Creative Telehealth Training in an Academic Setting

1. 3/21/2019 The NCTRCWebinar SeriesPresented byThe National Consortium of Telehealth Resource Centers

2. www.telehealthresourcecenters.org

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4. Creative Telehealth Training in an Academic Setting Sue Chase-Cantarini, DNP, RN, CHSE Susan Hall, DNP, APRN, WHNP, FNP

5. Background HRSA Grant (2013-2016) “AnInterprofessional Education (IPE) Model for Telehealth Management of Multiple Chronic Health Conditions in Rural Populations” SIMULTANEOUS MOVEMENTS IN HEALTH CARE • Affordable Care Act and • Interprofessional Practice Competencies • Information technology and telemedicine growth to improve patient care delivery and health outcomes

6. Educational Model Core Team Oversight (curriculum, schedules, IT, facilitators, students, etc.) Graduate Nursing PCNP, ACNP, WHNP/CNM, Psyche, NNP, CM Phase 2: Clinical Immersion Rural PCNP students present de-identified patient cases to IP teams in collaboration with Project ECHO Phase 1: Interprofessional Telehealth Course 3 online self-paced interactive educational modules followed by a 2 hour interprofessional (IP) simulation session College of Social Work College of Pharmacy College of Health ESS, Nutrition, Wellness Coaching School of Medicine Utah Telehealth Network

7. Online telehealth course 3 Educational Modules • Canvas platform • Interactive pages and videos • Modules updated/evolved based on technologic advances, student feedback and participant mix 2 Hour Simulation “Consultation” Session • Students logged on from their personal computer to participate • Faculty facilitators guided the session providing a welcome, orientation, ground rules, then debriefing afterwards • Students led the simulated consultation session

8. Online telehealth module content Module 1: Introduction to Telehealth/Telemedicine • Telehealth 101: terminology, FAQs • Telehealth Practices: Uses, benefits, trends • Utah Telemedicine practices (specialty areas) • Clinical applications and delivery • IP core competencies (scope of practice, communication, collaboration, shared values) Module 2: Telemedicine Practice • Telemedicine Equipment (simple to complex) • Clinical practice guidelines • Telemedicine etiquette/ethics (assignment to test AV/computer equipment) • Telemedicine visit/consultation • Cultural aspects of rural health Module 3: Simulation Preparation/Logistics • Preparation materials for simulation (schedule, roles, log-in instructions, consent form, patient chart, provider scripts, surveys, etc.)

9. Preparation for simulation session Students Test log-ins Complete modules/preparation materials Review charts, assigned role (with script/talking points) Faculty Facilitators Review Facilitator Handbook: TVC equipment, timeline, pre-post/debriefing questions, charts Administrators Send reminders, room reservations, orient faculty and SPs, troubleshooting/UTN, manage course grading

10. IPE Telehealth simulation timeline 2 Hour Simulation Timeline: • Facilitator and SP Set-up (10 min) • Introductions (5 min) • Warm-up Activity (10 min) • Review Scenario Objectives (2 min) • Ground rules/expectations (3 min) • Case presentation by (DNP or SOM) student moderator (5 min) • Interprofessional consultation (30 min) • Treatment plan summary (5 min) • Prioritize top 3 recommendations (10 min) • Debriefing by facilitator (40 min) * • * Best practices of simulation/debriefing incorporated

11. IPE telehealth simulation cases/scenarios • Seven cases/charts have been developed • Each patient has multiple chronic conditions including mental health and social issues – live in rural Utah • Scripts developed by faculty for each discipline and level of schooling • Primary care elderly rural widowed farmer patient/DM • Primary care woman in rural community/obesity and depression • Adolescent patient (asthma) and grandmother • Women’s health/PCOS pregnancy planning • Acute care Veteran transfer to urban med center • Newborn resuscitation and transfer to urban med center • Complex discharge from acute to rural setting * Best practices of simulation/debriefing incorporated

12. Course modules & simulation evaluation Pre and post module surveys: Assessment of student knowledge regarding telemedicine, rural healthcare needs, and IP competencies Knowledge increased or remained the same in 89% of questions asked Pre and post simulation survey: Interprofessional Attitudes Scale (IPAS) with additional telehealth technology questions assessed beliefs and attitudes towards IP learning and telemedicine Attitudes and beliefs increased in 85% of questions asked Responses towards simulation activity was positive overall (71-91%)

13. Survey data(attitude towards Telemedicine technology) P value <0.001

14. Reflection exercise/responses • What students learned about telemedicine, interprofessional practice and providing care to patients with multiple chronic conditions “This simulation was a great experience. It reminded me that we don’t always have the answers and it is OK to ask for help. Healthcare is constantly evolving and it is great to witness such a huge step toward advancing care of the patient through collaboration.” “Telemedicine provides a wonderful option to care for certain populations that are not able to have direct access to healthcare. It is not only a new way of providing care, but an excellent method of interprofessional communication.” How students plan to apply what they have learned into future practice “I will be based out of a rural community health care clinic that has limited resources. Telemedicine would be a great addition to our plan of care and compiling many resources for our patients.” “I definitely saw the benefit of telemedicine for the patient as well as getting all the different disciplines together.” I am really excited about telemedicine after completing this session. I hope to make it a part of my practice someday because I think it will positively affect patients.” “I am really excited to see how I can use this sort of technology in my future clinical practice. I think the opportunities are endless at this early stage of using telemedicine for healthcare delivery. I think those who are able to adapt and learn how to use this type of tool will be able to provide a unique level of care to those who are otherwise unable to receive certain medical attention. I plan to return to my rural community and will feel less intimidated or isolated knowing this technology exists.”

15. Where we are today(IPE Telehealth course) • IPE telehealth course has continued past the 3 years of grant funding • 1,400+ students have participated (300/year) • Scenarios now include baccalaureate nursing students (pre-licensure and RN-BS) and dental students • 30+ faculty facilitators participating in course

16. Phase 2 Clinical Immersions (Partnership with Project ECHO)

17. Clinical immersion with Project echo Project ECHO (Extension for Community Healthcare Outcomes) • Link expert specialist teams in an academic center with primary care clinicians in rural communities (tele-mentoring/teleconsulting) Model expanded to include graduate students from multiple disciplines DNP Wellness Coach Nutrition Social Work Pharmacy

18. Clinical immersion surveys • Clinical Immersion – 3 surveys • 1. Rural clinical site capacity: Assessment of site telemedicine interest and readiness • 2. Student self-evaluation: telemedicineleadership, IP competencies, and experience • 3. Preceptor evaluation: of student performance • Rural Site Capacity • 80% of DNP clinic sites did not have TVC or telemedicine • Of those, 40% were interested in learning more about its usage and implementation in their care setting • Most already had desktops and cameras

19. clinical immersions – self evaluation Student Self Evaluation: 19 students completed a self-performance evaluation on how well they demonstrated the IPP domains • 18/19 students felt confident they could: • Operate TVC technologies in the clinical setting • Lead in promoting TVC as a vehicle for improving health care access in their future practice • Promote IP teamwork through TVC in the care of rural patients with multiple chronic conditions • Promote TVC as a mode of collaborative communication to improve patient care

20. Additional feedback - clinical immersions Students: “I definitely saw the benefit of telemedicine for the patient as well as getting all the different disciplines together.” “I am really excited about telemedicine after completing this session. I hope to make it a part of my practice someday because I think it will positively affect patients.” Faculty Facilitators: “We need to get the word out and involve more disciplines. This technology is the way of the future!” “Students are going to share what they learned with their preceptor and patient. They are applying it to practice.” Sustainability of Clinical Immersions: Three of the NP clinical tracks require students to attend ECHO sessions and share with preceptors how to access an ECHO session

21. Partnership with Utah Area Health Education Center (ahec) • Application for HRSA Grant – Utah Area Health Education Center (Utah AHEC) Scholar’s Project • Exploring teaching methods • Connecting students from across Utah in one classroom • Pilot • The purposeis to assess if students from different state institutions are able to come together via teleconferencing to work as an interprofessional team

22. Ahec pilot • Pilot - 5 participants • Primary Care Nurse Practitioner Student • Baccalaureate Nursing Student • Pharmacy Student • Dental Hygienist • Medical Social Worker Student

23. Pilot Pre-survey

24. Pilot Post-survey

25. Comments and outcomes • Comments were positive • Three Universities are supporting the AHEC Scholar’s Certificate Program

26. Future endeavors • Continue to teach the concepts of telehealth and alternative methods to increase access for health care • Enroll other disciplines from the University of Utah • Have students present actual cases to a team • Have students present cases to Project ECHO • Expand the number of colleges and universities and disciplines enrolled in the Utah AHEC Scholar’s program to teach about telehealth

27. Ripple effect –Unexpected Outcomes • DNP projects • Graduates as leaders in their communities • GWEP grant (learning communities) has ECHO model • Faculty scholarship/research and practice using telehealth to improve patient outcomes

28. Questions and contact information Susan “Sue” Chase-Cantarini, DNP, RN ,CHSE Susan.chase@nurs.Utah.edu Susan Hall, DNP, APRN, FNP-C, WHNP-BC Susan.hall@nurs.Utah.edu

29. The NCTRC Webinar Series occurs 3rd Thursday of every month. Our Next Webinar Telehealth Topic: Telemedicine: How to do it right! Presenter: David E. Roth, MD, FAAP, FAPA Hosted by: Pacific Basin Telehealth Resource Center Date: Thursday, April 18, 2019 Times: 8:00AM HST, 10:00AM AKDT, 11:00AM PDT, 12:00PM MDT, 1:00PM CDT, 2:00PM EDT

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