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Telehealth. A New Way to Look at the Business of Healthcare Nancy Nahlik Missouri Baptist Medical Center BJC HealthCare March, 2014. Background. Missouri Baptist Medical Center is a Community Hospital in a large m etropolitan market What could we do to set ourselves apart?

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A New Way to Look at the Business of Healthcare

Nancy Nahlik

Missouri Baptist Medical Center

BJC HealthCare

March, 2014



Missouri Baptist Medical Center is a Community Hospital in a large metropolitan market

What could we do to set ourselves apart?

Developed relationships with rural hospitals

Educated Medical Staff on value of outreach

Created a hospital philosophy dedicated to rural markets

Started working on program development specifically for rural hospitals and patients

CME programs

Missouri Heart Network

Affiliation Agreements



2002 – 82 specialty outreach clinics in…

13 rural markets by …..

45 different physicians

2006 – Rural markets represented 31% of total MoBap “cases”

110 outreach clinics in …

17 markets by ….

63 different physicians

and now

And Now

2013 – Rural markets represented 28% of total MoBap“cases”

90 clinics in…

15 markets by….

50 different physicians

other outreach programs
Other Outreach Programs
  • Access to Purchasing Contracts through BJC
  • Heart Life Line Alliance


  • ED to ED Transfer Program
why telehealth
Why Telehealth?
  • Economy
  • Physician retirement
  • Younger physicians looking for quality of life and work/life balance
what is telehealth
What is Telehealth?

Telehealth: The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

telehealth is
Telehealth is…..
  • NOT Texting pictures from phones

Telehealth must be:

- HIPAA compliant

who is using telehealth across the country world
Who is Using TelehealthAcross the Country & World?
  • Cleveland Clinic
  • Mayo Clinic
  • Johns Hopkins
  • University of Michigan
  • Emory
  • University of Missouri
  • Missouri Baptist Medical Center
  • many more
how are they using telehealth
How Are They Using Telehealth?
  • ICU Coverage
  • Hospitalist Services
  • Stroke Coverage
  • Consulting Services
  • Surgical Assistance
  • Physician “Office” Visits
  • Pharmacy Support
  • School Nurse programs
  • In-home monitoring
  • Long Term Care Assistance
  • Chaplain Assistance – patient and family education
and this
And this

And this

telehealth at missouri baptist medical center
Telehealth at Missouri Baptist Medical Center
  • Mo Bap can beam into 4 rural robots
      • Specialty physician visits
      • ED transfers
      • Working with a Long Term Care Company to put a robot in one of their skilled and rehab units
specialty clinics
Specialty Clinics
  • Cardiology
  • Oncology
  • Pulmonology
  • ENT – discussed, but not implemented
  • Neurology – within 3 months
specialty clinic
Specialty Clinic
  • Seeing 60 – 70 patients a month in two rural locations
  • Both new patients and followups
  • Patient satisfaction is HIGH
  • Physician satisfaction is HIGH
  • MoBap satisfaction is HIGH
emergency services
Emergency Services
  • Robots in 4 rural CAHs
  • Available 52 hours a week
  • In a 5-month period in 2013:
    • 86 encounters an average of 20 min. each
    • 64 were direct admits to a floor
    • 12 admitted to ICU
    • 4 were recommended for a higher level of care
    • 2 came to our ED
    • 1 discharged from rural hospital
emergency services in 2014
Emergency Services in 2014
  • Averaging 4 calls a day
  • 3 physicians providing service
  • Will be starting 24 hour 7 day a week “Consulting Services” through the ED within the next 3 months
emergency room telehealth in action
Emergency Room Telehealthin Action–
  • ER Physician in a rural ER determines that a patient needs to be transferred to MoBap. He calls Dr. Winer’s cell phone.
  • Through Telehealth - on an IPAD - Dr. Winer is able to “beam into” the rural ER.
  • Robot taken into the patients’ room.
  • Dr. Winer introduces himself to the patient and through telehealth is able to confirm the condition of the patient – and reassure them about the transfer.
  • Dr. Winer calls the MoBap ICU and arranges for a bed. The patient becomes a direct admit.
what does this accomplish
What Does This Accomplish?
  • With “eyes on” – the MoBap physician can be reassured about the condition of the patient
  • MoBap can make recommendations on method of transportation – Ground vs. Air
  • Keeps patient from being in 2 EDs
  • Patient and family satisfaction
telehealth in nursing homes
Telehealth in Nursing Homes
  • In the beginning phases
  • Working with one group within Metropolitan Service Area
  • Consults will NOT be billable
  • Patients will have a record at MoBap whether the patient is admitted here or not
advantages to nursing home
Advantages to Nursing Home
  • A resource for staff during “off hours” to help determine whether a resident needs to go to the Emergency Department.
  • Reduces the number of residents sent to Emergency Departments
  • Reduces hospital re-admissions
  • Makes nursing home a choice referral source for discharges from MoBap, knowing that they are involved in keeping the resident out of the hospital
  • Clinical training/education supporting our staff
advantages to hospital
Advantages to Hospital
  • A reduction in non-Emergency visits to the Emergency Department
  • A potential increase in true Emergency Department admissions
  • A reduction in re-admissions
  • A collaborative partner on the clinical care of patients
why telehealth1
Why Telehealth?
  • Efficient patient care
  • The technology is dependable
  • It is reimbursed by most insurance plans
  • Strengthens rural providers
  • Provides a platform to grow marketshare
  • Consistent with our Mission:

To improve the health of the people and communities we serve