Winona Deep Dive: Telemedicine

1. Mike Allen, Marti Bollman, Terry Donnal, M.D., Gary Evans, Christa Frazier, John Goodman, Rod Hughbanks, Kathleen Lanik, Betsy Midthun, Dennis Theede, Peter Walsh, Linda Wencl, Brad Zuehlke Winona Deep Dive: Telemedicine Background Information Deep Dive Objectives Major Telemedicine Issues Defined Alpha Requirements Home and Community Options, Inc. • Background: The Winona Deep Dive aims to utilize the unique market position and resources of Winona Health along with its Winona Community Partners to expand Beacon Medical Applications. • Primary Partners: • Winona Health (WH) is a community owned, nonprofit organization whose primary mission is to meet the lifelong healthcare needs of the Winona, Minnesota, regional community. WH is vertically integrated with hospital, clinic, nursing home, assisted living, hospice, and home health care operations. WH is partnered with Cerner and has been awarded the “100 Most Wired Hospitals in America” title 8 years running. WH has had an EMR system for eight years. This EMR is unique in that it is a community EMR, utilized by more than one organization in the community as an example of a very complex but very successful collaboration. WH Leadership was invited in 2007 to testify in front of congress regarding this system and its development and implementation. In 2008, PBS did a special on WH, and their implementation and unique success with their EMR. • Home and Community Options Inc. (HCO) was awarded an alternative license in 2009 by the Department of Human Services (DHS) in Minnesota, allowing them to become one of the first agencies of its kind to implement remote monitoring for overnight supervision of one of their homes housing four men with developmental disabilities. The remote monitoring has now taken the place of what had always been supervision of sleep-in staff. HCO already utilizes some of the technology that will be further leveraged by the A-Vu system to monitor this home. This system took a great deal of investment and development on the part of HCO, and has now been in place for several months with great success. • Hiawatha Broadband Communications, Inc. (HBC) has operated its broadband network since 1997 and is recognized as one of the most advanced small market operators in the country. It has been a leader in upgrading its network to fiber technology. They currently provide broadband services throughout Winona. They also provide network support for the Winona Community Telemedicine Network (WCTN). • A-Vu Media is a newly formed company created to partner with WH, HBC, and HCO to develop telemedicine and other innovative applications to serve older adults, the disabled, and other vulnerable populations with broadband enabled services. Together these organizations have an established track record of performance. Each of these organizations has shown a clear dedication to excellence in their respective fields, service excellence to their customers, and technological advancements that benefit the Winona Community. Telemedicine Adoption Barriers SE MN Beacon Impact WCTN Summary • The Deep Dive proposes to leverage the application and meaningful use of EMR and related HIE strategies developed within Beacon using community based telemedicine applications. • Obtain cost reduction by leveraging commercial and consumer technologies on Broadband Networks • Create a remotely managed system to significantly improve ease of use for telemedicine • Expand applications and locations via Broadband • Enhance ease of use by using a multimode system that supports both data collection and live teleconferencing • Establish EMR connection expanded by Beacon HIE • Develop one internal medical operating structure for all telemedicine applications • Document a sustainable telemedicine model Integrated View of Healthcare Provider • Telemedicine has been around for many years with mixed success. • There is a significant need for one integrated system. • Sustainability requires ROI justification that has significant historical issues of reimbursement, adoption, and cost to implement. • The WDD program will first implement telemedicine structures highlighted in green. Patient Perspective of Telemedicine Office Visit • Telemedicine endorsed and actively used by 50% of WH physicians • Increase EMR assessment data by 300% for diabetes and juvenile asthma patients • Reduce lost work/school days due to healthcare issues • Document a sustainable telemedicine model • HCO Home Care Impact for diabetes and other chronic conditions: • Implement remote monitoring in 75% of managed residences • Telemedicine deployment to 25% of served population • Reduce medication administration errors by 33% • Reduce on-site nurse visits by 33% to telemedicine served population • Reduce external trips for healthcare by 20% • Reduce ER visits by 25% Integrated View of Healthcare Provider Clinician Perspective of Telemedicine Office Visit • Limited utilization has been one of the bigger barriers to success. • Ease of use and reliability are often cited as the biggest barriers. • Better EMR connections would enhance system value. • Patient satisfaction has not been an issue. • Recent changes for required licensure will help with future adoption and system expansion.  2011 Mayo Foundation for Medical Education and Research