A TO Z DEVELOPING TELEBEHAVIORAL HEALTH CAPACITY TO SERVE THE NEEDS OF YOUR PATIENTS - PowerPoint Presentation

A TO Z DEVELOPING TELEBEHAVIORAL HEALTH CAPACITY TO SERVE THE NEEDS OF YOUR PATIENTS Health Centers Healthy Start Programs Ryan White HIV/AIDS Program Grantees and Service Providers Rural Health Clinics Session 6 Lessons Learned August 21, 2013

2 8/20/2013 Phil Hirsch, PhD Chief Clinical OfficerHealthLinkNowphirsch@healthlinknow.com Michael R. Lardiere, LCSWVP HIT & Strategic DevelopmentNational Council for Community Behavioral Healthcare Today’s Speakers Jodi Mahoney, MBAChief Operating OfficerNorth Central Behavioral Health Systemsjmahoney@ncbhs.org Cari Greb RN, BSN-BC Patient Care Coordinator-Home Telehealth James A. Haley Veteran’s Hospital Outpatient Clinic Cari.Greb2@va.gov Melanie Perez, PhD Licensed Clinical Psychologist Lakeland Military Sexual Trauma Coordinator Melanie.Perez3@va.gov

3 8/20/2013 1: Identify for their own organization one or more telebehavioral health service models that are clinically appropriate and a pathway to sustainability;2: Identify and engage the range of stakeholders necessary to successfully establish telebehavioral health services;3: Coordinate their telebehavioral health activities with pertinent local, state and federal partners. Goals of the Training

4 8/20/2013 Session I: Overview & Laying the Groundwork May 22, 2013 @ 12:00 PM EST Register HereSession I: Office Hours Q+A May 29, 2013 @ 12:00 PM EST  Register HereSession II: State Regulatory/Reimbursement Topograpy; Engagement and Outreach June 5, 2013 @ 12:00 PM EST  Register HereSession II: Office Hours Q+A June 12, 2013 @ 12:00 PM EST Register HereSession III: Economics, Partnerships June 19, 2013 @ 12:00 PM EST Register HereSession III: Office Hours Q+A  June 26, 2013 @ 12:00 PM EST  Register Here Session IV: Technology and Logistics  July 17, 2013 @ 12:00 PM EST  Register HereSession IV: Office Hours Q+A July 24, 2013 @ 12:00 PM EST Register HereSession V: Implementation August 7, 2013 @ 12:00 PM EST Register HereSession V: Office Hours Q+A August 14, 2013 @ 12:00 PM EST Register HereSession VI: Launch, Refinement, Lessons Learned and Wrap Up August 21, 2013 @ 12:00 PM EST Register HereSession VI: Office Hours Q+A August 28, 2013 @ 12:00 PM EST Register Here T/TA SERIES SCHEDULE

Jodi Mahoney, MBA Chief Operating OfficerNorth Central Behavioral Health Systemsjmahoney@ncbhs.org

Thumbnail of NCBHS’s TelehealthUse 3 different forms of videoconferencingLarge Polycom Units – Office BasedIndividual Polycom Software – Individual ComputersCustomized Web Based PlatformAll 7 of our Outpatient Offices have Polycom EquipmentOur Residential CILA Home has Polycom Equipment6 Local ED’s using web based platform and laptops to connect with our crisis workers for crisis assessments.

Rural vs. Urban Utilization Going Beyond PsychiatryED – VAC ProjectElectronic vs. PaperStart Small and BuildClinicians Attitudes Towards Telemental HealthPerceptions of Client Suitability for Telemental HealthHIPPADevelop Backup Process for Unplanned Downtime.Lessons Learned

Rural vs. Urban Utilization Telebehavioral health originated from the need for “Access” in rural geographical areas.Telebehavioral health is just as effective in urban areas (e.g. population density causes the same time/travel constraints as open space)

Going Beyond Psychiatry Telebehavioral health is suitable for the majority of services provided in CMHC’s. Start small and build on itDon’t assume staff are on board with technologyDevelop backup processes for unplanned downtime

VAC Outcome of Connections VAC Service OutcomesVAC Satisfaction SurveyED – VAC Project

VAC Connectivity Outcomes

VAC Service Outcomes

VAC Satisfaction Survey 5 Hospitals/12 Key Participants/4 Respondents/7 Questions

Electronic vs. Paper EHR is a necessity VS.

Start Small & Build Overall Infrastructure Diagram 2005

Start Small & Build Overall Infrastructure Design 2013

Start Small & Build Overview Polycom Legacy 2005

Start Small & Build Web Based PlatformPolycom Overview2013

Clinicians Attitudes Toward Telemental HealthDon’t Assume Your Staff are On Board with Technology Depends on mental health workers willingness to use technologyResearch suggests worker concerns but attitudes and concerns have not been thoroughly evaluated Source: Canadian Psychology 2011, Vol. 52, No. 1, pg. 41-51

Perceptions of Client Suitability for Telemental HealthIndividual mental & physical health statusClient experience with technologyClient’s ageLevel of trustSource: Canadian Psychology 2011, Vol. 52, No. 1, pg. 41-51

Personal Health Information Laptop SecurityEncryptionMobile DevicesHIPPA

Develop Backup Processes for Unplanned Downtime PhoneAccess to Electronic Health Record

Home Telementalhealth delivering innovative quality health care in the patient's home through technology James A. Haley Veterans' Hospital & Community Outpatient ClinicCari Greb RN, BSN-BCPatient Care Coordinator-Home TelehealthMelanie Perez, PhD Licensed Clinical Psychologist/Lakeland Military Sexual Trauma Coordinator

Any views or opinions presented here are solely those of the authors and do not represent those of the Department of Veteran Affairs

Right care Right timeRight place

James A. Haley Veterans' Hospital & Community Outpatient Clinics James A. Haley Veterans' Hospital (JAHVH) is part of the Veterans Integrated System Network (VISN) 8. JAHVH and its four satellite community based outpatient clinics serves 116,000 veterans, and include the nation’s largest polytrauma rehabilitation center. JAHVH, serves four counties in Central Florida. Tampa (Main Hospital)New Port Richey (Outpatient Clinic) Zephyrhills (Community Based Outpatient Clinic)Lakeland (Community Based Outpatient Clinic)Brooksville (Community Based Outpatient Clinic)

What is Home Telehealth? Home Telehealth is the wider application of care and care management principles to the delivery of health services using health informatics, disease management protocols and Telehealth technologies to facilitate access to care and to improve the health of designated individuals and populations with the specific intent to providing the Right Care in the Right Place at the Right Time.Goal of CCHT is to prevent unnecessary long-term institutional care.

JAHVH Telehealth ProgramClinical Video TeleHealth (CVT) clinics include: Diabetes, Renal, GI, Speech, Geriatrics, Smoking Cessation, Move, Cardiac, Pre-op, Mental Health, LymphedemaTeleHealth Mental Health, TeleMove, SCI, TeleHealth (medical)Store and Forward Dermatology, Retina

Home Telehealth (HT) VA initiative started in 2000.Mental Health program in existence since early 2002.A best practice model of care coordination combined with technology to facilitate a holistic, interdisciplinary approach to the care of veterans with mental health illnesses.

Home Telehealth from the Veterans’ home Patient’s home CCHT- JAHVH Austin, TX.

Home Telehealth Equipment

Goals of Program Teach Disease Self-management skillsExpand patient knowledge of diagnosisImprovement in Depression, PTSD, Schizophrenia, and Bipolar managementEnhance communication and collaboration with providersImprove access to clinics, and departments Reduce healthcare costs , complications, provider no-show ratesCoordinate health care treatmentsDecrease unscheduled visit to ED, Urgent Care and Acute CareImproved patient satisfactionProvides evidence based preventive health care

Provider Benefits Decrease provider visits and phone calls to the providerIncrease quality of care and more efficient use of resourcesIncrease access to care Improve provider no-show rates Improve utilization of hospital resources

Patient Benefits “Just in time” healthcare advice from a nurse/providerIncreased access to health careCoordination of care/services.Deliver care to patients: The Right Care at the Right Place at the Right Time

Program Benefits Care Coordinators are case managers who are able to leverage the use of health informatics, telehealth technologies and disease management strategies to coordinate care of patients with high risk, high cost or high utilization patternsTeam working on behalf of veteran to facilitate symptom management, improve quality of life, easing caregiver burdenAssists in navigating VA system by providing a single/additional point of contact

Admission Criteria More than 2 admissions to a Mental Health Facility Multiple ED visits for psychiatric issues Multiple appointment no-showsChronic suicidal ideation or High Risk flagA diagnosis of Depression, Schizophrenia, Bipolar or PTSDCurrently prescribed a psychiatric medicationPatients having difficulty complying with medicationsPatients that require close monitoring in order to improve compliance

Exclusion Criteria A home/residential environment that is unsafe for patient, staff, or equipmentDocumented violence/aggression towards staffActive substance abuse Currently enrolled in MHICMHomelessnessUnwillingness to participate in and adhere to program requirementsPatients without access to electricity or a cell phone

Disease Management Protocols Health BuddyUsername: view_contentPassword: reviewAuthentidate

What the Nurse sees

HOME TELEMENTAL HEALTH IN ACTION

Consult

Consult

Enrollment/Screening Process All consults will print to centralized printerConsults will be reviewed by Nurse within 24 business hoursPatient must have a home telephone "land line or cell phone”Willing to enroll/participate in the Mental HT Program Ability to use technology/Family willing to assist

Enrollment process continued Chart reviews by Mental Health RNSchedules enrollment appointmentOrient and educate patient/caregiver to telehealth equipment (45 -60 min visit) via classes up to four patients or individual or telephone educationMonitor home Telehealth data/daily trends (notes titles in CPRS *Care Coordination*)Not everyone receives equipment, Veterans have the choice to self-report using Interactive Voice Response (IVR) to answer questions

Criteria for Discharge Achieves goalsNon compliance with Telehealth plan of care Becomes homelessBecomes verbally abusive to Home Telehealth staff Refuses to submit daily transmission Admission to a facility greater than 27 days Moves away from the catchment area Requests discharge from program Incarceration Death

Lessons Learned Resistance comes from all sidesEngaged health system leadership: Buy in from Chief, Medical Directors, Clinic leaders and administrationEngaged Staff: Buy in from PCPs, psychiatrists and psychologist (training on the new program on how to refer, understanding the different roles of all the providers involved and how to utilize the Telemental Health services. Clear lines of responsibility between teams to facilitate handoffsClarity around shared workloads (Standard Of Operation Procedures)Measurable goals and outcomes must be agreed upon a prioriMental health and medical health have different cultures we are in the process of developing a new culture where technology is part of the treatment team.Can create dependence in mental health and medical providers

Lessons Learned Engaging Patients: Goes far beyond ‘warm hand-off’ Training Patients is taking longer than expected.Put the patient firstAdequate resourcesStaff “We had to get an additional RN person to assist with the Mental Health Consults,” Funding IT “currently working with vendors so that the information that is collected will be able to be put in chart in CPRS.” The Patient Centered Medical Home emphasizing patient self-management Requires a shared vision among providers

Resources Perez, M, Kugeares, S, Lewis-Crosswell, J., Grossenbacher, A.S., Keune, K.M., Agliata, D., Gironda, R. (2012). Trauma Informed Care: New Norms Lead The Way at the VA. National Council Magazine, The Future is Now, 2012; (1):pgs:36-37. http://www.thenationalcouncil.org/galleries/NCMagazine-gallery/12_NCCBH%20magazine%231_web.pdf VA Telehealth Services: http://vaww.telehealth.va.gov/index.asp

52 8/20/2013 The web site: http://www.integration.samhsa.gov/operations-administration/cihs-telebehavioral-healthThe Listserv:All Participants will receive an email and a link to join the ListservAll of the presentations will be archived on the web site

53 8/20/2013 Phil Hirsch, PhD Chief Clinical OfficerHealthLinkNow206.365.3096 phirsch@healthlinknow.comwww.healthlinknow.com Please utilize the Listserv for communication on issues Michael R. Lardiere, LCSWVice President Health Information Technology & Strategic DevelopmentNational Council for Community Behavioral HealthcareMikeL@thenationalcouncil.org Jodi Mahoney, MBA Vice-President/Chief Operating Officer North Central Behavioral Health Systems LaSalle, IL 61301 815.223.0160 jmahoney@ncbhs.org James A. Haley Veteran’s Hospital Outpatient ClinicCari Greb RN, BSN-BCPatient Care Coordinator-Home TelehealthCari.Greb2@va.gov Melanie Perez, PhD Licensed Clinical Psychologist/Lakeland Military Sexual Trauma CoordinatorMelanie.Perez3@va.gov

54 8/20/2013 Attend Session VI Launch, Refinement, Lessons Learned and Wrap up Q + A When: August 28, 2013 @ 12:00 PM EST Register Here: https://www2.gotomeeting.com/register/506801450 This and all webinars will be archived and available on the web site:http:// www.integration.samhsa.gov/operations-administration/cihs-telebehavioral-healthThe Listserv: All Participants will receive an email and a link to join the Listserv