MARK SINGH MD A.CHAKRABARTI MD DEB ZONA RN Nursing Home Telemedicine Program Mark Singh MD May 20, 2009 --- Confidential ---
M A R K S I N G H M DA . C H A K R A B A RT I M D
D E B Z O N A R N
Nursing Home Telemedicine Program
Mark Singh MD May 20, 2009 --- Confidential ---
Background: Clinicore
Leading edge Nursing Home Telemedicine company
Staff Back Ground Nursing home, hospital and clinic based medical
practice Medicare Advantage, Tufts Medicare Preferred case
management Nursing home medical management Affiliated with multiple hospitals in the south of
Boston region Relationships with Boston Tertiary hospitals Active involvement with major EMR implementation
projects in the regionMark Singh MD May 20, 2009 --- Confidential ---
Telemedicine: The Concept
John DoeClinical ResultsLabs: WBC 12
Hct 32Bun 45, Cr 2.4
John DoeEncounter Notes
Assessment:Pneumonia,
uncomplicated, stablePlan: observe, Abx
View ResultsVisualize patient,
examine with nurseDocument the
Encounter
Mark Singh MD May 20, 2009 --- Confidential ---
• Physician can remotely assess a patient using high-definition video conferencing and formulate a plan
• Key elements• View clinical results• Visualize the Patient• Document the encounter: assessment and plan
Medical Care Issues in Nursing Homes
Inconsistent Physician coveragePhysicians generally not onsite to address
medical problems as they arise: Pneumonia Wounds Rashes/lesions Post-Op issues, complications Other medical problems that usually require onsite
examination or close daily monitoring
Mark Singh MD May 20, 2009 --- Confidential ---
Consequences of Sub-optimal Physician Coverage
Needless emergency room visits/Ambulance rides
High admission and re-admission rates to hospitals
Delay in treatment for wounds/infections with resulting complications
Poor outcome measures (DPH, JCAHO)
Decreased Patient/Care-giver satisfaction
Mark Singh MD May 20, 2009 --- Confidential ---
Medicare Implications
Nursing Home Pay-for-Performance demonstration “Nursing Home Value-Based Purchasing”
demonstration Criteria includes “appropriate
hospitalization” Implications for re-imbursement/quality
measures 30 day Re-Admission Reduction
May be tied to hospital reimbursement Likely to be a reportable outcome by
hospitals Hospitals transfers will go to SNFs with low
re-admission rates and with good clinical programs in place
House Bill, HR 2068: will expand Medicare telemedicine coverage if passed
Mark Singh MD May 20, 2009 --- Confidential ---
Telemedicine Allows for On Demand Physician Care
Allows medical problems to be addressed by a physician as they occur
Treat patients onsite appropriately without having to transfer to the ER.
Cost savings: fewer ambulance trips
Improved Outcomes: Lower hospital admissions and re-
admission rates Fewer complications: wound care, post-
surgical careMark Singh MD May 20, 2009 --- Confidential ---
Does Telemedicine Work?
Telemedicine via video conferencing is comparable to in person evaluation (study done at MGH, May 2009, Journal of Telemedicine and Telecare)
Telemedicine can increase physician onsite availabilityDoes Onsite physician availability improve
outcomes? Multiple studies have concluded that onsite physician
availability at the nursing home and effective communication is key in reducing hospital admission rates and improved quality of care
Mark Singh MD May 20, 2009 --- Confidential ---
Nursing Home Implementation
Prerequisites Wireless broadband access in Nursing home DPH notification: intent to implement telemedicine
Promotion and training Staff physician consent process Nursing staff
Procedural and Compliance Nursing home credentialing of Clinicore physicians Approval of patient consent forms and process
Telemedicine equipment deployment Go live
Mark Singh MD May 20, 2009 --- Confidential ---
Clinicore Telemedicine Extension Program
Leveraging telemedicine equipment for administrative functions: virtual conferencing with multi-site organizations Remotely located “Lead Administrator” can “meet”
with entire local leadership team via high definition video conferencing
Nurse Training/Education via Video conferencing Educational rounds with local specialists
Infectious disease: i.e.,H1N flu, MRSA, review of in-house infections
Wound care Post-operative careMark Singh MD May 20, 2009 --- Confidential ---
Demo Slides
Mark Singh MD May 20, 2009 --- Confidential ---
Mark Singh MD May 20, 2009 --- Confidential ---
Telemedicine Cart Features
• Wireless high-definition videoconferencing
• Mobile: can be moved to patient room
• Wireless connectivity, internal battery
• Peripheral devices
• Exam camera for wounds, close ups
• Digital Stethoscope
Patient Evaluation at Nursing Home
Mark Singh MD May 20, 2009 --- Confidential ---
Images captured remotely during live sessions
Mark Singh MD May 20, 2009 --- Confidential ---
Patient with recent MRSA wound infection
Patient with new rash
Telemedicine Clinical Documentation
Consult note is generated for each encounter Note sent/faxed to patient’s nursing home physician Note for sent to nursing home for insertion into chart
Sample note See attached
Mark Singh MD May 20, 2009 --- Confidential ---