Case Study 4
See attached.
1
Case Study: Implementing telemedicine Solution
Introduction
One of our course goals this semester is to analyze the methods utilized to align a Healthcare information management plan with the corporate and strategic goals of a healthcare organization. This case study focuses on a hospital that has adopted a new information system to achieve a strategic goal. As you plan and create this case study report, focus on the below areas as you apply relevant concepts to this particular case.
Implications of Early Adoption
What are the ways in which Grand’s early adoption of other health care information system technologies might affect its adoption of telemedicine solutions?
How might an early adoption make the transition to telemedicine easier?
Barriers to Telemedicine
What do you see as the most likely barriers to the success of telemedicine in the areas of radiology, behavioral health, and intensive care?
Which barriers will be the most difficult to overcome? Why?
Which of these areas would be the hardest to transition into telemedicine? Why?
Which of these areas do you think would be the easiest to transition into telemedicine? Why?
Before you begin to work on Case Study 4, be sure to read Chapter 3 while paying special attention to the different types of clinical systems.
Method of Evaluation
As this 50-point case study is the first of four, your reports will be graded based on the completeness and yourunderstanding as of the material as outlined in theCase Study Grading Rubric.
Introduction:
Telemedicine has the potential to play an integral role in providing medical information and services across space and time via telecommunication technologies ranging from the telephone to robotics (Sood S., Mbarika V., Jugoo S., Dookhy R., Doarn C.R., Prakash N., Merrell R.C, 2007). One of the major goals of telemedicine is to enhance the delivery of health care to geographically disadvantaged and medically underserved populations, thereby providing an improved quality of care while decreasing costs (Ackerman M.J., Filart R., Burgess L.P., Lee I., Poropatich R.K., 2010).
Although telemedicine has a long history, its adoption has proven slow due to a multitude of barriers. These barriers have been technological, financial, and legal and have also involved business strategy and human resources. Recent events and activities in each of these areas in addition to U.S. health reform activities may do much to break down these barriers (Gupta A., Sao D, 2012).
Grand hospital set an example of hospitals which need to acquire telemedicine technology to overcome physician shortage problem, and it has to overcome the barriers of adaption a new technology as telemedicine.
Background:
Telemedicine can be a pivotal force in working to achieve care coordination and improvements in health disparity outcomes to ensure that patients receive the proper care (based on clinical need and evidence-based medicine) at the appropriate site (closest to where they live and work, aided by electronic links) by a suitable provider (based on explicit and rational triage criteria) while avoiding duplication and waste (using uniform protocols for diagnostics and procedures) (Rashid L. Bashshur, 2013).
The American Telemedicine Association (ATA) has suggested the beneficial uses of telemedicine in the ACO model (American Telemedicine Association, 2011). The underlying premise is that shared specialty services, coordinated care with more service sites, and easier access can reduce the cost of care. Numerous organizations, including the ATA, have called for the repeal of certain restrictions on telemedicine for Medicare reimbursement to work toward the goals of the ACO model (American Telemedicine Association, 2011).
Grand Hospital has a history of an early adaption of Healthcare Information system that provide the following:
Electronic health record with computerized physician order entry.
Patient registration and revenue management.
Imaging via a PACS.
Pharmacy management.
Laboratory management (Wagner, K.A., Lee, F.W., & Glaser, P. J., 2013)
Now they are looking for potential application of Tele-radiology, tele-psychology and Tele-ICU program, to address the organizations need for enhancement physician coverage in radiology, behavioral health and critical care medicine.
SOLUTIONS:
What are the ways in which Grand’s early adoption of other health care information system technologies might affect its adoption of telemedicine solutions?
Early adoption of other health care information systems may have a positive affect its adoption of telemedicine solutions, as we know that Grand hospital currently utilizing EHR and picture achieving and communication systems (PACS).
PACS is a healthcare technology for the short- and long-term storage, retrieval, management, distribution and presentation of medical images, allowing healthcare organization to capture, store, view and share all types of images internally and externally, that will help them a lot in store and forward method of telemedicine delivery specially in tele radiology service.
Also early the implementation of EHR, Laboratory management, gives many advantages for the hospital to implement telehealth as:
Providing accurate, up-to-date, and complete information about patients at the point of care
Enabling quick access to patient records for more coordinated, efficient care
Securely sharing electronic information with patients and other clinicians
Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
Improving patient and provider interaction and communication, as well as health care convenience
Enabling safer, more reliable prescribing
Helping promote legible, complete documentation and accurate, streamlined coding and billing
Enhancing privacy and security of patient data
Helping providers improve productivity and work-life balance
Enabling providers to improve efficiency and meet their business goals
Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health (Rogove, H. J., McArthur, D., Demaerschalk, B. M., & Vespa, P. M., 2012)..
How might an early adoption make the transition to telemedicine easier?
With all the previous mentioned advantage of the early adaptation of Health Information technology in Grand hospital will facilitate the transition to telemedicine much easier, as there will be no resistance among the clinic staff regarding the new technology, and they will have the proper training dealing with any new technology.
Also for the Grand hospitals executives and board of trustee they will have no issue financially regarding implementation of telemedicine solutions, as they previously they notice how Health information technology reduce cost, and it solve the problem of physicians shortage specially in the field of radiology, emergency and behavioral health.
What do you see as the most likely barriers to the success of telemedicine in the areas of radiology, behavioral health, and intensive care?
I. Regulatory barriers: State licensure laws: For healthcare professionals, especially when it comes to practicing across state lines, licensure can impede the ability to offer telemedicine services. AHA supports the Federation of State Medical Boards interstate medical licensure compact as a first step to address the challenges. However, the authors add that the compact is not perfect; one issue is the timetables states have for issuing licenses, which could extend the process.
II. Online prescribing: Physicians must be able to prescribe medications to patients treated through telehealth, but currently in most states there must be a physical evaluation of the patient before a med can be prescribed. Only 20 states allow physical examinations via telehealth tools.
III. Security concerns: Existing legal and regulatory rules surrounding privacy and security must be understood as they relate to telemedicine, the report says. Telemedicine brings even more sensitive data into the healthcare space, and that may require hospitals to update their risk analyses and privacy practices.
IV. Reimbursement: Insufficient capital expenditure and lack of reimbursements are serious financial issues for the telemedicine field. Similar to licensing laws, reimbursement models vary across the country. Certain criteria have to be met in order for practitioners to receive reimbursement. Our state-by-state policy guide has the most up-to-date information on these laws. When reimbursement is limited, patients in the affected regions are under-served. In many cases, the cost of telemedicine is a burden hospitals are expected to bear.
V. Credentialing: The telemedicine credentialing process can get very complicated. For example, in hospitals that work from a hub and spoke model, physician specialists at every hospital in the system must have telemedicine credentials at all the other hospitals. Not only is the volume of paperwork needed for credentialing time-consuming, but the administrative processing costs are through the roof. The time and money invested in approving physician credentials for telemedicine could be used to train hospital staff and onboard patients instead (LeRouge, C., & Garfield, M. J., 2013).
Which barriers will be the most difficult to overcome? Why?
There are significant privacy and security risks in telehealth systems that can adversely affect patients and clinicians level of trust and willingness to adopt and use the system. Noting that current regulations do not provide sufficient guidance for developers or protection for users, though there is a single federal agency, the Federal Trade Commission (FTC), coordinate the creation and enforcement of comprehensive privacy and security standards.
Any transfer offers the potential for a security breach, despite efforts to create secure devices and apps, many contain serious flaws, and hackers and malware pose an increasing threat to the security of telehealth systems (Hall JL, McGraw D, 2014).
Which of these areas would be the hardest to transition into telemedicine? Why?
Tele-ICU will be the hardest area to transition into telemedicine, due to presence of many barriers One of the main barriers to adoption of tele-ICUs has been adoption and implementation cost: the cost of construction, installation, and training. The command center for a tele-ICU system has been estimated to cost between $2 and $5 million, with each additional tele-ICU added to the system costing $250,000.20 Such substantial financial outlays can be a challenge for hospitals and health systems that lack significant financial funds or borrowing capacity, especially with annual operating costs of about $2 million, including maintenance costs, licenses, staffing expenses, and additional upgrades. If the tele-ICU system is not fully compatible with the hardware or software systems of the physical ICU, additional software, hardware, and infrastructure may be required, which would require additional cost to the hospital (Nielsen M, Saracino J, 2012).
Regardless of the need for upgrades, staff must overcome additional barriers such as computer issues, including difficulty logging on, short battery life, frequent rebooting, and other technical issues with computers or software. Some of the possible solutions for these problems include ensuring computers remain plugged in, confirming that passwords are able to be used in multiple programs, and providing information technology (IT) assistance by phone and on-site as required (Lyden C., 2013).
Which of these areas do you think would be the easiest to transition into telemedicine? Why?
Tele-Radiology will be the easiest area to transition into telemedicine, due to presence of many barriers due to the early adaptation of PACS Imaging technology, As a perfect Imaging most provides hosted tele-radiology software, hosted PACS systems, radiology workflow management software solutions, and tele-radiology service business solutions, tele-radiology PACS software solution simplifies the complex information and evolving image routing requirements associated with radiologists who must have multi-state licensure and service multi-state imaging facilities.
PACS will enable tele-radiology practices to operate more efficiently, reduce overhead, increase productivity, speed radiology report distribution and turnaround and create fast, accurate billing, resulting in improved profitability.
If you were charged by Grand to bring telemedicine to facility with eighteen months, what are the first steps you would take? Whom would involve in the planning process? Defend your response.
To bring Telemedicine to the Grand hospital within 18 months the first steps I will take are:
Constructing a well-designed Strategic plan with
Strategic goals
Mission
Vision
Forming a Committee.
Concentrating on Five project goals and methods.
Searching for the best possible vendor for the facilities information system.
Individuals Involving in the Planning Process are:
CEO
CFO
2 top physicians
2 top radiologists
2 top psychiatrists, about
3 RNs or nurses
Facility administrator,
Office manager of each department
CONCLUSION:
Grand hospital has to work tirelessly to find new, innovative ways to cut costs and to overcome physician shortage specially in the field of radiology, intensive care and behavioral health, while also improving patient care outcomes, telemedicine is a strategy that has risen to the top for a number of reasons.
1) Reduce hospital readmission rates
As many providers working in hospital systems know, theres a constant drive to keep down those readmissions rates or suffer the penalty. Beyond the potential financial penalty, its obvious that patient care is not being effectively managed when the unnecessary readmission rates are high.
Telemedicine provides a way to keep those readmissions rates down Because telemedicine solutions make it easier for patients to follow-up with questions and red flags, they increase the opportunity to catch and prevent a problem before it becomes another expensive, avoidable hospital stay.
2) Better medication adherence
According to the Annals of Internal Medicine, medication adherence can lead to almost $300 billion in avoidable healthcare costs this year. In addition, when patients dont follow the treatment plans you prescribed, theyre likely to end up right back in the hospital with the same problems.
Using telehealth video visits to do follow-up check-in visits give patients a simple, convenient and streamlined way to get clarification on their treatment plans and allows you to see how theyre doing without requiring a full, in-person visit.
3) Efficient post-operation follow-ups
As many orthopedic surgeons have told our team, they can spot-check a surgical wound in less than 30 seconds. But typical in-person patient appointments usually take much more time. Thats less time surgeons spend in the OR and more wasted traveling or waiting time for patients.
For that reason, many surgeons are using telehealth visits to conduct their post-operation follow-ups. With a simple spot-check over video, they can send patients on their way or e-prescribe any needed antibiotics without the recovering patient having to leave their home.
4) Extend access to specialty care
Its expensive to keep a fully staffed hospital running with access to all specialties. Many telemedicine companies now allow hospitals to hire out remote specialists to extend their specialty care programs. Or, even a simple telehealth solution can help give patients in one location access to your specialists at another branch. You can grow your care program without hiring additional FTEs.
5) Improves care outcomes.
All of these reasons to adopt telemedicine adds up to a better care program. When patients have an easy, virtual way to connect with their doctors, ask questions and prevent avoidable hospital visits, theyre more likely to have positive care outcomes. And like your readmissions rates, patient care outcomes are a metric you should be paying close attention to as you look to level-up your quality-of-care.
If youre not yet looking at adding telehealth to your health system, start shopping around now. Adding telemedicine is not just a strategy for improving your patient care program, its becoming a basic, expected service to keep you competitive with other health systems (El-Mahalli, A. A., El-Khafif, S. H., & Al-Qahtani, M. F., 2012).
References:
Ackerman M.J., Filart R., Burgess L.P., Lee I., Poropatich R.K. Developing next-generation telehealth tools and technologies: Patients, systems, and data perspectives. Telemed. e-Health. 2010;16:9395. doi: 10.1089/tmj.2009.0153
American Telemedicine Association. Comment Letter to Dr. Donald M. Berwick, Administrator of the Centers for Medicare & Medicaid Services, on Accountable Care Organization Proposed Regulations. Centers for Medicare & Medicaid Services; Washington, DC, USA: 2011. pp. 16.
El-Mahalli, A. A., El-Khafif, S. H., & Al-Qahtani, M. F. (2012). Successes and challenges in the implementation and application of telemedicine in the eastern province of Saudi Arabia. Perspectives in health information management/AHIMA, American Health Information Management Association, 9(Fall).
Gupta A., Sao D. The constitutionality of current legal barriers to telemedicine in the United States: Analysis and future directions of its relationship to national and international health care reform. Health Matrix. 2012;21:385442
Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff (Millwood). 2014;33(2):216-221.
LeRouge, C., & Garfield, M. J. (2013). Crossing the telemedicine chasm: have the US barriers to widespread adoption of telemedicine been significantly reduced?. International journal of environmental research and public health, 10(12), 6472-6484.
Lyden C. From paper to computer documentation: one easy step? Online Journal of Nursing Informatics [Internet] 2008. Oct, [cited 2013 Nov 14];12(3):[about 20 p]. Available from: http://ojni.org/12_3/Lyden.pdf.
Nielsen M, Saracino J. Telemedicine in the intensive care unit. Crit Care Nurs Clin North Am. 2012 Sep;24(3):491500. DOI: http://dx.doi.org/10.1016/j.ccell.2012.06.002.
Rashid L. Bashshur compelling issues in telemedicine. Telemed. e-Health. 2013;19:330332. doi: 10.1089/tmj.2013.9998
Rogove, H. J., McArthur, D., Demaerschalk, B. M., & Vespa, P. M. (2012). Barriers to telemedicine: survey of current users in acute care units. Telemedicine and e-Health, 18(1), 48-53.
Sood S., Mbarika V., Jugoo S., Dookhy R., Doarn C.R., Prakash N., Merrell R.C. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemed. e-Health. 2007;13:573590.
Wagner, K.A., Lee, F.W., & Glaser, P. J. (2013). Healthcare Information Systems. San Francisco: Jossey-Bass.
