First in our new series of articles contributed from industry leaders in each area

By Kim Lamb, OHN Executive Director

Following last month’s newsletter article announcing and clarifying the 12 health information technology (HIT) best practice areas, this edition marks a strategic shift in focus for OHN’s Progress Report. 

We identified the 12 best practice areas as those that require attention, investment and coordination in order for each provider organization or agency to effectively meet their HIT project goals.

These 12 best practices are designed to assist the entire health care community in translating and aligning from individual community and organizational goals and outcomes to serve a greater and commonly shared goal: the Triple Aim. Why? Our country’s health care system is literally in the midst of rebuilding itself into a nationwide delivery system that is patient-centered. But during this transition, most of the nation is still dependent on the outdated delivery system of the past. 

We are presented with a clear opportunity and choice: Build in chaos or build together in synergy, working toward the greater good. (“We” meaning the federal and state governments, the entire health care community, and the patient community.) Synergy builds momentum and takes the pressure off individual organizations; you don’t have to – and shouldn’t – go through this great transformation alone. Synergy supports the theory that the nation’s health care system is truly “only as strong as its weakest link.” It requires shifting away from self-serving survival and moving toward the space and opportunities for the greater community to not only survive, but to thrive. This isn’t about any one organization, it is about the future of health care delivery and each of our parts contributing to the whole to ensure that it’s at a level and standard deserving of this country and its citizens.

Inspiration aside, we all need a plan—a map. These 12 practices will hopefully begin to simplify and formalize the real-world needs of viable HIT solutions so that legislators, clinicians, operational and technical leadership, funding sources, HIT hardware, software and services providers and patients all understand, implement and accept them as a way to build and sustain the next generation of care. To do so effectively, efficiently, affordably and in a timely fashion, fierce focus and collaboration (or buy-in) from the entire community is required. While it may seem overwhelming, each of us plays a critical role in making that need become a reality. Systematic steps are required to support continued momentum, which can only be achieved if we all start supporting the same set of goals, rules and business assumptions.

In order to get the ball rolling, so to speak, we are going to use OHN's Progress Report to take the best practice framework to the next level of implementation. Each of the next several editions will focus on one of the 12 best practice areas. Nobody has a full and clear understanding of each of the 12 areas. Nobody. That’s why we have to learn and understand what we don’t know and share what we do know.  The goal is to expose all of the niche areas of expertise and allow the available state resources to rise to the top to better educate and help each of us to achieve success.

Best practice 1 – Strategy & Planning: Form must follow function

This month begins with the first best practice: strategy and planning. OHN directly contributes to the success of many of the best practice areas, but not all of them. Throughout this series, we will clarify how we fit in. When we aren’t directly relevant, we will bring in outside experts (local and national) to contribute their thoughts and experiences. If you would like to contribute, or know somebody who would be a good fit, please contact me, Kim Lamb, at klamb [at] oregonhealthnet [dot] org. We welcome the suggestions and contributions of the greater OHN community.

To launch this spotlight section, we have asked a strategic telemedicine consultant, Vanessa McLaughlin of EdithForge Consulting, to share her thoughts on the unique considerations and components providers should assess to ensure the success of a telemedicine or telehealth program. 

OHN is learning on a daily basis what our role should be as it relates to broadband connectivity and serving HIT goals.  As one of the first state-wide health care networks in the country, we have a unique perspective to contribute to the strategic discussion at the national and statewide levels that supports the entire health care community.

I recently crafted a phrase: “OHN should be known as the organization laying the infrastructure for Oregon’s current and future health care delivery system.”  As the core “highway” —one that benefits not only public and private health care communities, but also impacts economic and workforce development—we have a lot to contribute to HIT strategic planning discussions. OHN is Oregon’s health care highway system.

Leadership at the top levels should understand the direct relation between the strength of the OHN network and the strength of our health care delivery system, both in Oregon and across the country. Strong HIT that supports interoperability and patient-centered care requires robust, reliable and scalable connectivity. That’s OHN at its core.

Contributed by Vanessa Leigh McLaughlin, MPH, Founder and CEO, EdithForge and Christopher Thoming MD, Northwest Acute Care Specialists

With coffee in hand this week, I opened the morning paper to see the image of a beautiful baby girl, her mother standing over her ICU crib. The heart-wrenching story documented how the mother took her daughter to the local hospital for care.  The emergency physician, upon seeing the child, contacted the local pediatrician who suspected Meningococcemia, a disease that could have caused the child’s death within six hours.  Columbia Memorial Hospital used the Oregon Health Network (OHN) to connect to the Oregon Health Sciences University Telemedicine Pediatric Emergency physician for immediate consultation. Because of the live video connection, the OHSU specialist was able to diagnose and provide treatment recommendations immediately.  The story ends with the mother describing how she believed that connecting to the regional center was instrumental in saving her child’s life, a gift that she obviously treasures.

Today, telemedicine delivery and telehealth education stories are becoming more commonplace.  However, challenges of implementing telemedicine programs remain great due to the existence of proprietary programs, equipment and technology networks that often lack compatibility, standardization and common clinical protocols.  This may begin to change with the Patient Protection and Affordable Care Act (PPACA) and CMS’ Triple Aim goals.

Triple Aim goals align well with the goals of existing telemedicine and telehealth initiatives in the United States. Because of conflicting payment structures and competition, it is not intuitive to health delivery organizations across the continuum of care that it is in their community’s best interest to implement Triple Aim goals.  However, patient-centric health will not improve until whole population health measures and shared community strategies are in place.  Many, including Donald Berwick, MD, currently the Administrator for CMS, believe that telemedicine and telehealth technologies will play a strong role in this transition from silos of care to coordinated communities of care. 

Even without immediate implementation of the Affordable Care Act4, pressure to reduce health care costs is bringing regional leadership together to identify community-wide approaches that incorporate coordinated patient transitions from one source of care to another.   Simultaneously, individual health systems are working to identify how they can extend patient care services beyond their own walls.  As a vital health delivery resource, telemedicine and eHealth is unfortunately at the periphery of many of these conversations.
Until recently, metrics for telemedicine programs have been generated to support the needs of individual programs and networks.  In the past year, California Telemedicine and eHealth Center contracted with EdithForge to bring together national telemedicine leadership to develop a standard set of telemedicine metrics and evaluation tools.  The metrics evaluate networks, practitioners and programs for throughput, provider satisfaction and utilization, site utilization, and patient outcomes data. This is slated for completion later this year.


Growing Interest in telehealth and other eHealth Initiatives

• In the past three years, EdithForge consulting (www.edithforge.com) has seen an influx of regional health care systems seeking advice about how to leverage telehealth technology to meet their health delivery and financial goals.  Common requests include:
• Financial sustainability plans that support program development and growth.
• Meeting with regional health partners who want to build patient-centered medical homes to support local health care delivery.
• Valuation of connecting to regional health initiatives including OHN, HITOC, and OCHIN and CMS demonstration projects.
• Development of outreach programs to serve patients in their local (urban) facilities.

Telemedicine and other eHealth care strategies require internal and external considerations not commonly considered in direct patient health care delivery.  These oversights include the following assumptions:

• There is little or no reimbursement or payment mechanism for telemedicine.
• The network configuration meeting internal technical and security standards will also be compatible with other networks. 
• Consumer grade technical equipment will meet medical grade standards for telemedicine delivery.
• The existing model of onsite clinical visits works for patients.
• Telemedicine and telehealth programs can thrive as single implementation programs.
  
  

Remote health care delivery requires considerations not common to onsite delivery models. Five essential elements in the strategic growth and development of telemedicine programs are:

1. Telemedicine and telehealth delivery strategies must be tied to the organization’s strategic drivers (strategy, goals and plan) and aligned with senior leadership. 
2. Structure telemedicine as a business line complete with infrastructure that will allow any provider to utilize telemedicine ubiquitously in their ongoing practice.
3. No one-off programs.  Resist the temptation to call an individual telemedicine program your enterprise level solution, because it is not. 
4. “Who are you going to call?”  Groups like Oregon Health Network, HIE initiatives and Beacons are conveners of regional health care initiatives that provide the secure connectivity needed to answer the “who are you going to call?” question.
5. Money in your pocket. Increasingly health plans are paying when billed for remote patient consults. Medicare/Medicaid continues to support rural access, which fits well with health system outreach strategies.

Telemedicine and telehealth delivery is no longer about testing to see if the gadgets, technology and networks work, or to survey providers and patients to measure their satisfaction with the convenience.  It’s about using technology innovations to enhance the clinical moment, allowing patients to receive continuous care in their home or local community, allowing health care systems to discharge patients to a transition team that will follow their care for the next stage of returning to health. It’s about connecting across the distance to build collegial relationships that allow providers to trust one another and upgrade the acuity of care in a remote community so patients are appropriately triaged and transferred to a emergency department.

EdithForge Consulting Group is a national health care information (HIT) organization, located in Vancouver, Washington. We provide cutting edge solutions for strategic health care delivery initiatives. Our team includes MPH and PHD level business expertise, as well as CIO, Physician, and Nurse Administration resources all with proven health care performance and implementation experience. Our clients include hospitals and health systems, HIT networks (Beacon communities, FCC Rural Health Care Pilot networks, Health Information Exchanges) academic medical centers, physician organizations, and for-profit service providers entering the health care delivery market.    

Vanessa McLaughlin, MPH is a recognized leader in the innovative development of HIT solutions for the remote delivery of health care services. Ms. McLaughlin is founder of EdithForge Consulting Group.  Dr. Thoming is a physician leader with NWAC Specialists and Legacy Health Care System, Portland, Oregon. A complete copy of this white paper is located at www.edithforge.com.