patient administration, clinical systems and existing technologies - - PowerPoint PPT Presentation

• 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

Integrating telehealth in to current services; connecting with patient administration, clinical systems and existing technologies

• Integrating telehealth
• Shared learning
• Organisational Context
• Practical Implementation
• Bringing it together

What we want to achieve today

• An audience question… to gauge who’s in the audience and why?

Who is our audience?

• 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)

Alfred Health telehealth context

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

Physical infrastructure & ICT

• Platform(s) (e.g. Health Direct)
• Hardware and devices
• Physical infrastructure (‘blended’ rooms)
• IT support model / escalation path
• IT functions - integration
• IT systems – integration

Project establishm ent Diagnostic s Solution Design Implementa tion Evaluation Sustain

People

• Roles & responsibilities – integration into existing roles
• Onboarding
• Training (clerical, clinical, super-users)
• Telehealth resourcing (central) and ongoing support

Process / workflow – automate where possible

• Booking / scheduling
• Patient communications
• Checking in
• Monitoring patient flow
• Billing and MBS eligibility
• Coordination with partners, GPs
• Guidelines & procedures

Governance

• Strategy and business planning
• Oversight and risk (e.g. committee)
• Policies
• Monitoring and evaluation (performance dimension)
• Information compliance (security, privacy, records)
• Financial compliance & funding model

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

• 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 

“Administrators are humans too”*

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?

Awareness

• (Note this was

last!!)

Billing Follow-up

• .
• .
• .

Requesting

• .
• .
• .

Scheduling Running the appointment

• .
• .
• .

NASSS framework:

• Simple sandwich
• Complex unpredictable

raising a child

• Complicated but

predictable rocket

• 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!!

Requesting Telehealth appt in drop down list in Qflow Telehealth appointment option in paper forms WHO? Does what When; how Scheduling Appointment type in clinical software Translates from iPM (admin) to Qflow (clinicians) Translates to patient apt list (with /out local clinician) Verdi / Clinical Viewer Easily visible as telehealth in clinic lists – iPM – admin and Qflow - clinicians Running the appointment Telehealth (with or w/out clinician) is visible in clinic lists (Qflow) 'time stamps’ See & check-in patient; timing; Hardware Integration of TH platform, eg passwords, access etc TH apt is DHHS reportable in the clinical admin system Follow-up Sending pathology/ imaging forms etc to patient? Option to request telehealth for next appointment Identify patients who are ‘TH-enabled’?

(what does this mean?)

Billing Medicare telehealth Items in post-consult form (in-house) Confirming eligibility for Medicare billing Telehealth (with 50% calculation) in billing software Awareness ‘Regional patient’ prompt clinical viewer ‘Consider telehealth’ in post consult form Processes for managing patient requests for telehealth (fear of clinician push-back)

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