincoln University
SpeakerDr. Patrick MattisDNP, MSN, MSCS, RN-BC Informatics, CPHIMS, CNEDirector & Chair Department of NursingProfessor Lincoln University12
Explore the landscape of Telehealth Examine issues and challenges unique to TelehealthObjectives Gain Insights on Lessons-Learned and Best Practices for Successful ProjectImplementation13
TelehealthTelehealth — the use of telehealth, mobile and consumertechnology to deliver health-related services, such as remotehealthcare provider consultations and patient monitoring — isenabling healthcare providers and payers to address the UShealthcare industry's growing list of problems.14
Understanding TelehealthTelehealth is used tosupport the delivery of, andimprove access to, clinicallyappropriate careTelehealth offersopportunities forconsumers to become moreinvolved in their care and inhealth service planning.Patient-centered caremodel offering greaterpotential to improve healthoutcomes15
16Current and Future Landscape of Telehealth
US TelehealthadoptionTelehealth visits are exploding as doctorsand patients embrace distancing amidthe coronavirus crisisGeneral virtual health care visits expected totop 200 million this year, up sharply from theiroriginal expectation of 36 million visits for allof 2020.The adoption of telehealth flew into hyperdrive over the past few month, with all typesof telehealth interactions on pace to top 1billion by year’s end
Current Areas of Telehealth TeleAnesthesia TeleInfectious Diseases TeleOphthalmology TeleCardiology TeleImmunology TeleOrthopedics TeleCritical Care TeleInternal MedicineTeleDentistry TeleDermatology TeleEmergency Medicine TeleMental Health TelePsychiatry TeleEndocrinology TeleNeurology TeleSurgery TeleFamily Practice TeleNursing TeleStroke TeleGastroenterology TeleOncology TeleUrology TeleObstetrics TeleOtolaryngology TelePathology TelePediatrics19
Emerging Areas ofTelehealth - mHealth The future of implantable technologiesfrom smart stents to high-tech tattoos Implantable devices such as ECGrecorders, pacemakers, anddefibrillators can transmit the status ofthe heartbeat to healthcare providersand forewarn of potential problems. Implanted devices for heart failurepatients, can monitor heart failurestatus and transmit information onworsening of changes20
Emerging Areasof Telehealth Wearabledevices Wearable devices and mobile apps With increased accessibility to smartphones, providers also benefit fromapps and devices that help them care for patients. Wearable devices including health tracking and patient monitoring devicesbecoming the future of healthcare. Wearable devices help remove elements of human error for providers,because the communication of data comes directly from the device itself.21
Steinhubl, S. R., Muse, E. D., & Topol, E. J. (2015).The emerging field of mobile health. Sciencetranslational medicine, 7(283), 283rv3.doi:10.1126/scitranslmed.aaa3487Copyright 2015,American Association forthe Advancement ofScienceEmerging Areas of Telehealth - mHealth and DiseaseManagement.
Challenges, Critical Success Factors and Best Practicesin Telehealth Project Management23
Current Models: Telehealth & Clinical ServicesLIVE YNCHRONOUS)VIDEOCONFERENCINGREMOTE PATIENTMONITORING (RPM)MOBILE HEALTH(MHEALTH)NONCLINICAL HEALTHEDUCATION AND PUBLICHEALTH PROGRAMS.
Telehealth & Clinical Services Models The equipment needed may range from dedicated turnkey videoconferencing unitsto software-based videoconferencing programs for computers or mobile platformssuch as tablets and cell phones. The technology should be able to provide sufficient AV clarity needed for thepatient’s assessment and the ability for providers to communicate easily with eachother. The technologies should be able to connect peripheral medical devices that may behardwired or portable (eg, general examination camera, stethoscope, pulseoximeter, otoscope, ultrasonography device). Interoperability with existing telehealth services and technologies. The recommended criteria for current technologies are H.323 compliance, live videoresolution of 4 Common Intermediate Format (4CIF) (704 480) or higher The technologies should comply with current organizational, legal, and regulatoryrequirements and will change as technology develops.
Telehealth & Clinical Services Models Connection Provide adequate bandwidth to support the needs of the telehealth program goals. Provide point-to-point connectivity from within or outside the health care facility. Use a high-speed Internet connection. Occasionally, telehealth interactions use an ISDN connection when sites lack theinfrastructure to support high-speed Internet connections. For live synchronous telehealth, a frequently suggested minimum speed is a 384-kilobits-persecond bidirectional connection between the sites. Privacy and Security Telehealth interactions must comply with HIPAA and other regulatory requirements. Create a point-to-point encryption between the devices involved in telehealth interaction. Virtual private network tunnels are a common method used to facilitate the privacy of theInternet connection used for the telehealth interaction. Each covered entity should ensure the security of protected health information
Telehealth Integrates all Project management knowledge rmanagement
Telehealth Project Management Success and ostImplementation
Pre-PlanningDefine the Purposeof the TelehealthProjectEngage ExecutiveLeadership/KeyStakeholdersAssemble the teamDefine SuccessEvaluate VendorsContract
Pre-Planning: Needs Assessment & Infrastructure AnalysisAssess and confirm your organizationsreadiness for telehealth. It is costly, time consuming andchallenging to start a telehealth program A formal assessment of readiness havethe advantage of identifying potentialproblems and addressing them early. Increase support for the project byengaging people early.Best Practice: Perform A Needs Analysis A needs analysis will help yourorganization to identify key unmet needs Improves understanding of the natureand scope of the unmet need, Provides a sound foundation forplanning, helping to clarify objectivesand shared expectations Iimproved coordination of services andresources and provide supportingstructure for your program evaluation.
Pre-Planning – Define the Purposeof the Telehealth Project Why is a telehealth service model being considered andwhat is it intended to achieve? What is the problem that needs to be solved? How will telehealth contribute to the organization's overallvision? What outcomes are anticipated and how will these bemeasured? Have examples and evidence of effective telehealthtechnologies used in similar contexts been identified What population will be served?
Pre-Planning: Engage Executiveleadership Has the project gained support from senior leadership? Have internal champions been identified for the initiative? Is there recognition and support for change from cliniciansand executive? Does the project leader have good project managementskills to drive sustainable implementation, integration andorganizational change?
Pre-Planning:Engage Keystakeholders Ensure staff have the opportunity to beinvolved in developing the project plan anddeveloping the evaluation measures? Consult and Engage community or consumersin designing the service? Establish regular lines of communication tokeep all stakeholders well informed ofprogress? Create feedback mechanisms to ensure issuesand considerations of staff and consumers arecaptured and can be addressed?
Pre-planning: Assemble the Right Team(s)The success of any telehealth project depends on engaging the right people. It is critical to assemble the right team(s) to define the project’s objectives.Telehealth Involves people, processes, and technologies Leadership Team: Board of Directors/C-suite Executives Practice Owners/Partners Core Team: Information Technology/Physicians/Nurses Administrators/Compliance officers Finance/Patient engage officers/patient advocates Advisory Team Patient advisory board/Patients/Caregivers Implementation Team Information Technology/Physicians/Nurses
Pre-Planning: Define Project SuccessHEALTH OUTCOMESPATIENT EXPERIENCEREDUCED :Reduced: Health outcomes Continuity of care Compliance withstandards of care Patient satisfaction Patient engagement Patient retention andloyalty Convenience of care Care plan compliance Safety Access to care Cancellations/ NoShows Labor costs Cost per case Costs due toreadmissionpenalties Non-reimbursable care ER visits Burnout Turnover rate Appointment length Insight aboutpopulation health Quality of life MedicationmanagementReduced: ER visits Complications AdmissionRatesReduced: Wait time to receive careImproved: Patient reachImproved:Continuity of care Efficiency of care delivery Care team/patientcommunication
Define Project Success:IOM Dimensions ofQuality In addition to the triple or quadrupleaims of project management, includeclinical success factors Telehealth innovations should bedesigned to increase the quality ofcare. As much as possible, align projectsuccess with the Institute of Medicine’s(IOM) six dimensions of quality(STEEEP). Safe Timely Effective Efficient Equitable Patient-centered
Pre-Planning: Evaluate dor tionand Validation
Pre-Planning: Contracts Secure any remaining approvals within your organization to proceed withcontracting Negotiate terms (financial investment, customer support, additional services,upgrade schedule, success metrics, etc.) Document clear and measurable definitions of success for your workingrelationship and the initiative at large Identify the timeline for the current contract and outline when terms will berenegotiated Clearly outline the plan to scale your program, and align on any relevantcontingency plans Work with your legal, financial, procurement, or IT teams as necessary to getthe new contract signed or existing contract updated
ProjectImplementation
Project ImplementationWorkflow, Policies andProceduresStaff and PatientPreparationProject ImplementationEvaluation
Project Implementation: Workflow & ProceduresEnsure yourworkflowaddresses theentire telehealthlife cycle.Before thevisitDuring thevisit PatientEngagementand Education SchedulingProtocols: Patient intake Troubleshooting Virtual patientroom CommunicationAfter the visit Coding/Billing EHR Integration Summary
Project Implementation: Staff and Patient PreparationTRAININGSUPER USERSEDUCATE STAFF ONNEW WORKFLOWTRAIN STAFF TOEDUCATE PATIENTSCONDUCT INTERNALTELEHEALTH TEST VISITDEVELOP A PROCESSFOR ONGOINGFEEDBACK
The under-estimation of the personnelrequirements required to supportimplementation, has been identified as acommon cause of telehealth failureTraining andEducationConsider:Is there an adequateworkforce base to supportthe demand for telehealthservices?What technical andadministrative resourcesare required to support theservice?How will any additionalimpacts on the healthservice or clinicians bemonitored and managed?43
TelehealthTechnologyand ClinicalServicesDetermine who willactually provide careDetermine initial set ofacceptable diagnoses/visitreasonsDevelop workflow forconducting a visit(standard forms,demographic informationgathering, etc.)Develop triage protocolsDevelop telehealthtreatment protocols thatcomply with standardsand protocols of careDevelop follow-upprotocolsInfection control andcleaning of equipment44
TelehealthTechnology andClinical ServicesHow often the patientwill be monitored – oncea day, more? Also onweekends?The process to reportpatient problems – whattriggers a phone call orhome visit? When is thephysician contacted?Decide whichtelemonitoring devices /manual measurements touse – e.g. weight scale,blood pressure and SpO2,perhaps ECG rhythm stripon cardiac surgerypatients.Determine proceduresfor infection control
Evaluation Develop an evaluation and monitoring plan Conduct an end-to-end test of the entire process and all use cases, andconnection between all sites. Monitor and evaluate all key elements of the program on a regular and ongoingbasis. Include a range of topics in your plan Service usage, Patient and provider comfort level with particular technologies, devices andapplications Cost savings analysis. Be sure to monitor and track ancillary or related services benefiting from yourtelehealth program activities, e.g. lab and blood tests performed at local clinics,staff and nursing employment etc.
Telehealth UniqueChallenges
Telehealth ProjectManagement: ChallengesAlthough telehealth offers many benefits, thereare also barriers to adopting such technologywhich includes: Reimbursement models Interstate licensure challenges Legal and regulatory issues Concerns over security, privacy, andconfidentiality Lack of evidence about impact on healthcare costs, utilization, or outcomes Concerns about impacts to clinical dutyto provide safe and effective care Logistical space challenges
Telehealth PM – Interstate LicensureInterstate Licensure: Telehealth rules vary from state to state Include the legal and billing team as early in the process as possible tounderstand federal, state, and payer requirements and regulations Identify in which states your clinicians need to be licensed as well as inwhich states they are currently licensed Research interstate licensure, including the Interstate Licensure Compact the enhanced Nursing Licensure Compact (eNLC) the Interstate Medical Licensure Compact (IMLC) Check with your malpractice insurance carrier to ensure you are coveredto provide telehealth services
LEGAL DOCUMENTSTelehealth:Legal Issues Business Associate AgreementMaster Service AgreementScope of Work/Price QuotePurchase OrderFinancial Audit ReportsConfidentiality Agreement/Non-Disclosure AgreementW-9 FormVALIDATION DOCUMENTS IT Security and Risk Assessment510(k) Clearance:Liability InsuranceMedical Licenses for PractitionersThird-party Audit
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsQ&A51
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsWrap-Up & Next StepsWant to get involved? ChaptersCommitteesCommunitiesRoundtablesLearn more at: www.himss.org/chapters Contact:ihoffberg@himss.org52
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsEarn CEU credit!Visit the HIMSS Professional Development website to learn more.www.himss.org/certificationHIMSS PMI Provider #3252Finalize the PMI PDU Claim Submission process by logging onto https://ccrs.pmi.org to claimyour Category A PDUs. HIMSS does not supply this information to PMI.53
Telehealth Project Management: Unique Challenges and CriticalSuccess FactorsTHANKYOU!54
References Agency for Healthcare Quality and Research. (2008). Using Telehealth to Improve Quality and SafetyFindings from the AHRQ Health IT Portfolio. Retrieved # Becker’s Hospital Review. (August 15, 2019). Shriners Twin Cities, Boys Town Hospital partner ontelehealth services. Retrieved from elehealth-services.html Becker’s Hospital Review. (August 9, 2019a). Dartmouth-Hitchcock unveils Telemedicine ICU Unit.Retrieved from ml Becker’s Hospital Review. (August 9, 2019b). 16 Hospitals, Health Systems Launching TelehealthServices. Retrieved from vices.html Cohen, J. (2018). 5 Challenges Hindering Telehealth Market Growth. Retrieved fromhttp://multibriefs.com/ViewLink.php?i 5bef27b08637255
References HealthData Management. (August, 2019). Sen. Grassley: Telehealth is way to keep healthcare in ruralAmerica. l-america HealthIT.gov. (2019). What is Telehealth? How is Telehealth Different from Telemedicine. Retrieved ow-telehealth-different-telemedicine Institute of Medicine 2012. The Role of Telehealth in an Evolving Health Care Environment: WorkshopSummary. Washington, DC: The National Academies Press. https://doi.org/10.17226/13466. Institute of Medicine 2012. The Role of Telehealth in an Evolving Health Care Environment: WorkshopSummary. Washington, DC: The National Academies Press. https://doi.org/10.17226/13466 Taylor, J., Coates, E., Wessels, B., Mountain, G., & Hawley, M. S. (2015). Implementing solutions to improveand expand telehealth adoption: participatory action research in four community healthcare settings. BMChealth services research, 15, 529. doi:10.1186/s12913-015-1195-3 US Department of Health and Human Services. (2013). Modifications to the HIPAA privacy, security,enforcement, and breach notification rules under the health information technology for economic andclinical health act and the genetic information nondiscrimination act; other modifications to the HIPAA rules.Federal register, 78(17), 5566-5702. Vander Werf, M. (2004). "Ten critical steps for a successful telemedicine program." Stud Health TechnolInform 104: 60-68. World Health Organization. (2010). Telemedicine Opportunities and Development in Member Stats.Retrieved from https://www.who.int/goe/publications/goe telemedicine 2010.pdf56
Telehealth Project Management: Unique Challenges and Critical Success Factors Agenda Welcome HIMSS Innovation Community Updates / Announcements A word from the Project Management Work Group Chairs Presentation: Telehealth Project Management: Unique Challenges and Critical Success Factors Live Q&A Wrap-Up / Next Steps 4
telehealth services using Zoom with AccuCare under current federal guidelines as of 3/19/2020, and you should contact your local/state authority when it comes to telehealth and billing for telehealth. Zoom to AccuCare Workflow Implementing video conferencing to your clinical process to offer telehealth services can be simple. It does not
Benefits and Challenges of Expanded Telehealth Use Hospitals reported that telehealth has become an important care delivery model during the COVID-19 pandemic. Administrators also reported some challenges in delivering care with telehealth. These challenges are that telehealth, by its very
Managed Care Plan Provider Telehealth Resource Guide . I. Introduction to Telehealth . What is Telehealth? Telehealth, as defned in emergency rule 5160-1-21* of the Ohio Administrative Code (OAC), is the direct delivery of healthcare services to a patient via synchronous, interactive, real-time electronic communication comprising both
Province of BC Health Authorities Telehealth Clinical Guidelines 4 P a g e Version 9 (updated September 2014) Definitions Client: A potential or actual recipient of Telehealth services Provider: A healthcare professional offering Telehealth services Telehealth: The use of communications and information technology to deliver health and health care services and information over large and small .
Can Physical Therapists provide Telehealth (or telemedicine) services as part of a child's education? Yes. The Oregon Physical Therapist Board allows for telehealth delivery of services. The Board defines telehealth OAR 848-040-0100 as: (13) "Telehealth service" means a physical therapy intervention, including assessment or
Adapting ITIL for Effective Telehealth Service Management Session 141, Wednesday, February 13, 2019 . Explain how the RACI Matrix is applied to telehealth service management. Brief History of Telehealth . Implementation Model (T-SIM .
Focusing on telehealth as a case study in dis - . mobile health, remote monitoring, telecare, telehealth, telehealth nursing, telemedicine, telenursing, virtual nursing This technology uses remote monitoring, videoconferencing, and much more to extend the reach of nurses and improve care. . behalf of the European Society of Cardiology, con-
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