Ellen Murphy: And I want to welcome everyone. I'm Ellen Murphy. I know a number of you on the attendee list, and for those of you
I don't know, I am the director of Wake Forest Law's Master of Studies in Law program.
We're a part-time fully online program for working professionals like a number of you who want to know more about the law
but don't need to practice law, but need  law as a risk management tool in your workplace.
We have two tracks in our program.
We have a human resources track and a health law track, and we're really excited about our webinar and our speakers today,
because telehealth is directly related to
both of our tracks. We're seeing more and more
employers offering telehealth as a benefit to
their employees in addition to the proliferation of telemedicine within the entire healthcare
industry, just a little bit about technology before we begin: You can send your questions in using the
Q&A
feature in our webex virtual classroom.
So you can type your questions in and we will make sure that they get answered
for Bryan our presenter, or if you have questions about our program, there will be a short
survey after our program -- three questions. We hope that you will take that survey and provide us with your feedback
It'll be a little pop up on your
computer.
Our presenter today is Bryan Arkwright. Bryan is a managing consultant at Schumacher Clinical.
He is a telehealth expert. Bryan teaches to telemedicine course in our Master of Studies of Law
program. He's been focusing on telehealth,
telemedicine strategies, telehealth law
operations for a number of years.
He is a tremendous thought leader in the industry. He has a very robust Twitter feed. If you're interested in following it is
@stateoftheark - 'ark,' as in Ryan Arkwright. He is the --
He is, like I said, he's a consultant at Schumacher, but he has served in various telehealth capacities throughout
North Carolina, and as well as a corporate director and interim corporate director for an
International organization. He writes and is on the editorial board -- and [I] want to get the name right it is a peer-reviewed
Telehealth and Medicine Today. His Bachelor's is from Ohio State. Bryan also has an MHA Master of Health Administration.
He's a lot of fun very engaging. I think you're in for a real treat today. So Bryan. I'm gonna turn it over to you.
you
Bryan Arkwright: Well, there we are. Can you hear me okay?
Murphy: We can hear you. Thanks.
Arkwright: Excellent. I'm not sure if it's showing... Yeah, I'm showing video. Okay. Thank you so much for the wonderful introduction.
It's a pleasure to be here, very excited to cover this topic and go through it.
So with that we can kind of get started.
Go ahead and share my screen here.
Alright. Now everybody see that okay?
Excellent. Well, thank you again, very excited to cover this topic and
start this collaboration with Wake Forest University.
Here's the agenda for today. We'll go through
just a little introduction share a little bit more about
myself and the role I play in the industry,
give an overview of telehealth -- kind of run through that pretty quickly -- and then we'll get to telehealth legal issues and risk.
There are [a] number of items that come up across the board
And there are a lot of key stakeholders and the issues and rest can be very different depending on each stakeholder
So we will cover that and go through each of that
And then we'll have some closing comments and questions hopefully some time for some questions at the end
All right
So this is just a little bit about me as the alan mentioned have a Bachelor's
And a Master's and I also have a certified six sigma black belt
Which I obtained
a Few years ago
And its really helping me a lot as I
Infused it into many of the things I do with telehealth it a lot of telehealth is
process oriented
And driving out waste in [the] current healthcare environment, so it applies very well
First and foremost I am a consultant. We do a lot of strategy and design work we work with
National International
Clients across the country and across the
Beyond the United States we also do
the majority of our Clients are hospitals and health system, so
We work with providers to help set up
implement and then Sustain and grow their telehealth programs
And also mention the editorial board if you haven't checked out so health and medicine today journal
It's a great journal recently started, and it's really aimed at getting more
evidence-Based outcomes into the industry there's currently a lack of
a robust offering of
evidence-based protocols, so the goal of that journal is to really get more research and
evidence-Based outcomes and practices into the industry
And then they provide some great information
I'm also a start-up advisor. There's a awful lot [of]
startups in the digital Health and Telehealth space
So everything from advising
vendors to
maybe providers or physicians that want to get into the space, and there's a number of
Legal issues and risks that come up with related to start up, so there's a lot to consider there
and then lastly
Very active on social Media and enjoy speaking at conferences. I'm actually at a conference today in
Jekyll Island, Georgia, so hence the yellow wall behind me not my normal office that I'm working from
So let's get right into it as we define, telehealth
You know we I think it's important to kind of just define some simple
Terms here and really set a standard as we go through the rest of the presentation
first and foremost to provide patient care and consultations
services over a distance using video conferencing or other means
It helps reduce costs by Advancing preventive care models, and there's in healthcare [today]
There's a lot [of] push towards post-acute care chronic condition management
population health management as another big buzzword and the patient veteran medical home and telehealth can and does have
an area in each of those
Using it strategically the Target new Market is very common
It a great patient Data throughout the care continuum, and then lastly
It really ensures the patient's care needs are the focus so we really you know with
the industry
What you've seen today is really a focus on the patient rather than the technology however
The Growth of the industry has caused tremendous
market entrants in terms of new companies and new technology opera see offering so it's a lot to kind of work through and
being knowledgeable about the industry and and the basics of its are key just to begin with
Something we like to say is health is not a single so specialty application
It's not simply a telephone conversation or a fax
And it's not an email or text message. It is broader based in using video and some other ways
The next slide is talking about use types. So here we break down telehealth into four primary use tight
You have synchro gnaeus, so this is the most popular I would say
That's growing right now is using video to do live
In-person interaction between a patient and a caregiver, and there's a lot of exciting up opportunities in the space for hospital health systems
vendors and patients and
the lots of exciting things there
Store-And-Forward is one of the oldest
forms of telemedicine mistakes back to the early 90s when
Radiology was getting started to kind of spend images and then those images would be read by a
Radiologist and then sent backs, and so that's what we refer to as store and forward or ace and Crony in
And you can see this with patient Portals clinical results
images and then a lot of [education] can be done via store them forward as we
Or discussion today
Remote home monitoring and remote monitoring is a big area. That's growing as you
may or May not be aware of
the baby Boomers continue to age at a rapid pace and the amount of the population that
[is] then that age group has caused a
Number of new Innovations and as people are living longer
they're staying healthy or longer and they're opening up opportunities for
Patients to age in their home longer, so there's some very cool
Innovations and programs that are coming up popping up across the country with remote monitoring, and it's becoming a way to really
significantly cut cut a lot of
Health Care costs
and inflation, and then the last area that we see with Telehealth and use types of
wearables and digital health
This is everything from your fitbit to your I watch your apple watch
and many more things in [between] there's everything from
wearables in terms of clothes to
different
Really utilizing your phone for for so many different options
and what we see here is a lot of opportunities for Chronic care management in terms of weight Loss and
Managing maybe a patient's diabetes asthma or those kind of date that they?
diagnose [CC's]
There's tremendous growth in each of these
put the screen
Now as we talk about use types
You can then transition to services?
And this is where the tail out industry you know can
really feel
Giant and that it's touching everything
And there really are there's well over a hundred
different service lines
that you can use, Telehealth with
Across all of those use types we just discussed so the opportunities
and the innovation
Can be quite endless as [this] translates to this course and its offering is the complexity
Can get deep very quickly?
as each one of these
You can you know you're going to need to understand the clinical?
Financial
Technical
Ramifications for launching a service and the impact it has on patients and providers so as you can see are very broad
and there's lots of different services so depending on where a
Hospital a health system a vendor depending on where they focus their effort
can then kind of point you in the right direction in terms of
What else do you have to know but as you can see it's very broad?
Hey, Brian
Just just a quick question on that on [that] note that I thought of and I know folks with typing questions
And I'll shoot this to you
but who is the typical driver for Telehealth when it starts being implemented by an
Institution is it the patient the physician?
The insurer some other payor or my guess is it varies. I'm just curious
A great question and it really does vary you have
everything from some large vendors in the space that are going into a market where maybe
The local hospitals, maybe didn't plan on offering any telehealth
But because there's a new vendor offering the services they feel they have [to] get involved in order to compete
So and some of those situations is patient driven
And a lot of organizations, it's led by the leadership you know being able to offer
services that are
Meeting the patient demands. They're extremely convenient for patients a lot of times you're eliminating travel
Or some of the other complexity complexities to get to a an appointment
So there a number of things that can try that decision everything from competition
maybe a physician has
Experience with it and or maybe they're just been evasive and they see that
You know we had one patient. I'm sorry one physician group
I was a pediatric cardiology group and they had a
Really bad no-show rate
so when it got out to some other further out counties that they were seeing patients from
They had eighty and ninety percent of their patients that would not come to their second and third visit
So really that practice all that they needed to offer
Their patients another option. It didn't involve you know a two-and-a-half hour round trip
for 30 minutes return visit
So there's many different ways you can kind of get into that
What drives the decision to detail out a great question?
Okay, we actually have one question from the audience we have a couple I'm going to hold one because I have the inside of knowing
Where your presentations going?
But I we do have one question and probably from some of our hr
folks, and I think it probably came up when you said wearable although, I don't know but the question is you foresee a
significant trend and employers requiring employees to use
wearables
to monitor
individual it says the Workforce at individual worker health, but but
You know employers?
mandating the use of wearables
Good question I haven't seen anybody
Mandated however we [have] seen a couple health systems that have
incentivized greatly incentivized the use of a wearable
You know in terms of their health plan offerings?
If they employee elects to have a wearable
Track there, you know fill in the blank it could be exercised
It could be just their steps in general
There's a number of things that you can track if they are
Signing up for that. They may get a lower health plan option, so
Monthly the cost of their insurance offered by that employer would be less that they're participating in something like that
And we've seen some pretty good progress with with doing that the requiring is a very touchy
Thing and there's definitely some legal issues there
But I think that you know some of these smaller companies. They may have opportunity to do something like that
I haven't heard anybody of the requiring it but terms of on the Horizon
It could be coming down the pipe and you know two to three years
I you know healthcare is a little bit crazy right now that everybody knows. I think there's a possible decision today
on the repeal in place, so
More to come on that requiring could be a reality
Alright
and
Yeah, feel free to keep asking questions. I love that stuff, and it's always fun to kind of lead the
Lead the discussion to where at any point it
this next slide really gets into kind of you know we go from a long list of
Telehealth services, and if you can put tella in front of it
You can pretty much try telehealth one thing that we talked a lot about
to our
To the people that I work with is just because you can as I mean you should and so we work a lot with
Kind of applying some rigor and some methodology to you know what will give that [hospital] health system the most
Value for implementing something and that they kind of prioritize
where they want to start not just jump on everything, so
Here we have kind of 14 of really what I think are some of the top
Top
services to where you can see tremendous value in return and and
quality quality
with Co and patient satisfaction physician satisfaction
The first being Eicu this is something that's been around for quite a while
It really started with the government. You know doing some high-tech
And at the time very high cost
monitoring of
ICU patients or intensive care unit patients in hospitals. They found that really wiring up the
Patient's room with high-definition cameras and that those patients were not just being checked on
periodically by nurses and physicians they were
Really being monitored and their statistics were being monitored
Every minute you [know] that we were able to programs have been able to
improve their length to stay their mortality
h Ai and Cli our hospital acquired infections ways to quest by that and then improving
evidence-Based care compliance
And then you see some example organizations
Adventist Banner Banners on California Mercy
operates a very large
Telehealth Center
They have hundreds of employees
They have price forty or fifty I see you hooked up
Hundreds of patients that they're monitoring and and they've actually
transitioned from offering Their own services to
Actually selling their services to other hospitals
and tear out is out in Virginia Beach area and they're doing some cool stuff with Eicu same with the
University of Pittsburgh Medical Center
And then telepsychiatry is the next one that
really has been driving a lot of the growth for telehealth in general when you look at telehealth, you kind of split things by
care procedures by cognitive or procedural based and
Cognitive means you're really relying on that providers
knowledge their brain and their training and so that's where telehealth can be
Really [useful] as when there's really just a conversation occurring
and if you're relying on that providers
Training and knowledge
Cguro base these things are things more like orthopedics
where you or cardiology where you might use the use of
peripheral digital health peripherals like a digital stethoscope or a digital exam camera to
Assess [the] patient on [the] deeper level so telepsychiatry is purely cognitive conversations
with pSychiatrist psychologist
licensed clinical Social workers, and this has really just been a
tremendous
improvement for Healthcare
We're date reducing the link to stay from eight days under two days
There are some great programs out there. I can't say enough about psychiatry week. We love working with telepsychiatry
I'm at this conference today, and it's come up quite a bit
and I think as you look out over the horizon more and more states will begin to you know collaborate with the
Health systems in the state to see how they can maybe do something more broad-based in, North Carolina
Program that was launched probably been five years now was North Carolina Statewide telepsychiatry
program
NC. Step and that is a phenomenal program that has hooked up
Well over
65 Hospitals in the state who did not have any access or poor access to psychiatrist now I can
Call A number and request one and they'll have one in their emergency room via video. Thanks to toe health
Consulting on patients giving them the care. They need and getting them on what their day. So just great things with telepsychiatry
The next one is remote monitoring
This is something that you see the health systems on the on the right
These are really innovative health systems that are doing a lot of stuff with remote monitoring remote monitoring is quite complex
You're dealing with the most complex patients
that account for in medicare alone
These are about twenty percent of the patients that have chronic conditions while they make up eighty percent of the cost of medicare
So they're highly complex patients they
require a lot of touch a lot of customized work at health systems and
remote monitoring again putting
iPad different devices in the home hooked up to
pulse oximeters blood
pressure cuff
Asking them if they took their meds
there's some really cool stuff, and this has really been a little bit slowly slowly re going to
Adopted a slower rate, but the programs that really invest in it and take their time with it. I have realized some incredible
Results, so I think this is one of the key areas that you'll see in the future is a lot of [people] really
Focusing on this and doing it well
And I you know the industry getting a lot more results on on how to set up good programs
So they don't have another one sure thing
sorry two things one we got a
question from James and it
I it appears that our question field is limited to a certain number of characters
So I got the first part of your question james
But if you could type in the second part that would be great
And I'll make sure we get it answered and then a question for you
Brian about remote monitoring because we see this as an online educational program. We know the importance of
Access broadband Wi-Fi these kinds of things do do rural areas
implementing Telehealth for purposes of remote monitoring have issues with the
patients having access to the right
Technology right including broadband or Wi-Fi so that they can [be] monitored
Great question. I was actually just
hours ago talking to the ceo of the National Rural health association
And you know to answer your question. I'd say three four five years ago. Yes, that would have been a major
challenge and barrier However over the past three to four or five years
there's been a number of
Federal Communication commission FCC
related Initiatives Federal Initiative state
Initiatives to really connect that last mile they call it
Really get more fiber more broadband out there so and then in addition to the broadband
Really being implemented in
Hundreds and thousands of small towns across the country and so that's not such a barrier the technology has also improved quite a bit
too and so you don't always have to rely on a
[hard] [wired] [connection] for some of these remote home monitoring programs some of the technology actually uses
Cell cellular technology, so the combination of more
Cities and towns being connected as well as the cellular use in technology has really
Eliminate allow those challenges now that sound is really
Designing a program that it meets a lot of the key stakeholders [need] and delivers results
and
Then lastly is telestroke. This is another great one. That's just a
National shortage of Neurologists, especially in Rural communities and stroke is a time-sensitive
diagnosis and an issue that patients have and the quicker that you can get seen the less brain a
Tissue that's damaged
and the more Likelihood you have
To have a full rehabilitation
and then the
Opportunities that the care teams have to work on the patient are
Greatly increased the faster you get the hospital's. There's a drug. They're
called Tissue Plasminogen
Activator and
This drug is administered Thirty-nine percent of time in
programs that have Telestroke
Compared to three to six percent of the time nationally
So really you know it's a great drug
but nobody was getting access to it in time and one of the reasons of that grows so much is because of
A
Neurologist really have to make that call
to determine whether that if that patient is really having a stroke and if they could in fact benefit from that drug, so
really a the
classic
Position the classic patient access to a specialty physician issue there
And okay wake forest Baptist does great at that. No, that's good. That's good. That's in the state, so a little plug their 54th
okay, we have two questions the first the the first question is
Are there any issues?
with Ems providers
Who don't work for a physician?
like using telemedicine
to interact with a doctor for the benefit of a patient now
I'm I think I think I understand this hypothetical correctly, but I'll let you I'll let you
Do you have questions about that you want clarification on that brian um maybe read that reed bed first yes, so again
So I think this is when this is when paramedics are visiting patients at home
And this is someone who is the question came from someone? Who's a medical director in?
Emergency services right and so paramedics are visiting patients at home for a range of services including
Psychiatry and so the question is are there issues when the Ems provider is?
Working for not working for a physician
[but] is using telemedicine
to interact with the physician and I'm you know I'm guessing the
Kinds of issues and we had at the earlier question about this might be
You know confidentiality or it might be more
Contract types of issues but but I'm not sure
Any maybe mission okay? Yes? Yeah, I'll just run with that great question and thank you for the summary
There are there's a lot of innovation in this space right now
there's a
group in Houston doing some cool stuff with telestroke actually
that where paramedics are connecting to put this the physicians at the hospital to even get
Possibly give some of that tPA and other care interventions even sooner
There's a group in
my old stomping ground, Asheville, North Carolina Admission health doing some very cool stuff with the caromed 'ok
program of my
good colleague of mine
Charles Blankenship is doing some amazing things
up in [the]
Nashville region of North Carolina, and he's a if you kind of look at my peeps always willing and to talk about it
He's been talking a lot about his program. You know in terms of the question it it does come down to scope of practice
and those arrangements and really as you mentioned Ellen the contracting of things the
terms of use
types of things that and the policies and legislation in that state
some States require an in-person
Visit to have occurred with that
position before
that telehealth video consult can occur
there's a lot of
Complexity around the billing and reimbursement of that said interaction, and so that's a lot of the legislation a lot of work
The Charles this billions trying to kind of navigate through the billing and coding and the providers that are allowed to do
Telehealth and what medicare may state different state Medicaid will reimburse
So yes it comes down to the scope of practice it comes down to the use case of Telehealth
And and it really you know defining out in detail
[alright], we're going to do this program, and it's for this type of patient and so kind of having those policies and protocols in place
That are very black and white
Because [there's] some things you can do and there's some things you can't do I will kind of get into a little bit of that
that later with some of the confederation of state medical boards
things
items that I mentioned so great question
very innovative space
Go ahead um next question and then I know I know everybody I'm getting questions about
Getting lots of legal questions confidentiality and where you're a ball so good
I want to I want to make sure we get
But I do want to get this one question in and this came when you were talking about remote monitoring
And and I believe this was about remote monitoring, but if I mentioned her pretty please feel free to qa again
But the question is what vendors are out there that
organizations can use to
begin providing these types of remote monitoring services oh
Boy lots
And I should mention that as a consulting firm we are vendor agnostic
So we are never we don't sell a particular vendor and often we are helping clients choose vendors, so great question
I'll rattle off a few honeywell home med
Does a lot there's cardio calm with a company that recently got bought by medtronic
They're doing some great things
we've seen a lot of
programs use
Kind of build their own is an option that you can do using iPad
And there's taito care typ. O is a really cool israeli company that has recently
Come out and I think they threw all their fDa clearances now
And they sell a peripheral for like three hundred dollars
and
And so that's a good option. There's a I
Could go on and on Earth. There's quite a bit
it just talked to a
sensor med
Trying to think there's some diabetes focused ones that are very specific that that
Trying to think there's there's quite a bit it kind of Google remote home monitoring technology
Telemed x is one that I just saw that
Kaiser permanente is using Kaiser permanente Northwest up in Oregon. I have used telemed x
With some iPad, and [then] they [used] it there a lot of their staff head, I think it was iphone
5s and they were using telematics with a lot of success
So lots of options out there and you can also kind of take out build your own approach
All right this slide
I'll
Go pretty quick on these next few till we get to the legal issues in wrestling then we can just spend some time there just
kind of a laundry list lied
these are the
Domain value areas cost quality access, and then there's there's the telehealth I call it x factor or other
or you can get a lot of benefits and
Really Target services and and at times it can be really a competitive type of play
To kind of get into a new market
If you look at some health system like Mercy
Who is in St.. Louis, Missouri or in the middle of the Country?
they're taking their Telehealth services to
You know anywhere where as their service area before was, Missouri?
In Kansas so now they're really looking much further
But I won't get into all these but and I can I can definitely talk
For quite a while on each of these and there's some very exciting stuff going on
and lots of these are your
three main areas cost quality access
here
market drivers, I talked a little bit about
Throughout the presentation so far, but quickly to kind of hit on some of the data and the fact
Cost of Health [Care] is rising annually by over five percent
Reimbursements are decreasing they're shifting from a fee-for-service environment. Which is you know I have a
Visit with say Ellen and I'm the doctor and she's a patient and I get paid a hundred dollars for that visit
Reimbursements are shifting to well you've got to make sure ellen stays out of the hospital
so you have to provide care for her and we'll give you [a]
Payment and bundled payment, maybe for the month and you've got to take care of her so shifting to value
And bundle payments over just fee for service interactions
Readmission penalty it's a big part of that keeping patients out of hospitals and really penalizing
Physicians and hospitals really is who can't keep them out of hospital. He'll perform
I won't even I'm not even gonna talk much about that today because it's a cluster
I still out there in DC. So it is walking and what everyone may actually right? I'm not been [Killin]
But we're hoping it improves
Telehealth adoption however
Literally speaking with that ceo of the national Rural health association
He was very cautious and concerned about some of the cuts that the president's talking about right now and one of those very cusses is
proposed cuts to the appalachian
Regional Commission, I think it's called which funds a lot of school-based bailout programs through Rural appalachia
So you know senator Tom price the new hhs guy is a big?
Proponent of Southeast from the state of Georgia and George is pretty Mature with Telehealth applications
But some of the cuts give us a little bit of caution right now
And then lastly the global health market, and that's one thing. I've talked a lot about there's tremendous growth in
Germany, Australia
Venezuela Mexico is doing tons of stuff with telehealth so lots of a global growth Aaron. I mean 14 billion
to 35 billion with that compound annual growth rate is pretty incredible so lots of fun action in the space and
there'll be like the opportunity for you know the students out there or
Individuals there's tons of opportunities to kind of get plugged in the different, Telehealth in the telehealth industry
Legal issues, and rest all right. This is good
I was trying to got here a little after a half hour
but that's where I want to get so just a couple notes at the start you know every and I was so excited when
Ellen asked me that you know get involved this course cuz
You know I work with legal professionals a lot
And general you know the general counsel and [the] legal departments at companies Vendors
Hospitals we are that is one of the individuals. We spend the most time with
Because there are so many
policy and
Regulation and protocols and compliance impacts that towel is telehealth is such a disruptor
So we have to really work with legal department that all these organizations to ensure that they have the proper
policies and
You know methods to organize and manage their their ideas that they had with fill out
the Federation of State medical board
With telehealth as a top priority in 2017 this was very telling up on the statistic
in an article and
you know this is the group that these are all the
medical societies for each state
So each day has their own
Medical society and they all in the federation is the kind of their overarching
Organization and they really all want to have tile health as a priority sort through the use cases
Sort through the requirement just like that question earlier
If you ask that question you might not be able to answer it in a very clear way in some state
So putting some clarity to that
Learning Curve both from a leadership perspective
and the entire organization oftentimes
There's a considerable
Learning curve with telehealth understanding the use case the service type
Technology
The opportunities that that health system might have and so you know as you as the atTendees listen to this up
a webinar
Know that you know as they become more knowledgeable about kal-El
They can help that learning curve improve and they can help inform their organization and our leadership teams about Telehealth
Again, there's new technologies and new care deliveries
It seems every week there come and it is very complex with the legislation the policies the providers
And it's extremely competitive right now and so
Depending on who you're talking to you might not be getting kind of the full
Understanding of the truth or you have to be kind of really weary of who's telling you what?
because there's
So many players in the in the space right now and many are just trying to kind of you know capitalize on a growing industry
And and make some money
So now we'll get into the long list of telehealth legal issues and rest and all things to be informant go ahead
Can you start with confidentiality because I've heard that one?
I will try bein that one and how you know and I you know is it so there's that there's an
analogy to law offices
Where both traditional lawyers and then and then other legal professionals practice and we have law practice management software
And so while the lawyers are responsible for the confidentiality
It's frequently it gets pushed onto the software providers who end up being the [one] who?
ensure Confidentiality and I
Can't help but wonder and I see that at least one person on our in our group wonders as well. Is it similar in?
In in medicine or intel affects the interesting I hadn't heard that before
How you just described it and yes, I think a lot of it
You know it is the responsibility of the hospital and the provider, but so much when you talk about confidentiality of
Telehealth and the technologies a lot of it is pushed on on the vendors and they do have to you know according to
the current regulations
State to state and nationally it does have to be hip a secure. I think it's
256-bit
Secure, So there are pretty strict
Technology standards that
in the past that not every technology has that level of
Could say that level of confidentiality and security
Now many more have it
but you know you still have to be pretty cautious and ask the right questions and and
And kind of ask that vendor you know explain to me how the solution?
Improves or ensures confidentiality
and security
Because it is not something to be taken lightly
And you do not want to be in a situation where you deny ask that question or do not prepare for that, so yes
I'd say it's probably pretty similar it's a
great thing to hear
So we'll just kind of get right through it, and then one more all right
I [want] to make sure we get out of love it so so another question can you imagine that Telehealth will contribute?
to the widening to
Widening the range of services that
non MD Medical
professionals can effectively and then in [parenthesis] and legally right provide
So this is another analogy to the legal profession
but I you know I first became aware of this in the medical field and hearing a
Podcast one day about pharmacists giving flu shots right or prescribing birth control, so we as we have this range of
non-Traditional MD professionals is Telehealth going to
Push [that] along do you think?
absolutely another great question
You know one example that I'll quickly go through is
You know the example of in telepsychiatry?
You have psychologists and you also have?
Licensed clinical social workers, and so what I've seen in a lot of these really innovative programs that
[have] just had
Tremendous quality improvements, and
You know give great care are ones that really break down that
step-By-step process of how patients and providers are doing things today and
They maximize each different providers
ability to hit kind of their scope of practice
And so using that telepsychiatry example
you can [use] a
Great programs often use licensed clinical social workers to do some of that initial intake and so kind of by using
Really great evidence-based
Templates of care and the questions to ask to determine that that patient needs in that moment
What they're they're kind of dealing with and and going step by step in and sometimes a highly?
Templated format
but it but a
You know a very streamlined process you can use that out lCSW and then you hand off to the position?
When appropriate and and and then that physician can go through that that template format?
form
and really
You know be more effective
And streamline their care
because they've
use technology and
those other providers to Collect and
You know some key information before the visit so absolutely not and that's one thing that you know everything from Pa is the nurse practitioners
There's so many
Wonderful health care workers in Health care they can use technology to kind of last month care another example is
Remote home monitoring, so utilizing
Rn
To do a lot of that care and again
You know tracking the key indicators
patient's weight Went up
documenting it
streamlining that information to the physician if appropriate or
Maybe an N
nurse practitioner in that state can
can you know they ran out of medication and maybe they can prescribe medicine in that and that particular situation or Pa or
that so yeah great question and absolutely, and that's one of the reasons that I think it's the
how'd it as
such a
Opportunity to Improve Health care could use it across this conscious position?
And that kind of brings us to really legislation. I think there were over a hundred and fifty pieces of legislation
Work involving fell out that were submitted last year
Just in the last Few Years we've gone from
15 states that have payment parity laws and payment Perry's e is defined as the
[payers] in the state are required to pay the reimburse the same
as in-person visits
Now you get down a detailed saying all right. You can't do tell out for x but you can do it for y
well if you're doing it for why those payers have to reimburse the same amount of meant revenue or
Dollars that they would have if that patient came in for a visit, and this is a big challenge
Across the country [and] it you've gone from you know a handful of states
Probably three four years ago to I think we're up to about 32 or 33 states to have payment parity
so it's really changing and
Often hospitals and health systems look at this is to say well. I don't know if I want to get into health yet
until the reimbursements the same
so that's a big barrier that it's
coming down
from a state to state perspective
Prescribing is a big one in terms of some states, and how they look at online prescribing
the level of
drugs that they can prescribe is a big one and then lastly patient provider relationship all three of these are big pieces of
every State legislation
The patient provider relationship. There's a big battle in Texas over
Originally the Texas state medical board said that you had to a physician had to see a patient in person first
Before they could do to help at all to establish a relationship, so other states
Define
Telehealth in a virtual
interaction
Mostly we required to be live and it can't just be asic crony anisur you know an email
has to be live and many most states that they define that [as] an
Established patient you can have your [very] first visit with the position through live video can be considered
you [know] having a relationship so lots of variation wants the
issues their state medical boards I've talked a lot about
Many other, and then I kind of time me so they come right down
These are [some] of your big ones that are
All related to legislation
uh-Huh, and
and I think that's why you
when I say a hundred and fifty plus pieces of sellout legislation
Were submitted last year at state level and and and how to deal with it, and then you can see why?
Health is at the top of state medical boards priorities for 2017 is because there are numerous
Impacts, and you can go deep on almost any of these and you know for the attendees that are?
Working in the in the legal world
At Hospitals health systems or vendors or large employers?
you know if you're considering a
partnership or
signing with a with a telehealth company, you know these are the important things that aren't always discussed and
You know ensuring that maybe that company that you're partnering with you know do they have physicians in your state those your state require that?
Even if you're doing tell some time some states out there require that the physician be in the state
that to be in the same place, but they can't be outside state line so all sorts of
legal
issues in Risk
That legislation is driving, and it's constantly changing too. There was something in
Virginia has had payment parody for a long time, but they're they're they're
Updating updated every 12. Why are they they submit legislation it impacts it or
Change take something out
so lots to stay on top of
This is my favorite line
contracts contracts and contracts
Vendors Providers partners
If you're a big health system, and you partner with a rural hospital. You're going to have a contract for that affiliation
and
Cms center for Medicaid medicare services they have different compliance and regulatory
requirements where
You know there's for example or their quality statistics that have to be reviewed on a regular basis
You have to ensure that
provider and patient satisfaction can occur
so contract is probably the
One of the major areas that that attendees or our?
potential students may get involved with with tell altas you know a contract comes across the table and
You have to do some pretty good due diligence
And you don't have to be a lawyer to really sit down and go through that contract and and understand
What those impacts are and then getting down to these other related items?
Because that's where contracts are kind of the rubber meets the road with the stuff above it
How it impacts your your organization technical standards? We actually talked a little bit about earlier. So won't go into that policies
Standard operating procedures guidelines these are all things that
Startups hospitals health system providers, they really need to have if they're doing telehealth
And that's that's a big part of what we do is is helping these organizations have these
detailed documents
Because without them. They're just kind of winging it and that's when that's where risk comes into the equation
And some of the things we've we've seen
some things I've kind of worked with a you know it definitely gives you a little bit of Concern and
When hospitals and health systems or employers aren't concerned with that
Having [that] it is definitely an issue
Reimbursement we talked a lot about with the payment parity governance. This is a big part of really enabling
The policies and the Standard operating procedures and the guidelines meeting compliance and regulatory is
Having you know defined roles and responsibilities to take on that lead tell that organization x this can be coordinators
managers or for lon directors of programs
mention the CMS compliance make the quality example and
then I
Haven't mentioned yet is state health and human services offices often are either
Following up on many of them have compliance and regulatory requirements for tell out that near
Cms, but I'll have them add to that too. So you want to be make you want to make sure that your company?
If their partner with a tow a lender or if you're doing tell out the hospital how system that that you comply with all state
rules as well, Pennsylvania is an example that we opened up a
program for a client and
The Hospital is in
Philadelphia, and it was connecting to one site in Virginia and another site in Puerto Rico and
We had we had to demonstrate
The technology and go through an actual audit for both of those sites
And so literally I had you know for department of Health and Human services for Pennsylvania
Individuals in front of me, and we were walking through the program and we had to prepare a binder for them so that they had
every single one of the regulatory
Requirements met and we had to demonstrate that we we knew what was in that book, too
So that's something that's really on the rise
and
As you can see that
There's statewide
State to state and international so depending on what type of telehealth you're doing or partnering one at Thirty are in
learning lots of legislation impact
Hey, oh yeah, yeah um so we've only got we've just got a couple minutes but but two things
So it is when you talk about the the state to say it is not unlike our Hr professionals
Who are with us today who are dealing with companies that have employees right in every state and you get into the riad?
right The Myriad of
regulations
James had a comment that I just want to make sure that that I that I think it's a great comment when we were talking
about reimbursement that Ems gets into
issues with telehealth because they don't get reimbursed based on certain regulations unless they
Transport and so while it can increase access in certain ways it comes with certain
limitations
That can be challenging, and I want to make sure that everybody when we when we wrap up in a comment
I want to make sure that we get everybody gets your contact information
Um and and and Brian and I can can stick around if anybody has any questions
That you want to follow up
But I want to make [sure] that that everybody feels free at one if they need to go back to wrap up
Sure thing. Here's all the stakeholders and as you can see
You don't have to work at a hospital health system to run into tell out or need to do some stuff patella or be knowledgeable
about self
Really excited. You know to close. I think there's tremendous
Value for the students to learn more about Telehealth, and this is definitely a trend across the country that more and more medical schools are
implementing a telehealth course for
Students, and then you're seeing undergrad programs that are also focusing on it. So very cool stuff. I
don't think [I] have my
Contact on the first slide. Oh, that's right. I'm sorry
That's okay
Get too many animations in here. Yeah, that's good. That's good. We like we like animations I
Don't have it on here. Actually well if you want if people want to find you
Yeah, through through linkedin. I know there were a couple questions that were fairly specific questions that I saw I would just
Have folks directly directly to give my cell phone and email
I'll try let me put it in the chat here
but uh
Yeah, thank you very much. Oh, this was this was great. I really appreciate you guys had really good questions
Oh, yeah, great question really really good questions. I we appreciate [you] being here. We will be archiving. This if you
Want a copy of it you can just let us know if you have questions about our
MSL program you can reach me at
Murphy me Mu our phy emmy as in Mary Ellen at WFU edu
We will have another way of in that webinar coming up on April fourth. It's a Tuesday during the lunch hour
And we'll be sending information about that webinar as well, which will focus on how human resource professionals
human resources professionals can respond to the the Kata transition of a new
administration
Well, thanks special. Thanks to everyone for attending and
Try and get my information out just feel free to contact me
Know every why the course yep? Thanks guys
I'll stick around and fame by this question
I will as well if folks want to want to type questions in and I'll stop the recorder in Case folks have questions that they
If they'd like to ask
