1. Nursing Home
Telemedicine Program
MARK SINGH MD
A.CHAKRABARTI MD
DEB ZONA RN
May 20, 2009
Mark Singh MD, A.Chakrabarti MD, Deb Zona

2. Background: Clinicore
 Leading edge Nursing Home Telemedicine company
 Staff Back Ground
 Nursing home, hospital and clinic based medical practice
 Medicare Advantage, Tufts Medicare Preferred case
management
 Nursing home medical management
 Affiliated with multiple hospitals in the south of Boston region
 Relationships with Boston Tertiary hospitals
 Active involvement with major EMR implementation projects
in the region
Mark Singh MD, A.Chakrabarti MD, Deb Zona

3. Telemedicine: The Concept
John Doe
John Doe Encounter Notes
Clinical Results Assessment:
Labs: WBC 12 Pneumonia,
Hct 32 uncomplicated, stable
Bun 45, Cr 2.4 Plan: observe, Abx
Visualize patient, Document the
View Results
examine with nurse Encounter
• Physician can remotely assess a patient using high-definition
video conferencing and formulate a plan
• Key elements
• View clinical results
• Visualize the Patient
• Document the encounter: assessment and plan
Mark Singh MD, A.Chakrabarti MD, Deb Zona

4. Medical Care Issues in Nursing Homes
 Inconsistent Physician coverage
 Physicians generally not onsite to address medical
problems as they arise:
 Pneumonia
 Wounds
 Rashes/lesions
 Post-Op issues, complications
 Other medical problems that usually require onsite
examination or close daily monitoring
Mark Singh MD, A.Chakrabarti MD, Deb Zona

5. Consequences of Sub-optimal Physician Coverage
 Needless emergency room
visits/Ambulance rides
 High admission and re-admission rates to
hospitals
 Delay in treatment for wounds/infections
with resulting complications
 Poor outcome measures (DPH, JCAHO)
 Decreased Patient/Care-giver satisfaction
Mark Singh MD, A.Chakrabarti MD, Deb Zona

6. Medicare Implications
 Nursing Home Pay-for-Performance demonstration
 “Nursing Home Value-Based Purchasing”
demonstration
 Criteria includes “appropriate hospitalization”
 Implications for re-imbursement/quality measures
 30 day Re-Admission Reduction
 May be tied to hospital reimbursement
 Likely to be a reportable outcome by hospitals
 Hospitals transfers will go to SNFs with low re-
admission rates and with good clinical programs in
place
 House Bill, HR 2068: will expand Medicare
telemedicine coverage if passed
Mark Singh MD, A.Chakrabarti MD, Deb Zona

7. Telemedicine Allows for On Demand Physician Care
 Allows medical problems to be addressed
by a physician as they occur
 Treat patients onsite appropriately
without having to transfer to the ER.
 Cost savings: fewer ambulance trips
 Improved Outcomes:
 Lower hospital admissions and re-admission
rates
 Fewer complications: wound care, post-surgical
care
Mark Singh MD, A.Chakrabarti MD, Deb Zona

8. Does Telemedicine Work?
 Telemedicine via video conferencing is comparable
to in person evaluation (study done at MGH, May 2009, Journal of Telemedicine and
Telecare)
 Telemedicine can increase physician “virtual onsite”
availability
 Does Onsite physician availability improve
outcomes?
 Multiple studies have concluded that onsite physician
availability at the nursing home and effective communication
is key in reducing hospital admission rates and improved
quality of care
Mark Singh MD, A.Chakrabarti MD, Deb Zona

9. Nursing Home Implementation
 Prerequisites
 Wireless broadband access in Nursing home
 DPH notification: intent to implement telemedicine
 Promotion and training
 Staff physician consent process
 Nursing staff
 Procedural and Compliance
 Nursing home credentialing of Clinicore physicians
 Approval of patient consent forms and process
 Telemedicine equipment deployment
 Go live
Mark Singh MD, A.Chakrabarti MD, Deb Zona

10. Clinicore Telemedicine Extension Program
 Leveraging telemedicine equipment for
administrative functions:
 virtual conferencing with multi-site organizations
 Remotely located “Lead Administrator” can “meet” with entire
local leadership team via high definition video conferencing
 Nurse Training/Education via Video conferencing
 Educational rounds with local specialists
 Infectious disease: i.e.,H1N flu, MRSA, review of in-house
infections
 Wound care
 Post-operative care
Mark Singh MD, A.Chakrabarti MD, Deb Zona

11. Demo Slides
Mark Singh MD, A.Chakrabarti MD, Deb Zona

12. Telemedicine Cart Features
• Wireless high-definition videoconferencing
• Mobile: can be moved to patient room
• Wireless connectivity, internal battery
• Peripheral devices
• Exam camera for wounds, close ups
• Digital Stethoscope
Mark Singh MD, A.Chakrabarti MD, Deb Zona

13. Patient Evaluation at Nursing Home
Mark Singh MD, A.Chakrabarti MD, Deb Zona

14. Images captured remotely during live sessions
Patient with recent MRSA
wound infection
Patient with new rash
Mark Singh MD, A.Chakrabarti MD, Deb Zona

15. Telemedicine Clinical Documentation
 Consult note is generated for each encounter
 Note sent/faxed to patient’s nursing home physician
 Note for sent to nursing home for insertion into chart
 Sample note
 See attached
Mark Singh MD, A.Chakrabarti MD, Deb Zona