Delineate the step-by-step operational details that are consistent and non-disruptive to existing clinical and operational processes.Develop telemedicine policies that are incorporated into existing policies (do not develop “one-off” policies that make telemedicine unique.).Select software and hardware with the input of senior leadership, physicians and nurses.Ensure clinical team is fully invested in telemedicine use.Ensure senior leadership advocates the use of telemedicine and sets achievable goals.Below is a 10-step guide to implementing telehealth in a skilled nursing facility. A workflow list clearly posted in multiple locations supports the deployment and use. In order to overcome the barriers, robust training should occur. One of the most frequent issues I encountered was password forgetfulness! Although some of the telemedicine software is straightforward, due to HIPAA compliance,the software is not as simple as accessing a website. My experience is that the barriers to adoption reside almost entirely in staff’s resistance to change and fear of technology. There should be visible support for telemedicine with senior leadership clearly participating in the training, encouraging use, and offering incentives (if possible.) Below are some guiding factors to initiate and successfully deploy telemedicine at your facility.įirst, engage the senior leadership to advocate use of the telemedicine platform. You have decided that your facility is ready to adopt telemedicine. In short, telemedicine can be an inexpensive and effective tool to reduce transportations and increase patient access to physicians. Telemedicine allows the physician to assess the situation from his or her home and drive to the facility only if “hands on” treatment is required. One strategy is to have the after-hours coverage physician or nurse staff the telemedicine platform and chart in the existing Electronic Medical Record. The facility must have physicians or nurses available for consultations. Important factors for success tend to be operational ones. In fact, an iPad at the bedside loaded with Zoom or VSee could suffice. When deployed and used, it reduced unnecessary patient transportation to the emergency department for non-emergent situations.įor most facilities, the barriers to telemedicine adoption are the perceived expense of the equipment or software. Telemedicine can be powered by a specialized telemedicine cart or a computer with a camera that facilities a live video connection between a patient and nursing assistant at the facility and the off-site resource (physician or nurse). Telemedicine offers great promise as a strategy to reduce the skilled nursing/emergency department loop. The skilled nursing/emergency department loop creates stress for the patient, the hospital and the skilled nursing facility. As a result, patients are routinely transported to emergency departments for assessment and care. They are accountable for patient outcomes but caring for the fragile, complicated patients often is outside of their licensure limits and skill set. The staffing model puts the paraprofessional medical staff in a difficult situation. The physicians are mostly located off-site with weekly or bi-weekly rounds to supplement telephone availability. The staffing model at skilled nursing facilities relies largely on paraprofessionals, including nursing assistants supervised by a registered nurse. “Between 20, the percentage of Medicare SNF patients with eight or more co-mobidities increased from 74.8 to 86.9 percent.” And, the “proportion of patients in SNFs categorized as having major or extreme severity of illness increased from about 45 percent in 2005 to 53 percent in 2009.” Accordingly, skilled nursing facilities are accepting patients who are frailer and more complicated. The hospitals are under pressure to treat only the most acute conditions and then move the patient to facilities with lower costs of care. The care continuum increasingly relies on the skilled nursing facility to extend patient care beyond the acute care facility before the patient is sent home.
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