DISCLOSURES “VIRTUAL RT” TELEHEALTH Telehealth Service...A Telemedicine-Based Intervention...
Transcript of DISCLOSURES “VIRTUAL RT” TELEHEALTH Telehealth Service...A Telemedicine-Based Intervention...
7/23/2018
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“VIRTUAL RT”TELEHEALTH
Reliable Medical SupplyRespiratory Roundup
Curt Merriman, RRT, CPFT, Chief Sales Officer
CORE Staffing/rtNOW Telehealth
DISCLOSURES
Relevant Financial Relationships:
Relevant Non-financial Relationships:
➤ Chief Sales Officer CORE Staffing & rtNOW Telehealth Service
OBJECTIVES➤ Define "telehealth"
➤ Discuss the current state of telehealth legislation
➤ Highlight AARC strategic goals
➤ Why telehealth?
➤ The Future: "Virtual RT"
➤ rtNOW Case Studies
WHAT IS TELEHEALTH / TELEMEDICINE?
a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies
“telehealth” is a more universal term for the broad array of applications in the field.
Becoming more widely used over the term “telemedicine”.
DEFINITION OF TELEMEDICINE
"Telemedicine" means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care.
Found at: The Center for Connected Health Policy @ http://cchpca.org.
QUADRANTS OF TELEHEALTH
Store-and-Forward (Asynchronous)Live Videoconferencing (Synchronous)
Mobile Health (mHealth)Remote Patient Monitoring
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QUADRANTS OF TELEHEALTH
Store-and-Forward (Asynchronous)Live Videoconferencing (Synchronous)
Mobile Health (mHealth)Remote Patient Monitoring
QUADRANTS OF TELEHEALTH
Store-and-Forward (Asynchronous)Live Videoconferencing (Synchronous)
Mobile Health (mHealth)Remote Patient Monitoring
Encore AnywhereAirView
QUADRANTS OF TELEHEALTH
Store-and-Forward (Asynchronous)Live Videoconferencing (Synchronous)
Mobile Health (mHealth)Remote Patient Monitoring
QUADRANTS OF TELEHEALTH
Store-and-Forward (Asynchronous)Live Videoconferencing (Synchronous)
Mobile Health (mHealth)Remote Patient Monitoring
STATE OF TELEMEDICINE IN US
“Telehealth policy intersects or is impacted by a multitude of government programs, regulations, laws and policies related to health.”
Found at: The Center for Connected Health Policy @ http://cchpca.org.
POLICY PLAYERS
• Physicians
• Nurse Practitioners (NPs)
• Physician Assistants (PAs)
• Nurse-midwives
Practitioners who may receive payment for telehealth services
Medicare Fee-For-Service Program
• Clinical nurse specialists (CNSs)
• Certified registered nurse anesthetists
• Clinical psychologists and social workers
• Registered dietitians
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POLICY PLAYERS
Medicaid
TELEHEALTH IMPACTS
SUPPORT PLAYERS AARC PROMOTES: RT TELEHEALTH PILOT PROJECT ON HILLPilot Project Promoted RT's to provide via Telehealth:
COPD patients
➤ Self-management education and training
➤ Demonstration/evaluation of inhaler techniques
➤ Smoking cessation counseling
Pilot project bill soon to be introduced into the House of Representatives!!
VIRTUAL LOBBY CAMPAIGN SPRING 2018VLW Campaign Results
➤ Total Emails- 33,222
➤ Facebook Posts- 332
➤ MN Facebook Posts- 6
➤ MN Ranked #15 in nation
➤ 799 Total Emails
➤ 179 Total Activists
LEGISLATION - H.R. 2550 -“TELEHEALTH PARITY ACT”
Introduced: House of Representatives in 2017
Bipartisan supportMike Thompson [D-CA] introducing the bill on behalf of Reps. Gregg Harper [RMS],
Peter Welch [D-VT] and Diane Black [R-TN].
Summary:
• Expanded access to telehealth services in rural areas
• Added respiratory therapists as telehealth practitioners
• Included respiratory services as a covered CMS telehealth benefit
• Added an individual’s home as a “telehealth" site
• Incremental coverage of remote patient monitoring for chronic conditions, i.e. COPD
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LEGISLATION - H.R. 2291- “H.E.A.R.T ACT”
Introduced: House of Representatives in 2017
Summary: Includes Community Access Hospitals
Rural Clinics as telehealth sites and covers
remote monitoring for patients with CHF, COPD
including evaluation and management of the condition.
LEGISLATION - H.R. 766 - “TELEHEALTH FOR INDIVIDUALS RESIDING IN PUBLIC HOUSING”
Introduced in the House of Representatives
in 2017
Summary: Provides coverage of respiratory care
and other therapy services as part of a 5 year pilot
program for public housing residents.
MN TELEHEALTH STATUTES- MEDICAL ASSISTANCE➤ MA covers telehealth by a licensed health care provider - 3x/yr
➤ Medical provider or mental health provider
SUPPORTING ORGANIZATIONS OF TELEHEALTH LEGISLATION
AARC STRATEGIC PLANS 2015 - 2020
"Expand the scope of practice in respiratory care
Good News
Bad News
12% growth in job demand through 2025
Retirements and workforce attrition
AARC Personnel Study Statistics
AARC & TELEHEALTH
Brooke Yeager, MSc, RRT - Program CoordinatorEmergency and Inpatient telemedicine
RTs at MUSC use telehealth for inpatient ICU education (Peer-to-Peer Learning)
Get creative and think about how we can provide our unique services via telehealth. - AARC Telehealth and the RT
http://www.aarc.org/careers/career-advice/professional-development/telehealth-and
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AARC TIMES MAY 2018, "FROM RRT TO VRT"➤ Atrium Health initiated 2 pilot studies
First Study
➤ 2 RT's for 8 wk to identify ways RT could interface with VCC Team
➤ data collection assisting RT's at bedside of outlying hospitals: SBT, ideal body wt settings, standards of care
Second Study
➤ 2 RT's for 8 wks/full access to VCC Team tools-Critically ill
➤ Supported advanced ventilator modalities, high risk low volume
Result: VRT now part of VCC Team 12 hrs a day/7 days per week!
THE FUTURE
Virtual RT
CURRENT RESEARCH
Willard KS, Sullivan JB, Thomashow BM, et al. The 2nd National COPD Readmissions Summit and beyond: from theory to implementation. Chronic Obstr Pulm Dis (Miami). 2016; 3(4): 778-790. doi: http://doi.org/10.15326/jcopdf.3.4.2016.0162
Respiratory therapists should be included as central members of the health care team for people with COPD while hospitalized and post-discharge. For those organizations that have not yet included respiratory therapists in their COPD care teams as well as those who have integrated them into their care processes, efforts should be made to clearly elucidate the role of respiratory therapy and therapists at every stage of care.
CURRENT RESEARCH
Francis C. Cordova, David Ciccolella, Carla Grabianowski, John Gaughan, Kathleen Brennan, Frederick Goldstein, Michael R. Jacobs, Gerard J. Criner. A Telemedicine-Based Intervention Reduces the Frequency and Severity of COPD Exacerbation Symptoms: A Randomized, Controlled Trial. Telemedicine and e-Health, 2015; 150810084730007 DOI: 10.1089/tmj.2015.0035
Eighty-six patients were screened; 79 met entry criteria and were randomized (intervention group, n=39; control group, n=40).
Daily peak flow and dyspnea scores improved only in the intervention group.
A telemedicine-based symptom reporting program facilitated early treatment of symptoms and improved lung function and functional status.
CURRENT RESEARCH
Chitra Dinakar, MD et al. Telemedicine is as effective as in-person visits for patients with asthma. Annals of Allergy, Asthma & Immunology, September 2016 DOI: 10.1016/j.anai.2016.07.012
• All had a small, although statistically insignificant, improvement in asthma control over time.
• Telemedicine was noninferior to in-person visits.
• Most of the telemedicine group subjects were satisfied with their experience.
Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits.
CURRENT RESEARCH
Rebecca C Bell, Phoebe H Yager, Maureen E Clark, Serguei Roumiantsev, Heather L Venancio, Daniel W Chipman, Robert M Kacmarek and Natan N Noviski. Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study. Respiratory Care February 2016, 61 (2) 149-154; DOI: https://doi.org/10.4187/respcare.04080
• Sixteen RTs performed 40 assessments (20 face-to-face and 20 telemedicine)
• 11 subjects, (6 in the pediatric ICU and 5 in the neonatal ICU)
…telemedicine can be used to reliably assess easily visualized, pre-programmed parameters for mechanically ventilated patients in the pediatric and neonatal ICUs. It remains less clear whether dynamic, patient-triggered parameters can be reliably evaluated via telemedicine.
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Live bedside support
Disease management
Equipment troubleshooting
Patient Education
Staff Education
Research Coordination
CASE STUDIES
➤ NPPV in ED
➤ Questions @ EzPAP
➤ “Reelin’ in the Years”
NPPV IN ED
ED-12/23/16
• 73 y/o female - 42 kg• Hx: COPD, CHF• Arrived to ED via EMS with SOB
• RR 52• SpO2 98%• CXR: Clear. No infiltrates or fluid.
NPPV IN ED
ED Treatment
• Duoneb tx.• Solumedrol• Ativan• Toradol• Antibiotics
ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
ICU-12/23
• 1930• Transfer to ICU• RR 52
ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
NPPV IN ED NPPV IN ED ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
rtNOW Initiated
• 2300• RT able to appreciate increased WOB
• Diminished BS• NPPV initiated upon RT recommendation
• LTV - Rate 12; IP 15; EP 5; FiO2
100%.
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NPPV IN ED
rtNOW Follow-up
• 0000• FiO2 weaned to 50%• Vte - 274-400/min• MV 4-8 lpm• Spont. RR 15-18• “Thumbs Up”
ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
NPPV IN ED
rtNOW calls
• 12/24 and 12/25• Troubleshooting alarms
• Mask fit• Skin Evaluation• Weaning support• Nursing staff education
ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
NPPV IN ED
rtNOW support
• 12/26• Pt. avoided intubation and transfer
• Close to home during holiday weekend
• Pt discharged to home!
ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
rtNOW calls
• 12/24 and 12/25
• Troubleshooting alarms
• Mask fit
• Skin Evaluation
• Weaning support
• Nursing staff education
NPPV IN ED - LESSONS LEARNED!ED-12/23/16
• 73 y/o female - 42 kg
• Hx: COPD, CHF
• Arrived to ED via EMS with SOB
• RR 52
• SpO2 98%
• CXR: Clear. No infiltrates or fluid.
rtNOW calls
• 12/24 and 12/25
• Troubleshooting alarms
• Mask fit
• Skin Evaluation
• Weaning support
• Nursing staff education
➤ Direct Critical Care Support - Possible!
➤ Just-In-Time recommendations -Possible!
➤ Reduce patient transfers from critical access - Possible!
➤ Proof of concept.
QUESTIONS @ EZPAP
Client Background
• Critical Access
Hospital
• RT services - 2
days/wk
• Policy and
Procedures
• Nursing staff perform
respiratory duties
QUESTIONS @ EZPAP
rtNOW Call
• Staff nurse initiated
rtNOW call
• Question regarding
EzPAP use on a post
pneumonectomy pt.
• RT gathered additional
patient information.
Client Background
• Critical Access
Hospital
• RT services - 2
days/wk
• Policy and
Procedures
• Nursing staff perform
respiratory duties
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QUESTIONS @ EZPAP Client Background
• Critical Access
Hospital
• RT services - 2
days/wk
• Policy and
Procedures
• Nursing staff perform
respiratory duties
rtNOW Actions
• Obtained Pt surgical
history (5 years since
pneumonectomy)
• Reassured staff that
EzPAP use would be
ok.
• Provided staff with
their own P/P.
• Education
QUESTIONS @ EZPAP - LESSONS LEARNED!
Client Background
• Critical Access
Hospital
• RT services - 2
days/wk
• Policy and
Procedures
• Nursing staff perform
respiratory duties
➤ Patient safety
➤ Staff support
➤ Just-in-Time education
➤ RT Staff Training is critical for consistency
REELIN’ IN THE YEARS
Situation
• RT unable to work in
a traditional clinical
setting.
• RT not close to
retirement age.
REELIN’ IN THE YEARS
Background
• RT with 23 years of
experience:
• Management
• All aspects of RC
• PFT
• Trained into rtNOW
REELIN’ IN THE YEARS
Assessment
• RT had limited
exposure to LTV
ventilator
• First call required
recommending
changes on device
REELIN’ IN THE YEARS
Recommendation
• Training needs to
include broad array of
devices
• How do you keep it
all straight?
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REELIN’ IN THE YEARS
Recommendation
• Training needs to
include broad array
of devices
• How do you keep it
all straight?
REELIN’ IN THE YEARS - LESSONS LEARNED!
Recommendation
• Training needs to
include broad array
of devices
• How do you keep it
all straight?
➤ Harnessing the years of experience of current workforce
➤ Extending careers of RTs who want more
➤ Productive retirement
➤ Addressing the workforce shortages
➤ Bridge to virtual disease management
PEER TO PEER
Hospital RT initiates
rtNOW call
Peer to Peer
interaction
Collaborative plan
Peer to Peer follow
up
Results: positive pt
outcome!
SUMMARY➤ Telehealth is preferred term for the method of
delivering healthcare, education, monitoring.
➤ Four types of telehealth “flavors”:
➤ synchronous
➤ asynchronous
➤ remote patient monitoring
➤ mHealth
➤ Telehealth policy intersects or is impacted by a multitude of government programs, regulations, laws and policies related to health.
SUMMARY
➤ Early research supports “parity” of telehealth care.
➤ “Get creative and think about how we can provide our unique services via telehealth.” - Brooke Yeager, RRT “
If you CHANGE nothing,
NOTHING will change.
-Bryan Wattier, RRT and part-time philosopher