Telemedicine Overview for Patients – Winona Health
Winona Deep Dive
Winona has been designated as a community in the Beacon program that will implement an expanded use of broadband technologies for internal hospital operations and for community wide Telemedicine. This program is also referred to as the Winona Deep Dive. Winona Health is in a unique position to implement these additional broadband strategies. Winona Health has been a beta site for Cerner Software development for 10 years and has been recognized as one of the top 10 Health IT enabled regional hospital systems for the past 8 years. Cerner will be a participant in developing these new medical applications and connections to the core HIT systems at Winona Health. Many other organizations in Winona have also committed to implement this expanded use of broadband enabled Telemedicine.
The new broadband network will be called the Winona Community Telemedicine Network (WCTN). This network will be hosted by Hiawatha Broadband, a local broadband network operator that already serves the participating organizations. It will provide a secure, HIPAA compliant, high capacity system that connects all participants in the program. This network will provide a minimum of 40 Telemedicine stations located at public schools, public subsidized housing, older adult assisted living and nursing home facilities, the county jail, group homes for the disabled, St. Mary’s University of Minnesota, Cotter Private Schools, and Winona County agencies that serve these populations. Each location will be given a shared access multi-media Telemedicine station that includes live encrypted video conferencing. These stations will support remote medical data collection, patient assessment, confidential access to personal health records, and communications to all healthcare services on the network.
Winona Health will be implementing the needed technology for all of its internal operations to utilize the new telemedicine network. The WCTN will allow Winona Health and other providers to evaluate the addition of telemedicine to the care plans for the diabetes and juvenile asthma patients that will be part of the Beacon Program.
Home and Community Options (HCO) will also be receiving technology upgrades for its Winona operations serving the disabled. HCO is already a recognized leader and innovator for using remote monitoring and other broadband enabled services for its residents. The Beacon program will extend their service profile to include the use of Telemedicine for their served population of persons with disabilities.
Olmsted Medical Center Expansion
In June 2012, a telehealth strategic planning team formed at Olmsted Medical Center. They work with OMC leadership (including the Senior Administrative Team, Department Chairs, and others as identified by the Senior Administrative Team) to develop a strategic plan that captures the vision related to offering telehealth and telemedicine services to OMC’s patients. In cooperation with SE MN Beacon leadership, a scope and budget was identified for multiple telehealth-related projects to be launched in 2013 in alignment with the vision and strategic objectives of the plan.
The strategic planning effort provided an opportunity for OMC’s senior leadership team to reaffirm its commitment to integrating telehealth services into its portfolio of healthcare delivery methods. The following telehealth Strategic Principle was defined: “We will apply established telehealth technologies to facilitate the effective management of our patients’ chronic diseases; to improve the convenience for our patients to interact with their care team; and to create telehealth services that are sustainable.”
Telemedicine has effects on patients in more ways than just their physical health, all factors link together to affect the patient’s overall health. For instance, an 87 year old diabetic patient living in Lewiston called on her daughter to bring her to provider visits, whether it is her eye doctor, medical doctor, or her diabetes educator due to the fact that she no longer is able to drive long distances. This 87 year old woman felt bad that her daughter had to take time off work, drive from Rochester to pick her up, and then take her to appointments in Winona. When Winona Health offered this patient Telemedicine visits to check up on her diabetes, she was relieved. The patient was able to walk the 2 blocks she lived from the Lewiston Clinic without being a burden to her daughter. And more than that, she continued using Telemedicine for medical visits as she needed them.
Although he can’t reach out and touch his patient, Dr. Bryan Reed, DO, said he can give his patients the same quality care through telemedicine as he could in person. Then as he needs, he can schedule them to come in for a more standard doctor’s visit. “The benefits far outweigh the drawbacks. There’s even a feature that allows as many as eight family members to remotely connect, using computer cameras, to a patient’s appointment. This is very beneficial for nursing home residents, which I also see in my practice,” said Dr. Reed.
Mary is usually one of the active lively members of her nursing home group. She enjoys crafts, simple games and talking about her family. At 97, Mary has outlived two husbands, the second died last year after living with her in the nursing home since 2007. All 6 of her siblings have died and now her family is only her three children who live on the two coasts and are unable to visit Mary often in Minnesota.
Mary requires a wheelchair to travel more than a few steps and requires help with her daily personal care. But beginning about two months ago Mary increasingly refused activities, sat passively through her daily care and preferred to just stay in her room. Her children with whom she speaks regularly on the phone were concerned but unable to travel to visit or assess the situation. The nursing home staff asked for a psychiatric evaluation for Mary’s declining mood and increasing forgetfulness. Mary refused to travel the 50 miles to visit Dr. Lombardo at Olmsted Medical Center in her office saying she would not travel. The nursing home has only transported Mary once in the past two years for medical care and that required a medi-van and her to be accompanied by a personal care attendant.
With our new telepsychiatry availability at OMC, Mary was offered a visit by telehealth. The staff were pleased when Mary accepted. Dr. Lombardo was pleased to find that Mary adjusted to the interaction via “a television” Mary answered questions, discussed her family and her mood. She agreed that she was depressed and volunteered that she had been depressed previously and treated with antidepressants. Therapy has begun with Dr. Lombardo able to explain the treatment and possible side effects to Mary and the nursing home’s nurse supervisor at the same time.
Four weeks later Mary has had two additional telepsychiatry appointments, the first just 15 minutes just to check on side effects and answer questions from Mary and the nursing supervisor and the latest to reassess Mary’s depression. With upcoming holidays, Mary is happy to report she has written a few Christmas cards to her children and grandchildren. She brought one of her holiday crafts to her most recent appointment and expressed her pleasure at feeling much better and telling her nursing home fellow residents that the TV appointments are just fine—“I would never have gone all that way to see the doctor but she can come to me with that TV”. The nursing home staff is pleased with Mary’s progress believing she would have just “curled up in her room without help” and they did not want to bring her to the office against her wishes. Even Mary’s family has sent holiday thanks to “those television doctors”.
Dr. Lombardo expresses her great pleasure in being able to provide care for a woman that she otherwise would have been able to reach. In SE Minnesota there are many nursing home 15 to 50 miles from Rochester who have had no access to care for complex mental health conditions and no consultation support for agitated or depressed elderly patients. “This technology allows us to provide the care that these individuals need and deserve. I was surprised how quickly Mary and others have been able to adapt to this distance communication and interaction.” “Beacon has allowed us to provide the ultimate in health information exchange—long distance between the patient and the doctor,” says OMC’s site lead, Dr. Barbara Yawn.