In part 1 of our article featuring Avera’ Health’s Telemedicine program, we examined the business needs which drove the telemedicine program at the organization, telemedicine roll-out with the Obstetrics department, and positive preliminary outcomes with Gestational Diabetes, including adherence to protocol, lower rates of shoulder dystocia, C-section in labor, and neonatal hypoglycemia. Below is part 2 of the article.
Having implementation experience with telemedicine solutions in the past and now working for Galen, who has some of best data migration and archival solutions on the market, I know that data is a pretty big deal. How accessible is it, how accurate is it, how portable is it, are all questions you need to ask when integrating another solution into your EMR. Unfortunately data captured within the American Well platform doesn’t always play nice with the integrated EMR, resulting in a lot of double documentation for the end users.
“The data exchange is exactly what we are interested in! We document in MEDITECH and we have our platform for Gestational Diabetes on American Well. There isn’t integration right now. I believe integration may come, but it would be in the form of PDF documents which is obviously not discrete data that we can pull and use. Improving data integration is a piece that we are very interested in exploring” says Laberis.
Anything that is documented in American Well needs to be printed and scanned back into MEDITECH. Important data elements such as Allergies, Problems, Rx history and Vital Signs are free text which doesn’t support the unique 1:1 relationship needed for most data exchange within an EMR. “Getting those discrete points to flow from one system to the other so you don’t have to be logged in to two places at once would be a big win” adds Dr. McKay.
Functionally, Avera looks at this program as a virtual office and that is why this missing data piece is so vital to their daily operations. Luckily, our Galen Data team has begun looking into methods to streamline these frustrating workflows as more and more hospitals adopt telemedicine technology.
Other advice to hospitals looking to implement telemedicine
It won’t solve all your problems. “Just because you are doing it through telemedicine does not mean you are going to have the same problems you would have in a brick and mortar practice. Sometimes insurance won’t pay for a prescription or sometimes you have to make that call to bring the patient in for a face time visit” says McKay.
Know your budget and what will be reimbursed for your particular use case. Currently the AveraNow Gestational Diabetes Program is grant funded but are hopeful in turning those numbers around through data, “Telemedicine is a fabulous solution, but right now it is, to a certain extent, very cost prohibitive. We are not getting reimbursed for any of this and the only way you can start to get reimbursed is to say I now have proof of concept and a case study to send to Medicaid.”
Insurance companies are not always pro-telemedicine as it can result in more frequent visits.
Know what your staff capacity to properly plan, prep and implement and support a telemedicine solution. Process mapping, resource mapping and the collection of data points for case study reference are vital to success.
Do your homework. Talk to the end users of some of the solutions you are evaluating and as with everything: weigh the pro’s and con’s. Remember that it’s not going to solve all your problems but it should improve them if you do it right.
What’s next in 2018
“We are in the process of talking about a use case for AveraNow for postpartum depression, postpartum blood pressure monitoring, post op C-section incision checks and also potentially pre-eclampsia monitoring from home. Costs and budget are a big piece of this so we need to prove that it makes us more efficient” says Mckay. “We have a pretty good use case for lactation but have had difficulty rolling that piece out because its one of those programs that needs to be staffed most of the day. Lactation consultants are expensive to train and good ones are hard to find, so staffing is our biggest barrier at this point.”
If that doesn’t seem like enough of an undertaking, Avera also sees plans for a virtual, maternal/fetal medicine, genetics and general obstetrical consultation clinic in their future. They eventually want to roll that into the acute delivery of obstetrics services but need to evaluate any liabilities that may surround that offering. McKay added, “It’s also a humongous undertaking and we don’t want to get that done until we are comfortable with all the process mapping we need to do to ensure patient safety and provider safety.”\
We sincerely thank our friends at Avera Health for their sage advice and contributions they were able to provide for our telemedicine blog series and we’re excited to the program evolve.
About Avera Health
Avera Health is a regional health system based in Sioux Falls, S.D., comprising more than 300 locations in 100 communities throughout a 5 state region. Avera serves South Dakota and surrounding areas of Minnesota, Iowa, Nebraska and North Dakota through 6 regional centers in Aberdeen, Mitchell, Pierre, Sioux Falls and Yankton, SD, and Marshall, MN. Avera is comprised of 33 hospitals, 208 primary and specialty care clinics, 40 senior living facilities in addition to home care and hospice, sports and wellness facilities, home medical equipment outlets and more.
Are you thinking about implementing a telemedicine solution but aren’t sure where to start? Galen is here to help by offering project management, process/resource mapping, implementation guidance, and clinical data integration consultation.