Integrating telehealth in to current services; connecting with patient administration, clinical systems and existing technologies • Greg Moran • Innovation and Business Development - HISA • Dr. Genna Burrows • Telehealth Lead – Alfred Health, Victoria • Susan Jury • Telehealth Program Manager – Peter MacCallum Cancer Centre, Victoria • www.linkedin.com/in/susanjurytelehealth
What we want to achieve today • Integrating telehealth • Shared learning • Organisational Context • Practical Implementation • Bringing it together
Who is our audience? • An audience question… to gauge who’s in the audience and why?
Alfred Health telehealth context • 2017 State Government telehealth project funding • Outpatients: approx. 363,000 appts. in 16/17; approx. 42 medical specialties • State-wide and national services • Three main metro hospitals (Alfred, Caulfield, Sandringham)
Context – Alfred Health and Peter Mac • Two large metro hospitals • Specialist Clinics telehealth • DHHS 1-year project funding • Needed to be sustainable & cost-neutral (no telehealth team or coordinator) • ‘Business as usual’ – processes, roles, responsibilities • Web based technology (Healthdirect Video Call) with online waiting area • Increasingly the main platform across Victoria • Variable approaches to admin processes – e.g. Alfred and Peter Mac have a ‘decentralized’ approach to booking telehealth • Primary focus on integration rather than disruption or separate model
Integration approach • Organisational • Service level (e.g. clinics) • Need to integrate beyond the clinic to make the change stick.
Integration approach Project Diagnostic Solution Implementa establishm Evaluation Sustain s Design tion ent Physical infrastructure & ICT - Platform(s) (e.g. Health Direct) People - Roles & responsibilities – integration into existing roles - Hardware and devices - Physical infrastructure (‘blended’ rooms) - Onboarding - IT support model / escalation path - Training (clerical, clinical, super-users) - IT functions - integration - Telehealth resourcing (central) and ongoing support - IT systems – integration Process / workflow – automate where possible Governance - Booking / scheduling - Strategy and business planning - Patient communications - Oversight and risk (e.g. committee) - Checking in - Policies - Monitoring patient flow - Monitoring and evaluation (performance dimension) - Billing and MBS eligibility - Information compliance (security, privacy, records) - Coordination with partners, GPs - Financial compliance & funding model - Guidelines & procedures
Part 2 – a.k.a. Getting Brunel’s train to the next station… ….. Hopefully in less than 17 years…. Practical Approaches – How do you integrate and enable telehealth across services and systems? (administration, worker roles, scheduling and billing, clinical systems, patients and practitioner access etc.) A snapshot from the Peter Mac experience to help inform workforce discussion
“Administrators are humans too”* • The major benefits are to patients (especially regional) • The major providers are clinicians (especially metro) • The biggest workflow IMPACT is on administrators – Thus – THESE are our human-centred design humans…. Our administrators were key to informing process and technology tweeks / changes *Thanks Karrie Long
People, processes and systems (a ‘people and what they do’ approach) Who does what; what IT systems need adapting, what training, skills are required at each step? How do they inter-relate? Requesting Scheduling Running the NASSS framework: appointment • Simple sandwich • . • . • . • . • Complex unpredictable • . • . raising a child • Complicated but predictable rocket Awareness Billing Follow-up • (Note this was • . last!!) • . • .
• The initial impact on ICT for enabling the integration of telehealth was significant – not the video calling platform but everything around it – process integration • >14 small or more significant IT / clinical system modifications But it’s still not as complicated or unpredictable as raising a child!!
Telehealth appt in Telehealth WHO? Requesting drop down list in appointment option Does what Qflow in paper forms When; how Appointment type in Translates from iPM Translates to patient Easily visible as Scheduling clinical software (admin) to Qflow apt list (with /out telehealth in clinic lists – iPM – admin (clinicians) local clinician) Verdi / Clinical Viewer and Qflow - clinicians 'time stamps’ Telehealth (with or Integration of TH TH apt is DHHS Running the appointment w/out clinician) is See & check-in platform, eg reportable in the visible in clinic lists patient; timing; passwords , access clinical admin system (Qflow) Hardware etc Follow-up Sending pathology/ Option to request Identify patients who are ‘TH - enabled’? imaging forms etc to telehealth for next patient? appointment (what does this mean?) Billing Medicare telehealth Confirming eligibility Telehealth (with 50% Items in post-consult for Medicare billing calculation) in billing form (in-house) software ‘Regional patient’ ‘Consider telehealth’ Awareness Processes for (fear of clinician prompt clinical in post consult form managing patient push-back) viewer requests for telehealth
The aim in the design of the train (telehealth processes)? • To ditch the manual!!
Finally – and why? Scale changes the rules - scale changes everything (Eric Schmidt @HIMMS 2018) (thanks Chris Ryan) Hence why we aim to ‘get it right’ now (integrate, simple) to enable capacity – ”We are barely delivering 0.8% of what’s possible by telehealth…” Ashley Young - Hunter New England (and all of us!)
Sample system changes screen shots
Prompt – ‘consider telehealth’ for patients from RA2 -5 or interstate • Is the alert ‘at the point of action’? • Do the right people see it? • Has been good for prompting admin staff to think of telehealth – less so for clinicians
• Having the alert at the point where the clinician is requesting the follow-up • External vendor = $$$ & time
Interactions between different systems and views…. • A way to identify that an appt is telehealth • In all the right places and points • Identify the different types of telehealth – why? • Be able to count and report it (behind the scenes – VINAH) • Needs to convert to other displays (eg clinic lists, patient appt lists) • Other considerations?
• Past appointments; future appts; • Different hospitals!
Telehealth letters • With clinician • Patient only • Different instructions • Generic instructions for all
• Promotion • Consumer voice
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