Telehealth Nutrition: Trials, Tribulations, and Triumphs Janice Waterman, RD, CDE THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
I have no financial relationship with a commercial entity producing healthcare- related products and/or services relevant to the content I am presenting. THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
History The VT Rural Health Alliance (VRHA), founded in 2007, is a health center controlled network and program of Bi-State Primary Care Association. The VRHA Telehealth Network (VTN) is a subset of VRHA comprised of 27 federally-qualified health center sites (FQHCs), 1 hospital, and Bi- State. Polycom telemedicine units were purchased for sites within VTN using funding from the U.S. Department of Agriculture, the Health Resources and Services Administration, and the VT Dept of Health Office of Rural Health & Primary Care. THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Grant Opportunity In 2012, Bi-State, on behalf of VTN, applied for and received Telehealth Network Grant Program funds from HRSA . Identified Needs: 1) To share personnel and expertise to improve care for patients with a Body Mass Index (BMI) >30; 2) to strengthen clinical and informatics integration to improve and evaluate health care access, quality, and efficiency aligning with state and national health care reform. Identified Goals/Objectives: To increase access to clinical services, improve quality of health care, and improve network capability to monitor and impact quality, access, and cost indicators. THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Receiving Buy-in from Partners The Health Center was identified as the clinical hub site for the project Met with Medical Directors of all Vermont FQHCs to discuss opportunity and provide nutrition and obesity resources Changing Landscape in Vermont: Blueprint for Health had expanded since application was written; some sites had since received on-site nutrition services Pilot spoke site identified: Hardwick Area Health Center, a site of Northern Counties Health Care, was interested in offering telemedicine nutrition services to their patients Met with Hardwick providers to start building relationship between the two sites THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Creating Workflows Preparation prior to offering services How to identify patients for telemedicine nutrition services? How to refer patients? How to ensure needed clinical information is shared? Who at the spoke site will assist the patient? Where to have patients located within the clinic? How to bill for services? THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Equipment Challenges Attempted multiple different equipment setups; laptops, tablets, TVs Experienced technical issues related to bandwidth, Wi-Fi, software Caused a delay in starting to offer services to patients Performed Quality Improvement Cycles to find most effective setup so that patients would have the best possible telehealth experience THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Providing Services! In August 2013, the first patients had appointments via telemedicine THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Workflow Quality Improvement Once services were actually being provided, needed adjustments to workflow were identified: Scheduling Process Room in which patients are located Staffing Discharge Instructions THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Clinical Improvements Weight Loss Diabetes and Hypertension Control Self-Management THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Patient Feedback Each patient is asked to complete a survey so as to provide feedback regarding the program. 100% of those responding indicated that they were satisfied with the appointment. The majority of patients stated that they preferred having the visit via telemedicine at their primary care clinic vs. traveling “ Everything went well, I am happy that this program is offered to people with weight problems & that are diabetic.” THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Reduced Costs Travel costs saved by allowing patients in remote areas to receive services at their local clinic Almost half of the patients indicated they would have not received nutrition services had telemedicine not been available to them; healthier patients with control of their chronic conditions will have reduced complications and affiliated expenses in the future THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Continued Network Building Regular communication with referring providers Providing updates and education Creating a network of dietitians and diabetes educators THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
“Food, Fun, & Fitness” Free summer program offered to kids ages 10-13 Teaching children how to make healthy choices Keeping kids active outside of school Curriculum can be used in the future Lessons learned THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Where do we go from here? Expansion of services to other sites Strategic Planning to determine other needed services that could be offered via telemedicine THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
Contact Information Janice Waterman, RD, CDE The Health Center 157 Towne Ave Plainfield, VT 05667 (802) 454-8336 jwaterman@the-health-center.org THE HEALTH CENTER HEALTH CARE THE WAY IT OUGHT TO BE
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