This document outlines a presentation on building a telehealth system for ALS patients. The presentation covers definitions of telehealth and telemedicine, making the business case for telehealth's financial benefits, developing a technology matrix to decide the best options, installing and securing a telehealth system, supporting the system, and ensuring patients and practices benefit from telehealth. The presenter is Richard Strozewski from the Louis Stokes Cleveland VA Medical Center who provides his contact information and discloses no commercial or financial interests regarding the presentation.

1. BUILDING A SYSTEM
FOR
RAPID DEPLOYMENT
OF
FISCALLY SOUND
TELEHEALTH TECHNOLOGIES
FOR
ALS PATIENTS
Richard Strozewski
SCI/D Telehealth Program Specialist/Telehealth Master Preceptor
Louis Stokes Cleveland VA Medical Center
Spinal Cord Injury/Disorders (SCI/D) Service

2. Contact Information
Phone: (216) 791-3800 ext. 4702
E-Mail: Richard.Strozewski@va.gov
Alternative E-Mail: ALS-Veteran-Assist@technologist.com

3. Disclosures
• Commercial Support was not received for this activity.
• Richard Strozewski has no financial interest to disclose

4. Presentation Learning Objectives
• Definitions of Telehealth/Telemedicine.
• Making a Business Case – The Financials behind using Telehealth for ALS Patients.
• Developing a Telehealth Technology Matrix - The different telehealth technologies
and deciding which technology will work best.
• Building a working Telehealth System – Installation, security and support issues.
• Making Your Telehealth System Work – For your patients and for your practice.

5. Question (Raise your Hands)
How many are VA Employees?
How many are Non-VA Hospital Employees?
How many are in Private practice?

6. Telehealth/Telemedicine
Definitions and Distinctions

7. Telehealth
The use of electronic information and telecommunications technologies (ICT
or E/ICT) to support long-distance clinical health care, patient and professional
health-related education, public health and health administration, all in the
interests of advancing the health of individuals and their communities”

8. Telemedicine
• Term coined in the 1970’s
• Literally “HEALING AT A DISTANCE”
• The delivery of health care services, where distance is a critical factor, by all health care
professionals using information and communication technologies for the exchange of valid
information for diagnosis, treatment and prevention of disease and injuries, research and
evaluation, The delivery of health care services, where distance is a critical factor, by all health
care professionals using information and communication technologies for the exchange of
valid information for diagnosis, treatment and prevention of disease and injuries, research and
evaluation, and for the continuing education of health care providers, all in the interests of
advancing the health of individuals and their communities” (WHO Definition)

9. 4 Elements
• Its purpose is to a provide clinical service.
• Overcome geographical barriers, connecting users who are not in the same
physical location as their provider.
• It involves the use of various types of ICT.
• Its goal is to improve health outcomes and/or Quality of Life.

10. The Financials behind using
Telehealth for ALS Patients

11. 50 states - 90 sets of rules

12. What are telehealth parity statutes ?
Laws that require private insurers to
cover telemedicine services if those
same services are covered when
provided in-person.

13. Current Status of Telemedicine Parity Statutes.
• Currently, 17 states have telemedicine parity statutes in place,
• 13 states have legislation pending regarding telemedicine parity for private
insurers.
• The vast majority of Medicaid programs (47 states) do cover telemedicine
services for their beneficiaries, although coverage is usually limited to those
services provided via live interactive communication and/or have
geographical limitations.
• Other Medicaid programs expressly cover remote monitoring services
(Telehealth). (While these statutes require coverage, many don’t mandate
the same level of reimbursement for telehealth as those services
provided face-to-face.)

14. Making a Business Case
• Reduced costs
• Reimbursements from Medicare; Medicaid; the Children's Health Insurance
Program; TRICARE and Private Insurance companies regulated by the Affordable
Care Act.
• Improved Customer Communications and Customer Service
• Increased Throughput
• Additional Services
• Inter-State Licensing
• Plan on a long term ROI

15. Developing a Telehealth
Technology Matrix:
The different telehealth
technologies and deciding which
technology will work best.

16. The Basics
Synchronous – Live and Interactive
Asynchronous – Delayed Interaction

17. Synchronous
Examples
Video Visits
Telephone
Online Interactive communications

18. Asynchronous Examples
Store and Forward technologies
Electronic Medical Records
Readings from home biosensor instruments connected
to a personal computer transferring data to a home
telemedicine web site.

19. Building a working Telehealth
System – Installation, security
and support issues.

20. Rules – Security
• HIPAA Requirements are the same as “in-Person” visits
• Telemedicine clinicians have the same duty to safeguard a patient’s medical records and
keep their treatments confidential.
• Use common sense.
• Storage of electronic files, images, audio/video tapes etc., needs to be done with the same
precaution and care ascribed to paper documents.
• Set your protocols to be compliant
• Follow your protocols
• Document that the protocols have been followed
• Never, Never use open Internet connections.
• Ask the question “Is my carrier HIPAA Compliant”
• Do they have documentation to prove it
• CYA yourself with Patient Informed Consent

21. Rules – Implementation
• Don’t fret the Tech
•Work with a technologist who understands Clinical
Processes, Clinicians and Patients.
• Schedule internal installation during off.
• Test, Test, Test before you bring patients online

22. Rules – Support
• Stick with a single Vendor for supporting you entire telehealth operation
• Your office, your network, your software and your patients
• Have a single point of contact.
• Have a tight, well defined Service Level Agreement.
• Have a Plan B.

23. Making Your Telehealth System
Work
For your patients and for your
practice.

24. • Be confident in the technology – do not try to out-think it
• Be confident in your support structure
• Consider your support staff your partners in success.
• Use it in appropriate circumstances when there is a benefit to the patient
• Not just because it is there
• If using video , Learn how to talk in front of a camera.
• Do not make is stressful for patients.
• Don’t Fret the Tech

25. Telemedicine and
Telehealth
are
A Means to an End

26. And Now
The Commercial

27. Ask your patient if he or she is a
Veteran,
If they are,
Referring them the local
Veterans Health Administration
facility could be one of the best
services you could provide to
them…

28. Richard Strozewski
Louis Stokes Cleveland VA Medical Center
Phone: 216-791-3800 Ext: 4702
VA-Email: Richard.Strozewski@va.gov
Alt. Email: ALS-Veteran-Assist@technologist.com

29. Questions?