Transcript:
good morning everybody all right that’s
good energy while today’s on conference
day so I hope everybody is ready to
engage and interact and and lead
sessions and have big ideas we’re gonna
have a great day
but first and I hope everybody had fun
last night I dragged a bunch of our team
down and do some line dancing and then
chickened out myself oh well but I hope
everybody had a great time last night
our first session today is a session
that I’m super excited about this is our
little leader
leaders innovating telehealth Awards and
our awards are really all about honoring
our customers and the great things that
you guys are doing to really change the
lives of others so very very excited
about this session our late award
finalist we had a great set of
nominations really some incredible
stories and we have some great
submissions and our Award finalists are
Children’s Hospital Colorado and and the
Charleston Dorchester mental health
center working with MUSC and then the
Morris health system so what we’re going
to do here this morning is that each of
our finalists is going to come up and
they’ve got 12 15 minutes to share their
stories we want to learn about what
they’ve done learn about the benefits
that that they’ve delivered and how they
have really made the lives of patients
better
and then what you’re gonna do is you’re
gonna vote on your favorite story all of
our Award winners will receive a lovely
piece of glass pretty heavy
don’t worry we’ll we’ll mail it to you
will ship it to you you don’t have to
put it in your suitcase so what I’m
gonna do now is I’m going to invite our
first presenter we’re trying to be as
Democratic as possible and go in
alphabetical order so our first
presenter will be from Children’s
Hospital Colorado
our first speaker is a health care
policy educator system designer and
entrepreneur with over 15 years of
experience in public health advocacy
health innovation and model development
he’s currently director of echo Colorado
as well as the director of telehealth
services for Children’s Hospital
Colorado you may have met him yesterday
please join me in welcoming Fred Thomas
to this week you have a clicker all
right so they warned me this morning not
to do what I did yesterday so I’ll try
so in preparing for this last week I was
talking to the team and they said you
don’t have any of these compelling
videos with crying people and and old
people that didn’t have to go out in the
snow and I said don’t have me those so
this is my 15th 16th 17th year somewhere
in there telemedicine I’ve done plenty
of those videos and they go along with
grants and pilot projects and once the
funding is done with the pilot project
or the grant if you don’t have data that
goes along with those stories thanks for
the story
so what I’m going to try to show you
today is a little bit that it is a
compelling story relative related to a
topic that that impacts every state in
the nation every hospital if you ask
them they’re top issues that they deal
with their mental health related
services and and addressing that
impressively so I’ll tell you also last
week I was in Washington when I was
giving this preparing for this and data
kept coming up so I spoke to every
member of the Congressional Colorado
congressional delegation two senators
from other states the Health and Human
Services Department and several
conversations they brought up this
Harvard study last year the year before
that impact that demonstrated that
telehealth would actually make services
or people use more services and the idea
for that is they kept dragging this one
study back out of the dirt relative to
kind of here’s what we’re going to
here’s what we’re worried about is this
one study that there
for data they want data and that right
now health care reform is happening and
we have the right tools frankly to make
to make a move in health care reform
right now and so if you don’t have data
get data work on data
so our telehealth work is embedded in
everything that we do we have
approximately I think a hundred and
twenty-five 130 different use cases of
telemedicine lots of breath not a lot of
depth relative to happening in multiple
areas of the hospital but it what we
look at is a little bit as like how it
happens across the day of the spectrum
of a patient’s day in the hospital
before they get here do they need to be
here
while they’re here and the entrepot
inter-agency kind of specialty consults
and then after they leave to make sure
that if they don’t need to be at the
hospital and can get care in the
community or at their home that they
stay in the community and don’t have to
come back too soon so here’s like a few
little things and again I put that up
there so if you have a topic Ventris you
see there you go Fred I want to talk to
you about blank you can come talk to me
about blank so this is the study so when
it effectives we have that’s not a
perfect study it’s not a randomized
control trial but it is a very natural
study demonstrating an impact of a
program over a year comparing non tella
traditional as usual treatment as usual
with a telemedicine approach with the
same sort of hospital setting the same
doctors different locations and
different outcomes so again mental
health is a issue for every state and
about one in five children have a mental
health issue that they have to deal with
on a regular basis and then about one in
five of those children actually get some
aspect of care and there’s those that
don’t get the care that they need in
their community generally cycling in and
out of emergency room settings acute
related settings and they’re trying to
be dealt with in a setting that’s not
really set up for doing comprehensive
mental health care with a coordination
back into the community and so this in
effect was an effort that looked at the
that it was a problem the hospital had
the prior year that we had looked at the
data we
had five different urban locations and
if a child presented at that emergency
room in those other locations what would
happen is the doctor that was there
would say we don’t do mental health here
they’d call an ambulance an ambulance
would come and get them and then they
would schlep them over to the the main
academic hospital they would wait
between 8 and 20 hours and then 52
percent of them would be discharged
immediately because they didn’t meet
inclusion criteria not a good use of
resources not good for patient
satisfaction or care and certainly a
waste of time and money for all involved
so what we did is we looked at the idea
of looking at behavioral health versus
traditional we wanted to look at the
quality of care whether or not we made
better transfer decisions discharge
dispositions based with telehealth we
wanted to look at the length of stay if
we could reduce that because in effect
if you transfer them from one of these
network of care locations that’s less
expensive real estate to an urban
hospital that’s an academic center this
way more expensive real estate and
you’re competing for that space it’s
very expensive to receive care and bad
care in that space
maybe bet the best care but maybe not
the care that’s needed there and then of
course we wanted to make sure that we
were looking at whether or not you know
you can reduce cost by not giving care
so you know that’s the most efficient
way right is basically you don’t spend
any money at all and people die and they
go away and you don’t provide care
anyway
that may be the Republican plan frankly
but but but in effect really you kind of
have to look at this exchange rate
relative to are you reducing costs
maintaining a level of care that’s the
satisfactory or better and then having
better outcomes and so we wanted to look
at all those sort of things so here’s
our takeaway so in one year we looked at
a pretty good end was about 500 in and
what we did in the year is basically
reduced the transfer rate by more than
50% and so that alone accounted for
about four hundred and two thousand
dollars of ambulance rides for the
system that it’s just sort of one of
these things that happens along with the
with the the change of the of the
practice model four hundred and two
thousand dollars and so here’s another
one of the takeaways so if you’re a
parent and you’re dealing with this
horrible time
that generally happens at 11 o’clock 12
o’clock 1 o’clock 2 o’clock in the
morning and you have to go to the
emergency room and then they say we’re
not going to treat you here get back in
your car we’re going to take your kid
strap them down an ambulance and we’re
going to take them over to the other
emergency room you need to drive over
there and wait bad thing so if you look
at this data right here what you see is
the the traditional care most of the
people live down there beyond 12 hours
12 to 20 hours 20 hours plus and if you
look into the telemedicine efforts most
of the people live between 0 & 8 hours
so in effect what you’re looking at
there is a dramatic change in the amount
of time it took to provide adequate care
and this was this was published a couple
of weeks ago in psychiatric services and
you can find that that Journal article
again if you do this in a way that
people say holy crap we did save time
and we save money but I really hated it
that’s also not a good value proposition
so the idea that we actually improved
from 72% of which is a satisfaction
certain level for traditional to 97%
either satisfied or very satisfied with
the type of care is a dramatic change
also and then here’s your big takeaway
this is what people want to hear about
so in effect what we did is we we change
the pathways of care and just changed it
and made it more practical so if one if
one pathway of care was if you’re this
child is presenting in the emergency
room at this other location you get in
an ambulance you come to the main
emergency room they’re going to meet you
they reach riaj you then they after they
decide that you’re going to be admitted
in a patient then they transfer you
again to the inpatient ward well a
change and pathway would be if you’re
going to be admitted we do the triage
that the less expensive space do all of
that move information not people and
then they make the decision that’s a gun
going to admit them and they transfer
them once to the inpatient ward and
saves a whole lot of money in time and
effort
the other big savings obviously is the
ones who don’t need to be admitted and
don’t need to wait for 20 hours could be
discharged from from the network of care
location so this in effect is what we
did an incremental cost sometimes safer
encounter
what you want to look at there is that
you want to look at anything here in the
low and away area the strike and the
lower right quadrant would be it saved
time and save money so anything here
would be it costs more and it took more
time anything here would be it costs
more but it took less it took it took
less time but in fact what you and you
and right here would be it took more
time but it saved money
so in effect every one of the pathways
that live here we’re pathways worth
adopting so you can look at every single
pathway save money and time by using
telemedicine
so in effect here’s here’s the big point
so the cost to establish telemedicine is
v network of care sites was about two
hundred twenty two thousand dollars that
included all the operational costs all
the fixed costs all the variable costs
of my time and all of our team doing all
the training aspects all the training of
the doctors and everything divided by
the number of visits and the the
proportion of the visits that that
psychiatry was of the total visits for
the hospital and then so you have the
average cost savings per patient by
converting which is nineteen hundred and
seventy seven dollars per case and you
divide the two hundred twenty two
thousand dollars it took to establish it
and what you have is you have a
break-even point of a hundred and
sixteen patients that it took to
establish telemedicine in that in that
section so what this is in effect my
friends is a an argument to another
group of people for the c-suite to take
to them and say this may not be your
perfect case example but we’re coming to
you next and here’s how we’re going to
do it so let’s convert the ones who
don’t need to be here to telemedicine so
where we going next you’ll hear your
heart more about echo and I have a
minute and twenty two second video at
the end of this so I have to save at
least that time so in effect what we’re
doing is like trying to combine all
these different approaches the in person
care because we’re not going to change
in person care some aspect of care needs
to happen in person if you took this
example would be if you have this child
that has a primary care doctor out in
rural wherever and they have this rapid
cycling bipolar disorder that
periodically kind of throws
I’m off the loop and they end up in the
emergency room what you want to do at
the end of the day is you want to
instead of having them continually cycle
through the emergency room as you want
when you get back to that primary care
doctors office you want the primary care
doctor to be trained related to what to
be looking for for the for the
presenting factors that say in two days
they’re going to be back in the
emergency room in another day they’re
going to be back in the emergency room
so what you can do via via telemedicine
would be able to have the care done by
that psychiatrist in the primary care
office so they’re sharing the
decision-making about that and then as
this primary care doctor out there is
dealing with more diabetics more
asthmatics more different kids with
different chronic health issues they sit
in echo sessions and learn more about
how to manage more of these things on
their own and so the idea is you give
them more capacity to do more in the
primary care space and then the idea
also would be if they in an echo session
the panel at the University says you’re
way off on your formulary there they
could pull them into an e consult
directly and talk to them about changing
their formulary or changing the
prescription or whatever so it’s a sort
of an accordion of care if you will sort
of waxing and waning of an approach that
you could use to help manage conditions
better so what we’re doing with our own
money and they were saying earlier the
people with the biggest budget may
actually have a you know anyway we’re
moving like that argument way but we’re
using a lot of money to do this so we’ve
spent about eight million dollars on
developing these issues or these topics
and what we’re actually developing our
approaches they use each of these
different tools with partners that are
meaningful partners in the state
Medicaid the foster care group Denver
health and school-based
asthma and different management sort of
things like that and topics of interest
asthma diabetes mental health concussion
different things like that that are
managed in a way so that we’re trying to
demonstrate to the through these pilots
a evidence approach of a value-based
care delivery
model and so again without data a lot of
this sort of stuff goes away so what
we’re actually trying to do is actually
put together the right sort of studies
to demonstrate with data that we have a
compelling argument about a new delivery
for healthcare and that might be used as
one of the arguments for healthcare
reform that is not just given less care
they’ll go away it’s more like give them
the right care at the right place at the
right time and and and reduce cost and
increase access so what I have here is a
little video that we put together it’s a
little bobble heads
no crying old people no sad little young
people it’s bobble heads because I need
to be appropriate relative to the right
use of color and gender and identity
except anyway so we’re going to show
this and and see which thing there are
many inefficiencies in the healthcare
system for a patient needing healthcare
these inefficiencies can create
unnecessary treatment barriers for
patients diminishing their experience
and negatively affecting their health
outcomes at Echo we see this as an
opportunity for improvement we connect
health professionals from different
communities with a variety of knowledge
and breadth of experience and allow them
to share best practices and resources to
improve the quality and efficiency of
healthcare echo one part of a bigger
practice paradigm together we want to
make the inefficient efficient with
coordinated care a decreased need for
in-person appointments and an
improvement in overall healthcare value
by empowering the integration of the
practice paradigm into the
patient-centered medical home and
medical neighborhood we can optimize
talent techniques and technology shared
knowledge from specialists and experts
creates opportunities for other
providers and staff to practice at the
top of their ability increase capacity
and efficiently manage complex care with
your help we can institute a new
efficient practice paradigm that
optimizes patient experience and
outcomes lowers the per capita cost of
healthcare and improves the work life of
our tireless health care providers
[Music]
knowledge held by one has the power to
change lives knowledge shared by many
has the power to change the world a
better life for patients and providers
starts here let’s echo so thank you
appreciate that my time is up oh that
was great
and I can tell you the reason that that
Children’s Colorado was selected was
because of the evidence-based approach
and I think in in our in this industry
right we struggle to prove the benefits
and drive drive adoption across across
North America across the US and also in
Canada for for what we’re doing and so I
think that the fact that you that you
have built that ROI model and that
evidence-based data is exactly why you
were selected as a finalist but I
question for you in terms of what do we
collectively need to do everybody here
who has a program runs a program what
should we collectively be doing to
really do more of what what you’ve got
here select more dad
yeah demonstrates that there’s an impact
in one of the areas of increasing access
is all good and fine but if you increase
that access and it costs more the
current people who are making the
decisions about health care reform don’t
care about that it’s got a it’s got to
provide the same amount of care with at
least the same amount of satisfaction
costing less and so that’s where we need
to be right now I think frankly so this
might be a great unconference topic as
well and one of the things that that
mark talked about in his presentation
analytics monitoring we want to do more
also to help you get the data that you
need those water stress they are I’m
gonna go get one thank you there you go
Thank You Fred okay okay
our next speaker is the director of
special operations for Charleston
Dorchester mental health center in
Charleston South Carolina she is trained
as a crisis negotiator and serves as a
program manager for several divisions of
service as CDM HC it would have been
easier to just say Charleston Dorchester
mental health center because I actually
got that including emergency services
Forensic Services and the Tri County
crisis stabilization Center please
welcome Melissa camp to the stage
[Applause]
40 3.8 million that’s the number of
adults in the United States estimated to
experience a mental illness over the
course of a year one in eight of which
will go to an emergency department for
their symptoms 3193 that’s the number of
psychiatric emergency calls received by
Charleston County EMS last year in
Charleston South Carolina 80 percent of
which get transported to the local
emergency department my name is Melissa
camp as she said and I work for the
South Carolina Department of Mental
Health
based out of I’m stationed in Charleston
South Carolina and today I want to tell
you about an exciting new project that
we started about six months ago that I
believe puts us on the cutting edge in
the world of emergency mental health
treatment so in Charleston we have a
problem
that I’m sure none of the rest of you
guys have where our emergency rooms are
constantly overwhelmed with behavioral
health patients that doesn’t exist
anywhere else right now that’s just us
and so through the years we’ve done some
things to try to address that in 2007 we
started a telepsychiatry program that’s
been really successful be as Michael
mentioned yesterday our state is
relatively rural and there were ers
where people were waiting days to get an
evaluation by a psychiatrist which is
just completely unacceptable and so now
we’re able to use telepsychiatry to get
those folks evaluations within hours
instead of days and that has been really
successful and gets those folks
connected to care
we also about 30 years ago created a
mobile crisis team so we for those of
you that don’t have mobile crisis it’s a
24/7 365 day a year program emergency
response team that will go out into the
community
and respond to those in crisis so they
will provide the same kind of mental
health evaluation that you get in an
emergency room just on-site so my team
will go anywhere though we go to the
airport the side of the road somebody’s
house the local library any of that and
then that team was developed to try to
divert people away fro health patients
away from the emergency departments
because it just isn’t a great outcome
for them and mostly because the
emergency department they have to be
equipped to serve so many things that
it’s just not an ideal location for a
behavioral health patient there’s not
always somebody who has adequate
training or time or resources to do what
they need they’re so mobile crisis has
been invaluable to our community to be
able to divert a lot of those people
away from the emergency department but
despite us having that for 30 years in
Charleston we still have the same
problem everybody else has where our
IEDs are overwhelmed with behavioral
health patients and so as we got to
talking to our folks at Charleston
County EMS they we started talking to
them about what what was happening that
they weren’t utilizing mobile crisis
more so we only on average get about
four or five calls a year from local
Charleston County EMS we get police
calling us all the time
family members community members calling
us but AMS only called us four or five
times in a year and as I said they had
like over 3,000 calls in a year and
basically what it boils down to is our
county is long so it’s it’s like a
hundred miles from end to end and my
mobile crisis team we don’t much to our
dismay we don’t get lights and sirens
and get to speed through traffic we have
to go the same as everyone else and so
sometimes response time can take 30 40
minutes to get on scene and EMS just
simply doesn’t have that time they can’t
tie up an ambulance sitting there
waiting 30 to 40 minutes just for us to
get there and then for us to start our
process to assess them and connect them
to care and so it was faster for them to
just throw that person in the ambulance
take him to a needy drop him off get
back in service for medical and
agency’s so that made sense to us and
and the one of the doctors with our
local EMS this is about five years ago
now said it would be really neat if we
could use telehealth somehow to connect
mobile crisis to EMS a little bit more
quickly but at the time we were still
very thick into the throes of what our
telepsychiatry looks like which it
requires a lot of equipment specialized
equipment and and stable endpoints for
everything and and so we believed that
we were going to need a pretty sizable
grant to make that happen because unlike
Fred’s group we don’t have any money
we’re a state agency so so we started
looking for grants and we partnered up
with gentlemen it with MUSC who is a
forensic psychiatrist technically but he
was helping us find some grants that we
could apply for and in 2016 we applied
for and were awarded a grant a
telehealth grant through the South
Carolina telehealth Alliance to
implement this project where we are
connecting EMS and mobile crisis via
telehealth and over coffee one morning
at a Starbucks I met with Michael and
Wendy and and we mapped out what this
workflow would look like and and and
they I actually I’ll be the first to say
I had no idea that video even existed
prior to that and so I’m grateful
forever to Michael and Wendy for
bringing that into our worlds and and
Michael said I think this is going to be
a really good fit for you guys and for
your program and and so we’ll talk a
little bit about why that’s a good fit
for us but first just so you guys can
get an idea I want to show you this
video so you can see what this process
looks like for us it’s a sector of the
population in need of help that
oftentimes ends up in the wrong place
we’re talking about people with mental
health issues or addiction routinely EMS
units are dispatched out to help but
without a means to address the core
problem in the past EMS has had really
two alternative
we could either release them to law
enforcement for transportation to prison
or to jail or we could transport them to
the emergency department beyond that
there was really no other options for us
and our focus was really what kind of
treatment do we give people in the back
of the unit as opposed to really where
do they need to go as a most appropriate
treatment for them today a new
multi-agency collaboration has taken the
crucial steps towards a solution for
those in need
it’s called telepsychic and it’s
designed to keep mental health and
addiction patients out of the jail and
the emergency room helps address the
root cause helps address their mental
health and substance use disorders and
it doesn’t have them in an emergency
department or in jail and then that also
directs taxpayer dollars resources where
they need to be officers can get back on
the street faster our emergency vehicles
can be back out on the streets faster so
that they can address community concerns
that are more emergent here’s how it
works
dispatch receives a call for assistance
and routes EMS paramedics will first
clear the patient of any immediate
medical needs and contact a duty
supervisor in a quick response vehicle
so the ambulance can get back out on the
road next a member of the mobile crisis
team is contacted once they determined
that a person doesn’t need primary care
services to then call supervisor out to
the scene who has a program called video
in his SUV and then he can bounce back
to mobile crisis which is our emergency
response team to have that patient
immediately evaluated for psychiatric
needs while the EMS is on the scene and
they don’t have to wait for anybody to
come out they don’t have to transport
the person necessarily to an ER they can
have the assessment done immediately
on-scene well I’m one person standing
here I could really realistically if
I’ve invited everybody that’s a part of
this collaboration have this entire
stage full so that’s a huge piece of
what has made this a success is we had
to have everybody from multiple agencies
in our community on board and willing to
try this thing out and I’m so using
video we’ve been able to cut our
response time from maybe thirty to forty
minutes to
like five minutes and that’s been huge a
huge time saver in our area
why we chose Y Michael thought that
video was a good fit for us so with our
County although chart the city of
Charleston is great we with our County
being so long we’ve got some more rural
areas where cell phone our cellular
reception isn’t great band with us
limited and so the the fact that video
can accommodate for that and adjusts for
the bandwidth fluctuations was without
interrupting the providers ability to do
the assessment was a big deal for us and
has made a huge difference because we’ve
got EMS vehicles out in the middle of
nowheres Ville trying to connect to us
and we need to make sure we’re providing
good quality care the other thing that’s
worked well with us since its mobile
crisis is a team of people who are
on-call 24/7
EMS it’s different supervisors who are
out different times videos meeting rooms
afforded us the option of not you don’t
have to know the name of who you’re
going you know and try to find them
within the directory to meet with them
we have mobile crisis meeting rooms
virtual meeting rooms on there and we’re
able to just connect into that room and
provide the assessment so that cuts on
down on a lot of complications that
would ordinarily be there so quickly
some results that we’ve had again we’ve
been doing this set we started at the
beginning of May so we’re right at six
months now the the data I’ve got goes
roughly through about five and a half
months worth of time we had
approximately four to five calls a year
from EMS prior to this in this first
five and a half months we’ve gotten
three hundred and sixteen calls we
expected the program to be successful
but not quite like this so one lesson
learned really quickly is we first got
set up with one room one little meeting
virtual meeting room and very quickly I
was like Michael how quickly can you get
me a second room because we had multiple
assessments going on at the same time
and and and keep in mind this is just
them calling us on low-level calls with
no medic
emergency to it so they get roughly that
I think they estimate around 12
behavioral health calls in a year I rain
in a day sorry a year and they’re only
calling us out on the low-level calls
and you keep in mind before the stat I
said was 80% were transported to the
emergency department prior to this
program since this program we’ve been
able with the calls that they’ve given
us we’ve been able to divert 54% of
those from the emergency department a
pretty substantial number for just
getting going
47% we’ve been able to divert from the
hospital so we can connect people to
outpatient providers different things
that they may need in the community we
may be able to de-escalate a situation
while we’re interacting with them via
telehealth to where they don’t need to
go anywhere but we also have great
relationships with our local hospitals
and that they will allow us to get folks
right on to a psychiatric unit and
bypass the emergency department if
mobile crisis is the one assessing them
and then this stat to me is the most
profound so for only of those calls that
we’ve received only 13% of those have
resulted in the person still needing to
be transported to the emergency
department by EMS so that’s a that’s a
substantial decrease from eighty percent
to 13 in just five and a half months and
keep in mind the first you know week or
so of that was just us trying to figure
out what direction we were going in and
remembering that we trying to figure out
everywhere you went when you were on
call you had to have access so the
dollar amount as fred was saying that’s
what our leadership wants to see that’s
what county council wants to see when we
look at continuing a program like this
because in our state we can’t bill for
the service via telehealth for masters
level clinicians so we we base this on
approximate cost of three hundred and
fifty dollars for an ambulance ride
which anybody who’s had to pay for an
ambulance ride knows that’s a lowball
figure and two thousand dollars for a
very very basic psychiatric ER visit
again a lowball figure for most so in
the data we’ve collected based on
those estimates we estimate that in this
five-and-a-half months just in
Charleston County just with these
low-level calls we’ve saved the system a
little over four hundred and nineteen
thousand dollars so that’s huge
to me that I mean I look at that amount
and I think this is what we’re saving
the system because a lot of these folks
are unfunded so that’s numbers that
we’re paying attention to we’re
providing to community partners because
we need for them to know the hospitals
would be eating those costs otherwise
realistically because a lot of these
unfunded folks they can’t afford to pay
for the the hospital stay and so when we
look at future applications obviously
our leadership is really interested in
that so a couple of things to know that
are going on in our state while we’ve
had mobile crisis in Charleston County
for 30 years it doesn’t exist anywhere
else in our state and then this past
year we got awarded some money by the
Department of Health and Human Services
to create mobile crisis statewide so
that’s great and we’re that’s underway
and happening right now but
realistically in some of the more rural
counties it’s not doable to have it’s
not doesn’t make sense for somebody to
be responding in person always because
the response time would be pretty
extended in some of those counties so
telehealth is really what we’re looking
at as far as how we take this program
and blow it up across all 46 counties of
our state that that will be how we do
mobile crisis in some of those areas and
so we have a hundred and six emergency
transport EMS agencies in our state and
so that’s a project that I’ve been given
the responsibility for is to create to
figure out and do the research of what
that would look like and how we would
make that happen over the course of the
next year or so which you can imagine
the money state savings is pretty
substantial and then I’m out of time but
I do want to say one last thing the
other piece that we’re looking at is
putting it with law enforcement more and
more we hear if you know anybody
personally who’s an officer you know
that law enforcement is called upon to
make some decisions on mental health
issues on a regular basis with very
limited training for it and so one of
the aspects we’re looking at is
because of the ease of how video is can
be plopped onto their laptops most
agencies their officers have laptops in
their cars that we might could connect
mobile crisis to law enforcement to help
them in making some of those decisions
in our community so that we keep our
community safe we get people connected
to the care that they need and so it’s
exciting and as you if you couldn’t tell
I’m pretty passionate about this stuff
it’s exciting time to be doing this kind
of work and I really feel like as we
talk about health care reform this is
what we’re talking about this is where
we’re headed and so I’m excited to be a
part of it thank you guys thank you
that’s a great story
I just do want to reinforce that point
so it was at four hundred nineteen
thousand and savings one County there
are 46 counties in South Carolina so
basically I know it’s not quite as base
simple as a basic extrapolation of that
number but that is really significant
savings when you take it across the
entire state yeah it’s exciting
the other thing that I found really
compelling about your submission was the
fact that you were coordinating across a
number of different agencies can you
talk just a second about the the
challenges or lessons learned associated
with you know making that work breaking
through the red tape yeah well I think
the the biggest thing has been that we
had pre-existing relationships with a
lot of these folks so we work really
hard to keep great relationships with
the partners in our community and so
that was huge and just keeping that
communication open so we’ve been going
for five and a half months and we still
have almost every Friday at 9:00 a.m. a
phone conference between EMS and mental
health and anybody else that one needs
to join in on the call to discuss what
kind of problems did we come up with
that week or how can we tweak this and
make it better and I think that
communication is huge and that’s that’s
been the leadership my executive
director has joined those calls on
occasion their medical director their
director have joined those calls because
it’s just that important to our
community great okay well thank you very
much
[Applause]
okay and certainly last but not least
it’s last in the alphabetical order our
our next speakers are from the Nemours
Children’s Health System we’ve got a duo
here the first speaker is the telehealth
leader for Nemours Delaware Valley he
has served in health care for over 15
years and was one of three people who
started the telehealth program at
Nemours
that’s Jeff Bernal oh just he will be
joined by cedar tell telehealth
technical coordinator from Nemours care
contact the telemedicine program for
Nemours children’s health centers so
please join me in welcoming Jeff Bernal
oh and Colin McQueen so Colin you’re
basing Florida thank you thank you very
much so I’m Colin that’s Jeff like to
thank Fred and Melissa we’re honored to
be up here sharing the stage with
wonderful organizations to get started
I’m going to tell you a little bit about
Nemours and who we are
so we’re a nonprofit health organization
devoted to children’s health were funded
off the enduring legacy of Alfred I
DuPont and after two poncy death in 1935
he left the bulk of his estate to the
care of children so following through
with his wishes the foundation built the
Alfred I DuPont orthopaedic Institute in
1940 and later in the 80s that was
transformed into the Alfred I DuPont
Hospital for Children which is where
Jeff is located in Wilmington Delaware
and then in 2012 we opened a second
free-standing hospital in Orlando
Florida Nemours Children’s Hospital
which is where I’m located so to give
you a little perspective we have about
400,000 patients we care for throughout
our health system our mission is to
transform how health care is delivered
by leveraging technology and increase
access and improve outcomes very similar
to what most of us in here trying to do
what we call our true north is really
our mission statement which helped me
receive exactly the care I need and want
how and what I need and want it again
very similar
– what we’re trying to do and I think
everybody else out here is trying to do
so those are the metrics we strive for
obviously we do not meet those that’s
just always the goal but telehealth fits
perfectly into our mission and goal and
vision the our comprehensive program was
called care connect so that that that’s
really what we named our entire program
telehealth program on very similar goals
is what we try to do improve outcomes
leverage technology to meet demands of
today’s family’s ever-changing
especially with the Millennials that
people are expecting this technology to
care for their children so I’m gonna
turn it over to Jeff he’s going to kind
of talk about where we started and dive
in and thanks Colin thanks everybody
just real quick you know kind of where
we started not unlike a lot of people
that are in here you know we looked at
critical care consults we looked at
referring hospitals in the Delaware
Valley and in Florida and where we could
you know make some impact so we looked
at critical care referring pediatric
referring Hospital adult referring
hospitals we looked at the delivery of
pediatric specialty care specifically to
our underserved areas in southern
Delaware and some of the rural areas in
Pennsylvania we implemented all of this
within 60 days and after success we
moved on and looked at things that we
would do in the region in Florida so we
talked about why critical care consults
it’s a simple implementation of
leveraging technology but a very
important one improved patient outcomes
for our most complex kids as we went out
and talked to these community IDI
physicians and we talked to them about
what would happen when you guys get a
really complex or a child where you’re
you know kind of not understanding of
how to treat this kid the first thing to
do is just pick up the phone and call
our transport line and we would just
come get them and that in himself in of
itself is very
inefficient so we looked at reducing the
number of unnecessary patient transports
keeping them in their medical home and
then also at the same time streamlining
our intake process so we knew what
patients we were getting and where they
would go to so some kids didn’t sit in
the IDI for hours some didn’t end up in
our ICU with a larger level of care when
they actually needed to be in a lower
tertiary floor unit so where are we now
we have iPad carts in more than 60
locations located all over the five
states in which we serve we have these
consoles broadened into specialty care
consults in to emergency rooms and to
Nick use and pick use and impatient
floors private PCP offices and even
cruise ships we looked and saw a sharp
reduction and unnecessary transports I
think the number was just a little bit
above 33% before we started and is now
below 9% avila 10% so somewhere between
around nine point three percent if you
look at the average of three to seven
thousand per pediatric transport we’re
saving just like Fred Melissa talked
about an enormous amount of money an
enormous amount of tax on our healthcare
system not to mention the things we
can’t measure quality of life issues
with a family who gets uprooted in the
middle of the night ends up three and a
half hours away in one of our EDS and
then turnaround because it was
completely unnecessary
so this is where rat we’re also
increasing the efficiency and the
comfort for these small rural adult
facilities for treating and caring for
some of these kids and we’re starting to
see that really pay off we’ve got well
over a thousand consults in about two
years
and quite simply it’s making a
difference so then we talked a little
bit about the delivery of pediatric
specialty care
it’s a large number of no-shows and
cancellation rates where a patient base
and rule an impoverished area of
southern Delaware I know people are
talking about Delaware’s really really
really really small we know that we get
that but also Delaware only has one road
if you’ve ever been on it
we apologize in advance if you’re going
on at anytime soon
we’re sorry there’s one road it takes
forever to get from one end of the state
to the other and so with these you know
rural areas it’s important that we take
care and bring it to them because we’ve
seen over time they’re not coming to us
whatever care they need if they didn’t
get it in their community they weren’t
going to get it and I think over time
you’ll see the negative outcomes that
we’ll have so our mission and our goal
is to bring care to these kids into
these families increasing quality of
life and in better clinical coordination
between these multiple multidisciplinary
visits and at the same time we’re
optimizing care allowing for more
patients to be seen I think we’ve seen
some studies that we’ve done some of our
physicians have done where you know
remote telehealth visits have actually
saved an amount of time for our
physicians allowing them to see a lot
more kids so where are we now over 27
pediatric specialties deliver a form of
telemedicine in one way shape or form as
Collins shared with you earlier we’re a
700 run 748 physicians we have well over
300 physicians trained and have done
some level of telehealth and
telemedicine visits so we’re very proud
of that that is a very big number for us
partnerships with six private
PCP offices so basically kids of this
these private PCP offices they go there
they go to their medical home and we
deliver specialty care to them in things
like endocrinology weight management
nutrition psychiatry psychology and I
can go on for you know almost 20 more
but if you look at the outcomes and what
that’s doing and having an impact across
the board we’re lucky in Delaware we
have patient parity we’re getting paid
not necessarily so in Florida but we
have taken advantage of that so that we
can deliver care in the best way
possible and their demand for these
remote specialty partnerships is high I
get a cold phone call every week from
all sorts of different states hey can we
partner with you can we partner with you
it takes time
I think by the end of this year we’ll be
an eight-hour contract for what we want
to do and where we want to go leads us
to about 10 by the time 2018 is over
with so where are we now we continue to
expand and our direct to consumer
offerings beyond online Urgent Care we
do that as well we leverage our
direct-to-consumer services for Jews
after disaster relief so if you look at
what had happened with hurricane Irma in
Florida we work closely with the
Department of Health on disaster
recovery plans in the state of Florida
we’ll also be looking at that for the
state of Delaware they’ve reached out to
us and said hey you know we need to
start having this conversation we
deployed carts to emergency relief
disaster centers in the airport for
Refugees and things of that nature and
what we’ve seen was a substantial
increase in enrollments and visits
during these natural disasters and here
we are where are we with the delivery of
pediatric specialty care it’s part of
our community health needs assessment
we’ve seen a large reduction in no-sew
cancellations rates to below 10% that’s
at nine point one percent that’s a huge
deal and is a big staff issue with
the large amount of no-shows and
cancellation rates that happen in the
pediatric room we also partnered with
Press Ganey to pilot a telehealth
specific satisfaction survey and we’re
very proud to say that we’re in the 98th
percentile its eighty nine point seven
percent likely to recommend and that
puts us telehealth offerings at the
highest of all Nemours health systems so
we’re very proud of that and
reimbursement across the board is above
seventy five percent so what’s next it’s
a little snippet of what we’re doing
where we’re headed integration with
people like echo stethoscope and title
care we’re growing our specialty and we
continue to look at the cost savings and
the quality of life savings in the
impact that telemedicine is having and
we’re looking into getting into the
remote patient monitoring world for our
complex patients so what do we learned I
think this is important for me
telemedicine is not the next fad in
healthcare I think we all know that
bye-bye why we’re all here it’s it’s
just not that’s how we deliver care this
is an additional tool for Nemours and
how we deliver care to our families
because they deserve and need it
telemedicine is embedded into the
culture of care delivery in our
organization we have complete buy-in and
that I think is important as we continue
to drive data is a great thing and
although we don’t have all these great
data numbers to show you I think what we
would impress upon all of you as is that
because we are growing and that we are a
larger team than the three people that
we started off with that shows the data
there that we have proven that this is
making a difference and quite frankly it
has a profound impact on the patients
and families we served so telemedicine
does make a difference
everyone in this room knows it I’m going
to share with you a story of talent and
I’m not going to say his last name
because I always butcher it but talent
is a at the time three year old young
man who was doing everything that
three-year-old boys do outside running
around loved tractors unfortunately one
day Talon found himself in the arms of
his father with a 90% of iteration of
his abdominal cavity for those that
don’t know what that means he was about
85% cut in half and so it was an amazing
story I can’t really show just the power
of what telemedicine can do on this next
short video but what I can tell you and
share with you is I watched it I happen
to be in our ICU at the time and I
watched the power of this
multidisciplinary team from our group
and this small rural community Hospital
get together to save this young boy’s
life and so for me this is just another
example of all the great things that
we’re doing not just us but quite
frankly all of you so we want to share
this video with you
a quick trip to the backyard to mow the
lawn can be life-changing as a
Phoenixville family learned when their
three-year-old almost died
Eyewitness News reporter David’s pond
has the story of how a devastating
accidents in a local mother on a mission
to bring awareness the relationship
between doctors Sudha Raman and
three-year-old Talan Wolstenholme is a
special one to put it plainly she saved
his life back in May a family member was
mowing the lawn on an industrial-sized
tractor when Talan ran out from behind
the bushes and was run over in my
wildest dreams I didn’t imagine that I’m
gonna run into a dad carrying his son in
his arms completely you know filled with
blood ramen is the medical director of
Nemours DuPont pediatrics at
Phoenixville hospital and operated on
Talon minutes after he arrived
he was almost cut completely in half dr.
ramin was able to help Talyn thanks to
an iPad and technology called
telemedicine is a secure way of
obtaining expertise at a moment’s notice
about an hour later Talyn was in a
helicopter on his way to Japan in
Wilmington where he underwent a
nine-hour surgery he continues to come
back to Wilmington for therapy with his
mom Alicia Wilson home she still thinks
about that day Talon was run over my
first reaction was I thought he was dead
Wilson home tells Eyewitness News her
son has defied all odds it’s a miracle
the angels are with him that day talans
case unfortunately is common according
to the Consumer Product Safety
Commission more than 17,000 kids and
teams are injured each year in similar
accidents that’s almost 50 a day
Wolstenholme wants to see more safety
information available to the public
she’s already started a public awareness
campaign hoping to save other kids from
her son’s fate you go out you want to
mow your lawn you want to get it done to
spend more time with your family but you
don’t realize what you know the
ramifications of it can actually be
Alicia Wilson home reached out to US
congressman Ryan Costello who told I
would news in the statement there needs
to be more public awareness about little
kids and heavy machinery
especially lawnmowers Wolstenholme hopes
meet with the congressman soon to
continue to bring attention to little
kids and lawn mower safety it’s really
amazing just to see how well little
Talon is doing considering those
injuries it’s only been a few months we
were live in the CET center David sponge
cbs3 Eyewitness News I was going to
share with you just this other little
video but Alan but I know we’re out of
time but what I will say is that we
still remain in contact with Alan’s
family and we still use the power of
telemedicine and technology to follow
him through PT and things of that nature
so it’s a great story it’s a it’s a
great use case and it’s wonderful that
we are able to and have the trust and
buy-in of an organization to simply
level leverage technology to make a
difference that’s what our organization
exists for and that’s our guiding
purpose and that’s
what we do thank you thank you okay
you guys want to see the video yeah look
at it it’s really really really short
[Music]
[Laughter]
yeah tell Kailyn wanted us to share that
with all of you so thank you yeah that
was that was definitely worth seeing I
knew it was short so thank you guys
right now the reason the when when we
got the new Morra submission we had to
haul it out of the truck cuz it was it
definitely won from the fact that it was
the longest submission no but what you
guys have done and I think what what you
shared besides of the talent story which
is really an incredible success story
life-saving story but what I think is
really interesting is the fact that you
talked about telemedicine as JSON or
said yesterday it’s just medicine it’s
woven into the fabric of what you do so
if you could just spend a second talking
a little bit more about how what did you
do to make that happen I think it was
about you know just the power of getting
people to understand and leverage
technology that we use every single day
whether it’s at home or in the school
and having those conversations and and
we’re an organization where we take
pride in we let our clinicians make
choices and decisions and our job is to
empower them and to give them the tools
and I think we we it’s it’s a matter of
just having great communication and good
interpersonal skills in establishing
relationships with our clinicians I
think you know I think Colin will will
agree with that we like to go out and
have relationships and conversations and
then that way it helps as we look at
trying to change the
of treating you know patients that we’ve
done for hundreds and hundreds of years
so you’re out there you’re meeting the
physicians you’re finding your champions
you’re getting them to help absolutely
Drive the awareness okay great thank you
guys thank you very much okay three
fantastic presentations I thought
hopefully you agree and now it’s in your
hands so here’s how we’re gonna do the
voting everybody has a phone right I
need to get mine but everybody has a
phone right of course
alright so here’s what we do if this is
very very simple it’s just texting note
app downloads or anything like that so
the first thing you need to do to sort
of make the polling system aware of you
is you need to text at video HCF just as
you see here to this number eight five
five nine one zero nine six six two so
let’s do that together the audience
winner was Charlton dorchester mental
health so congratulations and we hope we
will get you a so congratulations to you
and congratulations to you all
[Applause]