The document discusses a telemedicine program for nursing homes. It describes how physicians can remotely evaluate patients using video conferencing. This allows medical issues to be addressed without transferring patients to the emergency room, improving outcomes and reducing costs. The telemedicine program aims to provide more consistent physician coverage at nursing homes to reduce hospital admissions and complications through remote treatment and monitoring of patients.

1. MARK SINGH MD A.CHAKRABARTI MD DEB ZONA RN Nursing Home Telemedicine Program Mark Singh MD, A.Chakrabarti MD, Deb Zona May 20, 2009

2. 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 region Mark Singh MD, A.Chakrabarti MD, Deb Zona

3. Telemedicine: The Concept Mark Singh MD, A.Chakrabarti MD, Deb Zona 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

4. Medical Care Issues in Nursing Homes Inconsistent Physician coverage Physicians 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, A.Chakrabarti MD, Deb Zona

5. 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, A.Chakrabarti MD, Deb Zona

6. 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, A.Chakrabarti MD, Deb Zona

7. 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 care Mark Singh MD, A.Chakrabarti MD, Deb Zona

8. 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 “virtual onsite” availability Does 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, A.Chakrabarti MD, Deb Zona

9. 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, A.Chakrabarti MD, Deb Zona

10. 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 care Mark Singh MD, A.Chakrabarti MD, Deb Zona

11. Demo Slides Mark Singh MD, A.Chakrabarti MD, Deb Zona

12. Mark Singh MD, A.Chakrabarti MD, Deb Zona 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

13. Patient Evaluation at Nursing Home Mark Singh MD, A.Chakrabarti MD, Deb Zona

14. Images captured remotely during live sessions Mark Singh MD, A.Chakrabarti MD, Deb Zona Patient with recent MRSA wound infection Patient with new rash

15. 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, A.Chakrabarti MD, Deb Zona