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									Collaboration for an Effective
     TeleHealth Project

    Catherine Bruno, FACHE
         January 2001
Catherine Bruno, FACHE

Current position (4 months)
 Vice President
 Medicalis Corporation, Boston, MA
 Software company connecting radiologists to ordering
 physicians
 Funded by Brigham & Women’s Hospital


Prior position (11 years)
 Chief Information Officer
 The Ohio State University Medical Center, Columbus, OH
 1,000-bed academic medical center
Agenda

TeleHealth Landscape
 Technology
 Regulations


Scenario for Collaboration – a TeleHealth Project
Framework

Case Studies
 The Ohio State University Medical Center Telemedicine
 Program
 Radiology at Brigham & Women’s Hospital
TeleHealth Landscape - Technology

The Internet - Connectivity
 Worldwide connection
 Browser
 Wireless
Computer Hardware
 Smaller, faster, lighter, less expensive
 Video
 Handhelds
Software Frontiers
 Voice Recognition
 Character Recognition
 Data Mining
TeleHealth Landscape - Regulations

New Telemedicine Legislation
that expands reimbursement

HIPAA - Clinton Administration
Issues Regulations on Medical
Record Security

Canada strengthens Internet
privacy
New Telemedicine Legislation

Substantially improves existing Medicare coverage of
telemedicine effective October 1, 2001

HCFA will issue rules early in 2001

Serves as a major step forward in expanding services
throughout the U.S.
HIPAA - Medical Record Security

Effective Feb 26, 2003
Covers all medical records and identifiable health
information: electronic, paper, & oral
Provisions:
 Consumer Control Over Health Information
 Boundaries on Medical Record Use and Release
 Ensure the Security of Personal Health Information
 Establish Accountability for Medical Records Use and Release
 Balancing Public Responsibility with Privacy Protections
   Special protection for psychotherapy notes
   Equivalent treatment of public and private sector health
   plans and providers

       Source: HHS Fact Sheet, Dec 20, 2000
Canadian Internet Privacy

Protects personal information disclosed through
electronic transactions
Jan 1, 2001 for companies that are federally regulated
By 2004, anyone doing business in Canada must comply
Consent of consumers is required if their personal
information is used commercially
Consumers have the right to review any information
about them that is on file
A privacy commission is being set up to investigate
violations
Companies must name someone responsible for privacy
matters
European companies already operate under similar rules

      Source: New York Times, Dec 23, 2000
Agenda

TeleHealth Landscape
Technology
Regulations


Scenario for Collaboration – a TeleHealth Project
Framework

Case Studies
The Ohio State University Medical Center Telemedicine
Program
Radiology at Brigham & Women’s Hospital
Overview

Effective TeleHealth Projects provide
 ongoing support for
 improved health
 using telecommunications tools

Many TeleHealth projects are initiated as
 independent projects that are grant-funded
 have a limited scale
 often not part of the health care organization’s technical
 plan


TeleHealth is not an “Island;” it requires significant
integration into the organization and operations for
success
   Scenario for Collaboration –
a TeleHealth Project Framework
Three Keys to Success

   People                 Processes



              Effective
             TeleHealth
               Project




       Technology
Scenario for Collaboration – a
TeleHealth Project Framework
People
 Support of key medical staff, administrative, project, and IT
 staff
 Sufficient resources
 Collaborate throughout the process
 Communicate, communicate, communicate
 Strict patient confidentiality
Processes
 Change Management
 Organize and structure the project
 Ensure fit with operations
Technology
 Integration into the organization’s systems
 Systems & Technical infrastructure
People: Support of key medical
staff, administrative, project,
and IT staff
Medical Staff involvement and leadership
Administrative support
Project executive sponsor or committee to remove
roadblocks
Fit with the health care organization’s strategic
direction and market
Consensus on clear project goals and expectations
Identify key end users who can be trusted to shape the
project
Vendor involvement
People: Sufficient resources

Money for equipment, systems, connectivity, etc

Staff with technical and clinical operational expertise

Large projects require a dedicated project manager
People: Collaborate throughout
the process
Starting in the planning phases

Continuing through design, development or selection,
testing, implementation, and support

Regular meetings to track progress and remove
roadblocks
People: Communicate,
communicate, communicate
Communicate often

Use multiple methods
 Project meetings
 Leadership meetings
 Organizational communications (regular staff meetings, grand
 rounds, etc.)
 Pizza lunches
 Newsletters
 Internet
 Etc.
People: Strict patient
confidentiality
In the United States
 Medicare regulations
 Newly created HIPAA privacy rules
 State laws on privacy – especially for psychiatric and AIDS
 information
 Regulatory agencies, e.g., JCAHO, CARF

In Canada – new internet privacy regulations

Organizational Policies
 E.g., Research oversight, e.g. Human Subjects Committees
Scenario for Collaboration – a
TeleHealth Project Framework
People
 Support of key medical staff, administrative, project, and IT
 staff
 Sufficient resources
 Collaborate throughout the process
 Communicate, communicate, communicate
 Strict patient confidentiality
Processes
 Change Management
 Organize and structure the project
 Ensure fit with operations
Technology
 Integration into the organization’s systems
 Systems & Technical infrastructure
Processes: Change Management

Build a shared vision
Document current processes and operations - “An accurate,
insightful view of current reality is as important as a clear
vision.”
“Use the gap between the vision and current reality to
generate energy for change.” Collaborate to develop new
operational procedures to accommodate the new
functionality/system
Consider the interconnectedness with the rest of the
organization
Prototype the new processes and system
Level of testing depends on the newness and criticality of the
system
Measure and communicate the results

       Source: The Fifth Discipline by Peter Senge
Processes: Organize and structure
the project
Assemble and structure the team with the needed skills
and knowledge
Define clear roles
Develop a reasonable schedule
Track status; Measure and report project performance
Manage Vendor to deliverables and dates
Implement the technology in phases
 Iterative changes to operations
 Opportunity for the system to evolve from feedback &
 experience
                Typical Planning Process


WHERE ARE WE NOW?           WHERE ARE WE GOING?       HOW DO WE GET THERE?

        TASK 1                      TASK 5                     TASK 7
       Project                  Needs Analysis             Alternate Strategy
     Organization                                             Assessment


       TASK 2                       TASK 6                      TASK 8
      Goals and                 Identify/Prioritize       Strategy Selection
      Objectives                    Projects                   and Plan


        TASK 3
   Inventory of Current          Status Update              Status Update
      Environment

        TASK 4
     Environmental
      Assessment


     Status Update
Processes: Ensure Fit with the
Operations
Analysis of current operations
Work with people who do the work every day to
redesign the processes to fit the new system
Monitor implementation and change where needed
Operational considerations:
 Convenience/accessibility of location
 Physician scheduling
 Who do you call with questions or issues?
Scenario for Collaboration – a
TeleHealth Project Framework
People
 Support of key medical staff, administrative, project, and IT
 staff
 Sufficient resources
 Collaborate throughout the process
 Communicate, communicate, communicate
 Strict patient confidentiality
Processes
 Change Management
 Organize and structure the project
 Ensure fit with operations
Technology
 Integration into the organization’s systems
 Systems & Technical infrastructure
Technology: Integration into the
organization’s systems, where
practical
Conformance with standards

Sets the stage for current and future integration of
information with other systems and processes

Allows integration with support services

Makes ongoing support and updates easier
Technology: Systems and
Technical Infrastructure
Technical standards   Vendor support

Planning              Support services such as
                       the help desk
Connectivity
                       Information integration
Bandwidth
Obstacles

Obstacles can arise in any area and at any step of the
project

With collaboration and consensus on goals, the team can
work through all the other obstacles

For example
 If resources are scarce, the leadership group can figure out
 how to get what’s needed
 If the technology is too immature, you can work out an
 appropriate exit strategy
Agenda

TeleHealth Landscape
 Technology
 Regulations


Scenario for Collaboration – a TeleHealth Project
Framework

Case Studies
 The Ohio State University Medical Center Telemedicine
 Program
 Radiology at Brigham & Women’s Hospital
Examples of Effective Collaboration

Massachusetts General Hospital
 Teleradiology using electronic images
  Source: “Medical Imaging over the Internet” by Keith
  Dreyer, DO, PhD, Corporate Director, Partners Healthcare
  System, presented at eHealthcareWorld, Dec 2000
 Real-time stroke intervention, including scoring the deficits
 and collaborative patient management
  Source: “Telemedicine-enabled patient care: New
  Approaches to healthcare delivery” by Lee Schwamm, MD,
  MGH, presented at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration

DOD Walter Reed Army Medical Center: telemedicine
web-based clinical applications to enhance access to
subspecialty medical consultation: dermatology,
dentistry, echocardiography, sleep medicine, podiatry,
and ophthalmology
 Source: “Medical Imaging over the Internet” by Colonel Ron
 Poropatich, MD, Walter Reed Army Medical Center, presented
 at eHealthcareWorld, Dec 2000
Examples of Effective Collaboration –
Case Studies
The Ohio State University Medical Center telemedicine
program

Radiology at Brigham & Women’s Hospital
  Case Study: The Ohio State
   University Medical Center
(OSUMC) Telemedicine Program
OSUMC – Telemedicine Program
Description
Overview
 Began in 1996
 6,000 consults per year
 12 specialties with highest use in internal medicine,
 pulmonary care, and dermatology
 32 sites, dedicated half-T1 connections
 Administration shared between OSUMC and Ohio Department
 of Rehabilitation and Corrections (ODRC)
 Cost $2.5 million
 Cut the transport of prisoners by 30%
High physician satisfaction
 Easy to use
 Readily met their clinical needs
Three Keys to Success

   People                 Processes



              Effective
             TeleHealth
               Project




       Technology
OSUMC – People

Key OSUMC and ODRC Medical Staff, administrative, and
IT leadership
Sufficient resources – Funded by ODRC and a grant from
Ameritech
 Full time OSUMC project leader
 Full time technical coordinator
 Significant involvement by Ameritech and OSUMC IT network
 staff
Close working collaboration between OSUMC and ODRC
throughout the process
Frequent communication via meetings, phone, etc.
Strict patient confidentiality
 Behind the OSUMC firewall
 Physical security
OSUMC - Processes

Shared vision to improve quality and timeliness of care
and reduce cost by minimizing patient transports for care
Started with a prototype in internal medicine
Full time project leader assigned by OSUMC to organize
and manage the implementation and ongoing operations
Ensure fit with operations
 Technical coordinator for scheduling the physician time and
 technical resources
 Convenient/ accessible location at OSUMC
OSUMC - Technology

Systems and technical infrastructure
 Conformance with network standards
 Support by OSUMC network staff
 Vendor support
  Case Study: Radiology at
Brigham & Women’s Hospital
           (BWH)
BWH – Radiology Information
Management System (RIMS)
Improve the quality and efficiency of health care
services by
 Facilitating the integration and flow of information among
 health care providers
 Providing evidence-based clinical knowledge at the point the
 physician is placing the order
 Improving access to billing code information
 Mining a data warehouse of indications and results to create
 evidence-based clinical guidelines


Over 100 radiologists, ordering physicians, and physician
office staff using the system for the past 2 years
           Radiology: Historical                 with the Internet
                                                       Generate Req
                       Consult favorite radiologist
                                                       Structured
    MD sees                                            Ordering &
    Patient       Consultation and Advice Engine       Scheduling

                                                       A
MD Receives Report Text: Call, Fax, US-Mail            N     PACS
Risk Management                                       A     Image
    Work lists                                        L     Enhancement
                           Web Result Delivery
    Patient letters                                   O
                          Manual Billing Coding        G
      Bill                                             Report Dictation/
    Generated                                          Transcription
                        ICD & CPT Mapping, ABN’s
                                                       Report
  Future Ordering     Consensus Wisdom                 Generation
      Data
   Warehouse      Indications & Results Analysis
Three Keys to Success

   People                 Processes



              Effective
             TeleHealth
               Project




       Technology
BWH – People

Support of key medical staff, administrative, project,
and IT staff – Medical Staff Leadership
 Initiated by a Radiologist
 Significant time commitment of the Radiologist
 Supported by Chair of Radiology
 Support from the Hospital COO and CIO
Sufficient resources - Staff to support the system funded
by the Hospital
 System Development
 Implementation
 Training
 Dedicated System Support Staff
BWH – People

Collaborate throughout the process
 Radiology leadership
 BWH Information Systems and BWH Operations Staff
Communicate, communicate, communicate
 Regular meetings
 Close communication with people using the system during
 implementation and on an ongoing basis
Strict patient confidentiality
 Conformance to BWH strict patient confidentiality policies
 Conformance with BWH security: standard login
 authentication
 Behind the BWH firewall
 Physical Security of the data center
 Privacy/security standards
BWH - Processes

Change Management
 Shared vision to improve quality and efficiency
 Prototyped the system in a primary care office with a
 supportive physician
 Designed the system to improve efficiency in the
 physicians office; added features based on feedback
   Scheduling
   Risk management

Ensure fit with operations
 Close working relationship with each physician office
 and the radiology department
BWH - Technology

Integration into the organization’s systems and
technical infrastructure
 Information sharing with Partners’ systems: EMPI, radiology
 and PACS
 Standard workstations and network connections
 Standard login authentication
 Standard fax server connectivity
 Standard paging server connectivity
 Central organizational support for Network, Workstation,
 Login
Further contact:

Catherine J. Bruno, FACHE
Vice President
Medicalis Corporation
850 Boylston St, Suite 312
Chestnut Hill, MA 02467

Phone: 617-734-1702
Email: cbruno@medicaliscorp.com

								
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