4 Best Practices in Telemedicine from IU Health

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IU Health offers telemedicine in many specialties and services including pediatric, neurology, pre- and post-transplant, dermatology, sleep analysis and stroke care. The stroke telemedicine program is quite robust with seven sites currently live and 14 sites set to go live over the next two years. With the IU Health telemedicine network, patients who live in the farthest reaches of Indiana have access to comprehensive care.

Doug Lawrence, MSM, PMP, is the manager of telemedicine at IU Health. He has witnessed mistakes and successes while setting up IU Health's statewide telemedicine network. Here he discusses four best practices that made IU Health's experience in telemedicine implementation successful.

1. Convince different healthcare organizations to collaborate. One of the biggest challenges in developing, implementing and using telemedicine networks is getting different healthcare organizations to work together. However, it is a best practice that could greatly benefit a telemedicine network. When IU Health implemented its telemedicine network for Telestroke services, which included a cloud system to store data, images and other health information, Mr. Lawrence approached the project with a teamwork-oriented mindset. He knew it would benefit the process because of seven telemedicine-capable sites that went live in 2011; only three were IU Health-owned. The others were small independent hospitals.

"In today's healthcare market everyone is very protective of their services and their patients," says Mr. Lawrence. "For example, organizations can be protective of the patient images they periodically store on a cloud system. We expected that for the hospitals and cloud-system in our Telestroke service."

To reduce a potential barrier, IU Health took a "Switzerland" approach to storing information on the cloud system, says Mr. Lawrence. The information was stored securely and HIPAA compliant, but in a neutral location not directly affiliated with any participating hospital. "If any entity wanted to take part in providing Telestroke services, they shouldn't have concerns about maintaining their patient records and keeping them private," says Mr. Lawrence. "Without approval, a hospital would have access only to its patient information."

For telemedicine to best live up to its potential, a network should extend to rural areas and potentially across communities, counties or entire states. If healthcare organizations do not collaborate to set up a network, the benefits of telemedicine may be harder to introduce to patients in rural areas. "It has to be a collaborative effort with other healthcare organizations across the state to benefit the patients," says Mr. Lawrence. "It is really important to make sure you have developed a solution or program that is not totally self-servicing. It can't just be for your organization's benefit — that doesn't work."

2. Find and apply for grants.
It is not breaking news that telemedicine services struggle to spread because the reimbursement is just not there. Even though requirements for reimbursement may be loosening, payors still prefer to reimburse for live interactions between patients and physicians, says Mr. Lawrence. While this gives hospitals and providers a big challenge to overcome, there are other ways to support the services financially.

"Most of the hospitals [that use our telemedicine services] are not in the [IU Health] network," says Mr. Lawrence. "By working with the Indiana Rural Health Association, we were able to secure grant money." The Indiana Rural Health Association (IRHA) is a non-profit corporation developed to improve the health of all the state's rural citizens. There are also rural health associations in 35 other states such as Alabama, California, Colorado, Delaware, Georgia, Hawaii, Idaho, Kentucky and Maryland.

According to Mr. Lawrence, IU Health received the grant to pay for upfront costs it does not provide for physician compensation. IU health was able to provide the neurologists to consult with patients via the telemedicine equipment. "The only cost to the rural hospitals was $2,000 paid to Silver Hill technologies, the equipment vendor. We were lucky we had the help of a grant to provide that service to the rural hospitals in Indiana." Other organizations such as the U.S. Department of Agriculture have provided grants for telemedicine projects. For example, the Mississippi Delta region received a USDA grant in November to provide health IT to the area's rural facilities.

IRHA is the lead entity for the Indiana Telehealth Network. The ITN is one of 50 remaining pilot programs under the Federal Communications Commission’s rural health care pilot program, administered by the Universal Service Administrative Company as part of the federal universal service program. The ITN, through this federal pilot program, has constructed over 200 miles of fiber throughout the state of Indiana to bring high-speed fiber optic internet and Ethernet services to rural healthcare providers. The pilot program pays up to 85 percent of eligible construction costs and monthly recurring charges for eligible healthcare participants for 48 months. The ITN has approximately 60 rural healthcare participants, including rural health clinics, community mental health centers, 25-bed critical access hospitals, as well as other rural and urban hospital partners. The bandwidth obtained through this program was critical to the meeting the needs of the Telestroke program. "Bandwidth is a crucial element of telemedicine, you really need fast internet," says Mr. Lawrence.

3. Conduct site visits and roundtable meetings.
Site visits and round-table meetings help to ensure that technical problems and human errors are accounted for as best as possible. IU Health held quarterly roundtable meetings with all the sites involved in the telemedicine network.

"We learned about interesting things such as the high-stress situations in which clinical staff use the telemedicine equipment," says Mr. Lawrence. "We needed clear protocol and training for managing stressful situations and family members while operating the high-tech equipment."

Additionally, the quarterly roundtable meetings allowed Mr. Lawrence to conduct site visits before launching the services. "It was important to take a technical assessment as well as a logistical assessment to answer pivotal questions," says Mr. Lawrence. "I checked everything from the wireless set-up to where equipment could be stored so that the clinical staff would only have to worry about patients and saving lives."

Mr. Lawrence recommends answering the following questions, among others, during a site visit:

•    What kind of wireless capability does the facility have?
•    What kind of connectivity can the facility receive?
•    How are the rooms set up?
•    Where can the equipment be stored safely?

4. Make it easy.
Since tensions are high with some stroke patients, the last thing clinical staff should be concerned about is how to turn on the equipment. The equipment should be easy to turn on, easy to operate, and the support number for problems or malfunctions should be clearly posted if not memorized by staff.

"From a technology and clinical standpoint, the clinical staff needs to know the protocol forwards and backwards before they are placed in high stress situations with the high-tech equipment," says Mr. Lawrence. "The telemedicine operation needs to be as simple as possible. Merely turning on the monitor and flipping one switch is the best." Mr. Lawrence also recommends thoroughly training clinical staff to enhance the success rate. "You would think that would be obvious but you want to make sure. You do not want the clinical staff to be unprepared during a crucial moment," says Mr. Lawrence.

More Articles on Telemedicine:

3 Solutions for Major Telemedicine Barriers
University Hospital in Cincinnati Installs Telemedicine Network With Indiana Hospitals
Hospitals Need Additional IT Infrastructure to Fix HIT Issues, Frustrations

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