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San Juan County Telepsychiatry HRSA Demo Project: May 2007 to April 2010

San Juan County Telepsychiatry HRSA Demo Project: May 2007 to April 2010. Beth Williams Gieger. Administrator Inter Island Medical Center Friday Harbor, WA bethwg@interisland.net. Access to Psychiatric Care. San Juan (Islands) County.

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San Juan County Telepsychiatry HRSA Demo Project: May 2007 to April 2010

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  1. San Juan County Telepsychiatry HRSA DemoProject: May 2007 to April 2010 Beth Williams Gieger. Administrator Inter Island Medical Center Friday Harbor, WA bethwg@interisland.net

  2. Access to Psychiatric Care San Juan (Islands) County Rural counties with Telemedicine collaboration initiatives

  3. Rural Barriers to Service for Patients: • Distance and isolation • Lack of providers • No psychiatrists • No other specialty providers • Ten Primary Physicians on three islands • Funding & payment • Political resistance • Quality of technology • Patient acceptance • Physician acceptance

  4. Telepsychiatry Demonstration Project • Rural Health Care Services Outreach Grant Program (HRSA) • Submitted by a consortium: • Inter Island Medical Center • Compass Health • San Juan County Health Dept. • $375 K over 3 years awarded May 1, 2007

  5. Goals of the Grant: • Create a technology infrastructure that gives access to psychiatry by live video • Serve a mix of children & adults in the demonstration • Convince payers to pay for telepsychiatry by demonstrating its acceptability & quality • Determine characteristics of the telepsychiatry service that improve the experience and quality of care

  6. Getting the Project off the ground. • Hired Project Coordinator • Educate Primary Care Providers on the service available and how to refer patients. • Educate the County population on the service (no charge to patients)

  7. Project Coordinator – Key to Success • New college graduate with degree in community health • Dedicated position to oversee all aspects of outreach and processing of patients • Helped set provider and patient expectations for this new service • Enter and maintain database of referrals and visits • See PDF “Behind the scenes of the San Juan County Telepsychiatry Project”

  8. Make it Easy! • Schedule appointment with Primary Care Provider • Get referral (using same processes as if service was face to face) • Project coordinator interviews patient and completes all necessary paperwork • Schedule telepsychiatry visit

  9. Our Patients • Nearly 100 patients referred to project • 221 telepsychiatry encounters • Patients aged 7 to 90 • Services: psychiatric evaluation and medication management when necessary • 34 patients discharged back to Primary Care for follow up

  10. Patient Outcomes • Do you think it made any difference in your treatment using telepresence vs. face-to face? NO DIFFERENCE • What worked best for you? CONVENIENCE – NOT LEAVING ISLAND • What could have made it better? CAN’T THINK OF A THING • Comments? ACCESS TO THERAPY NOT OTHERWISE NOT AVAILABLE

  11. Patient Exit Interview Comments

  12. Physician Responses What has been your experience involving Telepresence? • Psychiatrist: “Very positive, comparable to face-to-face encounter.” • Primary Care Physicians: “Much needed resource for our patients.”

  13. North Sound Regional Ombudsman (RSN) • Complaints about lack of access to psychiatric services in San Juan County drops to zero during third year of project

  14. Telemedicine Technology • Started with Tandberg (Cisco) • Transitioning to LifeSize (Logitech) for cost effectiveness and portability • Overall costs: $25,000 • Main telemedicine unit on a cart for use in the clinic plus two portable LifeSize units in secure cases to send to providers as needed • ARRA/USDA and other grants available to fund initial technology purchase

  15. Billing Insurance • All visits paid via grant funds • Future sustainability requires insurance to reimburse for services • CMS has established guidelines for billing telemedicine services http://www.cms.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf • Goal: Meet with Regence, Premera and Group Health to get services paid

  16. Challenges still faced: • Sustainability – Payment by health plans • Cultural – Each new install: “Show Me” • Network – Bandwidth in rural areas (need 768K minimum) • Support – sufficient to preclude troubleshooting by end user.

  17. Future plans • Add new services – TelePain & TeleStroke • Integrate into Home Health services • Use technology for provider and staff education • Encourage DSHS to use this technology for remote CSO for county residents to apply for coverage • Use in new CAH and potentially add TeleTrauma

  18. Q & A

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