Telehealth Secrets 2019: Bringing the 'Health' into Telehealth - Tom Garrison, MD, SonoBello
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Telehealth Secrets 2019: Bringing the 'Health' into Telehealth - Tom Garrison, MD, SonoBello
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Telehealth Secrets 2019: Bringing the 'Health' into Telehealth - Tom Garrison, MD, SonoBello
- 1. Tele Health WHERE IS THE ”HEALTH”?
- 3. Assertions TeleHealth often minimizes the “Health” component “Health” is more important / challenging than the technology
- 4. History History of TeleHealth Parallels the history of communication and information technologies Ancient – Greece and Rome ~500BC Fires, smoke signals, light reflecting beacons, drums horns Outbreak of plagues , births, deaths, etc. Modern – Advent of telegraph and telephone 1924 a patient communicated with a doctor via television and a microphone 1959 U of NE held first real time video telemedicine consultation Ask a Nurse Triage via phone to limit ER visits Radiology first medical specialty to fully embrace Rural and highly specialized services – greatest need Current – Internet based, technology driven VSee & this conference
- 5. Defining Assertions Tele Health is new, growing, evolving Tele Health is disruptive to current healthcare Tele Health is here to stay – better jump onboard Current emphasis is on the ‘Tele’ Time / cost efficient for provider and patient Legal environment needs to catch up to the technology Reimbursement and licensing issues to be resolved Patient relationship more problematic Lets not forget this is practicing medicine
- 6. Technology Assertions Technology is the means / backbone Expanding enabled devices – pulse, EKG, etc Anywhere Anytime Easy to use To record or not Limited physical exam Limited ancillary testing Limited patient - provider relationship Med Mal considerations
- 7. Technology Example Avoid the EMR debacle Government mandated Time consuming Complex Expensive Universally hated
- 8. Outcome Assertions OUTCOME OR END GAME MOST IMPORTANT QUALITY HEALTH CARE IS THE GOAL
- 9. Healthcare Assertions Physician patient relationship - must exist Physician educated, qualified, experienced – assumed or checked (google) Hospital reputation = physician reputation SAFE quality care at community standard – Medical Board / Licensing Quality Assurance - CMS guidelines for instance (Centers for Medicare and Medicaid Services) Outcome surveillance (Risk Management) - imbedded Patient satisfaction & customer service – Net Promoter Score
- 10. Provider Assertions Additional / better income, no insurance hassles Flexible hours, no office Efficient use of time - multitasking Larger sphere of influence – ego reach Enough time and info to diagnose and treat No hands on, ancillary testing more poblematic Licensing / med mal issues Patient-Provider relationship (prevents lawsuits)
- 11. Patient Assertions Convenient – smartphone Efficient – no driving, parking, etc. Cost effective – usually know up front Concierge Medicine? Insurance Shared medical records Provider confidence / trust When to use vs. wasted cost – limited usefulness
- 12. Future Assertions New ‘Normal’ Mid-level providers, nurses, pharmacists, less government oversight Low entry barrier = competition > lower cost of health care Hybrid – follow up, minor, screening/ triage, subspecialty care
- 14. APPC Provider Score Card 360˚ holistic approach Four key performance areas Surgical Skill Interpersonal Relationships Citizenship Core Values
- 15. Score Card Surgical Skill Heaviest weight Detailed data collection Peer and leadership case reviews Sub-metrics • Proficiency (positive outcomes) • Complications • Legal risk profile (escalations)
- 16. Score Card Interpersonal Relationships Weighted second Staff, leadership, peer and patient interactions Subjective surveys, feedback, online information Sub-metrics • Patient stewardship and interactions • Mangement and leadership interactions • Peer interactions • Chief Medical Officer interactions
- 17. Score Card Citizenship Equal weight with Core Values Conformity to policy, procedures and general medical practice Sub-metrics • Charting accuracy and timeliness • Peer review duties • Scheduling flexibility • Timeliness – arrivals and late starts
- 18. Score Card Core Values Sub-metrics Dedication to the organization Seniority - # cases / time employed New service line adoption Meeting additional expectations Adherence to “culture” Jack Welch of GE
- 19. Score Card - Summary Surgical Skill Interpersonal Citizenship Core Values Rapid assessment of all metrics to enable stack rankings: red – yellow - green Under Pay for Performance models can deduct pay for deficiencies
- 20. Tele Health Summary HERE TO STAY DISRUPTIVE, EVOLVING & IMPROVING BENEFICIAL ON MANY FRONTS SOME PROBLEMS LEFT TO SOLVE DONT FORGET THIS IS REAL MEDICINE