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- 1. Implementing Telehealth Home Monitoring Project Nicole Norris Chamberlain College of Nursing NR 640 Informatics Nurse Specialist Practicum I Summer 2014
- 2. Objectives Define telemedicine and how it works Identify and describe current home monitoring practices Define what CHF is and associated complications. Identify the cost of readmission of CHF patients Describe equipment required to monitor patients from home Identify the role of the patient, Assess costs of implementing a telehealth program Identify inclusion/ exclusion criteria for selected patients Identify the project goals Identify a proposal to implement project 2
- 3. Project Goals Improve quality of life for patients with congestive heart failure Provide continuous care through telehealth home monitoring Provide 24-hour technical support Document findings and make revisions to plan as needed
- 4. Institution’s Mission Dedicated to providing access to quality healthcare Provided supportive environment Devoted to excellence and safety Committed to outstanding healthcare Optimizing quality of life
- 5. Vision Statement National leader for excellence Deliver the highest healthcare Provide tailored healthcare experiences
- 6. What is Telehealth? Tele- “at a distance” “The use of electronic communications to exchange medical information to improve patient outcomes.” , (American Telemedicine Association, 2014)
- 7. Telehealth Services Remote patient monitoring Referral services Medical education Mobile health applications Biometric devices Online consults
- 8. What are the benefits? Decrease hospital admissions Decrease healthcare costs Improve quality of life Improve patient outcomes Improve access to healthcare Decrease use of emergency department
- 9. What is CHF? Congestive Heart Failure Most expensive chronic condition to treat Affects approximately 5.7 billion annually Leading cause of hospitalization in people >65.
- 10. Costs of CHF $37.2 billion annually $4,873 average daily cost for hospitalization. Length of stay approximately 4.76 days $17.4 billion for readmissions within 30 days
- 11. Telehealth Solutions The project is intended to utilize telehealth home monitoring for patients with chronic CHF on an out-patient basis. Successful implementation of this project will encompass tremendous benefits.
- 12. Telehealth Solution Home monitoring program Cost effective Wireless monitoring Monitors weight, blood pressure, pulse ox
- 13. How much does it cost? Budget Information IT Technical Support Staff $15,000 ($60,000/year, $5k/month x 3 months) Equipment Installation Fee $3,750 ($150 x 25) Telemonitoring Landline unit with b/p $5,775.00 ($79.00/month x 25 x 3 months) Weight Scale $1,496.25 ($19.95/month x 25 x 3 months) Blood Glucose $1,496.25 ($19.95/month x 25 x 3 months) Training $700 ($28/hour x 25) Total Estimated Budget $28,218
- 14. Inclusion/ Exclusion Criteria Inclusion Diagnosis of CHF Ambulatory Able to provide self-care Willingness to participate EJF <40% Exclusion Diagnosis of comorbidities such as renal failure or liver disease Non-ambulatory Refuse consent to treatment Alcohol use Smoker
- 15. Participate Training Train participates prior to discharge Arrange a date for home visit prior to discharge Provide simulation set-up prior to discharge Provide 24-hour phone support for 1st month
- 16. Critical Success Factors (CSF) Stakeholder support Referral mechanisms and protocols Effective communication between stakeholders Necessary resources Support government regulation and policies Demonstrate the effectiveness of telehealth for selected patients.
- 17. How It Works Daily monitoring sessions Questionnaire Prompted to call physician Advise given via phone to treatment plan Follow-up 6 months after trial
- 18. Staff Training All staff of Cardiac Wellness center ED nurses Quick 10 minute in-service training while at work
- 19. Proposal Select trial group of 25 patients from St. Louis Medical Center in Second Life Monitor patients via telehealth home monitoring x 3 months Provide 24-hour technical support Document findings and make revisions to plan as needed
- 20. End of Project Healthier Patients Happier Staff Decreased Cost Decreased Emergency Visits Increased Revenue
- 21. Let’s Get Started!! Let’s get ready to make SLMC the best by being the first hospital to implement a successful telehealth home monitoring program!!
- 22. Special Thanks Dr. Hebda Paul Woodcock Dr. Sipes St. Louis Medical Center Staff Classmates Phillips Home Monitoring Company Sunita Wadell INS, PG Community Hospital
- 23. References Desai, A. and Stevenson, L. (2012). Rehospitalization for Heart Failure: Predict or prevent? American Heart Association publication, Circulation. Retrieved from http://circ.ahajournals.org/content/126/4/501.full American Telemedicine Association (ATA), (2014). Retrieved from http://www.americantelemed.org/abouttelemedicine/what-is-telemedicine#.U3g2XP1OWM8 Center for Disease Control and Prevention (CDC, 2014). Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm Seibert, P., Whitmore, T., Patterson, C., Parker, P., Otto, C., Basom, J., Whitener, N. and Zimmerman, C. (2008). Telemedicine Facilitates CHF Home Health Care for those with Systolic Dysfunction. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2274890/
Editor's Notes
- Good evening everyone. My name is Nicole and I will be introducing the exciting new topic of telehealth home monitoring for congestive heart failure patients. I have been working closely with my mentor, Dr. Hebda to put together a program conducive to our environment. I am very excited about this project as it is the first time St. Louis Medical Center has implemented such a program. With this project, we will lead the way and set the standard for surrounding hospitals, becoming a leader healthcare field.
- The overall goals of this project are to improve quality of life for patients with Congestive Heart Failure, provide continuous care through telehealth home monitoring, provide 24-hour support to patients and staff and document findings and make revisions to plan as needed.
- St. Louis Medical Center (SLMC) is dedicated to providing access to quality healthcare in a supportive and caring environment with an unyielding devotion to excellence, safety and an unequaled passion and commitment to ensure outstanding healthcare that optimizes the quality of life for those we serve. As you can all see, implementing this telehealth home monitoring program fully supports the institution’s mission.
- The vision statement is SLMC will be a national leader for excellence and innovation in developing and delivering the highest quality of the next generation of consumer-driven healthcare; focus on our patients as individuals and provide healthcare experiences that are tailored and personalized to meet their physical, psychosocial, emotional, and/or spiritual needs.
- The first important part I need to address is what is telehealth? The terms, telenursing, telehealth and telemedicine are often used interchangeably and may have slightly different meanings within the same context (American Telemedicine Association, 2014). Telemedicine is defined as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data and education using interactive audio, visual and data communications. The American Nurses Association defines telenursing as a subset of telehealth in which the focus is on the specific profession’s practice (ANA, 2014).
- There are many different services that can be provided through telemedicine including, remote patient monitoring, referral services, consumer medical and health information, medical education, mobile health applications and biometric devices (ATA, 2014). Telehealth has been utilized for interpreting electrocardiograms, providing education and conducting consults through two-way audio and video technology (Schlachta-fairchild, Elfrink & Deickman, 2009).
- The next question you might ask is what are the benefits? The benefits of telemedicine include improved access to healthcare, decreased healthcare costs, improved quality of life, increased patient satisfaction, decreased emergency department visits and decreased hospital admissions. Telehealth is especially helpful in managing chronic conditions such as Congestive Heart Failure, which we will refer to as CHF.
- What is CHF? To give you a little background on just how serious CHF is, here are a few facts. According to the American Heart Association, CHF was the underlying cause of 57,120 deaths in 2004. Studies show that 47 percent of CHF patients are likely to be readmitted to the hospital within 4-6 months after discharge and 27 percent were likely to be readmitted within 30 days of discharge (Zales, E., 2009). It is currently the most expensive chronic condition to treat and affects approximately 5.7 billion people annually. It is the leading cause of hospitalization in people over 65 years old.
- According to the Center for Medicare and Medicaid Services (CMS), readmissions are an indicator of poor quality care and can be denied reimbursement. The cost of managing CHF is estimated to be $37.2 billion annually, $4, 873 daily and $17.4 billion for readmissions within 30 days. The average length of stay for a CHF patient is about 5 days. In 2004, CHF readmissions within 30 days of discharge costs $17.4 billion with an average hospital loss of $1,288 per patient (Zales, 2009). So as you can see, managing this condition will significantly improve the healthcare system as a whole just by reducing the costs of readmissions.
- One specific patient care population that can benefit from telehealth are the CHF patients. There has been a 10% increase each year for the last three years in the number of readmissions of CHF patients. Outcomes are best when follow-up visits upon discharge involve a collaborative healthcare team (Desai and Stevenson, 2012). One way to ensure compliance and meet the discharge goal of follow-up visits is through Telehealth home monitoring. This will allow the patient to be monitored with reported vitals to a database that can track the data and identify a potential problem before it leads to a re-admission to the hospital.
- The utilization of a telehealth home monitoring program is an ideal way to monitor these chronic patients. This program is cost effective and easy to implement because it involves wireless monitoring to measure weight, blood pressure and pulse ox. These are good indicators to measure because studies have shown that heart failure patients who experienced an increase in weight and blood pressure would be at risk for hospitalization or negative outcomes (Desai and Stevenson, 2012). Telehealth home monitoring has been proven to improve outcomes in CHF patients. This program includes software that allows for authorized access to the data from a remote location.
- So how much does a telehealth home monitoring program cost? The cost are based on the implementation of a telehealth home monitoring program for a selected trial group of 25 patients diagnosed with CHF from the St. Louis Medical Center Cardiac Rehab unit. The estimated total budget is $28, 218 for installation, tech support and monitoring for 3 months. The trial period of 3 months was selected to ensure the 30 day post-discharge date was covered as well as 2 months following to track progression.
- The implementation of a telehealth program will include a selected group of 25 patients discharged from St. Louis Medical Center and accepted into their Cardiac Wellness program. The inclusion criteria of selected patients are as follows; they must have a diagnosis of CHF, an ejection fraction of less than 40%, be ambulatory, able to provide self-care and provide consent to participate. Patients that are non-ambulatory, use alcohol, smoke or have co-morbidities such as renal failure or liver disease will be excluded. The goal is to focus on the diagnosis of CHF and with high risk factors such as alcohol and smoking, it will be difficult to isolate the admission diagnosis. There is a future for the use of telehealth to include these patients that should expand on this program once completion has been successful.
- In order for the telehealth home monitoring program to work effectively, participates must be trained properly and feel comfortable with the devices and process. This can be done by implementing a brief training session prior to discharge, arranging a date for home visit by nurse prior to discharge, provide a hands-on simulation set-up prior to discharge, as well as 24-hour phone support for the 1st month until clients have become comfortable with the process.
- Critical Success Factors (CSF) are conditions, variables or characteristics that directly impact a project’s variability, efficiency and effectiveness (Kodukula, 2011). One CSF includes stakeholder involvement. Stakeholders would include healthcare staff, such as doctors and nurses because they would have to accept and approve the process in order for it to be implemented. Insurance companies are stakeholders because healthcare costs would decrease. Patients are stakeholders because it will reduce costs, save time and increase convenience, which may improve compliance to treatments and overall health. Additional CSFs are that this project will have the availability of sustainable funds for implementation, will have clearly defined telehealth referral mechanisms and protocols, will have successful communication linkage between stakeholders, will have resources, equipment and personnel necessary for implementation, support Government Regulations and Policies and demonstrate the effectiveness of telehealth implementation for selected pilot program.
- This program works by having a representative hand deliver all necessary supplies to the participate’s house and gets the equipment ready to use. A brief review of instructions is given and understanding is evident by a return demonstration by the patient. Each morning, the participate will answer a brief questionnaire and take their weight, blood pressure and pulse ox. This information is transmitted electronically through the system. If there was a weight gain or loss of ≥ 3 pounds overnight, or a weight gain or loss of ≥ 5 pounds over one week, the participant will be prompted to contact their physician. Likewise, alerts are incorporated into the health questionnaire to notify the participant of signs and symptoms that should be reported. 6 months from the initial start date, a follow-up will be conducted and information regarding the number of times the patient contacted their doctor’s office, the number of office visits, emergency department visits and admissions to the hospital.
- Staff training will also need to be conducted to ensure everyone is on the same page. This will include a brief powerpoint explaining the process and a quick 10 minute in-service training session while employees are at work.
- Implementing a telehealth home monitoring program for a selected trial group of patients diagnosed with CHF will improve patient care outcomes, decrease costs, reduce hospital admissions and emergency department visits and improve quality of life for these patients. The cost of implementing a remote program is a very little price to pay. The data will be collected during the 3 month trial period and 6 months later to determine the number of emergency department visits, hospital admissions and hospital readmissions. This will provide evidence as to the success or failure of the program.
- My hope is that by the end of this project, we will all witness healthier patients, happier staff, decreased costs. Decreased emergency visits. Increased revenue and increased communication with the community.
- I hope I have all of you on board with this important project! Together, we set the precedence by being the first hospital to implement a successful telehealth home monitoring porgram.
- I would like to give a special thanks to my mentor Dr. Hebda, Paul Woodcock, Dr. Sipes, St. Louis Medical Center Staff, my classmates, Phillips telehealth company and Sunita Wadell, INS for PGCH. This project could not have been done without all of your help!