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- 1. Project Kickoff Meeting June 25th , 2014 St. Louis Medical Center Implementing Telehealth Nicole Norris Chamberlain College of Nursing NR 640 Informatics Nurse Specialist Practicum I Summer 2014
- 2. Sponsor Dr. Toni Hebda Phone: 630-535-8827 Cell: 724-809-3427
- 3. Project Management Project Manager: Nicole Norris 202-437-0195 N_norris1@yahoo.com Sponsor: Dr. Toni Hebda 630-353-8827 Thebda@chamberlain.edu Informatics Expert: Dr. Carolyn Sipes 630-353-8757 CSipes@chamberlain.edu
- 4. Kickoff Meeting Goals Meet and Greet Team Establish Communications Appreciate how this project Aligns with the Institution’s Mission and Goals Discuss Key Factors for Success
- 5. Institution’s Mission Dedicated to providing access to quality healthcare Provided supportive environment Devoted to excellence and safety Committed to outstanding healthcare Optimizing quality of life
- 6. Vision Statement National leader for excellence Deliver the highest healthcare Provide tailored healthcare experiences
- 7. Project Goals Improve quality of life for patients with congestive heart failure Provide continuous care through telehealth home monitoring Provide 24-hour technical support Document findings and make revisions to plan as needed
- 8. 8 Project Objectives Define telemedicine and how it works Define what CHF is and associated complications. Identify the cost of readmission of CHF patients Describe equipment required to monitor patients from home Identify the role of the patient, Assess costs of implementing a telehealth program Identify inclusion/ exclusion criteria for selected patients Summary of proposal
- 9. What is Telehealth? Tele- “at a distance” “The use of electronic communications to exchange medical information to improve patient outcomes.” , (American Telemedicine Association, 2014)
- 10. Telehealth Services Remote patient monitoring Referral services Medical education Mobile health applications Biometric devices Online consults
- 11. What are the benefits? Decrease hospital admissions Decrease healthcare costs Improve quality of life Improve patient outcomes Improve access to healthcare Decrease use of emergency department
- 12. What is CHF? Congestive Heart Failure Most expensive chronic condition to treat Affects approximately 5.7 billion annually Leading cause of hospitalization in people >65.
- 13. Costs of CHF $37.2 billion annually $4,873 average daily cost for hospitalization. Length of stay approximately 4.76 days $17.4 billion for readmissions within 30 days
- 14. Telehealth Solution Home monitoring program Cost effective Wireless monitoring Monitors weight, blood pressure, pulse ox
- 15. How much does it cost? Budget Information IT Technical Support Staff $15,000 ($60,000/year, $5k/month x 3 months) Equipment Installation Fee $3,750 ($150 x 25) Telemonitoring Landline unit with b/p $5,775.00 ($79.00/month x 25 x 3 months) Weight Scale $1,496.25 ($19.95/month x 25 x 3 months) Blood Glucose $1,496.25 ($19.95/month x 25 x 3 months) Training $700 ($28/hour x 25) Total Estimated Budget $28,218
- 16. Inclusion/ Exclusion Criteria Inclusion Diagnosis of CHF Ambulatory Able to provide self-care Willingness to participate Exclusion Diagnosis of co- morbidities such as renal failure or liver disease Non-ambulatory Refuse consent to treatment Alcohol use Smoker
- 17. Establishing Expectations Plan Change Management Risk Management Communication Plan Reporting requirements Closing Process
- 18. Senior Management The project is intended to utilize telehealth home monitoring for patients with chronic CHF on an out-patient basis. Successful implementation of this project will encompass tremendous benefits.
- 20. Project Management Objectives Initiate a project that will follow a successful plan for implementation Plan the project in an orderly fashion with established milestones and initiatives Meet all deadlines established within the project among all team members. Execute plan into Second Life
- 21. Project Team Roles Project Manager-manages overall project Technical Project Team Leader- reports to project manager SLMC Administrators- Support project manager Patients participating in program-must consent
- 22. Project Management Tools Project Charter Scope Communication plan Work breakdown structure (WBS) Gantt chart
- 23. Communication plan Project Team Member/Stakeholder Communication Preferred Timing Report Prepared by Dr. Toni Hebda Email Second Life Every Wednesday Project Manager Nicole Norris St. Louis Medical Center Administrators Email Second Life Every 1st and 3rd Friday Project Manager Nicole Norris Patients in trial group Telephone 1st of the month Home health nurse for agency Technical project team leader Email Every 2nd and 4th Friday Project manager Nicole Norris Primary doctors and healthcare staff Email 1st Monday of the month Project Team leader
- 24. Work Breakdown Structure (WBS) What the project will deliver Documents deliverables Facilitates checklist of tasks Most important tool for project managers Relies on effective planning process
- 25. Gantt Chart
- 26. Critical Success Factors (CSF) Stakeholder support Referral mechanisms and protocols Effective communication between stakeholders Necessary resources Support government regulation and policies Demonstrate the effectiveness of telehealth for selected patients.
- 27. Deliverables Clearly defined presentation Accurate research data Communication Plan Budget Training needs Proposal Presentation Inclusion criteria protocols
- 28. Project Key Milestones Project initiation Project Scope and Charter Budget Approval Finding a Vendor Finding an agency to Monitor data Inclusion/ Exclusion Criteria Trial group selection Implementation Monitoring and re-assessing
- 29. Meetings Important to maintain communication Required scheduled meetings Must participate
- 30. Managing Change
- 31. Change is Expected….. Organizational change Individual change Drives organizations to vision statement Requires learning new material
- 32. Risk Management
- 33. Managing Risk Risk register RACI chart
- 34. Assumptions SLMC will provide a designated space for storing and monitoring equipment. The funds will be available SLMC human resources department provide the staffing resources needed.
- 35. Constraints The project must be completed by the end of session 2 week 7 Limited selection of home monitoring equipment to choose from Project is completed in the virtual world with limited amount of feedback on progress.
- 36. Closing Process
- 37. End of Project Healthier Patients Happier Staff Decreased Cost Decreased Emergency Visits Increased Revenue
- 39. Positive Send-off to Kick Off the Project Let’s get ready to make SLMC the best by being the first hospital to implement a successful telehealth home monitoring program!!
- 40. References Desai, A. and Stevenson, L. (2012). Rehospitalization for Heart Failure: Predict or prevent? American Heart Association publication, Circulation. Retrieved from http://circ.ahajournals.org/content/126/4/501.full American Telemedicine Association (ATA), (2014). Retrieved from http://www.americantelemed.org/abouttelemedicine/what-is-telemedicine#.U3g2XP1OWM8 Center for Disease Control and Prevention (CDC, 2014). Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm Schlachta-Fairchild, L., Elfrink, V., and Deikman, A. (2009). Patient safety, telenursing, and telehealth. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2687/ Nickols, F., (2012). Tools for Improving the Performance of People, Processes and Organizations. Distant Consulting LLC. Retrieved from http://www.nickols.us/change.htm
Notes de l'éditeur
- I am the project manager for this project and can be reached at the following contact information. Dr. Hebda is the project sponsor and can be reached via email, however for any urgent concerns please feel free to contact me directly. Dr. Sipes is the Informatics Expert and can be reached at the following contact information during office hours. Please email her to set up appointments.
- Hello everyone, I would like to take this opportunity to thank everyone for attending. A special thanks to Dr. Hebda and Dr. Sipes for their ongoing support and commitment to this project. Implementing a telehealth home monitoring program for patients followed through the Amelia Earhart Cardiac Care Center really closes the gap from hospital post-discharge to home care. It will allow our patients to follow a continuum of care and lead to an improved quality of life. Key factors for success of this project will require the dedication and support of all team members, staff, patients and the community. This is a team effort and am confident this project is just the beginning of an innovative, technology-driven era within the world of healthcare and am proud to say it starts here with St. Louis Medical Center.
- St. Louis Medical Center (SLMC) is dedicated to providing access to quality healthcare in a supportive and caring environment with an unyielding devotion to excellence, safety and an unequaled passion and commitment to ensure outstanding healthcare that optimizes the quality of life for those we serve. As you can all see, implementing this telehealth home monitoring program fully supports the institution’s mission.
- The vision statement is SLMC will be a national leader for excellence and innovation in developing and delivering the highest quality of the next generation of consumer-driven healthcare; focus on our patients as individuals and provide healthcare experiences that are tailored and personalized to meet their physical, psychosocial, emotional, and/or spiritual needs.
- Implementing a telehealth home monitoring program for a selected trial group of patients diagnosed with CHF will improve patient care outcomes, decrease costs, reduce hospital admissions and emergency department visits and improve quality of life for these patients. The cost of implementing a remote program is a very little price to pay with significant benefits.
- I think it’s important for everyone to understand the project objectives and goals to ensure clarity and direct everyone’s focus in the same direction. This project will involve medical staff, administrative staff, lay people, patients, outside agencies and the community. For these reasons, it is important that all of us have a unified understanding of the objectives for the project that will be presented. The next few slides will review some of the key objectives in detail.
- The first important point I need to express is, “What exactly is telehealth?” The terms, telenursing, telehealth and telemedicine are often used interchangeably and may have slightly different meanings within the same context (American Telemedicine Association, 2014). Telemedicine is defined as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data and education using interactive audio, visual and data communications. The American Nurses Association defines telenursing as a subset of telehealth in which the focus is on the specific profession’s practice (ATA, 2014). One specific patient care population that can benefit from telehealth are the CHF patients. There has been a 10% increase each year for the last three years in the number of readmissions of CHF patients. In the United States, heart failure is the leading cause of hospitalization among adults >65 years of age and accounts for over $17 billion in Medicare spending annually (Desai and Stevenson, 2012). Outcomes are best when follow-up visits upon discharge involve a collaborative healthcare team (Desai and Stevenson, 2012). One way to ensure compliance and meet the discharge goal of follow-up visits is through Telehealth home monitoring. This will allow the patient to be monitored with reported vitals to a database that can track the data and identify a potential problem before it leads to a re-admission to the hospital.
- There are many different services that can be provided through telemedicine including, remote patient monitoring, referral services, consumer medical and health information, medical education, mobile health applications, biometric devices and online consults (ATA, 2014). Online consults are usually done using two way audio/ visual devices. Telehealth has been utilized for diagnosing Leukemia, interpreting electrocardiograms and education and consults through two-way audio and video technology (Schlachta-fairchild, Elfrink & Deickman, 2009).
- The benefits of telemedicine include improved access, cost efficiencies, improved quality and patient satisfaction. Telehealth is especially helpful in managing chronic conditions such as Congestive Heart Failure and has demonstrated successful outcomes on hospital re-admissions and early detection of risks leading to admission. Patients are monitored wirelessly without ever having to leave the comfort of their own home and has proven to decrease emergency department visits.
- We all know should have an idea of what Congestive Heart Failure is, but may know the statistics of those affected. According to the American Heart Association, CHF was the underlying cause of 57,120 deaths in 2004. Studies show that 47 percent of CHF patients are likely to be readmitted to the hospital within 4-6 months after discharge and 27 percent were likely to be readmitted within 30 days of discharge (Zales, E., 2009). It affects approximately 5.7 billion people annually and is responsible for approx 13 percent of emergency room visits (CDC, 2014).
- The costs of managing this chronic condition are so high, that hospitals are being held accountable for deteriorating conditions that could have been avoided. According to the Center for Medicare and Medicaid Services (CMS), readmissions are an indicator of poor quality care and can be denied reimbursement. In 2004, CHF readmissions within 30 days of discharge costs $17.4 billion with an average hospital loss of $1,288 per patient (Zales, 2009).
- Studies have shown that heart failure patients who experienced an increase in weight and blood pressure would be at risk for hospitalization or negative outcomes (Desai, A. and Stevenson, L. (2012). Telehealth home monitoring has been proven to improve outcomes in CHF patients. This program can be easily implemented because all of the equipment is wireless and includes software that allows for authorized access to the data from a remote location.
- The cost above are based on the implementation of a telehealth home monitoring program for a selected trial group of 25 patients diagnosed with CHF from the St. Louis Medical Center Cardiac Rehab unit. The estimated total budget is $28, 218 for installation, tech support and monitoring for 3 months. The trial period of 3 months was selected to ensure the 30 day post discharge date was covered as well as 2 months following to track progression.
- The implementation of a telehealth program will include a selected group of 25 patients discharged from St. Louis Medical Center and accepted into their Cardiac Wellness program. Patients must have a diagnosis of CHF, be ambulatory, able to provide self-care and consent to participate. Patients that are non-ambulatory, use alcohol, smoke or have co-morbidities such as renal failure or liver disease will be excluded. The goal is to focus on the diagnosis of CHF and with high risk factors such as alcohol and smoking, it will be difficult to assess the admission problem.
- The plan is to implement telehealth home monitoring program to a selected trial group of patients enrolled in the Amelia Earhart Wellness Center. The Amelia Earhart Wellness Center is a program that utilizes a multi-disciplinary approach to manage vulnerable patients on an outpatient basis to improve quality of life for patients with chronic heart disease. To effectively implement change, each of you must realize that change lies within you and must be exemplified your values, behaviors and collective actions. Together we can make a change for the better through telehealth. A communication plan has been developed and will require each of you to participate, by responding to emails without delay and attending scheduled meetings on time. You will each have assigned tasks to complete as the project progresses that will require you to submit your task on time. Any delay on a team member’s task will inhibit the entire project and add additional cost to the proposed budget. Our goal is to stay on track as best as we can to eliminate additional costs and hurdles.
- One specific patient care population that can benefit from telehealth are the CHF patients. There has been a 10% increase each year for the last three years in the number of readmissions of CHF patients. In the United States, heart failure is the leading cause of hospitalization among adults >65 years of age and accounts for over $17 billion in Medicare spending annually (Desai and Stevenson, 2012). Outcomes are best when follow-up visits upon discharge involve a collaborative healthcare team (Desai and Stevenson, 2012). One way to ensure compliance and meet the discharge goal of follow-up visits is through Telehealth home monitoring. This will allow the patient to be monitored with reported vitals to a database that can track the data and identify a potential problem before it leads to a re-admission to the hospital.
- The implementation of the telehealth home monitoring program for patients diagnosed with Congestive Heart Failure (CHF) is a project that cannot be successfully implemented without a thorough project management plan.
- This project approach will follow the five phases of project management including Initiating, Planning, Executing, Controlling and Closing. The project begins with the initiation phase and includes assembling a team and defining the reason for the project which can be seen in the objectives and project scope. The Planning phase includes all necessary tasks for project completion. It will include all deliverables and critical success factors that must be identified to move forward with the project, as well as the Work Breakdown Structure (WBS) and Gantt Chart to hold people accountable for their assigned tasks. The execution phase will implement the planned solutions and involves a review of resource allocation, communication with stakeholders and team members and troubleshooting.
- The roles and responsibilities of each team member needs to be identified and described in detail to ensure appropriate task assignment. The project manager ensures the appropriate management, customer and supplier involvement throughout life of the project. Establishes and communicates clear priorities among project activities. Has the primary responsibility of defining, planning, tracking and managing the project, for identifying key resources and providing the direction they require to meet the project objectives. Organizes the work into manageable activity clusters and determines an effective approach to completing the work. The project Manager also prepares the project plan and obtains management approval. The Technical Project Team Leader reports to the project manager and has the responsibilities to manage and communicate a clear vision of the project objectives, motivates the team to achieve them and tracks and reports on progress. The technical team leader manages all technical aspects of the project such as hardware procurement and configuration, networking and interfaces. The SLMC administrators support the project manager by approving and providing funding for the project. They also provide necessary members from Human Resources department to complete project upon request. Work with the project manager on all phases of project. SLMC administrators will provide necessary work space for storing and monitoring all equipment and provide data for subjects selected for pilot program. The patients selected for participation in program are responsible for following program instructions and recommendations and must consent to installation and education of home monitoring devices.
- A successful project will have a fully developed project charter and project scope document that lists the roles and responsibilities of each team member, describes the approach, project objectives, measures of success, assumptions, constraints and Mission Statement. The project Charter serves as an outline for a newly proposed project. The Scope statement provides an executive summary, project description, project milestones, project approach, authorizations, and the general scope of project. The communication plan, WBS and Gantt chart are additional tools that keep the project on task.
- Effective communication is the foundation of good business. It gives team members a sense of purpose, persuades executives and public opinion and increases project success rates (Project Management Institute, 2013). Studies have shown that projects with an effective communication plan have a higher success rate (Kodukula, 2011). Communication planning should not be limited to internal stakeholders, but is a coordinated effort by all team members and should include the community outside the organization or anyone else that may be impacted by the project (Project Management Institute, 2013). Communication is ongoing beyond the completion of the project between team leaders, sponsors, managers and end users to assess progress and track the value of the project. The communication plan identifies specific days and with whom communication will take place.
- After identifying the project scope, charter, critical success factors, deliverables, tasks must be identified and attached to their related deliverable with assigned timelines, otherwise known as the WBS and Gantt chart. The WBS defines the aspect of the what that the project will deliver as compared to the how to or when (Buchtik, 2010). It clearly documents the deliverables defined in the project scope and facilitates a working checklist of tasks that must be completed in order to successfully implement the project (Buchtik, 2010). According to Rose, (2009) the WBS is arguably the most important tool for a project manager and helps to define all aspects of the deliverables or work to be delivered. Managing deliverables successfully relies on an effective planning, process and monitoring plan that can implement strategy into action (Zofi, 2012).
- The Gantt chart is a diagram developed by Henry Laurence Gantt and is considered an important tool utilized in project management (Filip, 2009). It illustrates a project program’s beginning and end date of essential tasks through a type of bar chart (Filip, 2009). Limitations to the Gantt chart include attempting to define the work breakdown within the Gantt chart and useful for relatively small projects (Filip, 2009). This Gantt chart has identified the project starts with the project initiation and the longest portion of the project to complete is the Powerpoint presentation.
- Critical Success Factors (CSF) are conditions, variables or characteristics that directly impact a project’s variability, efficiency and effectiveness (Kodukula, 2011). One CSF includes stakeholder involvement. Stakeholders would include healthcare staff, such as doctors and nurses because they would have to accept and approve the process in order for it to be implemented. Insurance companies are stakeholders because healthcare costs would decrease. Patients are stakeholders because it will reduce costs, save time, increase convenience, which may improve compliance to treatments and overall health. Additional CSFs are that this project will have the availability of sustainable funds for implementation, will have clearly defined telehealth referral mechanisms and protocols, will have successful communication linkage between stakeholders, will have resources, equipment and personnel necessary for implementation, support Government Regulations and Policies and demonstrate the effectiveness of telehealth implementation for selected pilot program.
- Deliverables are related to the work of the project and must be known in order to have a successful project. Managing deliverables successfully relies on an effective planning, process and monitoring plan that can implement strategy into action (Zofi, 2012). All stakeholders need to have a clear understanding of the implications, benefits and pitfalls of telehealth implementation. Stakeholders need to be confident that the data presented is accurate and thorough in order to gain support. A communication plan is necessary to keep project team members and stakeholders informed on progress of project. An estimated budget will be necessary to ensure funding for project completion. The criteria used for including selected patients needs to be identified and standardized. Patients will need to be trained on the use of equipment and staff will need to be trained on the data collection and alerting process. Equipment will need to be installed at remote locations and the needs should be identified to ease the implementation process. Proposal for implementationPresentation in Second LifeDocument describing the need for telehealth home monitoring for CHF patients with supporting evidence.Presentation on telehealth describing what it is, benefits of implementation and requirements for success.
- The project key milestones are important parts of the project that weigh heavily on the implementation of the next task or goal. This project’s key milestones include the project initiation, scope and charter, budget approval, finding a vendor, finding an agency to monitor data, creating a standardized set of inclusion/ exclusion criteria, selecting group of trial patients to participate, implementing the plan and monitoring and re-assessing the results.
- Project meetings are important to maintain communication between team members, stakeholders and others that will be affected by the project. In order for the project to be successful, mandatory attendance and participation is required from all involved. We will try to coordinate these efforts as a group to promote 100% compliance.
- Change is a constant, ongoing process that is present in our personnel and professional lives. Managing change is a systematic, planned method of making change to an organization (Nichols, 2012).
- Organizational changes involve learning new processes, procedures or policies and rely on the individuals participating in that change. Individual changes are guided by certain behaviors, cultures and environments. Change is expected within an organization and can be one of the hardest things to implement. Change starts with an individual willingness to learn and participate. Members may be reluctant to change because it may require learning new material, but can be successfully facilitated through the project management phases. To effectively manage change, communication is key to gain buy-in to persuade members that the change is beneficial and necessary.
- A risk is a potential problem or uncertain event that has a positive or negative effect on a project parameter such as time, money, budget or plan (Young, 2009). Risk management should continue throughout implementation with the realization that a risk can impact the project objectives, constraints or benefits (Young, 2009). A risk management plan will assist in developing a strategy to minimize impact on the budget, schedule and operational performance (Susser, 2012).
- A Risk Register is document where risks are constructed and logged to help track and address issues as they arise (Susser, 2012). The document should include the risks and classification, mitigation strategies, impact on cost and schedule, and action items (Susser, 2012). Risk are classified as High, Medium or Low based on level of impact on project. Risk are scored based on their probability or likelihood of impacting the project. Baseline risks are identified in the planning process, while other risks are identified on a continuous basis throughout the project (Susser, 2012) The RACI chart is tool used for tracking the roles and responsibilities of tasks to be completed for project implementation. It stands for Responsible, Accountable, Consulted and Informed (Sarno & Herdiyanti, 2010). The RACI chart improves communication by clearly identifying who is responsible and accountable for thorough completion of tasks and whose opinions are sought and kept informed of task progress (Sarno & Herdiyanti, 2010).
- The assumptions are items that are assumed to be available for the project and are part of analyzing the potential risks. For this project, it is assumed that SLMC will provide a designated space for storing and monitoring equipment. The funds will be available to complete the project and SLMC human resources department will provide the staffing resources needed.
- The constraints are anything that may restrict or dictate the actions of the project team. The most common constraints are quality, time and resources, also known as the triple constraint. Constraints can be managed effectively with proper planning and effective leadership. The constraints for this project are related to these triple constraints. The time for completion is limited and must be completed by the end of session 2 week 7. Resources are limited because there are not many vendors to choose from for equipment purchasing and quality may be lacking because the implementation is in the virtual world with limited feedback to evaluate effectiveness.
- My hope is that by the end of this project, we will all witness healthier patients, happier staff, decreased costs. Decreased emergency visits. Increased revenue and increased communication with the community.
- I would like to take this time to answer any questions anyone may have.